Articles: nerve-block.
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Randomized Controlled Trial Clinical Trial
Evaluation of the effects of the addition of morphine sulfate to a standard Bier block solution in peripheral arm surgery.
The purpose of this study was to analyze postoperative pain differences in patients undergoing peripheral arm surgery. Differences between patients' perceived pain who received 2 mg of morphine sulfate added to the standard Bier block solution and the standard Bier block solution without morphine were studied. A quasi-experimental nonequivalent control group design was utilized. ⋯ A larger sample may have yielded different results. Many issues remain undecided regarding the potential role of opioids in various regional anesthetic techniques. Further studies are warranted to investigate the peripheral effects of opioids and to understand the mechanisms of action of opioid analgesics at peripheral sites.
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Anesthesia and analgesia · Oct 1998
Infraclavicular brachial plexus block: parasagittal anatomy important to the coracoid technique.
Infraclavicular brachial plexus block is a technique well suited to prolonged continuous catheter use. We used a coracoid approach to this block to create an easily understood technique. We reviewed the magnetic resonance images of the brachial plexus from 20 male and 20 female patients. Using scout films, the parasagittal section 2 cm medial to the coracoid process was identified. Along this oblique section, we located a point approximately 2 cm caudad to the coracoid process on the skin of the anterior chest wall. From this point, we determined simulated needle direction to contact the neurovascular bundle and measured depth. At the skin entry site, the direct posterior insertion of a needle will make contact with the cords of the brachial plexus where they surround the second part of the axillary artery in all images. The mean (range) distance (depth along the needle shaft) from the skin to the anterior wall of the axillary artery was 4.24 +/- 1.49 cm (2.25-7.75 cm) in men and 4.01 +/- 1.29 cm (2.25-6.5 cm) in women. Hopefully, this study will facilitate the use of this block. ⋯ We sought a consistent, palpable landmark for facilitation of the infraclavicular brachial plexus block. We used magnetic resonance images of the brachial plexus to determine the depth and needle orientation needed to contact the brachial plexus. Hopefully, this study will facilitate the use of this block.
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Previous work from the authors' group characterized a prolonged percutaneous blockade of the sciatic nerve in rats using bupivacaine-dexamethasone microspheres. The goals of the current study are to examine the (1) efficacy of bupivacaine microspheres with and without dexamethasone for intercostal blockade in sheep; (2) scaling of dose and duration with a 100-fold increase in body size from rats to sheep; (3) local toxicity and adverse systemic reactions to bupivacaine microspheres with and without dexamethasone. ⋯ A single administration of bupivacaine-dexamethasone microspheres produces an effective chest wall analgesia of several days' duration. This may prove useful clinically for thoracic surgery or trauma.
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Anesthesia and analgesia · Oct 1998
Comment Letter Case ReportsRelief of chronic refractory hiccups with glossopharyngeal nerve block.