Articles: nerve-block.
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Successful anaesthetic management of two patients with severe epidermolysis bullosa dystrophica was accomplished with the use of ketamine-diazepam dissociative anaesthesia in one and brachial plexus block in the other. The classification and pathology of epidermolysis bullosa is considered, and the problems associated with anaesthesia in patients with this disease are discussed.
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J Hand Surg Eur Vol · May 1988
Brachial plexus anaesthesia for upper limb surgery: a review of eight years' experience.
1248 supraclavicular brachial plexus blocks and 665 axillary plexus blocks were administered to 1913 patients undergoing upper limb surgery. Plexus block alone was successful in 83.5%. ⋯ The two percutaneous approaches to the brachial plexus did not differ in their success-rates but clinically apparent pneumothorax occurred in 0.8% of supraclavicular blocks. Brachial plexus block anaesthesia is recommended as a safe and satisfactory alternative to general anaesthesia for upper limb surgery.
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Am J Phys Med Rehabil · Apr 1988
Case ReportsDiagnostic peripheral nerve block resulting in compartment syndrome. Case report.
A hemiplegic patient with severe upper extremity spasticity 2 years after a cerebrovascular accident received a diagnostic median nerve block below the elbow with bupivacaine. He had been placed on Coumadin as prophylaxis for cerebrovascular arteriosclerotic disease, and prothrombin time was kept at twice the control value. ⋯ Compartment syndrome has not previously been reported as a complication resulting from a nerve block procedure. We conclude that (1) compartment syndrome may develop after a peripheral nerve block procedure for spasticity, (2) prophylactic anticoagulation may increase the risk for hemorrhagic events resulting from percutaneous injection and (3) early recognition is essential and appropriate decompressive fasciotomy may be indicated if a compartment syndrome develops after a nerve block procedure.
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Regional-Anaesthesie · Apr 1988
[Continuous block of the lumbar plexus with the 3-in-1-block catheter technic in pain therapy].
The evaluation of the test protocols on continuous lumbar plexus blockade using the 3-in-1 block with a lumbar plexus catheter showed the following results: The study included 104 patients. In 91.3% of cases, puncture of the fascial sheath of the femoral nerve proved successful. In 95.7% of cases, the plexus catheter could be positioned and left in place (Table 1). ⋯ All catheters could be left in place without complications until the end of therapy. Changing the catheter is possible at any time, as is the replacement of the catheter hub. Such steps were carried out in 5 cases.
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Regional-Anaesthesie · Apr 1988
Randomized Controlled Trial Comparative Study Clinical Trial[Combined ischiatic/3-in-1-block. II. 1 percent mepivacaine HCl versus 1 percent CO2 mepivacaine].
In a prospective randomized study on 26 patients, the clinical effectiveness CO2-mepivacaine 1% (group 1, 13 patients) and mepivacaine HCl 1% (group 2, 13 patients), was tested in patients having a sciatic-femoral block for surgical procedures of the lower extremity (20 ml for sciatic and 30 ml for 3-in-1 block). Blood levels of mepivacaine were determined for up to 90 min in 8 patients from each group. The onset of sensory and motor blockade was slightly earlier (4-5 min) with CO2-mepivacaine than with the hydrochloride (5-6 min). ⋯ There was a relatively large variance in intensity of blockade that was not necessarily related to the drug employed, but can be explained by individual factors and possibly by slight differences in blocking technique. Nevertheless, the rate of unsuccessful blockade was remarkably higher (38%) with the hydrochloride than with CO2-mepivacaine (7.7%). Determinations of blood levels did show the expected earlier peak (after 20-30 min) and higher blood-levels (means 3.8 micrograms/ml at 30 min) with CO2-mepivacaine 1% as compared to mepivacaine HCl 1%: 2.9 micrograms/ml at 30 min and 3.4 micrograms/ml at 45 min.