Articles: nerve-block.
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Randomized Controlled Trial Comparative Study Clinical Trial
A double-blind study of motor blockade in the lower limbs. Studies during spinal anaesthesia with hyperbaric and glucose-free 0.5% bupivacaine.
Sensory and motor blockade were studied double-blind during spinal anaesthesia in 20 urology patients who received 0.5% bupivacaine solution 4 ml with or without glucose. Using a new method for determining muscle strength, motor blockade during anaesthesia was recorded quantitatively for flexion of the hip, extension of the knee and plantar flexion of the big toe. Movements of the lower part of the thoracic cage were recorded at the same time. ⋯ Thoracic movements (maximal inspiration to normal expiration) did not appear to be notably influenced by the level of analgesia. Complete regression of motor blockade was not observed for any of the movements at grade O of a modified Bromage scale. Not until 1.5-2 h after the attainment of this grade was the muscle strength of all movements restored (90% of control value).
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The authors developed a new method of intrathecal local anesthetic injection in rabbits in order to study the relationship between anesthetic concentration and impaired neurologic function. They found that none of the local anesthetics studied produced persistent neurologic damage in concentrations used clinically. ⋯ Pure solutions of relatively insoluble local anesthetics (bupivacaine and 2-chloroprocaine) failed to produce comparable neurologic or neuropathologic changes when tested at concentrations up to their solubility limits. Extensive neurologic impairment was not necessarily accompanied by equally extensive lesions in the spinal cord and nerve roots.
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Postgraduate medicine · Sep 1985
Nerve blocks and chronic pain states--an update. 2. Clinical indications.
With the unfortunate exception of the differential spinal block, diagnostic nerve blocking has become somewhat obsolete with the development of newer, more sophisticated diagnostic technology. Therapeutic nerve blocks remain useful in treating patients with various terminal cancers, some forms of back pain, tic douloreux, causalgia, reflex sympathetic dystrophy, and many trigger point syndromes. For dysfunctional and pain-disabled patients (rated as class 1 or 3 on Emory Pain Estimate Model), block therapy must be structured in comprehensive pain rehabilitation programs.