Articles: nerve-block.
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Klin Monbl Augenheilkd · Feb 1994
Review Comparative Study[Peribulbar anesthesia versus retrobulbar anesthesia with facial nerve block. Techniques, local anesthetics and additives, akinesia and sensory block, complications].
Retrobulbar anesthesia (RETRO), combined with a facial block, is the most frequently employed method of anesthesia in cataract surgery. There is, however, an increasing tendency to use peribulbar anesthesia (PERI), which is claimed to provide the same degree of anesthesia and akinesia as RETRO while reducing many of the complications. ⋯ In randomized order, 160 cataract patients received PERI (technique with 2 injections) with 6, 8 or 10 ml of a bupivacaine-lidocaine-hyaluronidase mixture (without facial block) or RETRO (Unsöld technique) with 5 ml of the above mixture, combined with a Nadbath/Rehman facial nerve block (5 ml etidocaine-lidocaine mixture). Measured 20 min after injection (intervening period of oculopression), the smallest ocular motility (Kestenbaum limbus test) was left after RETRO. After administration of PERI - even with a volume of 10 ml - the range of residual ocular motility was always higher, i.e., there was a less reliable globe akinesia than after RETRO. The lid closure force (Straub technique) averaged zero after all methods of anesthesia; however, the smallest spread (highest reliability) was observed after PERI. Complete corneal anesthesia (Draeger esthesiometer) was found in nearly all cases, i.e., RETRO and PERI are comparably effective concerning sensory blockade...
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Subarachnoid injection during a retrobulbar block is a rare complication, requiring prompt recognition and management of life-threatening respiratory and cardiac depression. This case report describes a patient who began to decompensate 2 minutes after receiving a retrobulbar block. Central nervous system symptoms progressed from restlessness and confusion to respiratory arrest and cardiac depression. ⋯ Causes of respiratory arrest and unconsciousness after retrobulbar block include severe anaphylactic reaction, intravascular absorption, a major cardiovascular event, and subarachnoid injection of local anesthetic. The patient's symptoms in the case presented here suggested that the local anesthetic gained access to the cerebrospinal fluid. Anesthetists should be cognizant of the need to monitor and treat serious complications whenever a retrobulbar block is utilized.
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Langenbecks Arch Chir · Jan 1994
Randomized Controlled Trial Comparative Study Clinical Trial[A concept for decreasing postoperative pain after inguinal hernia operation].
In Germany approximately 150,000 inguinal hernias are surgically corrected every year. In addition to developing an optimum operation technique it is also the responsibility of a surgeon to treat pain during and after surgery. In a prospective random double-blind study, the pain after herniotomy performed with intraoperative anesthesia of the ilioinguinal and iliohypogastric nerves with a long-acting local anesthetic combined with a vasoconstrictor was compared by means of scores on a scale from 1 to 10 with pain in a control group. ⋯ An optimum pain therapy therefore has to start during surgery. Use of a local anesthetic is especially suitable. Side effects of systemic analgesics are avoided, and perioperative risks of ambulant hernia surgery can be reduced.
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Anaesthesiol Reanim · Jan 1994
Clinical Trial Controlled Clinical Trial[Mixtures of different local anesthetics for subaxillary plexus anesthesia].
In a prospective clinical study, 76 patients were scheduled for subaxillary plexus block in order to investigate onset time, duration of action and quality of motor and sensitive blockade of various mixtures of local anaesthetics. Sixty-one patients were allocated to four groups. Each of them received 15 ml of bupivacaine 0.5% with either 15 ml of lidocaine 1% (n = 14), of mepivacaine 1% (n = 16), of prilocaine 1% (n = 15) or of etidocaine 1% (n = 15). ⋯ But regarding the quality of motor block, the mixture of bupivacaine and lidocaine was less effective than the other combinations, of which the mixture of bupivacaine and prilocaine showed the best motor block. The combination of the two long-acting local anaesthetics bupivacaine and etidocaine had the longest effect and, therefore, this mixture is a real alternative to subaxillary block via catheter technique. Specific electric stimulation of the radial nerve leads to higher success rate of subaxillary plexus block.