Articles: nerve-block.
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Minerva anestesiologica · Jul 2002
Randomized Controlled Trial Comparative Study Clinical TrialLevobupivacaina, bupivacaina racemica e ropivacaina nel blocco del plesso brachiale.
To compare clinical profiles of levobupivacaine, racemic bupivacaine and ropivacaine at equipotent doses in axillary brachial plexus block in the orthopaedic surgery of wrist and hand. ⋯ In our experience levobupivacaine has been demonstrated to be a good substitute for racemic bupivacaine. Compared to ropivacaine, levobupivacaine induces a longer duration of postsurgery analgesia and, in our opinion, this datum seems to be the most significant.
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Acta Anaesthesiol Scand · Jul 2002
Clinical Trial Controlled Clinical TrialPharmacokinetics and pharmacodynamics of mivacurium in young adult and elderly patients.
Mivacurium is hydrolyzed by plasma cholinesterase, and is therefore less dependent on liver metabolism and renal elimination than other neuromuscular blocking drugs. This might favor the use of mivacurium in elderly patients. The purpose of this study was to compare the pharmacodynamics and the pharmacokinetics of the three isomers of mivacurium and their metabolites in young adult and elderly patients. ⋯ There were no significant differences in the potency or infusion requirements between the adult and elderly patients, but the rate of recovery was significantly, though only moderately prolonged, in the elderly patients. No significant difference in clearance was seen but the elimination half-lives of the metabolites was longer in the elderly patients.
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Minerva anestesiologica · Jul 2002
0.25% levo-bupivacaine for interscalene block during shoulder surgery. A survey on 20 patients.
Interscalene brachial plexus block (ISB) is an alternative procedure to general anaesthesia for shoulder surgery, and consents the anaesthetist to easily control postoperative pain that, indeed, is known to be intense and often requires strong analgesic administration. The introduction of regional anaesthesia for this type of surgery, contributed to the relief of acute postoperative pain occurring in the recovery room since the analgesic effects of block persist for several hours after surgery depending upon the selected drug. The aim of this study was to determine the effects of 40 ml of 0.25% levo-bupivacaine, a local anaesthetic derived from the racemic mixture of bupivacaine, on the speed of onset, quality and duration of ISB. ⋯ Levobupivacaine is a newly developed local anaesthetic derived from a bupivacaine racemic mixture from which the right isomer has been eliminated. Levo-bupivacaine, compared to racemic mixture, is acknowledged to be less cardiotoxic, faster at equal dosage, and ensures a longer analgesic interval. Zero point twenty-five percent concentration was preferred in this study in order to inject large volumes (40 ml) with a minimal anaesthetic amount (100 mg), resulting in short time for obtaining loss of sensibility, optimal intraoperative conditions and long lasting block with adequate postoperative analgesia.
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Anesthesia and analgesia · Jul 2002
Randomized Controlled Trial Clinical TrialNew landmarks for the anterior approach to the sciatic nerve block: imaging and clinical study.
In this study, we assessed the reliability of the inguinal crease and femoral artery as anatomic landmarks for the anterior approach to the sciatic nerve and determined the optimal position of the leg during this approach. An imaging study was conducted before the clinical study. The sciatic nerve was located twice in 20 patients undergoing ankle or foot surgery, once with the leg in the neutral position and once with the leg in the externally rotated position. The patient was lying supine. A 22-gauge, 150-mm insulated b-beveled needle connected to a nerve stimulator was inserted 2.5 cm distal to the inguinal crease and 2.5 cm medial to the femoral artery and was directed posteriorly and laterally with a 10 degrees -15 degrees angle relative to the vertical plane. The sciatic nerve was located in all patients at a depth of 10.6 +/- 1.8 cm when the leg was in the neutral position and 10.4 +/- 1.5 cm when the leg was in the externally rotated position (not significant). In the neutral position and in the externally rotated position, the time needed to identify anatomic landmarks was 28 +/- 15 s and 26 +/- 14 s, respectively (not significant), and the time needed to locate the sciatic nerve was 79 +/- 53 s and 46 +/- 25 s (P < 0.006), respectively. We conclude that the inguinal crease and femoral artery are reliable and effective anatomic landmarks for the anterior approach to the sciatic nerve and that the optimal position of the leg is the externally rotated position. ⋯ This new anterior approach to the sciatic nerve using the inguinal crease and femoral artery as landmarks is an easy and reliable technique.