Articles: nerve-block.
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Randomized Controlled Trial Clinical Trial
[Premedication in peripheral block anesthesia].
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Anaesthetists who manage acute and chronic pain need to be familiar with current research and practice guidelines in these areas. New local anaesthetics and new routes of administration for opioids and adjuvants may further improve our management of acute pain. ⋯ The limitations of nerve blocks are acknowledged and guidelines for managing chronic pain and opioids are available. Anaesthetists must recognize psychological difficulties as a significant perpetuating factor in chronic pain.
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Acta Anaesthesiol Scand · Aug 1998
Case ReportsAn unusual toxic reaction to axillary block by mepivacaine with adrenaline.
An increase in blood pressure, accompanied by atrial fibrillation, agitation, incomprehensible shouts and loss of consciousness, was observed in an elderly, ASA classification group II, cardiovascularly medicated male, 12 min after performance of axillary block with mepivacaine 850 mg containing adrenaline 0.225 mg, for correction of Dupuytren's contracture. After intravenous administration of labetalol, metoprolol and midazolam the patient's condition improved, and 15 min later he woke up. ⋯ Postoperatively, the patient refused DC cardioversion and was treated medically. Both the temporal relationship of events and the response to treatment suggest that a rapid systemic absorption of mepivacaine with adrenaline and/or interaction of these drugs with the patient's cardiovascular medications were responsible for the perioperative complications.