Articles: nerve-block.
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An association between intercostal nerve block and the development of a total spinal is rare. Usually, subarachnoid injection is considered to have followed intraneural placement or inadvertent entrance into a dural cuff extending beyond an intervertebral foramen. ⋯ This was a life-threatening event that occurred on two occasions before the definitive diagnosis was made. It is considered likely that the paravertebral catheter entered an intervertebral foramen and the tip perforated the dura.
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Am. J. Gastroenterol. · Feb 2001
Role of differential neuroaxial blockade in the evaluation and management of pain in chronic pancreatitis.
Chronic pancreatic pain is difficult to treat. Surgical and medical therapies directed at reducing pain have met with little long-term success. In addition, there are no reliable predictors of response including pancreatic duct diameter. A differential neuroaxial blockade allows characterization of chronic abdominal pain into visceral and nonvisceral pain origins and may be useful as a guide to the treatment. Pain from an inflamed, and scarred pancreas should be visceral in origin. The purpose of our study was to determine the frequency with which patients with chronic pancreatitis have visceral pain and whether our modified differential neuroaxial blockade technique using thoracic epidural analgesia can accurately predict which patients will respond to medical or surgical therapy. ⋯ Surprisingly, patients with chronic pancreatitis commonly have nonvisceral pain. Differential neuroaxial blockade can predict which patients will respond to therapy.
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Anesthesia and analgesia · Feb 2001
Anterior approach to the sciatic nerve block: the effects of leg rotation.
In the anterior approach to the sciatic nerve block, the femur often obstructs the passage of the needle toward the sciatic nerve. In this study, by using a human cadaver model, we assessed how internal and external rotation of the leg influences the accessibility of the sciatic nerve with the anterior approach. Ten lower extremities from five adult cadavers were studied. ⋯ Medial redirection of the needle (10 degrees--15 degrees) allowed it to pass the lesser trochanter but brought the tip of the needle too medial to the sciatic nerve. Internal rotation of the leg facilitated passage of all needles inserted at the level of the lesser trochanter. We conclude that internal rotation of the leg may significantly facilitate needle insertion in the anterior approach to sciatic block.
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This study assessed the efficacy of a modified transthecal digital block. Three-hundred-and-sixty consecutive digits were anaesthetised with this technique for the treatment of fractures, infections and foreign bodies. Complete palmar and dorsal anaesthesia was achieved in 357 of the 360 digits (99%), including 52 of 53 thumbs (98%). The technique was extremely easy to perform and no complications occurred.