Articles: nerve-block.
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Case Reports
[Case report: bilateral femoral and sciatic regional anesthesia in a polytraumatized patient].
To present a case requiring regional anesthesia for both lower limbs, and to highlight the considerations to avoid potential local anesthetic toxicity, as a result of high cumulative doses of local anesthetic in this setting. ⋯ Regional anesthetic techniques for the lower limb may require local anesthetic doses approaching toxic levels, especially when bilateral blocks are required. This case indicates that by considering the pharmacokinetic and pharmacodynamic characteristics of each agent, and by timing the blocks properly to minimize peak plasma concentrations, the potential for local anesthetic toxicity can be reduced.
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Multicenter Study
Regional anaesthesia for limb surgery: a review of anaesthetists' beliefs and practice in the Oxford region.
We conducted a postal survey of 210 anaesthetists in the Oxford region to determine their views and practice regarding the timing of regional anaesthesia when combined with general anaesthesia for adults undergoing limb surgery and to compare the results with those obtained in a similar survey conducted in 2001. Of the 151 respondents (72% response rate), 102 (68%) regularly combined regional and general anaesthesia for adult limb surgery. ⋯ Significantly fewer anaesthetists believed it necessary to perform peripheral nerve blocks before general anaesthesia than in 2001, marking another significant change in practice. Overall, the results indicate an increased popularity of regional blocks in combination with general anaesthesia when compared with 2001 practice, which we believe is related to high quality advanced training modules now on offer to senior trainees in the Oxford region.
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Comparative Study
[Combined transgluteal ischial and femoral nerve block: retrospective data on 65 risk patients with leg amputation].
For amputations of the lower limbs the combined blockade of the sciatic nerve (via the transgluteal approach) and the femoral nerve (via the inguinal route) may be a suitable alternative to general or neuroaxial anaesthetic methods. In highly comorbid, high risk patients this catheter-linked regional anaesthesia combines the advantages of avoiding controlled ventilation with decreased cardiovascular depression, as conveyed by the use of general anaesthesia or neuraxial techniques. Furthermore, improved postoperative analgesia may be achieved for several days. ⋯ In 58 patients (89%), a regional anaesthesia technique employing only a catheter technique was performed and only 7 patients (11%) required additional general anaesthesia. For postoperative pain management, local anaesthetics were administered via an indwelling nerve block catheter and excellent pain scores were achieved in these patients. However, successful employment of this technique necessitates sufficiently trained personnel as well as on-going training in the performance of catheter-based local analgesia.
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The present article will review the current technology and available literature regarding regional anesthesia in infants and children undergoing head and neck surgery. ⋯ The trigeminal nerve, along with the cervical nerve roots, supplies most of the sensory supply to the head and neck. The knowledge and application of the anatomical distribution of this area can increase the utilization of these blocks for a variety of different settings. The increased use of these blocks can reduce the need for additional postoperative analgesic that could in turn lead to fast-tracking of these patients and decrease the incidence of nausea and vomiting in the postoperative period.