Articles: nerve-block.
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The maxillary (or second division) nerve block is an effective method of achieving profound anesthesia of a hemimaxilla. This block can be used for procedures involving the maxillary sinus, including the maxillary sinus elevation procedure. The purpose of this study was to evaluate a computer-controlled anesthetic delivery system (Wand) for maxillary nerve block injection to attain maxillary sinus anesthesia for sinus floor elevation procedure. ⋯ The Wand appears to offer a number of advantages over the hand-held syringe when the greater palatine block technique for the maxillary nerve block is used. It is suggested that, when indicated, and with the required knowledge and respect for the associated anatomy, this technique should be considered with greater ease and more confidence.
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Paravertebral blockade (PVB) is a regional anaesthetic technique that allows the injection of local anaesthetic agents into the paravertebral space. It has been used for acute and chronic pain relief and as an anaesthetic technique for unilateral surgery of the chest, breast, shoulder, kidney, and inguinal region. Paravertebral blockade has been performed on a limited basis for breast surgery at the University Hospital of the West Indies (UHWI) since 1998. ⋯ Fifteen were done in combination with GA. No complications were recorded The initial experience shows that the performance of PVB is both possible and safe; it may offer an alternative to GA for breast surgery. A randomized prospective study is underway to allow a detailed comparison between the two methods.
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Anesthesia and analgesia · Jun 2004
Anterior approach to the sciatic nerve block: adaptation to the patient's height.
To improve the incidence of block of the posterior femoral cutaneous nerve (PFCN) when using an anterior approach as described recently, we hypothesized that the distance between the inguinal line and the puncture site depends on the patient's height. A preliminary radiological study performed in 13 patients established a formula describing the relationships between the patient's height and the puncture site "S." A line was drawn between the anterior iliac spine and the superior angle of the pubic tubercle (inguinal line) and another line from the midpoint of the inguinal line to the puncture site "S." "S" was calculated from the midpoint of the inguinal line as "S" = (height in cm--100)/10. A prospective study was conducted in 53 patients. Results are presented as median (range, 0.25-0.75). Two minutes were required to locate the sciatic nerve at a depth of 12 cm (10.5-13.0 cm). Complete sciatic and PFCN blocks were observed in 92% of the patients. We conclude that consideration should be given to the patient's height when the sciatic nerve is blocked using an anterior approach. This technique seems to improve the success of block of the PFCN, essential to tolerate a thigh tourniquet. ⋯ This prospective but noncomparative work was performed to evaluate a new anterior technique of sciatic block, an adaptation of the anatomic landmarks described by Chelly and Delaunay, to patient height.
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Anesthesia and analgesia · Jun 2004
Case ReportsPerioperative pain management of a complex orthopedic surgical procedure with double continuous nerve blocks in a burned child.
The use of catheters for continuous nerve blocks has been established in children, although in most series only one catheter was used. We report a case of a 3-yr-old child who underwent a toe-to-finger transfer managed with 2 regional catheters: axillary and sciatic. A pain score of 0 was noted during the entire study period. The total dose of bupivacaine was limited to an acceptable range, and the child recovered completely. This report adds to growing evidence in favor of the safety and efficacy of continuous peripheral nerve blocks in pediatric patients. ⋯ Double continuous nerve blocks allow optimal analgesia in burned children after complex orthopedic surgery without major adverse events. Plasma concentrations of bupivacaine remained small during the study period.
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Anesthesia and analgesia · May 2004
Case ReportsTransient vascular insufficiency after axillary brachial plexus block in a child.
Axillary block is used in children for procedures on the hand and forearm. We report on a child with an amputation of the thumb in whom an axillary block was given, after which the limb became pale and pulseless. The pulses returned spontaneously in 15 min. The awareness of this possibility and chances of spontaneous recovery should be considered. ⋯ Transient vascular insufficiency of the upper limb may happen as a rare complication after axillary block. Knowledge of this complication can help the anesthesiologist in the management of this problem.