Articles: nerve-block.
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Acta Anaesthesiol Scand · Aug 2002
Patients' experiences with multiple stimulation axillary block for fast-track ambulatory hand surgery.
Ambulatory axillary block by multiple nerve stimulation (MNS) is effective and time efficient, but may be rejected by patients because of block pain. This prospective study assessed patients' anxiety and acceptance of this block, identified which of the components of blocking procedure is most painful (i.v. line insertion, repeated needle passes, local anesthetic injection, or electrical stimulation) and recorded patients' anesthetic preferences for the future hand surgery. ⋯ Fear of block pain is diminished after experiencing the blocking procedure. Electrical stimuli was perceived as painful by 53% of patients, and this pain was more intense than with other block components. The majority of our patients would choose axillary block without sedation for future hand surgery and are satisfied with fast-tracking.
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Peripheral nerve blocks are almost always performed as blind procedures. The purpose of this study was to test the feasibility of seeing individual nerves of the brachial plexus and directing the block needle to these nerves with real time imaging. ⋯ The use of ultrasound appears to permit accurate deposition of the local anaesthetic perineurally, and has the potential to improve the success and decrease the complications of infraclavicular brachial plexus block.
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Case Reports
[A case report of hemidiaphragmatic paresis caused by interscalene brachial plexus block].
A 76-yr-old woman was scheduled for left upper extremity orthopedic procedure. Preoperative examinations were within normal limits except forced vital capacity. Interscalene brachial plexus block with 0.25% bupivacaine 15 ml, was performed under general anesthesia. ⋯ A chest X-ray demonstrated the elevation of hemidiaphragm. She was diagnosed as ipsilateral hemidiaphragmatic paresis, treated with oxygen inhalation under deep breathing for approximately one hour, and then transferred to the common ward. We conclude that respiratory movement should be carefully observed following interscalene brachial plexus block especially in geriatric patients.
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Anaesth Intensive Care · Aug 2002
Case ReportsInterscalene brachial plexus block for shoulder surgery in a patient with arthrogryposis multiplex congenita.
A five-year-old child with severe arthrogryposis multiplex congenita and malnutrition underwent surgery for chronic osteomyelitis of the head of the left humerus. The child had typical features of arthrogryposis multiplex congenita, including a difficult airway. Propofol was used for induction and maintenance. ⋯ No opioid was given. The child had an uneventful recovery with good postoperative analgesia. The anaesthetic implications of arthrogryposis multiplex congenita are discussed.
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We developed a continuous lateral sciatic nerve infusion technique for postoperative analgesia. ⋯ Continuous lateral sciatic infusion of 0.2% ropivacaine represents an alternative for acute postoperative pain control after major ankle and foot surgery.