Articles: nerve-block.
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Based on responses to controlled diagnostic blocks of cervical facet joints, the prevalence of cervical facet joint pain in chronic neck pain has been shown to range from 54% to 67%, with false-positive results of 27% to 63% with a single diagnostic block. Other confounding factors claimed to influence the diagnostic validity of cervical facet joint blocks include administration of anxiolytics and narcotics prior to or during the procedure. ⋯ The administration of sedation with midazolam or fentanyl is a confounding factor in the diagnosis of cervical facet joint pain in patients with chronic neck pain. However, if > or = 80% pain relief with ability to perform prior painful movements is used as the standard for evaluating the effect of controlled local anesthetic blocks, the diagnostic validity of cervical facet joint nerve blocks may be preserved.
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Reg Anesth Pain Med · Jul 2004
Randomized Controlled Trial Clinical TrialPatients' perception of pain during axillary and humeral blocks using multiple nerve stimulations.
Axillary or humeral blocks by multiple nerve stimulation (MNS) are used for ambulatory hand surgery. This double-blind study identified which of the three main components of the procedure (repeated needle passes, local anesthetic injections, or electrical stimulations) is most painful, quantified its intensity, and recorded patients' preferences for a future anesthetic. ⋯ This study found that more axillary-block patients compared with humeral-block patients reported electrical stimulation as the most unpleasant part of the block but failed to detect significant differences in the intensity of the 3 block components (repeated needle passes, local anesthetic injections, and electrical stimulations). Most patients in both groups would accept the same block for future hand operations. Patients were ready for surgery sooner after axillary block, but the clinical importance of this finding is doubtful.
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Randomized Controlled Trial Comparative Study Clinical Trial
Sciatic nerve block via posterior Labat approach is more efficient than lateral popliteal approach using a double-injection technique: a prospective, randomized comparison.
For peripheral nerve blockade, the double-injection technique proved to be superior to a single injection in previous investigations. The current study was designed to compare onset time and efficacy of two different double-injection approaches for sciatic nerve block with 0.75% ropivacaine. ⋯ A double injection with a relatively low volume of 0.75% ropivacaine generated a higher success rate and a shorter onset time of sensory and motor blockade after the classic Labat approach than after a lateral popliteal approach.
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Review Case Reports
Adverse central nervous system sequelae after selective transforaminal block: the role of corticosteroids.
Selective transforaminal epidural injections are frequently employed in the treatment of pain emanating from the spine. Complication rates are typically low and include paresthesia, hematoma, epidural abscess, meningitis, arachnoiditis and inadvertent subdural or subarachnoid injection. Persistent paraplegia after lumbar transforaminal block has been recently reported. Undetected intra-arterial injection has been implicated as a possible cause. ⋯ We present a case of quadriparesis and brainstem herniation after selective cervical transforaminal block. We propose a potential role for corticosteroid particulate embolus during unintended intra-arterial injection as a potential mechanism.
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Oral Surg Oral Med O · Jul 2004
Randomized Controlled Trial Clinical TrialInjection pain and postinjection pain of the anterior middle superior alveolar injection administered with the Wand or conventional syringe.
The purpose of this prospective, randomized, blinded study was to compare the pain of injection and post-injection pain of the AMSA injection using the computer-assisted Wand Plus injection system versus a conventional syringe. ⋯ The AMSA injection, using the Wand Plus, resulted in similar pain ratings for needle insertion as the conventional syringe but statistically lower pain ratings upon anesthetic solution deposition. However, the AMSA, using either the Wand Plus or a conventional syringe, has the potential to be a painful injection. We found the incidence of postinjection pain and sequelae was low with both techniques.