Articles: nerve-block.
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Acta Anaesthesiol Belg · Jan 1995
Motor blockade and absence of local nerve toxicity induced by liposomal bupivacaine injected into the brachial plexus of rabbits.
Bupivacaine has been encapsulated into multilameller liposomes in order to reduce its systemic toxicity and to lengthen its action. Low, constant and sustained plasma levels have been observed after epidural injection and brachial plexus administration to rabbits. The present experiment was performed in order to study the motor block effect and the possible neurotoxicity of bupivacaine encapsulated in multilamellar liposomes applied in vivo to intact peripheral nerve bundles. ⋯ Light microscopic analyses of the nerves after 2 and 7 days revealed weak inflammatory perineural infiltration. Electron microscopy showed no changes of the myelin sheaths and no alteration of unmyelinated fibers. It may be concluded that the pharmacologically active liposomal formulation of bupivacaine did not induce alterations of the nerve tissues.
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Comparative Study
Comparison of neostigmine-induced recovery with spontaneous recovery from mivacurium-induced neuromuscular block.
In 24 ASA I-II adults anaesthetized with thiopentone, fentanyl and nitrous oxide in oxygen, we studied neuromuscular transmission with isometric adductor pollicis monitoring. Patients received mivacurium 0.2 mg kg-1 followed by an infusion lasting at least 60 min and adjusted to maintain twitch height at 1-5%. After termination of the mivacurium infusion, when twitch height spontaneously regained 25% of its control value, the patients were allocated to two groups of 12 patients each. ⋯ All patients in group NEO recovered to a TOF ratio greater than 0.7 after 6 min compared with 15 min in group SPO (P < 0.005). A TOF ratio greater than 0.9 was observed in all patients in group NEO compared with only six in group SPO (P < 0.025). Nevertheless, RF50HZ and RF100HZ did not differ significantly (0.92 (0.01) (group NEO), 0.91 (0.01) (group SPO) and 0.83 (0.02) (group NEO), 0.78 (0.03) (group SPO), respectively).(ABSTRACT TRUNCATED AT 250 WORDS)
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Clinical Trial
[Axillary blockade of the brachial plexus. A prospective study of blockade success using electric nerve stimulation].
Axillary block is a common anesthetic technique for operations on the hand and forearm. In our hospital, with many trainees in anaesthesia, only 250-300 axillary blocks per year are performed by about 30 colleagues. This implies a small number of blocks for each anaesthetist. ⋯ Prior to injection of the local anaesthetic, the current for nerve stimulation should be reduced to < 0.5 mA. The time between the end of injection and the beginning of surgery should be no less than 30 min because complete sensory blockade can more often be achieved. The dose of mepivacaine should be no less than 6 mg/kg body weight.