Articles: nerve-block.
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Anesthesia and analgesia · Jun 1998
Quantitative analysis of respiratory, motor, and sensory function after supraclavicular block.
The incidence and clinical significance of hemidiaphragmatic paresis after supraclavicular block of the brachial plexus is unknown. Eight healthy volunteers received a supraclavicular block with a standard technique using 30 mL of 1.5% lidocaine. Respiratory function was assessed with ultrasound of the diaphragm, respiratory inductive plethysmography (RIP), and pulmonary function tests (PFT) every 20 min. Sensory block was assessed with pinprick and motor block with isometric force dynamometry every 20 min. Four of eight subjects demonstrated hemidiaphragmatic paresis on both ultrasound and RIP. No subject experienced changes in PFT values or subjective symptoms of respiratory difficulty. Motor and sensory blockade outlasted hemidiaphragmatic paresis. These results are contrasted to the often symptomatic, 100% incidence of hemidiaphragmatic paresis seen after interscalene block. In this study of healthy volunteers, supraclavicular block was associated with a 50% incidence (95% confidence interval 14-86) of hemidiaphragmatic paresis that was not accompanied by clinical evidence of respiratory compromise. ⋯ Interscalene block is always associated with diaphragmatic paralysis and respiratory compromise. The significance of these side effects after supraclavicular block is unknown. Using sensitive measures of respiratory function, we determined that diaphragmatic paralysis occurs less often with the supraclavicular approach and is not associated with respiratory difficulties in healthy subjects.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of the posterior versus lateral approaches to the block of the sciatic nerve in the popliteal fossa.
The main disadvantage of the posterior approach to the block of the sciatic nerve in the popliteal fossa (popliteal block [PB]) is the need to place the patient in the prone position. In this study, the authors examined the clinical utility of a recently described lateral approach to PB that is performed with the patient in the supine position, and they compared its ability to provide reliable surgical anesthesia with that of the posterior approach. ⋯ Although blockade using the lateral approach took longer to accomplish, both techniques resulted in clinically acceptable anesthesia in the distribution of the sciatic nerve.
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Rev Esp Anestesiol Reanim · Jun 1998
Randomized Controlled Trial Clinical Trial[Arm adduction does not increase block extension in anesthesia of the brachial plexus by the axillary approach].
Arm abduction of 90 degrees during injection of local anesthetic followed by adduction of the arm has been recommended traditionally to favor proximal distribution of local anesthetic and extension of the blockade in the brachial plexus by the axillary route. A recent study demonstrated that there are no clinical or radiological differences between axillary blockades performed with abduction or adduction. ⋯ Axillary rotation of the arm is not a determining factor in sensory blockade in brachial plexus anesthesia by the axillary route.
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Femoral and sciatic nerve blocks have been used occasionally for unilateral total knee arthroplasty (TKA). In order to evaluate the effectiveness of this technique, combined femoral 3-in-1 and sciatic nerve blocks were performed in 20 cases of TKA, by the same surgeon. This surgeon also performed unilateral TKA under spinal anesthesia in another 20 cases. ⋯ Ten of the 20 patients who had spinal anesthesia complained of postoperative urinary retention, while none of those who had nerve block had this complaint. Neither group experienced postpunctural headache, neurovascular damage, or drug-over-dose toxicity. We conclude that combined femoral 3-in-1 and sciatic nerve block is an effective anesthetic alternative for unilateral TKA.