Articles: nerve-block.
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Cahiers d'anesthésiologie · Jan 1995
[Penile block. Block of ilio-inguinal and iliohypogastric nerves in children. Techniques, indications, advantages and adverse effects].
Peripheral blocks as penile blocks, ilio-inguinal ou ilio-hypogastric nerve blocks provide an useful alternative to caudal block in children, especially for penile surgery, herniotomy, and orchidopexy, frequently performed at this age. A precise anatomic location and a strict technique increase the success rate of these blocks. ⋯ Postoperative analgesia in ambulatory surgery is one of the best reasons to select these techniques. In addition they avoid prolonged motor effects observed with epidural anaesthesia.
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We performed an audiometric study in 20 patients who underwent surgery of the shoulder region under an interscalene brachial plexus block (IBPB). Bupivacaine 0.75% with adrenaline was given followed by a 24-hr continuous infusion of 0.25% bupivacaine. Three audiometric threshold measurements (0.25-18 kHz) were made: the first before IBPB, the second 2-6 h after surgery and the third on the first day after operation. ⋯ The maximum change in threshold was 35 dB at 6 kHz measured at the end of the continuous infusion of bupivacaine. This patient had hearing threshold changes (15-20 dB) at 6-10 kHz on the opposite side also. IBPB may cause transient auditory dysfunction in the ipsilateral ear, possibly via an effect on sympathetic innervation.
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Postoperative pain after shoulder surgery is known to be intense and requires usually opioid administration. The recent use of regional anaesthesia for this type of surgery has contributed to the relief of acute postoperative pain occurring in the recovery room since the analgesic effects of block persist for several hours after surgery depending upon the selected drug. Moreover, the development of less invasive surgery (arthroscopy) and experience with regional blocks have permitted to perform minor shoulder surgery on an outpatient basis. ⋯ However, for more invasive surgery, regional anaesthesia should be associated to a light general anaesthesia as well as the insertion of a supraclavicular catheter for postoperative analgesia. A diaphragmatic paresis secondary to a blockade of the phrenic nerve is constant radiologically after interscalenic block but remains symptomless. However, in case of severe preoperative chronic respiratory insufficiency, decompensation may occur rapidly after performance of the interscalenic block.
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Ann Fr Anesth Reanim · Jan 1995
Case Reports[Interscalenic block: accidental catheterization of the epidural space].
A case is reported of inadvertent insertion of a brachial plexus catheter into the cervical epidural space, at the sitting of an interscalene block for postoperative analgesia, during the recovery from general anaesthesia after surgical repair of a rupture of the rotator cuff of the shoulder. No features of cervical epidural anaesthesia were seen after the first injection of local anaesthetic, as it was made through the catheter insertion cannula. ⋯ The X-ray obtained after catheter opacification showed the penetration of contrast medium into the epidural space. In our case, two out of the three means of prevention of this complication were not possible: a) sitting of the interscalene block before induction of anaesthesia, as the insertion conditions of the catheter are better in a conscious, sitting patient; b) adequate cannula orientation (namely medial, dorsal and slightly caudal); c) routine X-ray control of the catheter position before the first injection, associated with careful clinical monitoring for 30 min after each local anaesthetic injection.