Articles: nerve-block.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparative local anaesthetic blocks in the diagnosis of cervical zygapophysial joint pain.
The utility of randomised, double-blind, controlled, comparative local anaesthetic blocks for the diagnosis of cervical, zygapophysial joint pain was studied in 47 patients with chronic neck pain following whiplash injury. Each patient was investigated with radiologically controlled blocks of the medial branches of the cervical, dorsal rami to anaesthetise the target cervical, zygapophysial joint. The blocks were performed using either lignocaine or bupivacaine, randomly allocated, and the patients' responses were assessed in a double-blind fashion. ⋯ The durations of pain relief obtained from the anaesthetics were consistent with the known characteristics of these drugs with bupivacaine lasting significantly longer than lignocaine (P = 0.0003). A subgroup of 13 patients were identified with unexpected, prolonged responses to one or both of the anaesthetics. Comparative, diagnostic blocks are a valid technique in the identification of painful zygapophysial joints, and constitute an implementable alternative to normal saline controls.
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Anesthesia and analgesia · Oct 1993
Randomized Controlled Trial Comparative Study Clinical TrialA comparative study of analgesia after knee surgery with intraarticular bupivacaine, intraarticular morphine, and lumbar plexus block.
Following arthroscopic surgery of the knee, 60 ASA I-II patients were randomly allocated to three different groups (n = 20 each) in an attempt to establish the best postoperative analgesic protocol: 20 ml of bupivacaine (0.25%; 50 mg) intra-articularly (IA) (Group 1); continuous three-in-one lumbar plexus block using a catheter to administer 0.25 ml/kg of bupivacaine (0.25%; single-shot) plus continuous pump infusion of the same drug (0.03 ml.kg-1 x h-1 of 0.25% bupivacaine for 24 h) (Group 2); or 1 mg of morphine with 20 ml of saline IA (Group 3). The results were appraised in a double-blind manner, and the degree of postoperative pain was evaluated by visual analog scale (VAS) at constant hourly intervals for the first 24 h, by the incidence of secondary effects, and by the need for complementary analgesia. Group 2 (three-in-one) VAS values were lower 16 and 24 h after surgery and also globally (P < 0.05), with respect to the other two groups. ⋯ No other secondary effects were observed. We conclude that all three analgesic methods proved efficient, as reflected by the scant requirements for additional analgesics and the degree of expressed patient satisfaction. However, lumbar plexus block (three-in-one) with continuous bupivacaine infusion was most effective, and, although it constitutes an added technique, its scant complications and easy performance make its use advisable.
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Clinical Trial
Spirometry, blood gas analysis and ultrasonography of the diaphragm after Winnie's interscalene brachial plexus block.
Ten patients with healthy lungs were subjected to radiology, sonography, spirometry and blood gas analysis before and after an interscalene brachial plexus block prior to shoulder surgery. Winnie's interscalene block induced ipsilateral hemidiaphragmatic paresis that was confirmed by radiology and sonography. ⋯ These changes should not cause further clinical symptoms in sitting patients with unaffected lungs. In patients with pulmonary disease, this method of nerve block should be limited to cases for which there is a clear indication.
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Randomized Controlled Trial Clinical Trial
Synergism between atracurium and vecuronium in children.
In 30 children under balanced anaesthesia, we have determined dose-response curves and maintenance requirement of three dose ratio combinations of atracurium and vecuronium (10:1, 4:1 or 1.6:1 on a microgram:microgram basis). Neuromuscular block was monitored by adductor pollicis EMG. An equipotent dose ratio (4:1) was most potent, with a mean (SEM) ED95 of atracurium 95 (6) micrograms kg-1 with vecuronium 24 (1) micrograms kg-1. ⋯ These results indicate that a combination of atracurium and vecuronium is supra-additive compared with the effects of each drug alone. However, all combinations maintained an intermediate character of neuromuscular block. Combining atracurium with vecuronium may reduce drug requirement by 40%.