Articles: nerve-block.
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Int J Clin Pharm Th · Dec 1999
Randomized Controlled Trial Comparative Study Clinical TrialSimilar motor block effects with different disposition kinetics between lidocaine and (+ or -) articaine in patients undergoing axillary brachial plexus block during day case surgery.
The aim of this investigation was to compare the clinical effects and pharmacokinetics of lidocaine and articaine in two groups of 15 patients undergoing axillary brachial plexus anesthesia. ⋯ For the axillary administration, lidocaine and articaine show similar pharmacodynamics with a different pharmacokinetic behavior and can therefore be used to the clinical preference for this regional anesthetic technique.
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Randomized Controlled Trial Clinical Trial
Interscalene brachial plexus anaesthesia with 0.5%, 0.75% or 1% ropivacaine: a double-blind comparison with 2% mepivacaine.
We have compared interscalene brachial plexus block performed with ropivacaine or mepivacaine in 60 healthy patients undergoing elective shoulder surgery. Patients were allocated randomly to receive interscalene brachial plexus anaesthesia with 20 ml of 0.5% ropivacaine (n = 15), 0.75% ropivacaine (n = 15), 1% ropivacaine (n = 15) or 2% mepivacaine (n = 15). Readiness for surgery (loss of pinprick sensation from C4 to C7 and inability to elevate the limb from the bed) was achieved sooner with 1% ropivacaine (mean 10 (SD 5) min) than with 0.5% ropivacaine (22 (7) min) (P < 0.001) or 2% mepivacaine (18 (9) min) (P < 0.02). Postoperative analgesia was similar with the three ropivacaine concentrations (11.5 (5) h, 10.7 (2) h and 10 (2.4) h with 0.5%, 0.75% and 1% concentrations, respectively) and nearly two-fold longer compared with 2% mepivacaine (5.1 (2.7) h) (P < 0.001).
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J. Cardiothorac. Vasc. Anesth. · Dec 1999
Randomized Controlled Trial Clinical TrialPlasma bupivacaine concentrations and effects of epinephrine after superficial cervical plexus blockade in patients undergoing carotid endarterectomy.
To determine if epinephrine (EPI) added to a solution of bupivacaine (BUP) injected for use in superficial cervical plexus blockade (SCPB) lowers plasma BUP concentrations after injection and whether this addition of EPI resulted in tachycardia, cardiac arrhythmias, or both. ⋯ BUP 0.25% consistently produced the lowest plasma BUP concentrations, particularly when EPI was added to the solution. BUP 0.5% without EPI can produce plasma BUP concentrations previously reported to be associated with central nervous system effects. The use of EPI in this setting does not produce untoward cardiac side effects.
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J Altern Complement Med · Dec 1999
Randomized Controlled Trial Clinical TrialNeural therapy in the treatment of multiple sclerosis.
To assess the therapeutic potential of neural therapy, a modified form of acupuncture, in multiple sclerosis. ⋯ Neural therapy is an effective, nontoxic and inexpensive treatment for multiple sclerosis that can confer both immediate and long-term benefits.
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Anesthesia and analgesia · Dec 1999
Comparative StudyAnatomical landmarks for femoral nerve block: a comparison of four needle insertion sites.
The site for needle insertion in femoral nerve block varies significantly among various descriptions of the technique. To determine the site with the highest likelihood of needle-femoral nerve contact, femoral nerve block was simulated in a human cadaver model (17 femoral triangles from 9 adult cadavers). Four 20-gauge 50-mm-long styletted catheters were inserted at four frequently suggested insertion sites for femoral nerve block. At the levels of inguinal ligament and the inguinal crease, the catheters were inserted adjacent to the lateral border of the femoral artery and 2 cm lateral to the femoral artery. During anatomical dissection, we studied the number of catheter-nerve contacts for each of the four insertion sites, and relationships between the femoral nerve and other anatomical structures of relevance to femoral nerve block. Insertion of the needle at the level of the inguinal crease, next to the lateral border of the femoral artery resulted in the highest frequency of needle-femoral nerve contacts (71%). Of note, the femoral nerve was significantly wider (14.0 vs 9.8 mm) and closer to the fascia lata (6.8 vs 26.4 mm) at the inguinal crease than at the inguinal ligament level. We conclude that needle insertion at the inguinal crease level immediately adjacent to the femoral artery produced the highest rate of needle-femoral nerve contacts. The main factors influencing this result include the greater width of the femoral nerve and the more predictable femoral artery-femoral nerve relationship at the inguinal crease level, compared with the inguinal ligament level. ⋯ Insertion of a needle at the inguinal crease level and immediately adjacent to the lateral border of the femoral artery results in a high rate of needle-femoral nerve contact.