Articles: nerve-block.
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Randomized Controlled Trial Comparative Study Clinical Trial
Analgesia for neonatal circumcision: a randomized controlled trial of EMLA cream versus dorsal penile nerve block.
To compare the efficacy of the dorsal penile nerve block (DPNB) with a less invasive form of local anesthesia, eutectic mixture of local anesthetic (EMLA) cream, for reduction of pain during neonatal circumcision. ⋯ DPNB provides better pain reduction during neonatal circumcision than EMLA cream. EMLA cream may provide pain reduction compared with no anesthesia during neonatal circumcision.
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Anesthesia and analgesia · Apr 1998
Randomized Controlled Trial Comparative Study Clinical TrialThe use of a selective axillary nerve block for outpatient hand surgery.
Although no guidelines concerning discharge criteria after axillary plexus block are available, many institutions consider recovery of motor function as a critical factor. With the midhumeral approach, the four main nerves of the upper extremity can be blocked separately using a peripheral nerve stimulator. The aim of this double-blind study was to block the radial (R) and musculocutaneous (MC) nerves with lidocaine, and the median (M) and ulnar (U) nerves with bupivacaine to recover motor function of the elbow and wrist more rapidly while maintaining long-lasting postoperative analgesia at the operative site. Patients undergoing surgery for Dupuytren's contracture were randomized into two groups in a double-blind fashion: in the control group (n = 17), each of the four nerves was infiltrated with 10 mL of a mixture of 2% lidocaine and 0.5% bupivacaine, whereas in the selective group (n = 17), the R and MC nerves were blocked with 10 mL of 2% lidocaine each and the M and U nerves were blocked with 10 mL of 0.5% bupivacaine each. Recovery of motor block was significantly faster in the selective group (231 +/- 91 vs 466 +/- 154 min). However, time to first sensation of pain was not different between groups (707 +/- 274 vs 706 +/- 291 min). In conclusion, this new approach at the midhumeral level enables the anesthesiologist to selectively administer local anesthetics on different nerves. ⋯ In outpatients undergoing surgery for Dupuytren's contracture, a midhumeral block was used with the musculocutaneous and radial nerves blocked by lidocaine and the median and ulnar nerves blocked with bupivacaine. Recovery of motor function and time to discharge were shorter compared with patients who received the mixture on all four nerves.
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To assess safety and efficacy of the regional anesthetic technique paravertebral block for operative treatment of breast cancer, and to compare postoperative pain, nausea, vomiting, and length of hospital stay in patients undergoing breast surgery using paravertebral block and general anesthesia. ⋯ Paravertebral block can be used to perform major operations for breast cancer with minimal complications and a low rate of conversion to general anesthesia. Paravertebral block markedly improves the quality of recovery after breast cancer surgery and provides the patient with the option of ambulatory discharge.
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Reg Anesth Pain Med · Mar 1998
Case ReportsInguinal paravascular (lumbar plexus) neurolytic block--description of a catheter technique: case report.
We provided care for a 47-year-old female with a history of lung carcinoma and bony metastases who sustained a pathologic fracture of the right acetabulum causing severe and uncontrolled pain in the right groin. Her pain was rated as 8-10 on a 10-point visual analog scale (VAS). Her terminal disease and poor surgical risk precluded therapeutic operative intervention. Consequently, a neurolytic block of the lumbar plexus was performed as a palliative measure. ⋯ This case report supports the feasibility of placing a catheter via a modified anterior inguinal paravascular block technique and its subsequent use for both local anesthetic infusion and neurolytic block of the lumbar plexus.