Articles: nerve-block.
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The authors report their experience about 50 cases of supra clavicular plexus block realised by Kulenkampff method. The anesthesia obtained has been complete in 84% of cases and in the 16% remaining general anesthesia was necessary to permit surgery. ⋯ Actually the adoption of perivascular techniques of brachial plexus anesthesia (interscalenic, supraclavicular, axillary) have greatly improved the performance of this variety of upper limb locoregional anesthesia, thus reducing the percentage of failure and eliminating or reducing the risk of pneumothorax. Locoregional anesthesia of the upper limb should constitute a daily method in the surgery of upper limb and not a technic subordinated to the contra-indications of general anesthesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Intrathoracic intercostal nerve block with phenol in open chest surgery. A randomized study with statistical evaluation of respiratory parameters.
Seventy-three patients who underwent thoracic surgery were randomly selected for intraoperative intercostal nerve block using phenol (32 block and 41 control subjects). The patients were divided into three groups: pneumonectomies, lobectomies and explorative thoracotomies and evaluated by pain level, respiratory function parameters (VT, IRV, ERV, VC) and blood-gas analysis, both six and 24 hrs after surgery. The patients who had intraoperative nerve block using phenol enjoyed a more comfortable postoperative period. In particular, respiratory parameters were statistically better.
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In summary, the clinical goal in regional anesthesia for hand surgery is to constantly approach the ideal of a well-conducted, smooth, "balanced regional technique." This begins with the preoperative interview, assurance, and preoperative sedation (po). In the operating room, monitoring (EKG, BP) and safety measures (IV port, nasal oxygen) precede the regional technique. The block is performed with asepsis, minimal "needling," and correct dosages. ⋯ Monitoring is continued in the recovery room, where special attention is given to positioning, cushioning of pressure areas, dressing, analgesia, and specific physical rehabilitation exercises. With a "balanced regional technique," the patient becomes an early participant in his or her own postoperative care and result. This balanced technique reduces the patient's overall operative risk and maximizes the surgical result.