Articles: nerve-block.
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Anesthesia and analgesia · Jul 1998
Randomized Controlled Trial Clinical TrialClonidine added to the anesthetic solution enhances analgesia and improves oxygenation after intercostal nerve block for thoracotomy.
We evaluated the effect of adding clonidine to bupivacaine on postoperative pain control and oxygenation after intercostal nerve blockade (ICB) for thoracotomy, and attempted to distinguish a systemic from a local effect of clonidine. ICB with 2 mg/kg 0.5% bupivacaine was performed in 36 patients undergoing thoracotomy. Patients were randomized to one of three groups: 1) a control group that received bupivacaine with saline for ICB and an IM injection of saline, 2) an IM group that received bupivacaine with saline for ICB and an IM injection of 2 micrograms/kg clonidine, and 3) a block group that received bupivacaine with 2 micrograms/kg clonidine for ICB and an IM injection of saline. Blood gases, visual analog scale (VAS) scores, and analgesic demand were determined hourly for 8 h after arrival in the postoperative care unit (PCU). Patients in the block group had significantly lower VAS scores, higher arterial oxygen tension, and lower analgesic demand for the first 4 h in the PCU, compared with the two other groups. No difference was noted thereafter. We conclude that the addition of clonidine to bupivacaine for ICB leads to a short-term effect enhancing postoperative pain control and improving arterial oxygenation, probably mediated by a direct effect on the nerves. ⋯ Severe pain after thoracotomy can lead to impaired ventilation. We studied the effect of adding clonidine to bupivacaine for intercostal nerve blockade after thoracotomy. Clonidine administered directly on the nerves enhanced analgesia and improved oxygenation for a short time compared with systemic administration or control.
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Anesthesia and analgesia · Jul 1998
Randomized Controlled Trial Clinical TrialEffects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia, and continuous three-in-one block on postoperative pain and knee rehabilitation after unilateral total knee arthroplasty.
In this study, we assessed the influence of three analgesic techniques on postoperative knee rehabilitation after total knee arthroplasty (TKA). Forty-five patients scheduled for elective TKA under general anesthesia were randomly divided into three groups. Postoperative analgesia was provided with i.v. patient-controlled analgesia (PCA) with morphine in Group A, continuous 3-in-1 block in Group B, and epidural analgesia in Group C. Immediately after surgery, the three groups started identical physical therapy regimens. Pain scores, supplemental analgesia, side effects, degree of maximal knee flexion, day of first walk, and duration of hospital stay were recorded. Patients in Groups B and C reported significantly lower pain scores than those in Group A. Supplemental analgesia was comparable in the three groups. Compared with Groups A and C, a significantly lower incidence of side effects was noted in Group B. Significantly better knee flexion (until 6 wk after surgery), faster ambulation, and shorter hospital stay were noted in Groups B and C. However, these benefits did not affect outcome at 3 mo. We conclude that, after TKA, continuous 3-in-1 block and epidural analgesia provide better pain relief and faster knee rehabilitation than i.v. PCA with morphine. Because it induces fewer side effects, continuous 3-in-1 block should be considered the technique of choice. ⋯ In this study, we determined that, after total knee arthroplasty, loco-regional analgesic techniques (epidural analgesia or continuous 3-in-1 block) provide better pain relief and faster postoperative knee rehabilitation than i.v. patient-controlled analgesia with morphine. Because it causes fewer side effects than epidural analgesia, continuous 3-in-1 block is the technique of choice.
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Comparative Study Clinical Trial Controlled Clinical Trial
Infant physiological responses to noxious stimuli of circumcision with anesthesia and analgesia.
To compare the efficacy of dorsal penile nerve block (DPNB) and eutectic mixture of local anesthetic (EMLA) for attenuation of neonatal pain during circumcision. ⋯ There is a trend toward better pain control with the DPNB as compared to EMLA.
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The study was performed to evaluate differential neural blockade during lumbar epidural anesthesia with a cutaneous current perception threshold (CPT) sensory testing device. Fourteen patients undergoing elective gynecological surgery received 10 ml of 2% lidocaine through an epidural catheter inserted at the L 1/2 interspace. CPTs at 2000, 250, and 5 Hz stimulation and sensation to light touch, temperature, and pinprick at ipsilateral dermatomes V, Th 9, and L 2 were measured before and every 5 min, until 60 min after the epidural lidocaine. ⋯ There was no effect on any measurements made at V. In conclusion, epidural lidocaine results in a differential neural blockade as measured with CPT testing. Since the 2000-Hz stimulus detect abnormalities that correlate with large fiber functioning, it is suggested that loss of touch sensation is associated with effects of epidural lidocaine on large fibers.