Articles: nerve-block.
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Case Reports
Paravertebral somatic nerve blocks for breast surgery in a patient with hypertrophic obstructive cardiomyopathy.
Patients with hypertrophic obstructive cardiomyopathy (HOCM), a genetic disorder resulting in idiopathic myocardial thickening, can present the anesthesiologist with significant management difficulties. This report reviews the physiology of this important disease process and describes the use of paravertebral nerve blocks (PVB) in the management of a patient with HOCM who presented for partial mastectomy with axillary lymph node dissection. ⋯ PVB provide excellent analgesia and are a useful alternative anesthetic when faced with the HOCM patient requiring major breast surgery.
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The antidepressant amitriptyline is commonly used orally for the treatment of chronic pain, particularly neuropathic pain, which is thought to be caused by high-frequency ectopic discharge. Among its many properties, amitriptyline is a potent Na(+) channel blocker in vitro, has local anesthetic properties in vivo, and confers additional blockade at high stimulus-discharge rates (use-dependent blockade). As with other drug modifications, adding a phenylethyl group to obtain a permanently charged quaternary ammonium derivative may improve these advantageous properties. ⋯ N-phenylethyl amitriptyline appears to have a narrow therapeutic range but is much more potent than lidocaine, providing a block duration several times longer than any clinically used local anesthetic. Further work in animal models of neuropathic pain will assess the potential use of this drug.
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Reg Anesth Pain Med · May 2002
Case ReportsMandibular nerve block treatment for trismus associated with hypoxic-ischemic encephalopathy.
We describe the use of mandibular nerve block for the management of bilateral trismus associated with hypoxic-ischemic encephalopathy. ⋯ Mandibular nerve block may be an effective treatment for patients with bilateral trismus due to ischemic-encephalopathy, even when consciousness is impaired.