Articles: nerve-block.
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Interventional pain management dates back to the origins of neural blockade and regional analgesia. Over the years, it evolved into a distinct specialty with the application of interventional techniques beyond those of simple neural blockade. The first therapeutic nerve block in pain management was described in 1899 by Tuffer. ⋯ Diagnostic blockade in pain management was pioneered by von Gaza with the use of procaine for determining the pathways of obscure pain. Interventional pain management has entered into the modern era in the twenty-first century, driven by contributions from pioneers including Bonica, Winnie, Raj, Racz, Bogduk, and others. This historical review examines the origins of interventional pain management, its pathophysiologic basis, the role of precision diagnostic interventional techniques, therapeutic interventional techniques, and the future of interventional pain management.
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Randomized Controlled Trial Clinical Trial
Comparison of three different volumes of mepivacaine in axillary plexus block using multiple nerve stimulation.
The multiple injection technique for axillary block, in which the four distal nerves of the plexus are located by a nerve stimulator and separately injected, has been shown to provide a high success rate and a short onset time. This randomized double-blind study was conducted to compare the effectiveness of three different volumes of mepivacaine 10 mg x ml(-1) in patients undergoing elective distal upper limb surgery under axillary brachial plexus block with the four-nerve approach. The number of complete sensory blocks was the primary efficacy variable. ⋯ The three volumes (38, 28, and 20 ml) of mepivacaine 10 mg x ml(-1) ensured a similar and high percentage of complete sensory blocks in axillary brachial plexus anaesthesia with nerve stimulation involving the location of four motor responses.
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Spinal and peridural anaesthesia has several advantages over general anaesthesia due to their low influence to endocrine and metabolic activity and their capacity to reduce postoperative surgical complications, intraoperative bleeding and deep venous thromboembolism incidence. Nevertheless, these anaesthesiologic techniques have a high risk of severe neurological events in patients treated with anticoagulant therapies and prophylaxis. However, this complication is rarely found in literature. ⋯ Anaesthetists must know the use and pharmacological properties of anticoagulant drugs in order to be able of giving up or modifying them during perioperative time, evaluating the risk of bleeding episodes and thrombotic events. An analysis of the literature has been made in order to establish favourable conditions, risk factors, international guide-lines and the real incidence of haemorrhagic complications associated to central blocks in patients being treated with drugs that modify their coagulative status. The survey of the literature and the international guide-lines shows that neuraxial anaesthesia should be performed in selected patients, respecting the free intervals of anticoagulant drugs, carrying out a correct postoperative neurological monitoring and evaluating, case by case, the risks and benefits of the procedure.
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Clinical Trial
The anterior combined approach via a single skin injection site allows lower limb anesthesia in supine patients.
Lower limb anesthesia (LLA) requires the combination of, at least, three-in-one and sciatic nerve (SCN) blocks. Anterior approaches are easier to perform with minimal discomfort in supine patients, specially for traumatology. Feasibility of a single needle entry combined approach is reported. ⋯ The anterior combined approach via a single needle entry represents a technically easy and reliable technique to perform LLA in the supine patient.