Articles: nerve-block.
-
Basic research indicates that systemic local-anaesthetic-type drugs that block sodium channels are effective in pain due to nerve damage. These drugs were first used as analgesics in the 1950s and they are still commonly used to try to relieve neuropathic pain and incident pain caused by cancer. As they are potentially toxic, these drugs should not be used without proven effectiveness. ⋯ Only minor dose-related adverse effects were reported in the 85 patients given mexiletine 225-750 mg. Local-anaesthetic-type drugs are effective in pain due to nerve damage, but there is little or no evidence to support their use in cancer-related pain. Copyright 1998 European Federation of Chapters of the International Association for the Study of Pain.
-
Anesthesia and analgesia · Mar 1998
Randomized Controlled Trial Clinical TrialAlkalinization of lidocaine does not hasten the onset of axillary brachial plexus block.
We assessed the onset of sensory and motor blockade as well as the distribution of sensory blockade after axillary brachial plexus block with 1.5% lidocaine hydrochloride 1:200,000 epinephrine with and without sodium bicarbonate in 38 patients. The onset of analgesia and anesthesia was recorded over the distributions of the median, ulnar, radial, and medial cutaneous nerves of the forearm, medial cutaneous and lateral cutaneous nerves of the arm, and musculocutaneous nerve. The onset of motor blockade of elbow and wrist movements was also recorded. Data were analyzed by using survival techniques and compared by using log rank tests. Only the onset of analgesia in the medial cutaneous nerves of the arm and forearm, and the onset of anesthesia in the medial cutaneous nerve of the arm were significantly faster (P < 0.05) with alkalinization of lidocaine. Our study showed that alkalinization of lidocaine does not significantly hasten block onset in most terminal nerve distributions. ⋯ We examined whether alkalinizing a local anesthetic would quicken the onset of a regional upper limb nerve blockade. We found that alkalinization of lidocaine did not offer a significant clinical advantage in axillary brachial plexus blockade.
-
N-butyl tetracaine has local anesthetic and neurolytic properties. An injection of this drug at the rat sciatic notch produces rapid onset and nerve impairment lasting > 1 week. This study aimed to elucidate the structure-activity relation of various tetracaine derivatives to design better neurolytic agents. ⋯ When n-alkylation is 4-6, n-alkyl tetracaine appeared as a strong neurolytic agent. Neurolytic derivatives retained their local anesthetic activity and elicited rapid onset of nerve block after injection. Such derivatives are potential local anesthetic-neurolytic dual agents for chemical lesions of the sciatic nerve.
-
In the early part of the century, when adrenaline first became widely available, it was used in an uncontrolled manner and cases of ischaemic necrosis led to it falling into disfavour for hand surgery. Local anaesthesia with adrenaline is currently widely used for palmar and dorsal hand surgery but there remains a very deeply ingrained resistance to its use for digital anaesthesia. ⋯ Our findings show that adrenaline only temporarily reduced digital blood flow. Perfusion of the digits persisted in every case.