Articles: nerve-block.
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Regional-Anaesthesie · Jul 1988
Randomized Controlled Trial Comparative Study Clinical Trial[Combined sciatic/3-in-1 block. III. Prilocaine 1% versus mepivacaine 1%].
In a randomized, double-blind study, the efficacy of prilocaine 1% (group 1, 30 patients) was compared to mepivacaine 1% (group 2, 30 patients). All patients had a combined sciatic/femoral block for surgery of the lower extremities; a tourniquet was applied in each case. In each patient the block was done using 50 ml of a 1% solution of local anesthetic: 20 ml for the sciatic and 30 ml for the 3-in-1 block. ⋯ On the average, patients were pain-free for 254 min with prilocaine and 267 min with mepivacaine. Four of 30 patients (= 13%) in group 1 an 6 of 30 patients (= 20%) in group 2 had an unsatisfactory blockade and had to be supplemented by analgesics or general anesthesia. The finding of a significant correlation between the voltage necessary for stimulation and the efficacy of the blockade underlines the importance of correct stimulation when identifying the nerves.
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The postoperative analgesic effect of opiate premedication and local anaesthetic blocks was studied in 929 patients having orthopaedic surgery. The median time to first request for postoperative analgesia was less than 2 h when neither opiate premedication nor block was used; opiate premedication increased the time significantly to more than 5 h; local anaesthetic block produced a further significant increase to 8 h and opiate premedication used with local anaesthetic block extended the median time further to more than 9 h. ⋯ Age had no significant effect. Prolonging the time before more pain relief is required may be worthwhile for both patients and staff.
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The similarities between phantom limb pain and preoperative limb pain have been noted, and this raises the possibility of modulating the pain by a preoperative blockade. The aim of this study was to investigate if it was possible to reduce postoperative phantom limb pain by giving lumbar epidural blockade (LEB) with bupivacaine and morphine for 72 h prior to the operation. 25 patients were interviewed about their limb pain before limb amputation, and about their phantom limb pain 7 days, 6 months and 1 year after limb loss. 11 patients, of mean age 77 years (52-93), received an LEB, so that they were pain-free for 3 days prior to operation. The control group, 14 patients of mean age 73.4 years (63.86), all had preoperative limb pain. ⋯ After 6 months all patients in the LEB group were pain-free, whilst 5 patients in the control group had pain (P less than 0.05). After 1 year, all the patients in the LEB group were still pain-free, and 3 patients in the control group had phantom limb pain (P less than 0.20). Preoperative lumbar epidural blockade with bupivacaine and morphine reduces the incidence of phantom limb pain in the first year after operation.