Articles: nerve-block.
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Randomized Controlled Trial Clinical Trial
Efficacy of pre-emptive analgesia and continuous extrapleural intercostal nerve block on post-thoracotomy pain and pulmonary mechanics.
Thoracotomy results in severe pain and deleterious changes in pulmonary physiology. The literature suggests that these alterations in pulmonary mechanics are inevitable and can only be minimised but not prevented by effective analgesia. We have re-evaluated this concept and assessed the efficacy of pre-emptive analgesia [preincisional afferent block, premedication with opiate and/or non-steroidal anti-inflammatory drug (NSAID)] in conjunction with postoperative extrapleural continuous intercostal nerve block on postoperative pain and pulmonary function. ⋯ We conclude that a balanced analgesic regime comprising preoperative pain prophylaxis and postoperative maintenance analgesia by NSAID and continuous extrapleural intercostal nerve block will minimise and even reverse the expected decline in lung function after thoracotomy. The postoperative decline in lung function is not obligatory but primarily due to incisional pain and thus is preventable by effective analgesia. An ideal balanced pre-emptive analgesic regime should include preincisional local anaesthetic afferent block and premedication with opiates and a NSAID:
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J Philipp Dent Assoc · Jun 1994
Comparative StudyA comparative study: classical, Akinosi, and Gow-Gates techniques of mandibular nerve block.
This study was conducted to compare the effectiveness and the degree of patient acceptability of the three techniques of mandibular nerve block, namely the classical, the Akinosi and the Gow-Gates. Forty five patients with mandibular posterior tooth/teeth indicated for extraction were chosen and divided equally into three groups to represent the three techniques of mandibular nerve block. ⋯ Tabulation and analysis of the collected data followed. Results show that the Gow-Gates technique was the most effective in inducing anesthesia while the Akinosi technique appeared to be the most acceptable among the patients.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of digital versus metacarpal blocks for repair of finger injuries.
This study compared efficacy, degree of discomfort, and time to anesthesia of digital blocks and metacarpal blocks for digital anesthesia. ⋯ Digital block and metacarpal block, as described in this study, are equally painful procedures. Digital block, however, is more efficacious and requires significantly less time to anesthesia for the injured finger.
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Pain relief in children during the perioperative period can be provided by means of peripherally or centrally acting analgesics or of regional anaesthetic techniques. Narcotics or regional blockde are indicated when peripherally acting analgesics prove inadequate to abolish pain. Side effects of narcotics must be taken into account: opioids must not be administered unless continuous safety monitoring of the child's respiration is assured. ⋯ All advantages and drawbacks of the various techniques that might be appropriate must be considered: the technique involving the least risk and side effects is the anaesthetic technique with a broad margin of safety when applied by an anaesthesiologist who has experience with paediatric regional blocks include topical anaesthesia, local infiltration, peripheral nerve blocks (e.g. nervi dorsalis penis, plexus axillaris) and caudal epidural blockade. Caution must be exercised whenever narcotics are administered systemically or epidurally; side effects must not be underestimated, even under conditions of intensive care observation. The provision of effective pain relief is a rewarding task-and particularly in little children.
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Randomized Controlled Trial Clinical Trial
Effect of ilioinguinal and iliohypogastric nerve block and wound infiltration with 0.5% bupivacaine on postoperative pain after hernia repair.
We have compared, in 40 adult males, the effect on pain in the first 24 h after herniorrhaphy of preincisional ilioinguinal and iliohypogastric nerve block and wound infiltration with 0.5% bupivacaine or saline. After operation, patients received morphine i.v. via a patient-controlled analgesia machine and visual analogue pain scores (VAS) at rest and on movement were recorded. The bupivacaine group consumed less morphine in the first 6 h after operation. ⋯ There was no significant difference in VAS scores at rest but there was a significantly higher pain score with movement in the saline group. We have shown that the combination of nerve block and wound infiltration reduces consumption of morphine in the first 24 h after herniorrhaphy. We have failed to show any effect of 0.5% bupivacaine beyond the first 6 h after operation.