Articles: nerve-block.
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Ann Fr Anesth Reanim · Jan 1993
Randomized Controlled Trial Comparative Study Clinical Trial[Analgesia after thoracotomy by extrapleural administration of continuous bupivacaine].
This study was aimed to assess the efficiency and the side effects of a continuous administration of bupivacaine into the paravertebral space. Twenty patients, ranked ASA 2 or 3, with a mean age of 57.9 years, and having had a posterolateral thoracotomy for resection of lung tissue, were randomly assigned to one of two groups, B or C. At the end of the surgical procedure, a 22 gauge catheter was inserted into the paravertebral extrapleural space, at T4 levels As soon as pain occurred during recovery (T0), the patients were given two-hourly intravenous boluses of buprenorphine. ⋯ In group B, plasma bupivacaine concentrations were measured throughout the infusion, and for an 8-hour period after its end. The statistical analysis included 15 patients only, as the catheter had moved into the chest cavity in the other 5. Analgesia was qualified to be adequate by all patients, but there was no statistically significant difference in the amounts of self-administered buprenorphine between groups B and C.(ABSTRACT TRUNCATED AT 250 WORDS)
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Regional anesthesia · Jan 1993
Comparative Study Clinical TrialPatient acceptance of interscalene block for shoulder surgery.
Regional anesthesia can be applied to shoulder surgery with an expected high success rate. To determine the level of patient satisfaction with regional anesthesia, we studied a group of patients who had undergone shoulder surgery more than once, with general anesthesia on one occasion and regional on another. ⋯ Interscalene brachial plexus block is well accepted by patients for reconstructive shoulder surgery.
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Ann Fr Anesth Reanim · Jan 1993
Randomized Controlled Trial Comparative Study Clinical Trial[Axillary plexus block by simultaneous blockade of several nerves. II. Evaluation of lidocaine-bupivacaine combination].
A mixture of carbonated lignocaine and bupivacaine for axillary blocks was assessed prospectively in a randomized double-blind study including 60 patients scheduled for upper limb surgery. A peripheral nerve stimulator was used to carry out the axillary block with a multiple injection technique. The musculocutaneous, radial, median and ulnar nerves were routinely stimulated. ⋯ Adrenaline only affected significantly the duration of anaesthesia in the lignocaine group (252 min vs 135 min with and without adrenaline, respectively) (p < 0.03). In axillary blocks, the mixture of carbonated lignocaine and bupivacaine has a faster onset of action than bupivacaine alone, and a longer duration of action than lignocaine alone. Both agents provided a quality of sensory and motor blockade similar to that obtained with the mixture.
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Ann Fr Anesth Reanim · Jan 1993
Randomized Controlled Trial Clinical Trial[Axillary plexus block by simultaneous blockade of several nerves. I. Influence of the volume of the anesthetic solution].
The influence of the volume of local anaesthetic solution on axillary blockade was investigated in a prospective randomized double-blind study including 120 patients presenting for upper limb surgery. A peripheral nerve stimulator was used to carry out the axillary block with a multiple injection technique. The musculocutaneous, radial, median and ulnar nerves were routinely stimulated. ⋯ The data demonstrated that, for a same amount of local anaesthetic, the larger volumes provided better quality sensory blockade than the smaller ones (p < 0.03). However, the volume of solution used affected neither the time of onset nor the duration of anaesthesia, nor the degree of motor blockade. It is concluded that, despite the use of a neurostimulator and simultaneous infiltration of several nerve trunks, the volume required to ensure a reliable degree of sensory block with the technique of axillary block is comprised between 40 and 50 ml (25 ml.m-2).
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Regional anesthesia represents a selective approach in shoulder surgery. The following technics can be used: brachial plexus block, cervical epidural and intra-articular anesthesia. The advantages of each technique are discussed.