Articles: nerve-block.
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A new technique involving the use of a local block to anesthetize the inferior alveolar nerve (V3), a branch of the mandibular division of the trigeminal or fifth cranial nerve, is described. Clinicians fail to administer a successful mandibular block in as many as 15 per cent of all cases. ⋯ A short description of other techniques are presented, some of which should be reserved for isolated cases and not used on a routine basis. By avoiding or eliminating the reasons for mandibular block failure, and using the new block described in this paper, clinicians should be able to reduce the failure rate to much lower levels.
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Anesthesia and analgesia · Jun 1997
Randomized Controlled Trial Clinical TrialEvaluation of residual neuromuscular block using train-of-four and double burst stimulation at the index finger.
We examined the percentage of tactile detection of fade in response to train-of-four (TOF), double burst stimulation3,3 (DBS3,3), or DBS3,2 at the index finger compared with that at the thumb during continuous infusion of vecuronium. One hundred five adult patients were studied. At TOF ratios (T4/T1) of 0.41-0.70, fades in response to TOF were more frequently identified by tactile means at the index finger than at the thumb (58% vs 26%, P < 0.05). ⋯ The baseline displacement of the index finger was significantly less than that of the thumb (P < 0.05). In summary, the percentage of tactile detection of fade in response to neurostimulation at the index finger is higher than at the thumb, and the absence of fade in response to DBS3,3 at the index finger is a good indicator of adequate recovery from neuromuscular block. This is probably because of the smaller baseline displacement of the index finger.
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J. Perianesth. Nurs. · Jun 1997
Review Case ReportsTotal spinal anesthesia after an interscalene block.
A case study is presented involving a 22-year-old male who developed total spinal anesthesia after interscalene blockade for an arthroscopic procedure of the shoulder. An understanding of the anatomical structures of the brachial plexus, autonomic nervous system function, and side effects of local anesthetics is presented to assist the perianesthetic nurse in assessing and anticipating patient needs and in clinical decision making.
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Changes in plasma cortisol concentrations during the first 4 hours after castration of 6-week-old lambs by one of four methods were measured. The methods were application of a rubber ring above the testes, application of a ring to shorten the scrotum below the testes, use of a castration clamp plus a ring, and use of a castration clamp alone. The efficacy of local anaesthetic in reducing or abolishing the cortisol responses to castration by all these methods except short scrotum was assessed. ⋯ Local anaesthetic injected into the scrotal neck or spermatic cords did not affect significantly the cortisol response to the IO-second clamp application. The following conclusions were drawn from this work: the testes as well as the scrotum were sources of noxious sensory input after ring application; the clamp plus ring method used here was ineffective in reducing the pain-induced distress (as indicated by cortisol concentrations) caused by ring-only castration; injection of local anaesthetic into the scrotal neck or into the testes prior to ring application blocked most noxious sensory input from both the scrotum and the testes; and on the basis of the present cortisol responses the 10-second clamp applications method could not be recommended in reference to the ring-only method, but the l-second clamp application method might be equally acceptable for castrating 6-week-old-lambs. Of the methods examined, injections of local anaesthetic into the scrotal neck or both testes were the most effective in reducing the pain-induced distress caused by ring-only castration.