Articles: nerve-block.
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Reg Anesth Pain Med · Sep 2004
ReviewNeuraxial and sympathetic blocks in herpes zoster and postherpetic neuralgia: an appraisal of current evidence.
Epidural, intrathecal, and sympathetic blocks are used for the treatment of pain caused by herpes zoster (HZ) and postherpetic neuralgia (PHN). This study was undertaken to evaluate and synthesize existing evidence for using these nerve blocks with various injectates (local anesthetic [LA] alone, LA + steroids) in treating pain of HZ, PHN (>6 months), and its prevention. ⋯ Evidence for the beneficial effect of epidural LA + steroid in HZ, and intrathecal LA + steroid in PHN appears to be consistent (grade A). If given within 2 months of HZ, epidural LA + steroid may reduce the incidence of PHN after 1 year (grade A). Evidence for use of sympathetic blocks in HZ and PHN, although generally useful (Grade B), requires RCTs for validation.
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Randomized Controlled Trial Clinical Trial
A double-blind randomised controlled trial of laparoscopic uterine nerve ablation for women with chronic pelvic pain.
To determine the effectiveness of laparoscopic uterine nerve ablation (LUNA) for chronic pelvic pain in women with endometriosis and women with no laparoscopic evidence of endometriosis. ⋯ LUNA is effective for dysmenorrhoea in the absence of endometriosis, although there is no evidence of effectiveness of LUNA for non-dysmenorrhoeic chronic pelvic pain or for any type of chronic pelvic pain related to endometriosis.
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Randomized Controlled Trial Clinical Trial
Femoral nerve block for total knee arthroplasty patients: a method to control postoperative pain.
This study was designed to determine the effects of a single-injection femoral nerve block (FNB) using 30 mL of 0.5% bupivacaine with epinephrine 1:200,000, on pain control following total knee arthroplasty (TKA). Forty patients were randomly distributed into 2 groups: Group A received general anesthesia plus a FNB (n = 19), whereas Group B received general anesthesia plus a FNB with 30 mL of preservative-free saline (n = 21). The amount of morphine used, sedation, and average pain perception were measured for the first 24 hours and daily postoperatively. ⋯ The average pain perception was significantly different (P =.002). Postoperative management of pain following TKA can be improved through a preoperative single-injection FNB with 0.5% bupivacaine plus epinephrine 1:200,000. The cost is minimal, risks appear acceptable, and the procedure is efficacious.
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Reg Anesth Pain Med · Sep 2004
Combination of intraneural injection and high injection pressure leads to fascicular injury and neurologic deficits in dogs.
Unintentional intraneural injection of local anesthetics may cause mechanical injury and pressure ischemia of the nerve fascicles. One study in small animals showed that intraneural injection may be associated with higher injection pressures. However, the pressure heralding an intraneural injection and the clinical consequences of such injections remain controversial. Our hypothesis is that an intraneural injection is associated with higher pressures and an increase in the risk of neurologic injury as compared with perineural injection. ⋯ High injection pressures at the onset of injection may indicate an intraneural needle placement and lead to severe fascicular injury and persistent neurologic deficits. If these results are applicable to clinical practice, avoiding excessive injection pressure during nerve block administration may help to reduce the risk of neurologic injury.