Articles: nerve-block.
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Anesthesia and analgesia · Dec 1994
Randomized Controlled Trial Comparative Study Clinical TrialEffect of oral clonidine and intrathecal fentanyl on tetracaine spinal block.
We studied the effect of oral clonidine and intrathecal (IT) fentanyl on the onset and duration of a hyperbaric tetracaine-induced spinal block. Forty adult males undergoing elective surgery were studied according to a randomized, double-blind, placebo-controlled protocol involving four treatment regimens: Group I, placebo per os (PO) + tetracaine 12 mg IT; Group II, placebo PO+tetracaine 12 mg IT+fentanyl 10 micrograms IT; Group III, clonidine 200 micrograms PO+tetracaine 12 mg IT; Group IV, clonidine 200 micrograms PO+tetracaine 12 mg IT+fentanyl 10 micrograms IT. Onset time to highest sensory level was 8.5 +/- 3.1, 8.2 +/- 2.3, 6.1 +/- 1.6, and 6.8 +/- 1.4 min in Groups I, II, III, and IV, respectively. ⋯ Episodes of bradycardia and hypotension were more frequent in the clonidine-treated patients (40%-50% vs 10%). We conclude that oral clonidine (200 micrograms) shortened the onset time of tetracaine's sensory block and prolonged the duration of sensory and motor block. However, clonidine premedication increased the risk of hypotension and bradycardia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Regional anaesthesia for circumcision in adults: a comparative study.
Penile block (PB) in adults is not a well-recognized technique. The aim of this study was to compare, in a randomized prospective manner, five different techniques of PB in 250 adults undergoing circumcision with regard to anaesthetic quality, complications and postoperative analgesia. Patients were divided into five groups (50 per group) according to the technique used: Group A--"10, 30-13, 30" approach; Group B--the subpubic approach; Group C--subcutaneous ring block; Group D--a combination of frenulum infiltration and the "10, 30-13, 30" approach; Group E--a combination of frenulum infiltration and the subpubic approach. ⋯ The five groups did not differ with regard to adverse effects or time until the onset of postoperative pain when the blocks were successful. It is concluded that good surgical anaesthesia, a low rate of adverse effects and prolonged postoperative analgesia can be achieved by the use of either subcutaneous ring block or a combination of dorsal nerve block (using the "10, 30-13, 30" or the subpubic approach) and infiltration of the frenulum. These approaches to the PB are effective anaesthetic techniques for circumcision in adults.
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Neuroblockade techniques can serve many functions in the management of the chronic pain patient. These various functions are discussed and a brief insight given for their use in specific pain syndromes. A run-down of the type of blocks useful in the management of cancer pain is also given.
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Comparative Study
The interpretation of pain relief and sensory changes following sympathetic blockade.
A comparative study of the effects of sympathetic blockade by stellate ganglion block (SGB) and intravenous phentolamine infusion (PhI) was carried out in 24 patients with presumed sympathetically maintained pain of an upper extremity. A total of 15 SGBs and 16 PhIs were performed, with seven patients undergoing both procedures. All patients developed a Horner's syndrome with SGB and nasal stuffiness and cardiovascular changes with PhI. ⋯ When SGB produces pain relief but PhI does not, systemic absorption of local anaesthetic and/or sensory blockade by spread to somatic nerves may be the reason. Thus, PhI appears to be a less sensitive but more specific test than SGB. These two procedures provide complementary information and both may be needed to establish the diagnosis of sympathetically maintained pain.