Articles: nerve-block.
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Early and efficient rehabilitation is necessary for improving outcome after shoulder surgery. Pain, which is severe to very severe in this condition, is the major factor which compromises early physical therapy. Interscalene block is a well recognized and efficient technique for controlling pain after major open shoulder surgery. ⋯ However, the application of a continuous infusion of local anaesthetics through an interscalene catheter is actually the best technique available to achieve pain relief at rest and on movement after this type of surgery. This chapter emphasizes the advantages of the modified lateral approach, the use of patient-controlled interscalene analgesia and the traps and tricks of the interscalene block. Thus, this chapter demonstrates why interscalene anaesthesia and analgesia are the most appropriate techniques for shoulder surgery.
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This case series describes the use of continuous lumbar plexus block with sciatic nerve block as an alternative anesthetic for total hip arthroplasty (THA). A retrospective chart review was performed on 10 consecutive patients who underwent THA at Walter Reed Army Medical Center using continuous lumbar plexus block and sciatic nerve block for anesthesia. ⋯ Peripheral nerve block may provide superior intraoperative outcomes, as suggested by lower operative blood loss and potentially lower transfusion exposure. Lumbar plexus block with perineural catheter and sciatic nerve block with perioperative sedation is an effective alternative to general anesthesia for THA.
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Regional anesthesia of the hand can be used in a vast array of hand injuries and minor operations. Local infiltration techniques require multiple injections and higher doses of anesthetic the that make them less preferable to peripheral nerve blocks. Regional anesthesia can be safe and effective as long as the provider has a firm understanding of the anatomy and technique. Multiple peripheral nerve blockade at the wrist can be a safe means of exploring complex wounds to the hand in both the emergency department and the operating room with minimal tissue distortion.
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Randomized Controlled Trial Clinical Trial
Continuous infraclavicular brachial plexus block for postoperative pain control at home: a randomized, double-blinded, placebo-controlled study.
This randomized, double-blinded, placebo-controlled study investigated the efficacy of patient-controlled regional analgesia using an infraclavicular brachial plexus perineural catheter and a portable infusion pump for outpatients undergoing moderately painful, upper extremity orthopedic surgery. ⋯ After moderately painful orthopedic surgery of the upper extremity, ropivacaine infusion using a portable, mechanical pump and an infraclavicular brachial plexus perineural catheter at home decreased pain, sleep disturbances, narcotic use and related side effects, and improved overall satisfaction.
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Best Pract Res Clin Anaesthesiol · Jun 2002
ReviewMajor surgery in the ambulatory environment: continuous catheters and home infusions.
The ability to provide continuous peripheral nerve blocks to patients safely on an outpatient basis has been a major advance in ambulatory surgery over the past several years. The first reports of patients self-administering local anaesthetic via wound and perineural catheters were published in 1998. Such infusions have now become a necessary component for the success of various ambulatory procedures. ⋯ Many of the concepts used to provide safe ambulatory infusion have been drawn from studies of patients receiving these types of therapies in a hospital setting. Few studies have actually examined these techniques is an outpatient environment. However, the advantages of these analgesic techniques over traditional oral narcotics for patients undergoing major surgery in the ambulatory environment have led to their rapid acceptance as a standard of care at many institutions.