Articles: nerve-block.
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Regional anesthesia · Sep 1991
Popliteal sciatic nerve block aided by a nerve stimulator: a reliable technique for foot and ankle surgery.
The reliability of popliteal sciatic nerve blocks was prospectively assessed in 625 blocks performed in 507 patients. The sciatic nerve was approached at the apex of the popliteal fossa, in the midline, with an insulated needle connected to a peripheral nerve stimulator partially designed by one of the authors. When needed, an inguinal paravascular femoral nerve block was also performed. ⋯ Overall satisfaction with perioperative analgesia was evaluated by 466 patients: 444 (95%) were completely satisfied, 20 (4%) expressed moderate reservations and two (1%) expressed major reservations. The authors conclude that the technique is a safe and reliable alternative to more common forms of anesthesia for surgery below the knee. They attribute the great success rate to a high popliteal approach, the use of insulated needles, a discriminating mode of nerve stimulation and the systematic search for optimal response to needle stimulation.
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Twenty consecutive patients requiring surgical procedures on a lower extremity received leg blocks using a modification of Labat's classic approach. A Doppler ultrasound pencil probe was used to identify the dominant arterial structure exiting the sciatic notch with the sciatic nerve. A block needle was inserted in the same orientation as the probe until paraesthesias were elicited; then 25 ml of local anesthetic was injected. Successful block was achieved in one or two attempts in 70% of the patients.
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Anesthesia and analgesia · Sep 1991
Neuromuscular effects of succinylcholine on the vocal cords and adductor pollicis muscles.
To quantify the effects of succinylcholine at the laryngeal adductor muscles and the adductor pollicis, 17 adult patients were studied during propofol-fentanyl anesthesia. Train-of-four stimulation was applied to the ulnar nerve at the wrist and the recurrent laryngeal nerve at the notch of the thyroid cartilage. Laryngeal response was measured as pressure changes in the cuff of the tracheal tube positioned between the vocal cords. ⋯ Time to 90% recovery of T1 after a bolus of 0.5 mg/kg was similar at the vocal cords (4.3 +/- 0.5 min) and the adductor pollicis (5.2 +/- 0.8 min) (NS). The ED50 was less at the laryngeal adductors (0.170 mg/kg) than at the adductor pollicis (0.278 mg/kg). It is concluded that, in adults, succinylcholine-induced blockade is more rapid and more intense at the laryngeal muscles than at the adductor pollicis.