Articles: nerve-block.
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Paired train-of-four (TOF) and double burst stimuli (DBS) were administered to the ulnar nerve at the wrist in 25 patients (group 1) paralysed with atracurium 0.5 mg kg-1; responses were measured mechanically (except every third DBS response which was manually evaluated). Another 30 patients (group 2) received a DBS every 60 s. A post-tetanic count (PTC) was performed when the first response (D1) was palpated. ⋯ D1 was palpable first with a median PTC of 7. Our results showed that palpation of a single response implied a satisfactory level of paralysis. DBS may be useful for intraoperative clinical monitoring of neuromuscular block.
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Acta Anaesthesiol Scand · Oct 1991
Cumulation of bupivacaine, desbutylbupivacaine and 4-hydroxybupivacaine during and after continuous interscalene brachial plexus block.
Desbutylbupivacaine (DBB) and 4-hydroxybupivacaine (4-OHB) are major metabolites of bupivacaine. They may cumulate during continuous infusion blocks. In the present study, all patients received an interscalene brachial plexus block with 20-28 ml of 0.75% bupivacaine plus adrenaline. ⋯ The bupivacaine concentration decreased by 54% and 45%, on average, during the first 6 h following the 24- and 48-h infusions, respectively. On average, the highest DBB concentrations were measured 2 h after the 24-h infusion (0.31 +/- 0.18 micrograms/ml) and 30 min after the 48-h infusion (0.33 +/- 0.13 micrograms/ml). The highest 4-OHB concentrations were measured 1 h (0.18 +/- 0.09 micrograms/ml) and 30 min (0.20 +/- 0.05 micrograms/ml) after the 24- and 48-h infusions, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)