Articles: nerve-block.
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Reg Anesth Pain Med · Jul 2001
Randomized Controlled Trial Clinical TrialBuprenorphine added to the local anesthetic for brachial plexus block to provide postoperative analgesia in outpatients.
Over the past 10 years, several studies have suggested that the addition of certain opiates to the local anesthetic used for brachial block may provide effective, long-lasting postoperative analgesia. One of these studies indicated that the agonist-antagonist, buprenorphine, added to bupivacaine provided a longer period of postoperative analgesia than the traditional opiates, but in this study, it is impossible to determine the relative contributions of the local anesthetic and the opiate to the postoperative analgesia because of the extremely long duration of the anesthesia provided by the local anesthetic, bupivacaine. By repeating the study using a local anesthetic of a shorter duration, the present study delineates more clearly the contribution of the buprenorphine to postoperative analgesia when added to a shorter-acting local anesthetic. ⋯ The addition of buprenorphine to the local anesthetic used for brachial plexus block in the present study provided a 3-fold increase in the duration of postoperative analgesia, with complete analgesia persisting 30 hours beyond the duration provided by the local anesthetic alone in 75% of the patients. This practice can be of particular benefit to patients undergoing ambulatory upper extremity surgery by providing prolonged analgesia after discharge from the hospital.
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Anesthesia and analgesia · Jul 2001
Randomized Controlled Trial Comparative Study Clinical TrialThe effects of single or multiple injections on the volume of 0.5% ropivacaine required for femoral nerve blockade.
We compared the effects of using a single- or multiple-injection technique on the volume of 0.5% ropivacaine required to block the femoral nerve, in a prospective, randomized, blinded fashion in which 50 premedicated patients received a femoral nerve block with 0.5% ropivacaine by use of a nerve stimulator and either a single- (n = 25) or multiple- (n = 25) injection technique. Muscular twitches were elicited at < or =0.5 mA before anesthetic injection. The designated volume of local anesthetic was equally divided among contraction of the vastus medialis, vastus intermedius, and vastus lateralis for the multiple injections, or it was injected at the contraction of the vastus intermedius with motion of the patella for the single injection. The local anesthetic volumes were varied for consecutive patients by using an up-and-down staircase method; a blinded observer determined the adequacy of nerve blockade (loss of pinprick sensation in the medial, patellar, and lateral portions of the knee, with concomitant block of the quadriceps muscle) 20 min after injection. The mean (95% confidence interval) volume required for blocking the femoral nerve with the multiple-injection technique (14 [12-16] mL) was significantly smaller than that observed with the single injection (23 [20-26] mL) (P = 0.001). According to logistic regression analyses, the 95% effective volumes of ropivacaine required to block the femoral nerve within 20 min after injection were 29 and 21 mL with a single or multiple injection, respectively. We conclude that searching for multiple muscular twitches reduces the volume of 0.5% ropivacaine required to produce blockade of the femoral nerve. ⋯ We evaluated the effects of using a single- or multiple-injection technique on the volume of 0.5% ropivacaine required to block the femoral nerve. The 95%effective concentration values for producing the same degree of sensory and motor blockade of the femoral nerve within 20 min after injection were 29 mL after elicitation of a patella twitch and 21 mL when the three main branches of the femoral nerve were identified, potentially leading to an important benefit for patients receiving peripheral nerve blocks.
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Clinical Trial
C2/C3 nerve blocks and greater occipital nerve block in cervicogenic headache treatment.
In the diagnosis of cervicogenic headache, greater occipital nerve (GON), cervical nerve, minor occipital nerve, and cervical facet joint blocks are used. In our study we compared the GON and C2/C3 nerve blocks in the diagnosis and treatment of cervicogenic headache. In both cases, repeated blocks proved to have a long-lasting effect in the treatment of this disorder, with both GON and C2/C3 blocks being found to be equally effective.