Articles: nerve-block.
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Regional-Anaesthesie · Apr 1983
[Modification of axillary plexus block with the loss-of-resistance method using a blunt needle].
A modification of the method of brachial plexus block is described using the "loss of resistance"-test and a needle with an extra short 45 degrees bevel (the Crawford bevel). This report is presented firstly to describe this needle and secondly because it is not necessary to search for paraesthesiae before injecting. ⋯ The initial failure rate was 3.7%, but a second attempt was successful in 2.3% to give an overall failure rate of 1.4%. No nerve injuries were observed and troublesome haematomas from accidental puncture of the artery were 2.7%.
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A new device for continuous axillary plexus block is described. Using the "loss-of-resistance"-method as in peridural anesthesia it allows a safe introduction of a catheter within the neurovascular axillar sheath. ⋯ The main field of application for this device is seen in the management of pain postoperatively, mobilisation of contracted joints as well as in sympathetic block for peripheral vascular disease of various etiology. Furthermore, its allows the anaesthesia of the axillary plexus for operations of long duration (i.e. plastic surgery).
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Continuous axillary brachial plexus block was performed in 597 patients undergoing prolonged operations on the hand. The technique required placement of a 5 cm 23 gauge teflon intravenous catheter in the axillary perivascular sheath. Lidocaine 1.5 per cent or mepivicaine 1.5 per cent (20-40 ml) were used for the initial block dose. ⋯ In 3.7 per cent of patients (22) the technique was considered a complete failure. Complications included local anaesthetic toxic reactions (2.85 per cent, 17 cases), nerve injury (0.50 per cent, three cases) and one case of major haematoma formation. The advantages of this technique and the possible complications are discussed.
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The differential sensitivities of A beta, A delta and C fibres of rat vagus nerve to bupivacaine, etidocaine and AL-381 were studied in vitro. In A beta fibres, at 35-37 degrees C, 50 mumole litre-1 of the drugs had similar effects on the action potential amplitude, while at greater concentrations (100 and 200 mumole litre-1) the greatest mean depression of amplitude was seen with etidocaine (n.s.). ⋯ Etidocaine 100 mumole litre-1 was more depressant than the same dose of bupivacaine. The C fibres were blocked most rapidly by AL-381, while etidocaine had the least effect.
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Anaesth Intensive Care · Feb 1983
Femoral nerve block--the anatomical basis for a single injection technique.
A technique for blocking the femoral nerve using a single needle placement is described. It depends on an appreciation of the anatomy and the need to feel loss of resistance twice as two fascial layers are penetrated during insertion of the needle just lateral to the femoral artery. A single injection of bupivacaine 0.35-0.5 per cent of at least 0.3 ml/kg will produce a satisfactory block.