Articles: nerve-block.
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Infiltration of local anesthetic agents to achieve analgesia for the repair of lacerations or the excision of large lesions requires multiple injections, uses large volumes of local anesthetic solution and frequently produces inadequate pain relief. Peripheral nerve blocks utilize a small number of precisely placed injections to anesthetize relatively large areas of the body. Many of these blocks are safe and easy to perform in an outpatient setting.
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Local anesthetics block nerve impulse propagation by occluding transmembrane sodium channels, so preventing depolarization. First, the uncharged lipid-soluble anesthetic base pentrates the membrane; then the positively charged cation binds to anionic components of the sodium channel's internal axoplasmic mouth. ⋯ The cation-base concentration ration is critical to optimal neural blockade. If there is too little base, few anesthetic molecules will penetrate to the neural target; if too little cation, few sodium channels will be plugged.
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J. Thorac. Cardiovasc. Surg. · Aug 1977
Kindness pays dividends: the medical benefits of intercostal nerve block following thoracotomy.
Postoperative pain is an important factor in the management of children undergoing thoracotomy. Intercostal nerve block has been used in adult patients, but its applicability in the pediatric age group has not been previously evaluated. Eighty-nine children (85 girls and 31 boys) aged 6 months to 16 years (mean age 4.7 years) underwent ligation of a patent ductus arteriosus (PDA) through a left thoracotomy. ⋯ The mean hospital stay was shortened in the patients with nerve block, 5.1 days versus 7.3 days for the control group. No ill effects of bupivacaine were noted. We conclude that intercostal nerve block is a valuable procedure reducing the need for postoperative analgesia and shortening hospital stay.
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The effective and safe use of brachial plexus block anaesthesia requires the careful practice of a simple technique, a healthy regard for its potential general and local complications, and due consideration for the patient's psychological comfort. Providing combined anaesthesia and motor block and a variable period of postoperative analgesia, it is the preferred anaesthetic for many forms of hand surgery. Further, it is a valuable alternative for most of the surgery of the upper limb in patients in whom general anaesthesia is particularly hazardous.
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During the past three quarters of a century, nerve blocks have been used with varying success as a primary treatment technique for patients with acute and chronic pain. However, practicing dolorologists soon realized that, in certain individuals, anesthetic blocking of noxious, peripheral afferent sensations did not always amelliorate pain complaints and at times even exaggerated them. The recent advent of the multidisciplinary approach to the management of pain, including neurosurgical procedures, new drugs, electrical stimulation and psychosocial intervention, has helped to clarify the indications for, limitations of, and disadvantages of the use of nerve blocks. The purpose of this article is to place nerve blocks in proper perspective and to define their role among the many methods currently available for the evaluation and control of severe pain.