Articles: nerve-block.
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Anesthesia and analgesia · Sep 2003
Case ReportsAn indication for continuous cervical paravertebral block (posterior approach to the interscalene space).
We present a patient who required perioperative analgesia with continuous nerve block for shoulder disarticulation, for whom the only approach possible to the brachial plexus was from posterior. A 51-yr-old woman was suffering from intractable upper extremity pain and dysfunction as a result of severe lymphedema after metastatic spread of breast cancer to the axilla. Her pain was poorly controlled despite aggressive treatment with oral, systemic, and intrathecal opiates. ⋯ In order to provide optimal postoperative analgesia, continuous peripheral nerve block was selected in consultation with the patient, and due to anatomic disfigurement and tumor invasion, a continuous cervical paravertebral block was placed preoperatively and shoulder disarticulation was performed using a combined regional/general anesthesia technique. The patient had an uneventful recovery without pain for the 6 postoperative days that the catheter was in place and 0.25% bupivacaine was infused at 5 mL/h. Because of anatomic considerations, which precluded the use of all other approaches to the brachial plexus, the posterior cervical paravertebral approach provided an effective means of pain control in this difficult clinical situation.
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Anesthesia and analgesia · Sep 2003
Randomized Controlled Trial Clinical TrialOnset time, quality of blockade, and duration of three-in-one blocks with levobupivacaine and bupivacaine.
Levobupivacaine is the isolated S(-)-stereoisomer of racemic bupivacaine. Important pharmacodynamic properties of levobupivacaine have not been determined for the femoral three-in-one block. In this randomized, controlled, double-blinded trial, we studied 60 ASA physical status I-III patients scheduled for surgery of the lower limb. ⋯ The analgesic quality of the blockade was also not significantly different among the three groups, whereas a complete sensory block was achieved in significantly fewer patients in the levobupivacaine 0.25% group (P = 0.02). The duration of blockade was significantly shorter with levobupivacaine 0.25% compared with the other groups: bupivacaine 0.5%, 1053 min (802-1304 min); levobupivacaine 0.5%, 1001 min (844-1158 min); and levobupivacaine 0.25%, 707 min (551-863 min) (P = 0.01). Levobupivacaine 0.5% is recommended instead of bupivacaine 0.5% for the three-in-one block.
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Interscalene brachial plexus block (ISB) anaesthesia is widely used with or without general anaesthesia in patients undergoing shoulder surgery, which is generally done with the patient in a sitting position. This position affects haemodynamics, and supplementing ISB with general anaesthesia can exaggerate these haemodynamic changes. This study compared ISB combined with general anaesthesia, with ISB alone, in 29 patients undergoing elective shoulder surgery. ⋯ All of the patients were either satisfied or entirely satisfied with their anaesthesia/analgesia. There were no significant differences in side-effects and no severe complications in either group. We advocate using ISB alone for patients undergoing shoulder surgery, but further larger studies are needed to confirm the present results.
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Reg Anesth Pain Med · Sep 2003
Clinical TrialRelationship between evoked motor response and sensory paresthesia in interscalene brachial plexus block.
This study sought to define the relationship between a paresthesia and a motor response (MR) to electrical nerve stimulation using a peripheral nerve stimulator (PNS) during interscalene block. We sought to determine if at a low amperage (< or =1.0 mA) a MR would precede a paresthesia. ⋯ MR preceded paresthesia in every patient. The most likely explanation for this observation is that MR can be achieved at a small distance from the nerve, whereas elicitation of mechanical paresthesia requires either nerve contact or more intimate location of the needle's tip relative to the nerve. Another possible explanation is that motor fibers are located in a more superficial position and are therefore encountered first. Motor and sensory responses are separate and discrete phenomena.