Articles: nerve-block.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of the pharmacodynamics and pharmacokinetics of an infusion of cis-atracurium (51W89) or atracurium in critically ill patients undergoing mechanical ventilation in an intensive therapy unit.
We have studied 12 critically ill, sedated patients who required a neuromuscular blocking drug to assist mechanical ventilation in an intensive care unit. Patients were randomized to receive an infusion of cis-atracurium 0.18 mg kg-1 h-1 (group 1, n = 6) or atracurium 0.6 mg kg-1 h-1 (group 2, n = 6) preceded, if necessary, by a bolus dose of 2 x ED95 of the same drug (cis-atracurium 0.1 mg kg-1 or atracurium 0.5 mg kg-1). Neuromuscular block was monitored using an accelerograph and the infusion rate adjusted regularly so that it was possible to detect the first response to train-of-four (TOF) stimulation of the ulnar nerve at the wrist. ⋯ Using the NONMEM program, a single compartment pharmacokinetic model was fitted to the plasma concentrations of cis-atracurium and the cis-cis, cis-trans and trans-trans isomers of atracurium. The mean population pharmacokinetic values for cis-atracurium were: volume of distribution (V) = 21,900 (SEM 416) ml; clearance (Cl) = 549 (79) ml min-1; half-life (T1/2) = 27.6 (3.6) min; and for the three groups of atracurium isomers were: cis-cis, V = 15,100 (720) ml, Cl = 449 (42) ml min-1, T1/2 = 23.4 (1.2) min; cis-trans, V = 18,000 (667) ml, Cl = 1070 (43) ml min-1, T1/2 = 11.7 (0.1); trans-trans, V = 13,100 (1280) ml, Cl = 1560 (55) ml min-1, T1/2 = 5.8 (0.4) min. Plasma laudanosine concentrations were lower in the cis-atracurium (peak value 1.3 micrograms ml-1) than in the atracurium (maximum 4.4 micrograms ml-1) group.
-
Rev Esp Anestesiol Reanim · Mar 1996
Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial[Brachial plexus anesthesia: results of a modified perivascular supraclavicular technique].
To compare a modified supraclavicular perivascular approach with the axillary perivascular technique for providing brachial plexus blockade. ⋯ The modified perivascular lateral supraclavicular technique is a safe, effective method for providing brachial plexus block.
-
J Pain Symptom Manage · Mar 1996
Clinical TrialNerve blocks with local anesthetics and corticosteroids in chronic pain: a clinical follow-up study.
During 4 years, 45 patients with various chronic pain conditions were treated with nerve blocks in our clinic. The blocks consisted of injections of local anesthetic and a corticosteroid on one or several occasions. At the end of this time period, the patients' pain was classified from their records as nociceptive, neurogenic, or unknown, according to International Association for the Study of Pain (IASP) criteria. ⋯ Only 6 of the 45 patients had pain relief for longer than 1 month. It is concluded that treatment with nerve blocks alone is not very effective as a long-term treatment for chronic pain. Further experimental and systematic clinical studies are necessary to define the ultimate place for nerve blocks in the treatment of chronic nonmalignant pain.
-
The effects of combined spinal administration of alpha(2)-adrenoceptor agonists, local anaesthetics, and opioids have been extensively studied. The motor and the sensory block of spinal and epidural anaesthesia is enhanced and prolonged by the combination of clonidine with the local anaesthetics lidocaine, tetracaine and bupivacaine. Because higher plasma levels of local anaesthetics were measured when clonidine was injected epidurally, the enhancement of the local anaesthetic's effect by clonidine is not due to slowed resorption, but rather to direct spinal and supraspinal effects of clonidine. ⋯ Despite the sedative properties of clonidine, there is no increased risk of respiratory depression when clonidine is given in combination with opioids. The inhibiting effect on the sympathetic nervous system activity regularly observed during spinal administration of clonidine supports the value of this therapy and will support its use in the future. Therefore, the combination of alpha(2)-adrenoceptor agonists with local anaesthetics or opioids is reasonable and may improve anaesthetic practice.