Articles: nerve-block.
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Randomized Controlled Trial Clinical Trial
Blockade of peripheral neuronal barrage reduces postoperative pain.
Peripheral afferent neuronal barrage from tissue injury produces central nervous system hyperexcitability which may contribute to increased postoperative pain. Blockade of afferent neuronal barrage has been reported to reduce pain following some, but not all, types of surgery. This study evaluated whether blockade of sensory input with a long-acting local anesthetic reduces postoperative pain after the anesthetic effects have dissipated. ⋯ Additionally, subjects in the bupivacaine group self-administered fewer codeine tablets for unrelieved pain over 24-48 h postoperatively (P < 0.05). These data support previous animal studies demonstrating that blockade of peripheral nociceptive barrage during and immediately after tissue injury results in decreased pain at later time points. The results suggest that blockade of nociceptive input by administration of a long-acting local anesthetic decreases the development of central hyperexcitability, resulting in less pain and analgesic intake.
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Many trauma repairs and dermatologic procedures performed on the face require anesthesia of the involved area. The specific requirements for anesthesia and vasoconstriction vary, depending on the location, size and depth of the injury or lesion. ⋯ In addition, direct infiltration of a volume of anesthetic sufficient to produce adequate anesthesia can cause distortion of the tissue, hindering the identification of margins. Intraoral nerve blocks routinely used by dentists can achieve safe and effective regional anesthesia in the anterior portion of the face.
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Anesthesia and analgesia · Apr 1997
Patient and surgeon satisfaction with extremity blockade for surgery in remote locations.
In a practice that may be unique to military health care, extremity nerve blocks are established by anesthesiologists before transporting the patient to a remote clinic for surgery without further monitoring by anesthesia personnel. The safety and acceptance of this practice was assessed through a prospective survey of the surgeons and their patients. Six hundred seventy-seven blocks were performed in a 1-yr period with no adverse events related to this practice. ⋯ Of the responding patients, 78% stated that they would be willing to undergo a repeat block. The surgeons were satisfied with the operating conditions in 96% of the cases. This study supports the safety and efficacy of this practice.
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Anesthesia and analgesia · Apr 1997
Randomized Controlled Trial Comparative Study Clinical TrialFemoral and genitofemoral nerve blocks versus spinal anesthesia for outpatients undergoing long saphenous vein stripping surgery.
Long saphenous vein stripping (LSVS) surgery is often used to treat varicose veins. We tested the hypothesis that femoral nerve block (FNB) with genitofemoral nerve infiltration provides sufficient analgesia and superior recovery characteristics to spinal anesthesia for LSVS procedures in the ambulatory setting. Thirty-six patients were randomized to receive FNB with 30 mL of 3% alkalinized chloroprocaine, and 32 patients received spinal anesthesia with 65 mg of 5% hyperbaric lidocaine. ⋯ Patients in the FNB group had significantly faster recovery (P < 0.01) and lower incidences of pain (P < 0.05) and complications (P < 0.05) than the patients in the spinal group. All patients who received FNB indicated that they would choose this type of anesthesia in the future, whereas five (15%) patients in the spinal group would refuse spinal anesthesia in the future (P < 0.01). We conclude that FNB is an excellent anesthetic choice for LSVS.
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Comment Letter Clinical Trial
Ambulatory surgical management of breast carcinoma using a paravertebral block.