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Dissection of the mental nerve from the periosteum facilitates visualization and permits moving of Early removal of the occlusal splint should always be the goal generic 25mg dipyridamole with visa arrhythmia electrolyte imbalance. Wassmund M: Frakturen und Luxationen des tion and dental tissues cheap dipyridamole 100 mg without a prescription arrhythmia episode,J Dent Res 54:708 buy generic dipyridamole 100 mg blood pressure medication gain weight, 1975 25 mg dipyridamole fast delivery arrhythmia during stress test. Hofer O: Operation der prognathie und mik- treatment planning for mandibular subapical J Oral Surg 29:13, 1971. Lewallen Armamentarium #9 Periosteal elevator Curved Freer elevator Oscillating saw, 11. Sub- Limitations and Contraindications sequently, Moose2-4 and others described intraoral procedures for mandibular reduction. Te work of Hall et al9 and Hall and McKenna10 vertical ramus lengthening are required. Vertical length- proposed technique refnements to minimize proximal ening of the ramus creates a distracting force on the condylar segment “sag. Intraoral vertical ramus osteotomy is indicated for the man- Distal segment advancement is less likely result in condylar agement of horizontal mandibular excess. Intraoral vertical ramus osteotomy is also forward rotation of the proximal segment). In the absence of internal fxation, a terior movement of the distal segment exceeds the width of period of maxillomandibular fxation is required. The lateral periosteum is elevated from the Nasoendotracheal intubation is required. The periosteal fap is further epinephrine is infltrated in the region of the external oblique released by stripping temporalis tendon from the anterior border ridge. The periosteum at the posterior portion of the preparation is not required, maxillary and mandibular arch bars ramus should not be elevated and the most tenacious attachment are applied from frst molar to frst molar, with ligation of all teeth. Access to the ramus is through a ramus-exposing incision that is Use of the Levasseur Merrill retractor is discouraged because this made 2 to 3 mm lateral to the mucogingival junction and extends retractor requires posterior border stripping. A second Bauer retractor may be placed more than 2 to 3 mm from the mucogingival junction often placed at the inferior border, although a single Bauer retractor create an unacceptable scar band that demarcates a food trap and generally is suffcient for the superior portion of the osteotomy. Alternatively, a ramus-measuring but not entirely reliable landmark is the antilingular prominence, instrument and laryngeal mirror or 30-degree endoscope may be a lateral bony protuberance that approximates the lingula on the used to visualize the planned osteotomy. Using the oscillating saw and the should be just behind the antilingular prominence. Alternatively, the inferior saw blade is reintroduced and the trial osteotomy is carried osteotomy can be completed frst. As the sigmoid notch is approached, osteotomy is likely too far anterior and the anterior-posterior posi- the blade depth is decreased to accommodate the thinner ramus tion should be reconfrmed. The cutting edge of the blade is then and minimize trauma to structures medial to the ramus. It segment can be moved lateral to the distal segment for the is very important to preserve a generous amount of medial ptery- entire length of the osteotomy. Therefore, the osteotomy incomplete osteotomy is at the sigmoid notch and/or midramus. In the worst case scenario, the misdirected osteotomy blade should not be used at the level of the sigmoid notch drops off the posterior border of the mandible, creating a very short because of the risk of injury to infratemporal vascular structures proximal segment with minimal medial pterygoid attachment. Continued Bauer retractor Alternate Oscillating osteotomy blade Unfavorable osteotomy Ramus- measuring instrument Medial pterygoid A muscle insertion B Figure 31-1 A, Use of a ramus measuring instrument to locate the vertical osteotomy 7 to 8 mm anterior to the posterior border of the ramus. An alternate, anteriorly directed osteotomy optimizes the proximal segment muscle attachment in larger setbacks. It Depending on the amount of overlap, the medial aspect of the is important that the proximal segment not be rotated posteriorly proximal segment is preliminarily trimmed and mortised with a (clockwise) because this predisposes to forward relapse in a Class rotary instrument and round bur. An inferior gap can be addressed with some additional and Verifying Proximal Segment Position judicious trimming superiorly (see Alternative Technique 2 later in After both ramus osteotomies have been completed, the planned the chapter). The osteotomies are submandibular region, it can be trimmed with a Kerrison rongeur. The incisions are irri- the proximal segment, the inferior aspect of the osteotomy is gated and closed with a running chromic suture. Proximal segment mortise C Figure 31-1, cont’d C, Medial edge of the proximal segment trimmed with a rotary instrument to ensure passive overlap of segments and close bone contact. Tis can be lation, a mandibular setback of this magnitude is unusual and addressed with coronoidectomy. Advocates of this modifca- suggests an element of maxillary defciency that should be tion cite less bony interference, improved visibility of the addressed with simultaneous maxillary advancement. In lieu of additional trimming of the medial ated with some counterclockwise rotation of the distal aspect of the proximal segment, a small triangular piece of segment and greater bony interference at the level of the distal segment may be excised from the superior aspect of the sigmoid notch. Tis interfer- triangle of distal segment, avoiding additional unwanted ence may also arise when there is a very small amount medial pterygoid stripping and proximal segment trimming of mandibular advancement, and premature contact occurs (Figure 31-3). Placement of the proximal segment hole and preservation of medial pterygoid attachment, condylar slightly below the distal segment hole provides a condylar seating is ensured and direct bone fxation is unnecessary in seating vector as the wire is tightened. When ramus lengthening has occurred, wire is passed from anterior to posterior and retrieved from there is a tendency for condylar sag. Furthermore, with a behind the posterior border of the mandible with a small poorly designed osteotomy and short proximal segment with Mixter right-angle clamp. In these situations internal fxa- Internal plate fxation can be achieved using L-shaped tion is advisable to ensure condylar seating. Screw Tis is accomplished by drilling a hole from the lateral aspect placement can be accomplished either transorally, using a of the distal segment through the cut edge of the distal right-angle drill and screwdriver system, or percutaneously, segment. With gentle lateral displacement of the proximal using a trocar and sleeve system (Figure 31-4). Some have advocated the use of an endoscope to include setbacks requiring a large amount of proximal improve transoral visibility. A poorly executed osteotomy that passes through lingual nerves, condylar sagging, condylar subluxation, skel- the posterior border of the mandible sacrifces medial ptery- etal relapse, bleeding, infection, and fbrous union. Constant vigilance is required to avoid this temporary inferior alveolar nerve sensory alteration is a con- error as the inferior portion of the osteotomy is developed. In general, the muscle action rotates the proximal segment anteriorly, with tab of the Bauer retractor, properly positioned in the sigmoid impingement on the inferior alveolar nerve as it enters the notch, minimizes injury to vascular structures at the sigmoid mandibular foramen. Another measure to minimize the risk of vascular loss in the frst several days after surgery. Proximal segment injury is minimizing the depth of the oscillating blade, espe- repositioning should be undertaken promptly to avoid long- cially in the sigmoid notch. Similarly, if a gap is noted at the inferior border, this Injury to the facial and inferior alveolar arteries and ret- often closes with postoperative clenching exercises. Active should be elevated from the inferior border to minimize the range-of-motion exercises are initiated during the fourth risk of soft tissue trauma from the oscillating blade. Passive range-of-motion exercises are union is extremely uncommon, even with no internal fxation. Postoperative Considerations Te position of the proximal segment should be confrmed with postoperative panoramic imaging. Oral Surg Oral Med Oral means of plastic oblique osteotomy of the and refnement of the intraoral vertical sub- Pathol Oral Radiol Endod 111:557, 2011. Blinder D, Peleg O, Yofe T et al: Intraoral Surg Oral Med Oral Pathol 10:677, 1957.
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Fasciae purchase 100 mg dipyridamole mastercard arteria profunda brachii, Superficial and Deep Cellular Spaces and their Relationship with Spaces Adjacent Regions (Fig trusted dipyridamole 100 mg heart attack 5 days collections. N Shevkunenko on the neck fascias to distinguish between 5: - First fascia (fascia superficialis) - lies in its leaflets m purchase 25 mg dipyridamole otc blood pressure wrist monitor. In violation of the innervation of the muscles of the neck becomes flabby appearance purchase dipyridamole 100mg amex hypertension blurred vision. Lower down the space communicates with the anterior mediastinum, which can move the inflammatory processes arising in the neck. In front of the fascia is the fifth cellular spaces, which extends to the level of pharyngeal lymphatic ring Pirogov-Valdeyra and down behind the esophagus and trachea, according to the posterior mediastinum. Posterior to the neck of - between the fourth and vertebral (fifth) fascia of the neck - is behind the visceral cellular spaces, spatium retroviscerale. On either side of the neck organs are enclosed in a common fascial sheath common carotid artery, internal jugular Vienna, the vagus nerve and the deep lymph nodes of the neck. At the back of the throat abscess purulent process can spread along the loose fiber in the posterior mediastinum with development back mediastenitis so retropharyngeal abscesses are subject to urgent surgery. Behind the third fascia is pretracheal space communicating with the fiber behind the breastbone. It is in this tissue can be injected air at the technical errors that arise when a tracheostomy is performed. The main neurovascular bundle of the neck (common carotid artery, the vagus nerve and the internal jugular Vienna) - projection above; 2. Sinocoratid reflexogenic zone (bifurcation of the common carotid artery) - is projected on the upper edge of the thyroid cartilage 1 cm outwards; 3. Application of the sympathetic trunk: the top node is projected onto the transverse process of C3; Average unit is projected onto the transverse process of C6; cervicothoracic (stellate) node is projected at the level of the neck of the first rib; 4. The subclavian artery and brachial plexus trunks projected in the middle of the clavicle. In the neck there are two groups of lymph nodes: front neck, nodi lymphatici cervicales anteriores, and lateral neck, nodi lymphatici servicales laterales. Deep nodes form a chain along the internal jugular vein, the lateral artery of the neck (supraclavicular nodes) and the back of the pharynx - retropharyngeal nodes. Because of the deep cervical lymph nodes deserve special attention nodus lymphaticus jugulo- digastricus and nodus lymphaticus jugulo-omohyoideus. The first is located on the internal jugular vein at the level of a large horn of the hyoid bone. They take language lymphatic vessels, either directly or through the submental and submandibular lymph nodes. The retropharyngeal nodes, nodi lymphatici retropharyngeal, lymph flows from the mucous membrane of the nasal cavity and paranasal its pneumatic cavities of the hard and soft palate, base of the tongue, nose and oropharynx, as well as middle ear. Lymph vessels: - skin and muscles of the neck directed to nodi lumrhatisi servisales superficiales; - larynx (lymphatic plexus mucosa above the vocal cords) - through the membrana thyrohyoidea to nodi lymphatici sevisales anteriores rrofundi; lymph vessels of the mucous membrane below the glottis are two ways: in front - through the membrana thurohuoidea to nodi lumrhatisi servisales anteriores rrofundi (predortannym) and posterior - to nodules located along n. Triangles of the Neck The inner (medial) triangle of the neck (trigonum cervicis mediale) (Fig. The medial triangle isolated suprahyoid region (regio suprahyoidea) and subhyoid region (regio infrahyoidea). Figure 39 Areas of triangles and neck 1 – trigonum submaxillare; 2 – trigonum caroticum; 3 – regio m. Within the area there are three suprahyoid triangle: submandibular triangle, lingual triangle, and submental triangle. Subhyoid region (regio infrahyoid) occupies the lower part of the medial triangle of the neck. Borders subhyoid region: top - hyoid and posterior belly of digastric (venter posterior m. Digastiici), laterally and below - the front edge of the sternocleidomastoid muscle. Skin, cutis, fat deposits, panniculus adiposus, outer lamina of superficial fascia, lamina externa fasciae superficialis, subcutaneous neck muscle, m. Platysma, inner plate of superficial fascia, lamina interna fasciae superficialis, intrinsic fascia of neck, fascia cervicalis propria, suprahorn interperoneurotic space, spatium interaponeuroticum suprasternale, scapular-fascia fascia, fascia omoclavicularis, superficial muscle layer, stratum musculare superficiale, parietal lamina of intrasternal fascia, lamina Parietalis fasciae endocervicalis, vestibular space, spatium previscerale, visceral plate of intracereal fascia, lamina visceralis fasciae endocervicalis, posterior vascular space, spatium retroviscerale, invertebrate fascia, fascia prevertebralis, deep Th muscular layer, stratum muscularis profundum, cervical spine, pars cervicalis columnae vertebralis. The sublingual region is divided into the drowsy and scapular-tracheal triangles, trigonum caroticum and trigonum omotracheale. Sternocleidomastoideus), below - the collarbone (clavicula), laterally - the trapezius muscle (m. The lateral triangle of the neck lower abdomen omohyoid muscle (venter inferior m. Omohyoidei) divided by scapuloclavicular and scapular- trapewievidny triangles (trigonum omoclaviculare et trigonum omotrapezoideum). Common carotid artery rises almost vertically upwards and out through the apertura thoracis superior in the neck. Here it is on the anterior surface of the transverse processes of the cervical vertebrae and surrounding muscles on the side of the trachea and esophagus, behind the sternocleidomastoid muscle and fascia of the neck pretracheal plate with embedded in the omohyoid muscle. Outside of the common carotid artery is the internal jugular Vienna, and back in the groove between the two - the vagus nerve. Common carotid artery in its course branches does not at the level of the upper edge of the thyroid cartilage is divided into: - External carotid artery (arteria carotis externa), - The internal carotid artery (arteria carotis interna). Then it falls in submandibular hole and enters into the body of the salivary gland. At the level of the neck of the articular process of the mandible external carotid artery is divided into the maxillary artery and superficial temporal artery. The group of rear branches - Sternocleidomastoid branch - Occipital artery - Posterior auricular artery 3. The group of terminal branches - Maxillary artery - Superficial temporal artery The internal carotid artery (Fig. On its way to the base of the skull internal carotid artery runs along the side of the pharynx (cervical part, pars cervicalis) medial to the parotid gland, separated from the stylohypoglossal and stylopharyngeus muscle. Figure 43 Options relations bifurcation of the common carotid arteries and veins Bifurcation of the above veins Bifurcation covered vein 1 – a. Leaves often right of the brachiocephalic trunk (truncus brachiocephalicus), and the left - from the aortic arch (arcus aortae). The second segment of the artery is located within the interscalene space is on I rib on it from the artery remains imprint - subclavian artery sulcus (sulcus a. The third segment begins at the outlet of the interscalene space to the outer edge of the ribs I, which already begins axillary artery (a. In the first otrez-ke it goes in superolateral direction lies horizontally in the second, and the third should be inclined downward. Thoracica interna), thyrocervicalis trunk (truncus thyrocervicalis) The branches of the second segment: From the second segment of the subclavian artery departs edge-cervical trunk (truncus costocervicalis) heading up the dome of the pleura and dividing into two terminal branches: the deep cervical artery (a. Jugularis externa) is formed at the angle of the lower jaw at the confluence of the posterior auricular vein (v. Thoracic duct, ductus thoracicus, collects lymph from both lower limbs, organs and pelvic wall and abdominal cavities of the left lung, the left half of the heart wall of the left half of the chest, on the left arm and the left side of the neck and head.
The sensitivities of both direct microscopy examination and culture are low dipyridamole 25 mg online heart attack get me going, only 40–70% [105] buy dipyridamole 25mg mastercard blood pressure diastolic. However purchase 25mg dipyridamole amex heart attack 70 blockage, the draw- backs of this assay are the instability of the probe purchase 25 mg dipyridamole with visa blood pressure chart by age and gender pdf, and the necessity to handle and dispose of radioactive materials. In one primer pair, a 102 bp genomic fragment was amplified and termed as A6p sequence, which appears highly selective for a broad range of T. Historically, the preferred method for diagnosis of herpes infection was viral isolation in tissue culture followed by type-specific immunofluorescence detection. The advan- tages of this fully automated assay are that it greatly reduces the turnaround time by reading up to 98 results in 2. By comparing these fingerprints to a database of reference spectra by the use of various algorithms, bacteria can be rapidly identified [130]. The acquisition time for this technique is only about 10 min for identification of Haemophilus spp. Another similar study was also demonstrated 29 Molecular Diagnostics of Sexually Transmitted Diseases 549 in which significant interspecies differences between N. Cluster analysis successfully separated mass spectra collected from three groups that corresponded to N. This approach, requiring only one bacterial colony for testing and using a fast and easy measuring protocol, provides a powerful tool for the rapid identification of pathogenic Neisseria and can be adopted for other sexually transmitted pathogens [133]. From an epidemiological perspective, accurate delineation of sexual networks and disease transmission patterns within populations can be constructed and understood by molecular typing methods. Automation and miniaturization will be the main future directions in the devel- opment of molecular diagnostics, as many of the available molecular tests are still labor-intensive. For most automated systems, the biggest challenge will remain at the initial sample preparation and processing procedures, even though a few recent developments of molecular detection workstations may be able to provide solutions for this longstanding issue. Highly automated extraction and detection systems are in the development pipeline that will allow small laboratories to perform high- throughput molecular detection. Schmid G (2004) Economic and programmatic aspects of congenital syphilis prevention. Dinc B, Bozdayi G, Biri A et al (2010) Molecular detection of cytomegalovirus, herpes sim- plex virus 2, human papillomavirus 16–18 in Turkish pregnants. Watson M, Lambden P, Clarke I (1991) Genetic diversity and identification of human infec- tion by amplification of the chlamydial 60-kilodalton cysteine-rich outer membrane protein gene. Soderblom T, Blaxhult A, Fredlund H, Herrmann B (2006) Impact of a genetic variant of Chlamydia trachomatis on national detection rates in Sweden. Catsburg A, van Dommelen L, Smelov V et al (2007) TaqMan assay for Swedish Chlamydia trachomatis variant. Klint M, Hadad R, Christerson L et al (2011) Prevalence trends in Sweden for the new variant of Chlamydia trachomatis. Alexander S, Coelho da Silva F, Manuel R, Varma R, Ison C (2011) Evaluation of strategies for con fi rming Neisseria gonorrhoeae nucleic acid amplification tests. Pope V, Fox K, Liu H et al (2005) Molecular subtyping of Treponema pallidum from North and South Carolina. J Clin Microbiol 34(1):49–54 29 Molecular Diagnostics of Sexually Transmitted Diseases 553 57. Dangor Y, Ballard R, da L Exposto F, Fehler G, Miller S, Koornhof H (1990) Accuracy of clinical diagnosis of genital ulcer disease. Chapel T, Brown W, Jeffres C, Stewart J (1977) How reliable is the morphological diagnosis of penile ulcerations? Dylewski J, Hsanze H, Maitha G, Ronald A (1986) Laboratory diagnostics of chancroid: sensitivity of culture medium. Chui L, Albritton W, Paster B, Maclean I, Marusyk R (1993) Development of the polymerase chain reaction for diagnosis of chancroid. Maeda S, Deguchi T, Ishiko H et al (2004) Detection of Mycoplasma genitalium, Mycoplasma hominis , Ureaplasma parvum (biovar 1) and Ureaplasma urealyticum (biovar 2) in patients with non-gonococcal urethritis using polymerase chain reaction-microtiter plate hybridiza- tion. Simms I, Eastick K, Mallinson H et al (2003) Associations between Mycoplasma genitalium , Chlamydia trachomatis and pelvic inflammatory disease. Blanchard A, Hamrick W, Duffy L, Baldus K, Cassell G (1993) Use of the polymerase chain reaction for detection of Mycoplasma fermentans and Mycoplasma genitalium in the urogeni- tal tract and amniotic fluid. Bebear C, de Barbeyrac B, Bebear C, Renaudin H, Allery A (1997) New developments in diagnostic and treatment of mycoplasma infections in humans. Mirnejad R, Amirmozafari N, Kazemi B (2011) Simultaneous and rapid differential diagno- sis of Mycoplasma genitalium and Ureaplasma urealyticum based on a polymerase chain reaction-restriction fragment length polymorphism. J Clin Microbiol 42(2):683–692 29 Molecular Diagnostics of Sexually Transmitted Diseases 555 97. Samra Z, Rosenberg S, Madar-Shapiro L (2011) Direct simultaneous detection of 6 sexually transmitted pathogens from clinical specimens by multiplex polymerase chain reaction and auto-capillary electrophoresis. Riley D, Roberts M, Takayama T, Krieger J (1992) Development of a polymerase chain reaction-based diagnosis of Trichomonas vaginalis. Bizzini A, Greub G (2010) Matrix-assisted laser desorption ionization time-of-flight mass spectrometry, a revolution in clinical microbial identification. There are approximately nine million new tuberculosis cases and two million deaths reported each year [1, 2]. Its generation time is 15–20 h, so visible growth takes 3–6 weeks on solid media. Kilic (*) Department of Microbiology , Gulhane Military Medical Academy , Ankara 06018 , Turkey e-mail: abkilic@gata. The cell wall confers shape, size, and protection against osmotic pressure, and it probably protects the plasma membrane from deleterious molecules in the cellular environment. The cell wall compo- nents of mycobacteria determine their most prominent feature: staining of the cell wall by carbol fuchsin is resistance to decolorization by acid alcohol (i. Despite the use of decolorizing agents containing ethyl alcohol-hydrochloric acid, carbol fuchsin cannot be readily removed from the cell wall. In the cell wall, the mycolic acids are largely bound to peptidoglycan by phosphodiester bridges and to arabinogalactan by esterified glycolipid linkages. The agglutination serotype of strain and colony morphology is related to the mycosides [6, 9 ]. Another important cell component of mycobacteria is cord factor (trehalose 6,6¢ -dimycolate) that is thought to correlate with virulence. Cord factor may cause chronic granulomas and inhibits migration of leukocytes [7 ]. Newly acquired tuberculosis infections occur at a frequency of every second in the world. South-East Asia is the second 30 Diagnosis of Mycobacterium tuberculosis 559 most affected region in the world with 3.
Permanent loss of cervical spinal cord function associated with interscalene block performed under general anesthesia buy 25 mg dipyridamole with mastercard blood pressure medication sleepy. Anatomy of the normal brachial plexus revealed by sonography and the role of sonographic guidance in anesthesia of the brachial plexus cheap dipyridamole 100mg without a prescription pulse pressure below 20. Paravertebral approach to the brachial plexus: An anatomic improvement in technique generic 100 mg dipyridamole with visa 13 pulse pressure diastolic. An evaluation of the supraclavicular plumb-bob technique for brachial plexus block by magnetic resonance imaging trusted dipyridamole 25 mg blood pressure medication making blood pressure too low. Surface landmarks of brachial plexus: Ultrasound and magnetic resonance imaging for supraclavicular approach with anatomical correlation. The catheter-over-needle assembly facilitates delivery of a second local anesthetic bolus to prolong supraclavicular brachial plexus block without time-consuming catheterization steps: A randomized controlled study. A novel infraclavicular brachial plexus block: The lateral and sagittal technique, developed by magnetic resonance imaging studies. A comparison of the vertical infraclavicular and axillary approaches for brachial plexus anaesthesia. Infraclavicular brachial plexus block: Parasagittal anatomy important to the coracoid technique. Magnetic resonance imaging demonstrates lack of precision in needle placement by the infraclavicular brachial plexus block described by Raj et al. At the cords, the pinkie towards: Interpreting infraclavicular motor responses to neurostimulation. At the cords, the pinkie towards: Interpreting infraclavicular motor responses to neurostimulation. Response to: At the cords, the pinkie towards: Interpreting infraclavicular motor responses to neurostimulation. A novel approach to infraclavicular brachial plexus block: The ultrasound experience. A prospective, randomized, double–blind comparison of ultrasound-guided axillary brachial plexus blocks using 2 versus 4 injections. Percutaneous electrode guidance and subcutaneous stimulating electrode guidance: Modifications of the original technique. Adverse events associated with intravenous regional anesthesia (Bier block): A systematic review of complications. The analgesic efficacy of transversus abdominis plane block after abdominal surgery: A prospective randomized controlled trial. The rectus sheath block in paediatric anaesthesia: New indications for an old technique? Effect of intercostals neural blockade with Marcaine (bupivacaine) on postoperative pain after laparoscopic cholecystectomy. Single–injection paravertebral block compared to general anaesthesia in breast surgery. 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Does ultrasound guidance improve the efficacy of dorsal penile nerve block in children? Magnetic resonance imaging of the distribution of local anesthetic during the three-in-one block. Continuous psoas compartment block for anesthesia and perioperative analgesia in patients with hip fractures. Continuous psoas compartment block for postoperative analgesia after total hip arthroplasty: New landmarks, technical guidelines, and clinical evaluation. Lumbar plexus in children: A sonographic study and its relevance to pediatric regional anesthesia. Prepuncture ultrasound imaging to predict transverse process and lumbar plexus depth for psoas compartment block and perineural catheter insertion: A prospective, observational study. A single injection ultrasound-assisted femoral nerve block provides side effect-sparing analgesia when compared with intrathecal morphine in patients undergoing total knee arthroplasty. Continuous femoral nerve blockade or epidural analgesia after total knee replacement: A prospective randomized controlled trial. Effects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia, and continuous three-in- one block on postoperative pain and knee rehabilitation after unilateral total knee arthroplasty. Ultrasound-guided infrapatellar nerve 2478 block in human volunteers: Description of a novel technique. Anatomical landmarks for femoral nerve block: A comparison of four needle insertion sites. Methods to ease placement of stimulating catheters during in-plane ultrasound-guided femoral nerve block. Ultrasound-guided continuous femoral nerve block for analgesia after total knee arthroplasty: Catheter perpendicular to the nerve versus catheter parallel to the nerve. Continuous femoral nerve analgesia after unilateral total knee arthroplasty: Stimulating versus nonstimulating catheters. 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