Articles: nerve-block.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of lumbar plexus block versus conventional opioid analgesia after total knee replacement.
A randomised controlled study was undertaken to assess the analgesic efficacy of continuous lumbar plexus block for the first 48 hours after total knee replacement surgery. Boluses of 0.5% bupivacaine with adrenaline 1 in 200,000 (0.3 ml/kg) were administered through a cannula inserted into the neurovascular sheath of the femoral nerve. Thirteen patients who received this block required significantly less morphine than a control group of 16 patients. Pain scores were similar and there were no complications related to this technique.
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Clinical Trial
Determinants of the reversal time of competitive neuromuscular block by anticholinesterases.
We have assessed, in 200 patients, the determinants of the reversal time of competitive neuromuscular block by anticholinesterase when alcuronium and atracurium neuromuscular block were antagonized by neostigmine 0.04 and 0.08 mg kg-1 and edrophonium 0.5 and 1.0 mg kg-1. A biexponential relationship was found between the reversal time (time from injection of anticholinesterase to a train-of-four ratio of 70%) and the degree of neuromuscular block at reversal (all groups; F ratio, P less than 0.05). Reversal time was determined by two processes: direct antagonism by the anticholinesterase and spontaneous recovery of the neuromuscular blocking agent, with the latter becoming the major determinant at profound levels of neuromuscular block (0-10% of control twitch height). ⋯ The reversal time for alcuronium became progressively longer relative to atracurium as neuromuscular block increased because of the slower spontaneous recovery rate. Avoidance of profound neuromuscular block at the completion of surgery is required to ensure reliable antagonism of the block within 5-10 min by an anticholinesterase. Neostigmine 0.08 mg kg-1 was found to be the most effective agent in antagonizing profound neuromuscular block.
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Randomized Controlled Trial Comparative Study Clinical Trial
Plasma concentrations of bupivacaine following combined sciatic and femoral 3 in 1 nerve blocks in open knee surgery.
We administered combined femoral 3 in 1 and sciatic nerve blocks to provide postoperative pain relief in 22 consecutive patients undergoing elective knee replacement surgery under spinal anaesthesia. The patients were allocated randomly to two groups. In group A (n = 11) the blocks were performed with 0.5% bupivacaine (with adrenaline) 3 mg/kg body weight and in group B (n = 11) 0.5% plain bupivacaine in the same dose was used. ⋯ No significant differences were found between the two groups. There were no clinical signs or symptoms of bupivacaine toxicity in each group. This study demonstrated that, after combined sciatic and 3 in 1 femoral block, concentrations of bupivacaine associated with toxicity were not reached, even though the dose of bupivacaine administered exceeded the manufacturer's recommended dose by 50%.
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Contemporary orthopaedics · Mar 1991
Sciatic nerve block for residual limb pain following below-knee amputation.
Ten adult patients with diffuse nonphantom limb pain in the residual limb following below-knee amputation underwent from one to four sciatic nerve blocks for the treatment of that pain. Amputation had been performed for peripheral vascular insufficiency in eight patients and for problems resulting from open fractures in two. None of the patients had responded to prosthetic modification, oral medication, or transcutaneous nerve stimulation for treatment of their pain. At one-year following treatment with sciatic nerve blocks as described in this report, one patient had not responded well to treatment but six patients had a resolution of their symptoms, and three had less subjective pain adequate to resume their normal daily activities.