Articles: nerve-block.
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A case of total obliteration of the axillary artery after axillary block is presented. This resulted from an accidental intramural injection of local anaesthetic (mepivacaine 1%, 40 ml, with adrenaline 1:200,000). ⋯ The diagnosis was made by palpation of the peripheral pulse and by comparison between the skin temperatures of each arm. The thrombosed part of the artery was successfully reconstructed with an autologous saphenous vein graft.
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Interscalene brachial plexus block is a simple and effective alternative to intravenous benzodiazepines or general anaesthesia for manipulation of the dislocated shoulder. Thirty interscalene brachial plexus blocks were performed on 29 patients with dislocations of the shoulder to provide regional anaesthesia for reduction. Pain was abolished by 14 out of the 30 blocks performed, improved by 13 and unchanged by three. ⋯ In 26 cases the block allowed reduction of the dislocation without additional analgesia or sedative. Reduction was not possible in four cases. There were no significant complications.
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Casopís lékar̆ů c̆eských · Aug 1989
[Differences in patient sensitivity to currently used non-depolarized curaremimetics and factors which affect it].
A whole number of factors which affect the depth as well as duration of the block after administration of non-depolarizing myorelaxants, both positively and negatively. However, the effect in one patient can be predicted only with difficulty--as this paper showed--as neither the hydration level, age nor kalemia concentration had any effect on the depth of the neuromuscular block. Neither in patients, otherwise healthy, is it possible to predict the degree of the neuromuscular block after administering a standard dose of curaremimetic. ⋯ The determination of the actual block depth can help to control relaxation according to the needs of the surgeon or anaesthesiologist, and according to the individual patient's sensibility. A different sensibility response to myorelaxants was found in pipecuronium, vecuronium and even in atracurium. It corresponds approximately to gaussian curve of frequency.
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Anaesth Intensive Care · Aug 1989
Comparative Study Clinical Trial Controlled Clinical TrialInterpleural administration of bupivacaine after cholecystectomy: a comparison with intercostal nerve block.
Pethidine requirements and verbal pain scores were recorded in 36 patients after cholecystectomy via subcostal incision. All patients also received 20 ml 0.5% bupivacaine with adrenaline 1/200,000. Group 1 (12 patients) received unilateral intercostal nerve blocks. ⋯ Small asymptomatic pneumothoraces were noted on chest X-ray in six of the 24 patients with interpleural catheters. Both types of local anaesthesia produced lower pain scores than pethidine alone (P less than 0.05) with 25% of intercostal nerve blocks and 63% of interpleural catheters requiring no pethidine in the following three hours. The provision of catheter 'top-ups' between six and 18 hours after surgery also resulted in lower pain scores and a reduction in pethidine requirements (P less than 0.05).