Articles: nerve-block.
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Anesthesia and analgesia · Feb 1997
Comparative StudyContinuous popliteal sciatic nerve block: an original technique to provide postoperative analgesia after foot surgery.
Our study describes an original technique of continuous popliteal sciatic nerve block (CPSB) (Group A, 60 patients) and compares its analgesic efficacy after foot surgery with intramuscular (IM) opioids (Group B, 15 patients) and intravenous patient-controlled analgesia (IV PCA) with morphine (Group C, 45 patients). CPSB was performed using Singelyn's landmarks. The sciatic nerve was localized with a short-beveled needle connected to a peripheral nerve stimulator. ⋯ Only 8% of patients required postoperative opioid in Group A compared with 91% and 100% in Groups B and C, respectively. No immediate or delayed complications other than postoperative technical problems (kinked or broken catheter 25%) were noted in Group A. In conclusion, CPSB is easy to perform, safe, and a more efficient technique than parenteral opioid for providing postoperative analgesia after foot surgery.
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Parascalene block is a technique of blocking the brachial plexus at the lateral border of the anterior scalene muscle superior to the clavicle. The objective of this study was to define the position of the needle in parascalene block with relationship to the brachial plexus and the dome of the pleura, which is important in determining whether this technique minimizes the incidence of pneumothorax. In the first group, 10 patients scheduled for minor upper extremity surgery agreed to parascalene block, which was performed in the computed tomographic examination room. ⋯ The distances from the skin to the interscalene groove and the interscalene groove to the first rib at the level of the needle insertion or the marker in both groups were measured to be 17 +/- 4 mm and 15 +/- 3 mm, respectively. This study suggests that the level of the parascalene needle entry is superior to the dome of the pleura. At this level, the incidence of pneumothorax should be minimized.
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Paediatric anaesthesia · Jan 1997
Para-umbilical block: a new concept for regional anaesthesia in children.
This preliminary study describes a new technique to provide analgesia in children undergoing umbilical hernia repair. The para-umbilical block consists of infiltrating the anterior cutaneous branches of the two tenth spinal roots over and under the rectus sheath far from the operative field. Intra and postoperative analgesia as well as operative conditions were assessed in 11 children 16.7 +/- 31 months old, weighing 8421 +/- 6941 g, the block being performed before surgery under light general anaesthesia. ⋯ The block proved to be safe and on the whole effective in this short series. The study should proceed on a multi-centre basis if possible. Indications can be extended.
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Regional anesthesia · Jan 1997
Comparative StudyFailure of meperidine to anesthetize human median nerve. A blinded comparison with lidocaine and saline.
Although meperidine safely produces clinical spinal anesthesia, the responsible mechanism is unknown. This study was undertaken to test the possibility that this drug acts as a local anesthetic by investigating its ability to inhibit conduction in a human peripheral nerve. ⋯ Meperidine produced no signs of local anesthesia, even when given at a dose (75 mg) and concentration (1.5%) that consistently produced systemic side effects. Thus, the coequivalent ability of meperidine and lidocaine to produce spinal anesthesia contrasts with their discordant ability to produce local anesthesia. This disparity suggests that meperidine may produce spinal anesthesia through mechanisms other than inhibition of sodium channel function.