Articles: nerve-block.
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Reg Anesth Pain Med · Jul 1999
Comparative StudyThe endoneurial response to neurolytic agents is highly dependent on the mode of application.
The variability and predictability of neurolytic neural blocks were studied using an experimental rat sciatic nerve model. The goal of the study was to compare endoneurial and clinical responses to commonly used neurolytic agents. ⋯ There were no differences in the effects of clinically used neurolytic agents after intraneural injections. Although the perineurally applied 7% phenol-aqua induced marked endoneural damage, the destructive effect of glycerol and phenol-glycerol injections seemed to be prevented by the perineurium; phenol-glycerol and glycerol treatments induced subperineural damage only after perineural injections. The ability to penetrate the perineurium favors the use of 7% phenol-aqua in peripheral perineural blocks when complete neurolysis is the goal.
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Reg Anesth Pain Med · Jul 1999
Randomized Controlled Trial Clinical TrialRetrobulbar/peribulbar block with 0.2% ropivacaine or 1% lidocaine for transscleral cyclophotocoagulation or retinal panphotocoagulation.
Brief analgesia is needed to complete krypton laser cyclophotocoagulation for glaucoma patients and is advantageous in argon laser panphotocoagulation for diabetic retinopathy. We studied whether 0.2% ropivacaine, known for analgesia with minimal motor block or 1% lidocaine, with rapid onset and short duration of action, both supplemented with hyaluronidase, are suitable local anesthetics for retrobulbar/peribulbar block for these procedures. ⋯ According to our preliminary data, neither 0.2% ropivacaine nor 1% lidocaine reached acceptable frequencies of adequate analgesia during transscleral cyclophotocoagulation, while all retinal panphotocoagulations could be completed under the initial block.
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Randomized Controlled Trial Clinical Trial
No enhancement of sensory and motor blockade by neostigmine added to mepivacaine axillary plexus block.
Intrathecal neostigmine induces analgesia but also several side effects. Recently, 500 microg neostigmine administered intraarticularly was shown to produce postoperative analgesia without side effects. The authors' goal was to determine whether 500 microg neostigmine added to mepivacaine in axillary plexus block prolongs postoperative analgesia. In addition, they wanted to determine the incidence of side effects in patients undergoing hand surgery. ⋯ This study suggests that 500 microg neostigmine added to mepivacaine in axillary plexus block does not prolong postoperative sensory block, but it does cause a relatively high incidence of side effects. These two findings raise doubts about the use of neostigmine associated with local anesthetics for plexus neural block.
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Acta Anaesthesiol Scand · Jul 1999
Block of the brachial plexus branches by the humeral route. A prospective study in 503 ambulatory patients. Proposal of a nerve-blocking sequence.
Brachial plexus is usually approached by the supraclavicular or axillary route. A technique for selective blockade of the branches of the plexus at the humeral canal using electrolocation has recently been proposed. The aim of the present study was to assess the feasibility of this technique in the ambulatory patient and to determine the optimal sequence of nerve-blocking. ⋯ This study shows that the nerve block at the humeral canal is an efficient and safe technique. Considering the onset times of nerve blocks, the following sequence for blockade can be recommended: median, ulnar, radial, musculocutaneous, medial (brachial and antebrachial) cutaneous nerves. The selective blockade of the main nerves of the upper limb at the humeral canal can be recommended for surgery of the forearm and the hand in the ambulatory patient.