Articles: nerve-block.
-
This study was undertaken to investigate why the superficial cervical plexus block for carotid endarterectomy is so effective. Initial consideration would suggest that a superficial injection would be unlikely to block all terminal fibres of relevant nerves. One possibility is that the local anaesthetic crosses the deep cervical fascia and blocks the cervical nerves at their roots. ⋯ The superficial cervical space communicates with the deep cervical space and this may explain the efficacy of the superficial block. The method of communication remains unknown. Our findings also indicate that the suitable site of injection for the superficial cervical plexus block is below the investing fascia of the neck, and not just subcutaneous.
-
Complex regional pain syndrome (CRPS) is a heterogeneous disorder that falls in the spectrum of neuropathic pain disorders. It is maintained by abnormalities throughout the neuraxis (the peripheral, autonomic, and central nervous systems). The pathophysiology of CRPS is not fully known. ⋯ To the extent that peripheral somatosensory nerve blocks can diminish nociceptive input to the central nervous system, these techniques may help reduce the nociceptive sensitization of spinal neurons. Pain relief, however it is achieved and however temporary it is, is intended to facilitate participation in functional therapies to normalize use and to improve motion, strength, and dexterity. Psychologic therapies, such as biofeedback and cognitive-behavioral techniques targeting pain, stress, and mood disorders, are valuable adjunctive treatments for pain control and can facilitate functional improvement.
-
Anesthesia and analgesia · Nov 2003
Clinical TrialUltrasound-guided supraclavicular brachial plexus block.
In this study, we evaluated state-of-the-art ultrasound technology for supraclavicular brachial plexus blocks in 40 outpatients. Ultrasound imaging was used to identify the brachial plexus before the block, guide the block needle to reach target nerves, and visualize the pattern of local anesthetic spread. Needle position was further confirmed by nerve stimulation before injection. The block technique we describe aligned the needle path with the ultrasound beam. The block was successful after one attempt in 95% of the cases, with one failure attributable to subcutaneous injection and one to partial intravascular injection. Pneumothorax did not occur. Our preliminary data suggest that a high-resolution ultrasound probe can reliably identify the brachial plexus and its neighboring structures in the supraclavicular region. The technique of real-time guidance during needle advancement can quickly localize nerves. Distinct patterns of local anesthetic spread observed on ultrasound can further confirm accurate needle location. ⋯ Real-time ultrasound imaging during supraclavicular brachial plexus blocks can facilitate nerve localization and needle placement and examine the pattern of local anesthetic spread.
-
Anesthesia and analgesia · Nov 2003
Case ReportsSciatic nerve block in a child: a sonographic approach.
Ultrasound technology can facilitate peripheral nerve blocks in clinical practice. In this case report, ultrasound imaging was used to identify the sciatic nerve and guide local anesthetic injection in the subgluteal region of a child undergoing Achilles tendon lengthening. Sonographic guidance may be especially useful for peripheral nerve blocks in children because the neural imaging is often excellent and reference landmarks are variable. ⋯ In this case report, ultrasound was used to identify the sciatic nerve and guide local anesthetic injection in the subgluteal region of a child. Sonographic guidance may be especially useful for peripheral nerve blocks in children because the neural imaging is often excellent and reference landmarks are variable.