Articles: nerve-block.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 1998
Case Reports[Combined sciatic nerve-3 in 1 block in high risk patient].
We report on a case of combined sciatic nerve block and 3-in-1 block for amputation of lower limb in an ASA IV-V patient 6 days after intraoperative cardiopulmonary resuscitation following induction of general anaesthesia. ⋯ The combined sciatic and 3-in-1 block is a rarely used technique, but for haemodynamically unstable patients it is a safe method for surgery of the lower limb.
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Anesthesia and analgesia · May 1998
Comparative StudyComparison of the three-in-one and fascia iliaca compartment blocks in adults: clinical and radiographic analysis.
The 3-in-1 (Group 1) and fascia iliaca compartment (Group 2) blocks, two single-injection, anterior approach procedures used to simultaneously block the femoral, obturator, and lateral femoral cutaneous (LFC) nerves, were compared in 100 adults after lower limb surgery. Pain control, sensory and motor blockades, and radiographically visualized spread of local anesthetic solution were studied prospectively. Both approaches provided efficient pain control using 30 mL of 2% lidocaine with 1:200,000 epinephrine and 0.5% bupivacaine and 5 mL of contrast media (iopamidol). Complete lumbar plexus blockade was achieved in 18 (38%) Group 1 and 17 (34%) Group 2 patients (n = 50 patients per group). Sensory block of the femoral, obturator, genitofemoral, and LFC nerves was obtained in 90% and 88%, 52% and 38%, 38% and 34%, and 62% and 90% of the patients in Groups 1 and 2, respectively (P < 0.05). Sensory LFC blockade was obtained more rapidly for the patients in Group 2 (P < 0.05). Concurrent internal and external spread of the local anesthetic solution under the fascia iliaca and between the iliacus and psoas muscles was noted in 62 of the 92 block procedures analyzed radiographically. Isolated external spreads under the fascia iliaca and over the iliacus muscle were noted in 10% and 36% of the patients in Groups 1 and 2, respectively (P < 0.05). The local anesthetic solution reached the lumbar plexus in only five radiographs. We conclude that the fascia iliaca compartment block is more effective than the 3-in-1 block in producing simultaneous blockade of the LFC and femoral nerves in adults. After both procedures, blockade was obtained primarily by the spread of local anesthetic under the fascia iliaca and only rarely by contact with the lumbar plexus. ⋯ In adults, the two anterior approaches, 3-in-1 and fascia iliaca compartment blocks, provide effective postoperative analgesia. The fascia iliaca compartment technique provides faster and more consistent simultaneous blockade of the lateral femoral cutaneous and femoral nerves. Sensory block is caused by the spread of local anesthetic solution under the fascia iliaca and only rarely to the lumbar plexus.
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Reg Anesth Pain Med · May 1998
Paravertebral somatic nerve block for outpatient inguinal herniorrhaphy: an expanded case report of 22 patients.
Inguinal herniorrhaphy is a common outpatient surgical procedure. However, anesthetic techniques for inguinal herniorrhaphy are still associated with numerous side effects. Paravertebral somatic nerve block (PSNB) has the potential advantage to offer unilateral abdominal wall anesthesia and long-lasting pain relief with minimal side effects. We report our initial trial of PSNB for outpatient inguinal herniorrhaphy. ⋯ The results of our initial experience suggest that PSNB is a potentially safe and effective technique. In general, the block provided long-lasting pain relief in most patients with few side effects. A randomized study comparing paravertebral blocks with conventional anesthesia choices is suggested given the findings in this initial series of patients.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of S(-)-bupivacaine with racemic (RS)-bupivacaine in supraclavicular brachial plexus block.
Bupivacaine is used widely as a local anaesthetic but has potential for severe cardiovascular and central nervous system (CNS) toxicity. It has an asymmetric carbon atom giving it a chiral centre, and the commercial preparation is a racemic mixture of its two enantiomers: dextro or R(+)-bupivacaine and levo or S(-)-bupivacaine. Preclinical studies have demonstrated reduced cardiotoxicity and CNS toxicity for S(-)-bupivacaine. ⋯ Duration of sensory block was prolonged with wide interpatient variation: 892 (SD 250) min, 1039 (317) min and 896 (284) min for 0.25% S(-)-bupivacaine, 0.5% S(-)-bupivacaine and 0.5% RS-bupivacaine, respectively. There were no differences in the overall success rate of the technique. We conclude that S(-)-bupivacaine was suitable for local anaesthetic use in brachial plexus block anaesthesia.