Articles: nerve-block.
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Anesthesia and analgesia · Mar 2001
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of ropivacaine and bupivacaine for cervical plexus block.
We compared bupivacaine 0.5% and ropivacaine 0.75% for cervical plexus block (CB). Forty patients scheduled for carotid artery surgery were allocated randomly to undergo superficial and deep CB with 30 mL of one of the two anesthetic solutions. We evaluated the onset of anesthetic block; the requirement for supplementation during the surgery; the patients' satisfaction; postoperative pain on a visual analog scale at 1, 2, and 3 h; and the use of paracetamol as a rescue analgesic medication. Arterial blood was sampled immediately and 1, 3, 5, 10, 15, 30, 45, and 60 min after CB for measurements of bupivacaine or ropivacaine concentrations. Patients in both groups had equivalent onset of CB, local infiltration with lidocaine during surgery, and satisfaction scores. In the Bupivacaine group, visual analog scale scores were lower at 2 and 3 h, and the delay before paracetamol administration was prolonged. Observed peak concentrations were larger in the Ropivacaine group (4.25 [2.07-6.59 mg/L] vs 3.02 [0.98-5.82 mg/L]), but time to reach peak concentrations was comparable (5 [1-15 min] vs 5 [0-45 min] in the Ropivacaine and Bupivacaine groups, respectively). We conclude that ropivacaine has no advantage over bupivacaine for CB. ⋯ Compared with bupivacaine (150 mg), a larger dose of ropivacaine (225 mg) produces comparable features of cervical plexus block but less postoperative analgesia and larger plasma concentrations. There is no reason to favor ropivacaine in such a case.
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Reg Anesth Pain Med · Mar 2001
Case ReportsThoracic paravertebral block for management of pain associated with multiple fractured ribs in patients with concomitant lumbar spinal trauma.
The need for continual neurological assessment in patients with lumbar spinal injury poses a challenge for effective management of pain associated with multiple fractured ribs. Two cases are presented to illustrate the benefits of using thoracic paravertebral block to control the pain of multiple fractured ribs without compromising the ongoing neurological assessment. ⋯ Thoracic paravertebral block is an option for managing pain associated with multiple fractured ribs in the presence of concomitant lumbar spinal injury requiring continual neurological assessment.
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Comparative Study Clinical Trial
Comparison of cisatracurium-induced neuromuscular blockade between immediate postpartum and nonpregnant patients.
To evaluate and compare cisatracurium-induced neuromuscular blockade and intubating conditions between immediate postpartum (PP) and nonpregnant (NP) patients. ⋯ This is the first published control study to compare the effects of cisatracurium between NP and PP patients. The results suggest that the mean onset time and clinical duration of cisatracurium are significantly shorter in immediate postpartum patients than those in nonpregnant female patients.
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Infectious complications after epidural anesthesia are infrequent and the most common are epidural and subdural abscess. We report one rare case of vertebral osteomyelitus associated with an epidural catheter and review the literature.