Articles: nerve-block.
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Randomized Controlled Trial Clinical Trial
The addition of clonidine to bupivacaine in combined femoral-sciatic nerve block for anterior cruciate ligament reconstruction.
Clonidine has been shown to prolong sensory analgesia when given as an adjunct to peripheral nerve blocks but has not been evaluated when given in conjunction with a femoral-sciatic nerve block. The purpose of this investigation was to determine whether the addition of clonidine to a femoral-sciatic nerve block would prolong the duration of sensory analgesia in groups of patients undergoing anterior cruciate ligament (ACL) reconstruction. This prospective, randomized, double-blind investigation was performed on 64 subjects undergoing ACL reconstruction. ⋯ No significant differences were noted between groups for pain intensity scores, duration of sensory analgesia, postoperative analgesic requirements, or overall patient satisfaction. Both groups reported minimal amounts of postoperative pain and high analgesic satisfaction scores. Based on our results, we do not recommend the addition of clonidine to a femoral-sciatic nerve block when given to facilitate postoperative analgesia in patients undergoing ACL reconstruction.
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Rev Bras Anestesiol · Aug 2004
[Evaluation of residual neuromuscular block and late recurarization in the post-anesthetic care unit.].
Residual postoperative paralysis impairs airway patency increasing the risk for postoperative complications. Anti-cholinesterase agents improve neuromuscular transmission by acetylcholine build up in the endplate. However, when there is no longer neostigmine effect, 'recurarization' is theoretically possible since the antagonist agent does not displace neuromuscular blocker from its action site. This study aimed at determining the degree of residual neuromuscular block in the Post Anesthetic Care Unit (PACU) and at observing whether patients receiving neostigmine presented the late 'recurarization' phenomenon. ⋯ The incidence of residual block was significantly higher in the pancuronium group. There has been no case of recurarization with neostigmine suggesting that this phenomenon has no clinical significance when patients have no signs of organ failure or co-morbidity impairing neuromuscular transmission.
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The Journal of urology · Aug 2004
Randomized Controlled Trial Comparative Study Clinical TrialComparison of 3 different methods of anesthesia before transrectal prostate biopsy: a prospective randomized trial.
Periprostatic nerve block (PNB) is the most common anesthesia technique used before prostate biopsy. However, needle punctures for anesthetic infiltration may be painful and cause higher infectious complications. We assessed whether addition of rectal lidocaine gel would improve its efficacy. We also investigated the efficacy and safety of tramadol, a codeine derivative, as a noninvasive method. ⋯ Any form of analgesia/anesthesia was superior to none. The combination of PNB plus gel provided significantly better analgesia compared to PNB alone or tramadol. If this can be duplicated in other trials, the combination may be accepted as the new gold standard of anesthesia for prostate biopsy. The efficacy of tramadol was similar to that of PNB, and was free of complications. Therefore, tramadol may have a role before prostate biopsy, which needs to be explored.
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Journal of endourology · Aug 2004
Renal capsular block: a novel method for performing percutaneous nephrolithotomy under local anesthesia.
Most of the pain of percutaneous nephrolithotomy is caused by dilatation of the renal capsule and parenchymal tract. We evolved a technique to block renal capsular sensations by infiltration of lignocaine (lidocaine) at the site of renal entry, permitting the procedure to be done with local anesthesia.
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Comparative Study
An audit of peribulbar blockade using 15 mm, 25 mm and 37.5 mm needles, and sub-Tenon's injection.
The efficacy of peribulbar anaesthesia performed with short, medium and long needles, with sub-Tenon's injection as a control, was audited. Two hundred patients undergoing cataract surgery underwent peribulbar injection using 25G needles of the following lengths: 15 mm, 25 mm or 37.5 mm. Sub-Tenon's injections were performed with a curved 25-mm sub-Tenon anaesthesia cannula. ⋯ After initial injections of local anaesthetic via the sub-Tenon's cannula or with 37.5 mm, 25 mm and 15 mm needles, supplementation was required in one (2%), 13 (26%), 22 (44%) and 32 (64%) of patients, respectively; the total number of supplementary injections required were 1, 16, 35 and 47, respectively. It is concluded that the efficacy of peribulbar anaesthesia depends upon the proximity of the deposition of local anaesthetic solution either to the globe or orbital apex. These data justify the classification of peribulbar anaesthesia into: circum-ocular (sub-Tenon's, episcleral), peri-ocular (anterior, superficial); peri-conal (posterior, deep) and apical (ultra-deep) for teaching purposes.