Articles: nerve-block.
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Regional anesthesia · Sep 1990
Plasma concentrations after high doses of mepivacaine with epinephrine in the combined psoas compartment/sciatic nerve block.
A combination of psoas compartment block and sciatic nerve block was performed with a total dose of 731.5 mg mepivacaine (55 ml, 1.33%) with epinephrine (1:600,000) in patients scheduled for orthopedic surgery on one leg. In 20 patients, arterial blood samples were collected at timed intervals over a 6-hour period to determine the mepivacaine plasma concentration. ⋯ Despite the high dose of mepivacaine, the plasma concentrations stayed below 6.0 micrograms/ml, with one exception, although no clinical signs of local anesthetic toxicity were observed. Plasma pharmacokinetic variables of mepivacaine were as follows: Cmax: 4.22 mg.l-1 (SD, 1.28); Tmax: 0.99 hours (SD, 0.76); T1/2: 3.25 hours (SD, 1.12); CL 0.55 1.hour-1.kg-1.
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A 58 year old man had been suffering from intractable left ophthalmic post herpetic neuralgia (PHN) for 7 years. He has also been treated for polyarteritis nodosa for 10 years. For pain relief, he was treated initially with frequent (4 times a day) stellate ganglion block (SGB) and peripheral ophthalmic nerve block for a month without relief. ⋯ Several days before the block, electric stimulation to control his pain was tested. Stimulation with the electricity (4.5 mA, 10 cycle and 400 microseconds) brought him complete relief from the pain during the stimulation. Trigeminal SEP showed no response to the stimulation of injured skin.
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Blockade of the superior hypogastric nerve plexus was performed for relief of chronic cancer related pelvic pain. The targeted sympathetic nerves lie anterior to the sacral promontory. ⋯ Sympathetically mediated pain was significantly reduced or eliminated in all cases and no serious complications occurred. Superior hypogastric plexus block is recommended for diagnostic/prognostic and therapeutic purposes in patients with chronic pelvic pain, particularly when pain is of neoplastic origin.
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Acta Anaesthesiol Scand · Aug 1990
Randomized Controlled Trial Comparative Study Clinical TrialContinuous blockade of the lumbar plexus after knee surgery: a comparison of the plasma concentrations and analgesic effect of bupivacaine 0.250% and 0.125%.
In 20 patients a continuous block of the lumbar plexus was administered after knee-joint surgery, and the analgesic effect of two different concentrations of bupivacaine was compared. The same volume of bupivacaine was given to both groups of patients: a bolus dose of 0.4 ml/kg, 0.5% or 0.25%, followed by infusion of 0.14 ml/kg/h, 0.25% or 0.125%, respectively, via a catheter placed in the neurovascular fascial sheath of the femoral nerve according to the "3-in-1 block" technique. The median morphine consumption during the first 16 h postoperatively was 6.0 mg when bupivacaine 0.5/0.25% was used and 9.5 mg when 0.25/0.125% was used. ⋯ The visual analogue pain scores were also similar in the two groups (P greater than 0.05). All plasma concentrations were below 4 micrograms/ml, the highest concentration measured being 3.6 micrograms/ml. It is concluded that when used for a continuous block of the lumbar plexus after knee-joint surgery, bupivacaine in a concentration of 0.125% offers the same pain relief as a concentration of 0.25%, and the risk of toxic reactions is reduced.