Articles: nerve-block.
-
Randomized Controlled Trial Clinical Trial
Does a mid-lumbar block level provide adequate anaesthesia for transurethral prostatectomy?
In this prospective, randomized study, 23 patients having spinal anaesthesia for transurethral prostatectomy (TURP) were evaluated for the adequacy of their block using a visual analog pain score (VAPS). Each patient with a "standard" (> or = T10) block level (n = 5) or "intermediate" (L1 or T12) block level (n = 5) found the block adequate. Sixty-two percent (8/13) of patients with a "low" (< or = L3) block level found their block adequate. ⋯ However, a smaller (P < 0.05) maximum percent decrease in diastolic blood pressure was found in LBPs, than in "intermediate" or "standard" block patients. It is concluded that a spinal block > or = L1 is adequate during TURP when bladder pressure is monitored and kept low. Mid-lumbar block levels should be reserved for patients in whom the benefit of minimizing haemodynamic changes outweighs the risk of a "less complete" anaesthetic.
-
Randomized Controlled Trial Clinical Trial
The addition of triamcinolone acetonide to bupivacaine has no effect on the quality of analgesia produced by ilioinguinal nerve block.
In a study of 30 men undergoing elective inguinal hernia repair under general anaesthesia no difference in postoperative pain, patient rating score or morphine consumption was found between patients who had pre-operative ilioinguinal nerve block with bupivacaine 0.5% plain and those who received a similar block with bupivacaine 0.5% plain and triamcinolone acetonide 40 mg. Mean (SD) morphine requirements using a patient-controlled analgesia system were 37 (22.2) mg and 32 (20.3) mg in the bupivacaine and bupivacaine/triamcinolone groups respectively (p > 0.05). The addition of triamcinolone 40 mg to bupivacaine 0.5% offers no advantages over unsupplemented bupivacaine when used for ilioinguinal block.
-
Comparative Study
The safety of dorsal penile nerve block for neonatal circumcision.
Dorsal penile nerve block (DPNB) was first described for use in neonatal circumcision in 1978. Since then, many studies have documented its effectiveness in alleviating pain in newborns undergoing circumcision. In 1989, the American Academy of Pediatrics acknowledged that DPNB may relieve the pain and stress of circumcision but stopped short of endorsing its routine use in this procedure, citing lack of data on its safety. ⋯ This study corroborates findings of smaller case studies, indicating that DPNB is associated with a low rate of minor complications.
-
Regional anesthesia · Sep 1994
Case ReportsSubdural anesthesia as a complication of an interscalene brachial plexus block. Case report.
Interscalene brachial plexus block is performed in the groove between the anterior and middle scalene muscles at the level of C6, just over the transverse process. Injection occurs within 1-2 cm of the dural sleeve and could be misdirected into the epidural, subdural, or subarachnoid spaces. ⋯ The case represents a partial injection of local anesthetic intended for the interscalene brachial plexus into the subdural space. The diagnosis is based on the normal evolution of the block into full motor and sensory anesthesia of the ipsilateral brachial plexus that evolved into a patchy, sensory, and motor block involving many dermatomes outside the brachial plexus, with minimal sympathetic block, and evidence of a normal interscalene block on emergence from general anesthesia. Subdural injection must be considered when unusual motor and sensory block occurs after interscalene block, especially after a time interval too long for epidural or subarachnoid injection, or with minimal evidence of sympathetic block, after suspected high central block injection.