Articles: nerve-block.
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Rev Esp Anestesiol Reanim · Dec 2003
Review[Peripheral nerve block for surgical anesthesia and postoperative analgesia of the legs].
Even though peripheral nerve blocks (PNB) on the lower limb offer advantages over neuroaxial blockades and general anesthesia, their use has not been fully established. The infrequency with which PNBs are used may be due to inadequate learning, the need to make several injections, the time until onset of block, or anesthesiologists' and surgeons' lack of familiarity with the benefits of regional blocks. Interest seems to have increased in recent years, as numerous publications have focused on lower limb PNBs for surgery and postoperative analgesia. Our aim was to review the main approaches used and the indications for each.
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Anesthesia and analgesia · Dec 2003
Randomized Controlled Trial Clinical TrialPreoperative interscalene block for elective shoulder surgery: loss of benefit over early postoperative block after patient discharge to home.
We performed a randomized, prospective, parallel-group, open-label, multicenter trial to compare the effects of pre- versus postoperative interscalene block using levobupivacaine on postoperative pain and analgesic requirements. One-hundred-two outpatients scheduled for elective shoulder surgery were randomized to receive 30 mL of 0.5% levobupivacaine either preoperatively (PRE group) or postoperatively (POST group). Analgesic outcome measures during the postoperative period were: (a). time to first request for analgesic medication after surgery, (b). pain intensity using the visual analog scale at rest and during arm movement, and (c). total analgesic consumption of nonsteroidal antiinflammatory drugs and opioids. The time to first analgesic request did not differ between treatment groups. However, mean maximum pain intensity scores during the day of surgery were significantly less for the PRE group than the POST group, both at rest (P = 0.001) and after movement (P = 0.004). The mean opioid administered during surgery was lower in the PRE than the POST group (P < 0.001). Levobupivacaine was well tolerated in both treatment groups, and no adverse reactions were related to this local anesthetic. In conclusion, preoperative interscalene block with levobupivacaine provided superior pain control for the first 12 h after surgery, but this benefit was not maintained during the week after discharge because the subjects assumed control of their own pain relief as outpatients. ⋯ Preoperative interscalene block with levobupivacaine provides safe and effective analgesia for same-day elective shoulder surgery, but the benefit of this one-time intervention does not persist.
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Case Reports
Anatomical variations of the phrenic nerve and its clinical implication for supraclavicular block.
This paper reports a case of simultaneous diaphragmatic and brachial plexus stimulation followed by a successful nerve block using the supraclavicular approach. An explanation for the qualitative differences in phrenic nerve block between interscalene and supraclavicular block is postulated, based on known anatomical variations.
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J Pain Symptom Manage · Dec 2003
Multicenter Study Clinical TrialCeliac plexus block for pancreatic cancer pain: factors influencing pain, symptoms and quality of life.
Neurolytic celiac plexus block (NCPB) is claimed to be an effective method of pain control for pancreatic cancer pain. However, the factors that may influence long-term analgesia, adverse effects, and quality of life after performing NCPB have never been determined. In a prospective multicenter study, 22 patients who underwent NCPB were followed until death. ⋯ The analgesic and symptomatic effect of NCPB is presumably advantageous for about four weeks. A possible factor interfering with long-term outcome includes the capacity of cancer to involve the celiac axis, which can distort the anatomy and prevent neurolytic spread, or modify the pain mechanisms. Outcomes are strongly based on individual variation.