Articles: nerve-block.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Dec 2004
[Along the anesthetic line: a new approach to the brachial plexus -- the subcoracoidal retrograde access].
Introduced is a new approach to the brachial plexus marked out in opposition to the common methods by some theoretical advantages. The needle is proceeded in an acute angle to the course of the plexus. Thus reduces the possibility of nerve damage. Second the insertion of catheter is simplified. The accidental puncture of the pleura is unlikely except in cases of gross deviations of the puncture instruction. In addition the plexus is hit before the musculocutaneous nerve leaves the brachial plexus. The objective of this investigation was to evaluate the usefulness of the subcoracoidal retrograde access in daily practice. Beside the influence of stimulating different fascicles or the necessity of reaching a defined low stimulation level on the success rate and effectiveness of the plexus blockade was investigated. ⋯ The described subcoracoidal retrograde access to the brachial plexus (SCREP) proved to be a safe and easy method with a low complication and high success rate compared with the known practised accesses. In contrary to other authors our findings do not support the connection either between success rate and stimulating certain fascicles nor achieving a defined lowest stimulation level.
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Nonradicular low back pain can be a difficult entity to accurately diagnose and treat. Facet joints, muscle, ligaments, and fascia have all been reported to be etiologies of acute and chronic low back pain. However, the facet joint as a source of low back pain is controversial. The diagnosis of facet joint pain is made by diagnostic facet joint or median nerve branch injections with a local anesthetic. The purpose of this study was to determine if the results of diagnostic facet joint injections are influenced by the technique used to perform these injections. ⋯ The results of this study demonstrated that local anesthetic injections are useful for the diagnosis of nonradicular low back pain but may yield false positive results with respect to lumbar facet pain depending upon the technique utilized.
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Anesthesia and analgesia · Dec 2004
Randomized Controlled Trial Clinical TrialSingle-injection paravertebral block before general anesthesia enhances analgesia after breast cancer surgery with and without associated lymph node biopsy.
Paravertebral block (PVB) seems to decrease postoperative pain and postoperative nausea and vomiting (PONV) after breast surgery, but the studies have not been placebo controlled. We studied 60 patients scheduled for breast cancer surgery randomly given single-injection PVB at T3 with bupivacaine 5 mg/mL (1.5 mg/kg) or saline before general anesthesia. The patient and attending investigators were blinded; the PVB or the sham block was performed behind a curtain by an anesthesiologist not involved in the study. ⋯ The average peak bupivacaine plasma concentration was 750 ng/mL. One patient had bilateral convulsions immediately after bupivacaine injection. We conclude that PVB before general anesthesia for breast cancer surgery reduced postoperative pain, opioid consumption, and occurrence of PONV and improved recovery from anesthesia.