Articles: nerve-block.
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Comparative Study
Nerve stimulators used for peripheral nerve blocks vary in their electrical characteristics.
Nerve stimulation with a low-intensity electrical current has become a vital part of the performance of peripheral nerve blockade. The purpose of this study was to compare the accuracy and characteristics of peripheral nerve stimulators used in clinical practice in the United States. ⋯ Nerve stimulators used for regional anesthesia vary greatly in accuracy of current output and in manufacturer-selected electrical characteristics (e.g., current duration, stimulating frequency, maximum voltage output).
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Anesthesia and analgesia · Apr 2003
Randomized Controlled Trial Clinical TrialThe effect of epidural test dose on motor function after a combined spinal-epidural technique for labor analgesia.
Labor analgesia initiated with intrathecal bupivacaine and fentanyl, without a local anesthetic epidural test dose, provides effective analgesia and allows ambulation. In this study, we sought to determine the effect of a lidocaine-epinephrine test dose administered immediately after the initiation of combined spinal-epidural (CSE) analgesia with bupivacaine 2.5 mg and fentanyl 25 micro g on parturients' hemodynamic stability, posterior column function, motor strength, and subjective ability to walk. Parturients (n = 153) were randomized to receive either 3 mL of epidural saline or lidocaine 1.5% with epinephrine 1:200,000. Hemodynamic variables, proprioception, straight leg raise, and the modified Bromage score were analyzed in 110 parturients who completed the study protocol and were not different between groups. Vibratory sense, the ability to perform a partial deep knee bend and to step up on a stool, and the subjective ability to walk were impaired in a larger number of parturients in the lidocaine-epinephrine group at 30 min (P < 0.05). At 60 min, there were no differences between the groups except that fewer parturients in the lidocaine-epinephrine group could step up on a stool. The straight leg raise against resistance and the modified Bromage scale did not correlate well with other tests of motor strength (Spearman's rho, 0.273-0.405). These data suggest that the test dose should be avoided immediately after initiation of CSE analgesia when early ambulation is desired. ⋯ A lidocaine-epinephrine epidural test dose (3 mL of lidocaine 1.5% with epinephrine 1:200,000), injected immediately after the initiation of combined spinal-epidural labor analgesia with bupivacaine 2.5 mg and fentanyl 25 microg, may interfere with the ability to perform simple tests of motor function and ambulation.
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This prospective observational study aimed to assess the feasibility and efficacy of bilateral continuous paravertebral blockade combined with general anaesthesia in "on-pump" cardiac surgery. One hundred and eleven elective patients had two paravertebral catheters inserted: one either side of the midline within 2.5 cm of the spinous process of the third or fourth thoracic vertebrae, through which a mixture of ropivacaine and fentanyl was infused during and after surgery. ⋯ In all patients, time to tracheal extubation, length of stay in the intensive care unit and the hospital, morbidity and mortality, and any complication attributable to the regional blockade were recorded. The technique was associated with good haemodynamic stability, good postoperative analgesia and short times to tracheal extubation, with few significant complications.
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Anesthesia and analgesia · Apr 2003
Case ReportsAirway difficulty after a brachial plexus subclavian perivascular block.
We report a case of upper airway obstruction after subclavian perivascular block in a patient with a preexisting unrecognized paralyzed vocal cord on the opposite side. We discuss the incidence of vocal cord paralysis after subclavian perivascular block and the risk of airway compromise if contralateral vocal cord paralysis is known or suspected.
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Anesthesia and analgesia · Apr 2003
Case ReportsSeizure after levobupivacaine for interscalene brachial plexus block.
This case report describes a patient who demonstrated generalized seizure activity after an injection of 30 mL of levobupivacaine 0.5% for interscalene brachial plexus block. No evidence of cardiovascular toxicity was noted.