Articles: nerve-block.
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Anesthesia and analgesia · Sep 2001
Randomized Controlled Trial Clinical TrialThe enhancement of sensory blockade by clonidine selectively added to mepivacaine after midhumeral block.
Clonidine added to local anesthetics results in an increased duration of anesthesia or analgesia after brachial plexus block. We investigated the effect of selective application of clonidine to the median and musculocutaneous nerves during midhumeral block, a technique allowing selective nerve blocks with the use of different local anesthetics. Initially, 58 patients scheduled for hand surgery were prospectively enrolled to receive a midhumeral block. ⋯ Adding 50 microg clonidine to the median and musculocutaneous nerves resulted in a significant increase in the duration of sensory block in these nerves (P < 0.0001). Recovery of motor block was not different between the two groups. No significant difference was found between the two groups in the mean plasma mepivacaine concentration.
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Local and regional analgesia, achieved by injecting a local anesthetic into tissues, or in proximity to certain parts of the peripheral nervous system, or into the epidural/subarachnoid space, to relieve pain has been used widely for many years. While nerve blocks no longer have the preeminent role as the pain management in cancer patients, they will remain useful tools in managing pain and increasing 'quality of life' of the cancer patients, only if they properly applied. The purpose of this chapter is to present an updated version of the regional analgesia in cancer pain management.
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The incidence of pneumothorax (PTX) after individual intercostal nerve block (INB) for postoperative pain reportedly varies from 0.073% to 19%.1-3 This study investigated the incidence of PTX after INB for rib fractures. ⋯ The incidence of PTX per individual intercostal nerve blocked is low. INB is an effective form of analgesia, and for most patients with rib fractures one INBP is sufficient to allow adequate respiratory exercises and discharge from the hospital.
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Clin. Orthop. Relat. Res. · Sep 2001
Applied anatomy of the axillary nerve for selective neurotization of the deltoid muscle.
Morphologic and internal topographic features of the axillary nerve were studied in 40 cadaveric shoulders to provide anatomic data for selective neurotization of the deltoid muscle in axillary nerve injury. The axillary nerve can be divided into three segments. Proximal to the subscapularis muscle, the axillary nerve is a single nerve trunk. ⋯ In 90% of cases, the posterior branch contains part or all nerve fibers to the posterior deltoid muscle. Nerve fibers to the teres minor and cutaneous sensory fibers are found in the posterior branch. In neurotization of the deltoid muscle, the best approach is to match the donor nerve to the lateral fasciculi group, which will give the highest percentage of reinnervation of the deltoid muscle.