Articles: nerve-block.
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A technique employing a nerve stimulator and an insulated needle was used for supraclavicular brachial plexus block in 71 patients using 0.5% plain bupivacaine 15-20 ml. The mean minimal stimulating current to produce paraesthesia was 0.09 mA. The plexus was identified at a mean depth of 27 mm below the skin. The block was successful in 98% of patients when the stimulation was felt in the index, middle or ring finger, but was often incomplete when felt in the thumb or little finger.
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Randomized Controlled Trial Comparative Study Clinical Trial
Cryoanalgesia for post-thoracotomy pain.
Intercostal block by a freezing technique was compared with blockade by local anaesthetics or no blockade as a method of treating post-thoracotomy pain. The 15 patients who received cryotherapy had significantly less postoperative pain than the 9 patients whose nerves were blocked by local anaesthetics or who did not receive any nerve block. The interruption of nerve function produced by cryotherapy was temporary (not more than 30 days), and there were no adverse sequelae.
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The human intercostal space has been studied by excision of the posterior part of the rib cage at autopsy, followed by fixation, decalcification, section and staining. Injection of India ink was used to simulate local anaesthetic. At a point 7 cm from the midline, the distance from the posterior aspect of the rib to the pleura averaged 8 mm. ⋯ An injection of 3 ml will also spread medially to enter the paravertebral space and surround the sympathetic chain. A small clinical study gave excellent analgesia after operation for a mean duration of 12.3 h following unilateral intercostal block with 3 ml of bupivacaine 0.5% (with adrenaline) into each of the intercostal spaces T5-11, before cholecystectomy through a subcostal incision. There were no complications in the series.
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Minerva anestesiologica · Mar 1980
Case Reports[Case of high spinal anesthesia as a complication of an interscalenic brachial plexus block].
A case of high spinal anesthesia complicating an interscalene brachial plexus block is described. After an apparently straightforward location of the plexus with good paresthesias, the injection of 10 ml of local anesthetic caused a high spinal block whose main feature was apnea. The patient retained his consciousness until he was anesthetized with thiopentone and N2O-O2 and had a vivid recollection of the accident. ⋯ The clinical picture compared to previous cases reported in the literature is commented on. A possible subarachnoid spread of the local anesthetic via the perineural space following intraneural injection is discussed. The author advocates the use of needles no longer than 1 inch for the interscalene approach to the brachial plexus.