Articles: nerve-block.
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J. Cardiothorac. Vasc. Anesth. · Jun 2001
Randomized Controlled Trial Comparative Study Clinical TrialComparison of continuous thoracic epidural and paravertebral blocks for postoperative analgesia after minimally invasive direct coronary artery bypass surgery.
To compare continuous thoracic epidural analgesia (TEA) and paravertebral block (PVB) for postoperative analgesia in patients undergoing minimally invasive direct coronary artery bypass (MIDCAB) surgery for quality of analgesia, complications, compliance to chest physiotherapy, hemodynamics, and respiratory effects. ⋯ PVB is as effective as TEA for postoperative analgesia after MIDCAB surgery. PVB is technically easier than TEA and may be safer than TEA because no complications were seen in the PVB group.
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Randomized Controlled Trial Clinical Trial
Clonidine as adjuvant for mepivacaine, ropivacaine and bupivacaine in axillary, perivascular brachial plexus block.
To evaluate the effects of clonidine on three local anesthetics (mepivacaine 1%, ropivacaine 0.75% and bupivacaine 0.5%) with comparable potency and almost the same concentration-response relationship. ⋯ The present study shows that the addition of clonidine has a different impact on each of the three local anesthetics investigated in terms of onset and duration of block.
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Anesthesia and analgesia · Jun 2001
Randomized Controlled Trial Clinical TrialPrevention of postoperative pain after thyroid surgery: a double-blind randomized study of bilateral superficial cervical plexus blocks.
Local anesthetic infiltration may reduce postthyroidectomy pain. We performed a double-blinded, randomized, placebo-controlled trial to assess the analgesic efficacy of bilateral superficial cervical plexus blocks performed at the end of surgery. Ninety patients undergoing elective thyroid surgery by the same surgeon under general anesthesia were randomized to receive 20 mL isotonic sodium chloride or 20 mL bupivacaine 0.25% with 1:200,000 epinephrine. ⋯ The main outcome variables were pain scores (NRS-11), the proportion of patients given morphine at any time during the 24-h period, and the amount of morphine administered. The Bupivacaine group had a smaller proportion of patients given morphine (66.0% vs 90.0%; P = 0.016), and lower initial median pain scores (P = 0.002). We conclude that bilateral superficial cervical plexus blocks significantly reduce pain intensity in the postoperative period after thyroid surgery but do not provide optimal pain relief alone.
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The perioperative period is characterized by a state of immunosuppression, which was shown in animal studies to underlie the promotion of tumor metastasis by surgery. As this immunosuppression is partly ascribed to the neuroendocrine stress response, the authors hypothesized that spinal blockade, known to attenuate this response, may reduce the tumor-promoting effect of surgery. ⋯ The addition of spinal blockade to general halothane anesthesia markedly attenuates the promotion of metastasis by surgery.