Articles: nerve-block.
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Anesthesia and analgesia · May 2007
Case ReportsUltrasound-guided infraclavicular block in an anticoagulated and anesthetized patient.
The author describes the use of ultrasound to facilitate a continuous infraclavicular brachial plexus block in a patient who had been anticoagulated with 5000 U of heparin. The procedure was done 2 h after the patient was anticoagulated, and his activated clotting time was 203 s. The patient had vascular checks with a laser Doppler monitor every hour and neurological checks every 12 h.
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Reg Anesth Pain Med · May 2007
Clinical TrialHigh-resolution ultrasound-guided high interscalene plexus block for carotid endarterectomy.
High-resolution ultrasound imaging (HRUI) allows real-time visualization of peripheral nerves, needle insertion, and the spread of local-anesthetic (LA) solution. We evaluated the feasibility of performing a high interscalene brachial-plexus block for carotid endarterectomy by means of HRUI, thereby limiting the amount of LA to the dose required to sufficiently surround the relevant nerve structures. ⋯ High-resolution ultrasonic imaging allows clear depiction of the target tissues and facilitates accurate needle placement during high interscalene brachial-plexus blocks. This technique may minimize the risk of direct puncture-related complications, as well as accidental intravascular injection of LA. The observation of LA spread in all patients, even in small increments of less than 1 mL might enhance safety by limiting the injected LA to the actual demand. Well-placed LA spread could potentially avoid central nervous toxicity caused by intravascular injection or resorption of inadequately high dosages, in particular in nerve blocks of the highly vascularized neck region.
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Anesthesia and analgesia · May 2007
The "axillary tunnel": an anatomic reappraisal of the limits and dynamics of spread during brachial plexus blockade.
Various anatomic factors have been described as affecting the distribution of a solution injected around the brachial plexus. Using computerized axial tomography dye studies, we introduce a new concept. ⋯ We conclude that the brachial plexus is contained within a rigid-walled tunnel of variable dimensions, which we call the "axillary tunnel." The scapula/subscapularis complex, related to the subcoracoid point of resistance, may account for the differing patterns of dye distribution observed.
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Anesthesia and analgesia · May 2007
Comparative StudyProlongation of intrathecal and sciatic nerve blocks using a complex of levobupivacaine with maltosyl-beta-cyclodextrin in rats.
We used a cyclodextrin-based drug delivery system, consisting of levobupivacaine complexed with maltosyl-beta-cyclodextrin (G2-beta-CD), in spinal and sciatic nerve blocks in rats to investigate prolongation of the local anesthetic effect. ⋯ The complex of levobupivacaine with G2-beta-CD prolonged the anesthetic effect of levobupivacaine in both intrathecal and sciatic nerve blocks in rats.
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We aimed to describe the ultrasound appearance of the radial nerve in the lateral aspect of the distal upper arm. This procedure was done to identify potential novel sites for ultrasound-guided radial-nerve block. ⋯ Points B and C may represent convenient, novel sites for ultrasound-guided radial-nerve block. The nerve is clearly visualized and has not yet divided into superficial and deep branches. Point C may be the optimal site for radial-nerve block because of the smaller risk of vessel puncture. Our observations also demonstrate the ability of ultrasound to identify nerves at sites not clearly defined by surface anatomic landmarks.