Articles: nerve-block.
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We describe the successful use of the short-acting, non-depolarizing neuromuscular blocking agent, mivacurium, in a patient with myotonic dystrophy. Increased sensitivity to mivacurium was demonstrated using train-of-four monitoring, with a single dose of mivacurium providing adequate block for 90 min of surgery. Spontaneous recovery appeared prolonged with a recovery index (25-75% T1) of 10 min and a recovery time (5-95% T1) of 30 min. The use of reversal agents and anticholinergic agents was avoided.
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With the increasing popularity of day case surgery it is important to ensure that safe and appropriate techniques are being used. We retrospectively reviewed a large series of 732 patients who underwent planned day case hand surgery under intravenous regional anaesthesia (modified Bier's block) over a 5-year period. We found a modified Bier's block to be ideally suited to day case surgery with no deaths, minimal morbidity and a success rate in excess of 98%.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effect of injection speed on anaesthetic spread during axillary block using the orthogonal two-needle technique.
One hundred patients undergoing scheduled upper limb orthopaedic surgery were studied to determine if the speed of injection of the local anaesthetic solution could modify the extent and depth of anaesthesia with the axillary approach to the brachial plexus. The blocks were performed using the 'orthogonal two-needle technique' in which two needles are positioned on the upper and on the lower aspect of the axillary artery, orthogonal to the neurovascular bundle and directed towards the fascial compartment containing the radial nerve. The patients were randomly assigned to one of three groups to receive one of three injection rates (10, 20 and 30 s) (n = 30). ⋯ A significant association was found between the injection rate and the anaesthetic spread for all tested areas with the exception of the regions supplied by the median nerve. A greater speed of injection was associated with less anaesthetic spread and more frequent block failure. A clear association between the anaesthetic spread to all branches of the brachial plexus and a slower injection rate of the local anaesthetic was found.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of bupivacaine plus buprenorphine with bupivacaine alone by caudal blockade for post-operative pain relief after hip and knee arthroplasty.
In a double-blind, parallel group trial, 15 patients who were given a caudal injection of 1.8 mg kg-1 of bupivacaine after induction of anaesthesia, were compared with 15 patients in whom 7.2 mg kg-1 of buprenorphine was added to the same dose of bupivacaine, prior to knee or hip replacement surgery. The duration of analgesia was much longer (mean 606 min vs. 126 min P < 0.001) in those receiving added buprenorphine; mean morphine consumption in the first 24 h was halved (14 mg vs. 28 mg) and patient satisfaction greatly increased. There were no significant differences in the incidence of complications although the group which had added buprenorphine had a lower incidence of vomiting.
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Randomized Controlled Trial Comparative Study Clinical Trial
Lateral popliteal sciatic nerve block compared with ankle block for analgesia following foot surgery.
The purpose of this study was to compare postoperative analgesia after foot surgery in patients anaesthetised either with popliteal sciatic nerve block or ankle block. In a prospective study, 40 patients scheduled for foot surgery involving osteotomies were allocated randomly into one of two groups. Following induction of general anaesthesia, Group PS (n = 21) received a lateral popliteal sciatic nerve block and Group AB (n = 19) received an ankle block. ⋯ The ankle block appeared to be more reliable, providing more consistent analgesia in the PAR. Postoperative analgesia in Group PS lasted a median of 18.0 hr and in Group AB lasted 11.5 hr (P < 0.05). Both techniques provided effective analgesia after discharge home and high levels of patient satisfaction.