Articles: nerve-block.
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Anesthesia and analgesia · May 2008
Case ReportsReversal of central nervous system and cardiac toxicity after local anesthetic intoxication by lipid emulsion injection.
A 91-yr-old man (57 kg, 156 cm, ASA III) received an infraclavicular brachial plexus block for surgery of bursitis of the olecranon. Twenty minutes after infraclavicular injection of 30 mL of mepivacaine 1% (Scandicain) and 5 min after supplementation of 10 mL of prilocaine 1% (Xylonest) using an axillary approach, the patient complained of agitation and dizziness and became unresponsive to verbal commands. In addition, supraventricular extrasystole with bigeminy occurred. ⋯ Plasma concentrations of local anesthetics were determined before, 20, and 40 min after lipid infusion and were 4.08, 2.30, and 1.73 microg/mL for mepivacaine and 0.92, 0.35, and 0.24 microg/mL for prilocaine. These concentrations are below previously reported thresholds of toxicity above 5 microg/mL for both local anesthetics. Signs of toxicity resolved and the patient underwent the scheduled surgical procedure uneventfully under brachial plexus blockade.
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Anesteziol Reanimatol · May 2008
Randomized Controlled Trial Comparative Study[Comparative analysis of the efficiency and safety of different types of neuroaxial blocks during total hip replacement].
The paper presents the results of a prospective randomized study in 108 elderly patients undergoing total hip replacement under different neuroaxial blocks. The characteristics of sensory and motor blocks, hemodynamic changes, and a need for infusion and sympathomimetic support under epidural, spinal, and unilateral spinal anesthesia were comparatively assessed.
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Although perioperative pain is multifactorial, there are two main factors on which we can act upon: the central sensitization - using opioid analgesics - and the peripheral nociceptive stimulus - by means of a peripheral nerve block. The use of these techniques for anesthesia and post-operative analgesia is increasingly frequent in orthopaedic surgery because they provide excellent sensitive and motor block and offer advantages over other types of analgesia concerning pain relief and early mobilization in the post-operative period. We present a clinical case in which we made a continuous sciatic block (popliteal approach) in a fourteen years old girl with a Hyperactivivity Syndrome and Mental Re-tardation proposed for a club foot corrective surgery, allowing an effective perioperative analgesia with minimum side effects and a quick return to her familiar environment.
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Ultrasound-guided peripheral nerve block has been gaining popularity in the community of anesthesiologists. Despite its well-known clinical benefits, inconsistent success in block has been one of the major limita- tions of conventional peripheral nerve block. Recent development in ultrasound technology enables us to see nerves, needles and surrounding structures in real-time. ⋯ In this article, we introduce some evidences that support the clinical benefits of ultrasound-guided peripheral nerve block, including performance time, quality, onset and duration of sensory blockade, cost analysis and patient satisfaction. However, ultrasound-guidance may be even more dangerous without appropriate imaging of target nerve and surrounding structures, accurate localization of needle tip and assessment of local anesthetic spread around the target nerve. These problems will be solved by future guidelines, teaching program and further advancement in ultrasound technology.