Articles: nerve-block.
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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.
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To evaluate the effectiveness of the dorsal penile nerve block in reducing the stress of circumcision upon newborns, physiologic measurements in 30 healthy full-term infants (including transcutaneous oxygen levels, crying time, heart rate, and respiratory rate) were monitored continuously before, during, and after the operation. Infants receiving the dorsal penile nerve block with lidocaine (1% Xylocaine) (N = 20) experienced significantly less stress, as evidenced by smaller decreases in transcutaneous oxygen pressure levels, less time spent crying, and smaller increases in heart rate, than infants circumcised in an identical manner without anesthetic (N = 10). No complications resulted from injection of the local anesthetic or from the circumcision procedure itself. Inasmuch as dorsal penile nerve block has a low complication rate, is simple to learn, and adds little time or expense to the overall procedure, and if it proves to be as effective clinically as the physiologic data indicate, the dorsal penile nerve block should be considered for every infant undergoing circumcision.