Articles: nerve-block.
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Acta Anaesthesiol Scand · Apr 1983
Randomized Controlled Trial Clinical TrialPerivascular axillary block II: influence of injected volume of local anaesthetic on neural blockade.
Perivascular axillary blockade was performed on 150 patients with the aid of a catheter technique. Blockade failure due to injection outside the neurovascular sheath was found in 5.7% of the subject material. The patients were randomly allocated to three groups. ⋯ Sensory and motor blockade was tested 30 min after each injection. The following results were obtained: 1) Apart from the axillary, musculocutaneous and radial nerves, a high frequency of analgesia was found in all cutaneous areas (over 85%). 2) In the axillary area, improvements were found with increasing volume. 3) Analgesia in the musculocutaneous area occurred in 52% of the patients in group 1 (20 ml) and improved to 75% in group 2 (40 ml). However, no difference was found between group 2 and group 3 (80 ml). 4) Volume had no influence on analgesia in the radial area. 5) Motor blockade was intensified with decreasing volume, i.e. with an increase of concentration of local anaesthetic solution.
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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.