Articles: nerve-block.
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Combining regional and general anaesthesia can have many advantages, particularly in patients undergoing major thoracic, abdominal or orthopaedic surgery. The use of regional anaesthetic techniques in anaesthetized children is an accepted standard of care, because needle and procedure phobias are very common and can result in severe anxiety, an inability to cooperate and sudden unpredictable movement. Epidural local anaesthetics have the potential of attenuating sympathetic hyperactivity, maintaining bowel peristalsis, sparing the use of opioids, and facilitating postoperative feeding and out-of-bed activity. ⋯ The present review focuses on the use of a combination of regional and general anaesthesia for a variety of surgical procedures. It also compares the two anaesthetic techniques in elderly patients. The review is based on studies published during the past year.
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Comparative Study Clinical Trial Controlled Clinical Trial
Local anaesthetic for minor oral surgical procedures. Review.
Pain following any surgical procedure is difficult to combat by man. Analgesics can be given for some amount of symptomatic relief. The need for a long lasting local anaesthetic is with the intention to reduce the most severe nature of pain, and decrease the analgesic consumption. ⋯ This is not sufficient since the most severe nature of pain is felt six to eight hours post surgery, where as Bupivacaine has duration of action of seven to eight hours. Hence the post operative pain experienced following administration of bupivacaine was found to be considerably lesser in degree than compared to the lidocaine group. To avoid severe pain and discomfort to the patient following any minor oral surgical, the use of bupivacaine is recommended.
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Randomized Controlled Trial Clinical Trial
Clonidine prolongs the effect of ropivacaine for axillary brachial plexus blockade.
To evaluate the effect of adding clonidine to ropivacaine, for axillary brachial plexus blockade, on the onset and duration of sensory and motor block and duration of analgesia. ⋯ The addition of 150 microg of clonidine to ropivacaine, for brachial plexus blockade, prolongs motor and sensory block and analgesia, without an increased incidence of side effects.
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Review
The advantages and disadvantages of Bier's blocks and haematoma blocks for Colles' fractures in A&E.
In the author's current area of practice the use of either the Bier's block or haematoma block for manipulating distal radial fractures seems to have been based mostly on the A&E consultant's preference. The purpose of this literature review was to determine if there was sufficient evidence on the advantages and disadvantages of each method of regional anaesthesia to advocate the general use of one and the exclusion of the other. When reviewing the literature the author specifically looked in to three key areas to answer this question: 1) the patient's perception of pain experienced during and after the manipulation; 2) patient safety i.e. the documented risks of the anaesthetic type used; and 3) the success of the manipulation as determined by repeat radiographs immediately after the application of a plaster of Paris cast.
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Anesthesia and analgesia · Oct 2000
Comparative StudyA magnetic resonance imaging study of modifications to the infraclavicular brachial plexus block.
A previously described infraclavicular brachial plexus block may be modified by using a more lateral needle insertion point, while the patient abducts the arm 45 degrees or 90 degrees. In performing the modified block on patients abducting 45 degrees, we often had problems finding the cords of the brachial plexus. Therefore, we designed an anatomic study to describe the ability of the recommended needle direction to consistently reach the cords. ⋯ Comparing the two arm positions, target precision and risk of contacting the pleura were more favorable with the greater arm abduction. We conclude that when the arm is abducted to 90 degrees, a 65 degrees -needle angle to the skin appears optimal for contacting the cords, still with a minimal risk of penetrating the pleura. However, this needs to be confirmed by a clinical study.