Articles: nerve-block.
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Minerva anestesiologica · Dec 2004
Randomized Controlled Trial Comparative Study Clinical TrialLevobupivacaine versus ropivacaine in psoas compartment block and sciatic nerve block in orthopedic surgery of the lower extremity.
The aim of this study was to compare the clinical profiles of psoas block and sciatic nerve block performed with either 0.5% levobupivacaine or 0.75% ropivacaine. ⋯ The differences between Groups L and R were characterised by: a faster motor onset time in Group L with a longer time between motor and sensitive resolution determining a lower demand for analgesic drugs postoperatively and greater support for motor control recovery.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of regional nerve block to epidural anaesthesia in day care arthroscopic surgery of the knee.
Day care minimally invasive surgery demands minimal complications with anaesthesia. Nerve blocks are increasingly being employed for surgical procedures on the lower limb, and we attempted to evaluate their benefits and drawbacks in a prospective randomised study in patients undergoing knee arthroscopy. We compared the effectiveness, onset time, duration of analgesia, patient acceptance, failure rate and post-operative comfort of epidural anaesthesia (with 20 ml of 2% lidocaine with adrenaline 1 in 200000) and peripheral nerve blocks (combined 3-in-1 and sciatic nerve block, with 50 ml of 1% lignocaine with adrenaline 1 in 200000, using nerve stimulator). ⋯ However 52.2% of patients in group-I required rescue analgesia postoperatively, as compared to only 18.7% in group-II (p < 0.05). We concluded that even though combined 3-in-1 and sciatic nerve block technique has longer anaesthesia induction time, the lesser need for postoperative rescue analgesia, and lesser potential complications like inadvertent spinal puncture, retention of urine and late onset of back pain, make this an attractive option for day care arthroscopy. The use of a nerve stimulator ensures accuracy, patient counselling allows good cooperation, and advance planning can include potential skin incision delays.
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Letter Randomized Controlled Trial Clinical Trial
Sub-Tenon's block without hyaluronidase.
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Rev Bras Anestesiol · Dec 2004
[Pain during spinal canal puncture and its relationship with ligamentum flavum, dura-mater and posterior longitudinal ligament innervation.].
Pain during spinal puncture is a warning that needle tip has touched a nervous structure. If patients refer pain during puncture, it is mandatory to interrupt the technique. Anesthetic solution should not be injected to prevent potential nervous root or spinal cord injury. Needle should be drawn back and have its direction changed before a new advance is attempted. Pain complain is totally impossible if patients are asleep under the influence of general anesthesia and that is why blockade with conscious patients is advisable. Pain is only referred when needle or catheter tip bypass the medium sagital plane to reach the antero-lateral epidural compartment, thus being able to touch nervous rootlets close to intervertebral foramina. Except for studies on skin, subcutaneous tissue and interspinous ligament innervation, this study aimed at reviewing the innervation of some spinal canal structures, namely, ligamentum flavum, posterior longitudinal ligament, dura-mater and intervertebral disk. ⋯ Ligamentum flavum is not innervated, thus explaining lack of pain during puncture. Other pains during puncture may be attributed to Luschka's nerve, which innervates posterior longitudinal ligament and dural ventral portion.
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Rev Esp Anestesiol Reanim · Dec 2004
Case Reports[Ultrasound-guided posterior approach to block the sciatic nerve at the popliteal fossa].
The recent introduction of ultrasound guidance for locating peripheral nerves and nerve plexi has allowed injection of anesthetic agents to block the sciatic nerve at the popliteal fossa proximal to division, thus preventing damage to adjacent structures, repeated punctures, and multiple nerve stimulations to verify anesthetic diffusion around the nerve. We report the case of a 23-year-old man, ASA I, who underwent reduction and osteosynthesis of a fractured right fibula. Ultrasound was used to guide the needle after identification of the sciatic nerve 10 cm from the knee fold and 3.5 cm deep. ⋯ The motor and sensory block of the sciatic nerve was complete and no adverse events occurred during or after surgery. We conclude that the combination of ultrasound guidance and nerve stimulation allows the sciatic nerve to be located easily. The approach to the point before division of the sciatic nerve can be guaranteed so that puncture of neighboring vessels can be avoided and optimal anesthesia provided.