Articles: nerve-block.
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Reg Anesth Pain Med · Mar 2004
Case ReportsAn unusual case of painful phantom-limb sensations during regional anesthesia.
The objective of this article is to describe a late-onset phantom-limb pain during a continuous analgesic popliteal nerve block after foot surgery and its alleviation and recurrence when stopping and resuming the local anesthetic infusion. ⋯ This observation suggests that phantom-limb pain can be of late-onset and might occur during a continuous infusion of low-concentration local anesthetic responsible only for an analgesic block, as shown by the fact that only thermal and pinprick sensations, known to depend on Adelta-fibers and C-fibers, were altered. Therefore, this case contradicts the usual belief that a profound block is necessary to elicit phantom-limb pain.
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Anesthesia and analgesia · Mar 2004
Clinical TrialContinuous parasacral sciatic block: a radiographic study.
Parasacral sciatic blockade results in anesthesia of the entire sacral plexus. In this study we sought to determine the spread of the local anesthetic injected through a parasacral catheter, the anatomical location of the inserted catheters, and the extent and reliability of the blockade. In this study, 87 consecutive patients undergoing major lower limb surgery were enrolled. After placement of the catheter and injection of 8 mL of radio-opaque contrast dye, radiographic images were evaluated for dispersion of the injectate. Sensory and motor evaluations were also performed. Radiographic analysis of the injectates revealed that nearly all catheters (86 catheters, 99%) were in the correct anatomical position. The mean volume of local anesthetic injection was 21 +/- 3 mL. All patients developed a full sensory block of all three major components of the sciatic plexus (tibial, common peroneal, and posterior cutaneous nerve of the thigh). We conclude that the parasacral sciatic block results in frequent success of blockade of all three major components of the sciatic plexus and it has a small risk of complications. Contrast radiography can be used to document the catheter placement. ⋯ The parasacral sciatic block results in a frequent success rate of blockade of all three major components of the sciatic plexus (tibial, common peroneal, and cutaneous nerve of thigh). A contrast radiography can be used to confirm the proper position of the catheter.
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Reg Anesth Pain Med · Mar 2004
Randomized Controlled Trial Comparative Study Clinical TrialPostoperative analgesia after total-hip arthroplasty: Comparison of intravenous patient-controlled analgesia with morphine and single injection of femoral nerve or psoas compartment block. a prospective, randomized, double-blind study.
The authors compared the analgesic effects and quality of rehabilitation of three analgesic techniques after total-hip arthroplasty in a double-blind, randomized trial. ⋯ PCA is an efficient and safe analgesia technique. FNB and PCB should not be used routinely after total-hip arthroplasty.
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Reg Anesth Pain Med · Mar 2004
At the cords, the pinkie towards: Interpreting infraclavicular motor responses to neurostimulation.
Identification of elicited muscle twitches while performing infraclavicular block of the brachial plexus is often confusing but is critical for success of the block. An easily defined endpoint when evaluating these motor responses to neurostimulation is essential, as it is necessary to block the appropriate cord or cords. ⋯ If the arm is positioned in the anatomical position, the 5th digit (pinkie) moves laterally (pronation of the forearm) when the lateral cord is stimulated, posteriorly (extension) when the posterior cord is stimulated, and medially (flexion) when the medial cord is stimulated. The pinkie thus moves "toward" the cord that is stimulated.
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Acta Anaesthesiol Scand · Mar 2004
Case ReportsApplication of a mandibular nerve block using an indwelling catheter for intractable cancer pain.
We report a case in which a mandibular nerve block using an indwelling catheter was employed for pain management in a terminal case of orofacial cancer. The patient was a 74-year-old female weighing 27 kg. She had a 27-month history of mouth floor and tongue cancer. ⋯ Second, a neurolytic block was applied to the mandibular nerve through the catheter. After the neurolytic block, the total dosage of morphine and diclofenac remained unchanged for 2 months. We conclude from the present case that this technique is an excellent means of obtaining long-term pain control in patients with intractable orofacial cancer pain.