Articles: nerve-block.
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Randomized Controlled Trial Clinical Trial
Epidural saline solution prior to local anaesthetic produces differential nerve block.
The loss-of-resistance technique is generally used to identify the epidural space usually with normal saline. However, the effect of epidural saline on anaesthetic spread has not been demonstrated. The purpose of this study was to determine whether epidural saline affected the anaesthetic level and the quality of analgesia. ⋯ Our results suggest that a large volume of saline solution injected in the epidural space to elicit loss-of-resistance dilutes the local anaesthetic solution, resulting in reduced spread of the block to pinprick.
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Case Reports
Bilateral continuous 3-in-1 nerve blockade for postoperative pain relief after bilateral femoral shaft surgery.
We tested the effectiveness of bilateral continuous paravascular femoral nerve blocks in a patient following bilateral femoral shaft surgery in whom other analgesic regimens were considered contraindicated or of limited effectiveness. Bilateral continuous femoral paravascular nerve blocks were performed using a previously described technique. General anesthesia was subsequently used to facilitate surgery, which was a bilateral osteosynthesis using dynamic hip screws for osteolytic metastases of the proximal extremities of both femurs. ⋯ Plasma concentrations of lidocaine were consistently below toxic levels (1.35 to 1.65 micrograms/ml). Radiographic contrast studies failed to demonstrate movement of contrast to the level of the lumbar plexus. Bilateral continuous femoral paravascular nerve blocks can be used to provide effective and safe analgesia in patients requiring aggressive analgesia in whom other techniques may be contraindicated.
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Many variations to the axillary approach to the brachial plexus have been described. However, the success rate varies depending on the approach used and on the definition of success. Recent work describes a new approach to regional anaesthesia of the upper limb at the humeral/brachial canal using selective stimulation of the major nerves. ⋯ No complications were described. Initial experience confirms the high success rate described using the Dupré technique. This technically straightforward approach with minimal complications can be recommended for regional anaesthesia of the upper limb.
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Reg Anesth Pain Med · Nov 1998
Infraclavicular brachial plexus block effects on respiratory function and extent of the block.
Axillary block is devoid of severe respiratory complications. However, incomplete anesthesia of the upper limb is the main disadvantage of the technique. Theoretically, the more proximal infraclavicular approach would produce a more extensive block without the risk of pneumothorax. However, neither its effects on respiratory function nor a detailed characterization of the extent of neural block has been assessed. The goal of this study was to evaluate the possible changes in respiratory function and also the extent of the block after infraclavicular block. ⋯ Infraclavicular block does not produce a reduction in respiratory function.
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Reg Anesth Pain Med · Nov 1998
Injection of the piriformis muscle by fluoroscopic and electromyographic guidance.
There is not a universally accepted single technique for injection of the piriformis muscle that has validated exact placement of the needle tip within the piriformis muscle. ⋯ Using this methodology, injections on 17 occasions in 11 patients resulted in needle placement within the piriformis muscle.