Articles: nerve-block.
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Anesthesia and analgesia · Nov 1999
Randomized Controlled Trial Clinical TrialModified continuous femoral three-in-one block for postoperative pain after total knee arthroplasty.
We prospectively studied the continuous "modified" femoral three-in-one block for postoperative pain after total knee arthroplasty. Sixty-two patients undergoing elective knee arthroplasty under spinal anesthesia with bupivacaine (B) and fentanyl were randomized to receive 0.2% B, 0.1% B, or placebo at 10 mL/h for 48 h after an initial bolus of 30 mL of the same solution via the femoral block catheter. The catheters were inserted under the fascia iliaca using a "double pop" technique and a peripheral nerve stimulator and were advanced 15-20 cm cranially. Venous plasma levels of B, desbutylbupivacaine, and 4-hydroxy B were measured daily for 3 days. All patients received patient-controlled analgesia with morphine and indomethacin suppositories for 48 h. Using computed tomography, we evaluated the catheter location for 20 patients. The catheter tips, located superior to the upper third of the sacroiliac joint in the psoas sheath, were labeled as ideally located. The group receiving 0.2% B had a larger block success rate, smaller morphine consumption in the immediate postoperative period (15 vs 22 mg) and during the first postoperative day (9 vs 18 mg), and achieved a greater range of motion in the immediate postoperative period (91 degrees +/- 10 degrees vs 80 degrees + 13 degrees ). Visual analog scores for pain during both rest and activity were low but similar between the groups. Forty percent of the catheters evaluated were ideally located. Ideal location and use of 0.2% B resulted in 100% success of blockade of all three nerves. The S1 root was blocked in up to 76% of patients. The plasma levels of B, 4-hydroxy B, and desbutylbupivacaine were below the toxic range during the infusion. We conclude that continuous fascia iliaca block with 0.2% B results in opioid-sparing and improved range of motion during the immediate postoperative period. Larger doses of bupivacaine may safely be used in the immediate postoperative period if needed. ⋯ Continuous fascia iliaca block with 0.2% bupivacaine reduces opioid requirements and improves range of motion in the immediate postoperative period compared with a placebo and 0.1% bupivacaine. Plasma levels are below the toxic range with this dose. Only 40% of the catheters are positioned in the ideal location. With the smaller dose of bupivacaine, the success rate with this block is small.
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To assess the most appropriate postoperative analgesic technique after hip surgery. ⋯ After THA, i.v. PCA with morphine, continuous "3-in-1" block, and PCEA provided comparable pain relief. Because it induces the fewest technical problems and side effects, continuous "3-in-1" block is the preferred technique.
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Clinical Trial
[Peripheral anesthesia techniques in surgery of the arm].
This report deals with the techniques of peripheral anaesthesia used by the Authors for surgical treatment of lesions of the upper extremity. ⋯ Surgeons and patients well accepted these techniques of anaesthesia because of: less bleeding during the operation, easy surgical performance, high percentage of success in reimplantations, absence of side effects due to narcosis, better recovery of psycho-physical conditions and long lasting postoperative analgesia.
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Oral Surg Oral Med O · Nov 1999
Comparative study of different syringes in positive aspiration during inferior alveolar nerve block.
The purpose of this study was to evaluate the detection of intravascular injection or hematic aspiration in relation to (a) the particular combination of syringe system and needle (there being 3 different syringe systems [2 self-aspirating and 1 non-self-aspirating] and 3 different needles); (b) the anesthetic technique used (direct or indirect) to induce inferior alveolar nerve block; (c) patient sex; and (d) the operator performing the block. ⋯ The Uniject K non-self-aspirating syringe system was associated with a higher number of hematic aspirations than the self-aspirating systems (Inibsaject and Aspiject). However, the detection of hematic aspirations was not dependent on length or gauge of the needles used, anesthetic technique performed (direct or indirect), patient's sex, or operator who performed the block.