The Journal of hand surgery, European volume
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J Hand Surg Eur Vol · Oct 1994
Case ReportsA burn caused by the operating microscope light during brachial plexus reconstruction.
A case of an accidental burn caused by the operating microscope light during brachial plexus reconstruction is reported along with the various factors which could lead to such an injury.
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J Hand Surg Eur Vol · Aug 1994
Case ReportsIntermittent axillary nerve palsy caused by a humeral exostosis.
We report an uncommon case of intermittent axillary nerve palsy caused by a humeral exostosis in an 11-year-old boy. After excision of the cartilagenous exostosis of the proximal end of the left humerus, the pre-operative symptoms of axillary nerve compression were alleviated.
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The incidence of long-term pain (between 1 and 48 weeks and at 2 year follow-up) unrelated to the surgical site following either regional brachial plexus or general anaesthesia was determined. In 834 patients with regional anaesthesia, the incidence (11.1%) was significantly higher than in the 86 patients with general anaesthesia (3.6%; P = 0.03). The incidence of pain was not significantly different among four common techniques of positioning the needle tip in the axillary sheath (9.9 to 11.1%). ⋯ A regional re-block was not associated with a higher incidence when compared to those blocked only once. A more distal local re-block was associated with a higher incidence of pain (23%). 2 years post-operatively, 0.5% of patients had pain related to the regional block. A significant proportion of patients developed some long-lasting post-operative pain following regional brachial plexus anaesthesia, although ultimate morbidity was minimal.
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J Hand Surg Eur Vol · Jun 1994
Randomized Controlled Trial Clinical TrialThe "mini-Bier's block": a new technique for prevention of tourniquet pain during axillary brachial plexus anaesthesia.
Tourniquet cuff pain is a significant cause of morbidity following regional anaesthesia of the upper limb. We describe a simple new technique for effectively anaesthetizing the area under a pneumatic tourniquet (the "mini-Bier's block"), which permits comfortable surgery under axillary block anaesthesia even if the local block is incomplete. We report a controlled study of 40 patients in whom statistically significant tourniquet cuff pain relief was obtained in patients receiving an additional low-dose intravenous injection of local anaesthetic localized beneath the cuff. This technique ensures that the safe axillary approach to the brachial plexus can always be used with avoidance of pain from the pressure of the tourniquet cuff.
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A sensitive non-invasive diagnostic test for intrinsic ligament rupture in patients with chronic wrist pain has still to be found. Differential displacement of the scaphoid, lunate and triquetrum can in some instances be seen during arthroscopy of acute wrist injuries and also on overdistraction of distal radial fractures with an external fixator. ⋯ The sensitivity ranged from 14% to 57% and the specificity ranged from 53.7% to 100% according to the amount of traction and ischaemic block. In view of these poor results we conclude the stretch test has no additional value in the preoperative assessment of chronic wrist pain.