Articles: nerve-block.
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Australian dental journal · Oct 1992
Complications associated with maxillary nerve block anaesthesia via the greater palatine canal.
This paper documents the type, frequency and duration of complications associated with regional anaesthesia of the maxillary nerve via the greater palatine canal in a series of 101 patients treated in the Oral Surgery Department, United Dental Hospital of Sydney.
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The diagnostic value of greater occipital and supra-orbital nerve blockades in patients with cervicogenic headache, migraine without aura, and tension-type headache was investigated. The pain reduction after greater occipital nerve blockade was significantly more marked in the cervicogenic headache group than in the other categories. Moreover, pain reduction in the forehead was generally only found in the cervicogenic headache patients (77%). ⋯ This procedure did not result in distinct pain reduction. The effect obtained in cervicogenic headache is, accordingly, probably due to the local anaesthesia. The present results support the postulate that different pathogenetic factors probably are responsible for cervicogenic headache, tension-type headache, and migraine without aura.
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Anesthesia and analgesia · Oct 1992
Randomized Controlled Trial Comparative Study Clinical TrialA comparative study of 0.25% ropivacaine and 0.25% bupivacaine for brachial plexus block.
The present study compares the effectiveness of 0.25% ropivacaine and 0.25% bupivacaine in 44 patients receiving a subclavian perivascular brachial plexus block for upper extremity surgery. The patients were assigned to two equal groups in this randomized, double-blind study; one group received ropivacaine 0.25% (112.5 mg) and the other, bupivacaine 0.25% (112.5 mg), both without epinephrine. Onset times for analgesia and anesthesia in each of the C-5 through T-1 brachial plexus dermatomes did not differ significantly between the two groups. ⋯ The mean duration of analgesia ranged from 9.2 to 13.0 h, and the mean duration of anesthesia ranged from 5.0 to 10.2 h. Both groups required supplementation with peripheral nerve blocks or general anesthesia in a large number of cases, with 9 of the 22 patients in the bupivacaine group and 8 of the 22 patients in the ropivacaine group requiring supplementation to allow surgery to begin. In view of the frequent need for supplementation noted with both 0.25% ropivacaine and 0.25% bupivacaine, we do not recommend using the 0.25% concentrations of these local anesthetics to provide brachial plexus block.
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The effects of increasing the maximum prescribed volume of 50 ml lidocaine 1% to 65 ml in a combined sciatic 3-in-1 block were investigated in 25 adult patients. The goal of the study was (1) to show possible increase in the success rate and (2) to determine if toxic plasma levels of local anaesthetic would be reached. Further more, we wanted to find out if there were any side-effects. ⋯ There were no statistical differences between the three groups. CONCLUSION. Increasing the dosage of lidocaine from 500 to 650 mg makes the block very successful without any toxic side-effects.
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Randomized Controlled Trial Clinical Trial
Dose-response relationships for neostigmine antagonism of vecuronium-induced neuromuscular block in adults and the elderly.
We have studied the dose-response relationship for neostigmine in 36 adult (ages 18-50 yr) and 36 elderly (ages > 70 yr) subjects during antagonism of neuromuscular block induced by vecuronium. All patients received vecuronium 0.08 mg kg-1 and neuromuscular block was monitored mechanomyo-graphically using the train-of-four (TOF) mode of stimulation. Six patients of each age group were allocated randomly to receive neostigmine 5, 15, 25, 35 or 45 micrograms kg-1 or saline at 10% recovery of T1 (first response in the TOF). ⋯ There was a significant difference (P < 0.05) in the time to spontaneous recovery of T1 to 10% between the adults (24 (SD 5.5) min) and the elderly (33 (7.8) min). Dose-response curves for neostigmine were parallel in the two age groups, but those for the elderly were significantly to the right of the curves for the adults. This suggests an apparently lesser relative potency of neostigmine, or the requirement of a larger dose, in the elderly for attaining antagonism of a moderately intense vecuronium block at the same time as in adults.