Articles: nerve-block.
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Fifty consecutive patients, studied prospectively, underwent an elective first metatarsophalangeal joint arthrodesis or proximal metatarsal osteotomy and modified McBride bunionectomy, with or without concomitant lesser toe procedures. A field block was administered only at and distal to the level of the tarsometatarsal joints using 30 cc equal parts 0.25% bupivacaine and 1% lidocaine without epinephrine. Before injection, the monitoring anesthesiologist gave the patient intravenous (IV) sedation, usually an amnestic agent. ⋯ The average duration of the local block was 8 hr (range, 5-14 hr); none of the patients had recall of negative events, and overall patient satisfaction was 98%. Midfoot blocks are easy to administer and provide reliable anesthesia for reconstructive forefoot surgery. Monitored IV sedation enhances patient acceptance, facilitates block administration, and provides a valuable measure of patient safety and comfort.
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Reg Anesth Pain Med · Sep 1999
Randomized Controlled Trial Clinical TrialEnhancement of axillary brachial plexus block anesthesia by coadministration of neostigmine.
The acetylcholinesterase inhibitor neostigmine has shown peripherally mediated analgesic action in recent preclinical and clinical studies. The present study investigates the effectiveness of adding neostigmine to a local anesthetic, mepivacaine, in patients receiving axillary brachial plexus block for upper extremity surgery. ⋯ Peripherally administered neostigmine improves postoperative analgesia in axillary brachial plexus block.
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Reg Anesth Pain Med · Sep 1999
Randomized Controlled Trial Comparative Study Clinical TrialInfraclavicular brachial plexus block: variation in approach and results in 360 cases.
Brachial plexus block is clinically useful. Although the infraclavicular approach to brachial block is the less commonly used form it may offer advantages. We describe the results with three local anesthetic mixtures used during this observational study. ⋯ The infraclavicular approach described is effective. It produced reliable anesthesia and is associated with minimal complications and side effects. The mixture of local anesthetics used in group II is not adequate for producing reliable anesthesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
A prospective, randomized comparison of preoperative and continuous balanced epidural or paravertebral bupivacaine on post-thoracotomy pain, pulmonary function and stress responses.
Both epidural and paravertebral blocks are effective in controlling post-thoracotomy pain, but comparison of preoperative and balanced techniques, measuring pulmonary function and stress responses, has not been undertaken previously. We studied 100 adult patients, premedicated with morphine and diclofenac, allocated randomly to receive thoracic epidural bupivacaine or thoracic paravertebral bupivacaine as preoperative bolus doses followed by continuous infusions. All patients also received diclofenac and patient-controlled morphine. ⋯ Areas under the plasma concentration vs time curves for cortisol and glucose were significantly lower in the paravertebral groups. Side effects, especially nausea, vomiting and hypotension, were troublesome only in the epidural group. We conclude that with these regimens, paravertebral block was superior to epidural bupivacaine.