Articles: nerve-block.
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Randomized Controlled Trial Comparative Study Clinical Trial
General anaesthesia combined with bilateral paravertebral blockade (T5-6) vs. general anaesthesia for laparoscopic cholecystectomy: a prospective, randomized clinical trial.
The efficiency of bilateral paravertebral blockade combined with general anaesthesia (active) vs. general anaesthesia alone (control) in reducing postoperative pain following laparoscopic cholecystectomy was evaluated using a prospective randomized study design. ⋯ When used as a complement to general anaesthesia, bilateral nerve-stimulator guided paravertebral blockade with lidocaine, bupivacaine, fentanyl and clonidine may improve postoperative pain relief.
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Paravertebral blockade (PVB) is a regional anaesthetic technique that allows the injection of local anaesthetic agents into the paravertebral space. It has been used for acute and chronic pain relief and as an anaesthetic technique for unilateral surgery of the chest, breast, shoulder, kidney, and inguinal region. Paravertebral blockade has been performed on a limited basis for breast surgery at the University Hospital of the West Indies (UHWI) since 1998. ⋯ Fifteen were done in combination with GA. No complications were recorded The initial experience shows that the performance of PVB is both possible and safe; it may offer an alternative to GA for breast surgery. A randomized prospective study is underway to allow a detailed comparison between the two methods.
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Anesthesia and analgesia · Jun 2004
Case ReportsSuperficial cervical plexus block for vocal cord surgery in an awake pediatric patient.
Medialization thyroplasty is a surgical procedure that decreases the incidence of dysphonia and dysphagia in patients who have vocal cord paralysis. We report a case of a pediatric patient who underwent this procedure with minimal sedation and bilateral superficial cervical plexus blockade. The use of a regional technique provided analgesia while allowing the patient to phonate at the request of the surgeon. ⋯ Medialization thyroplasty is a surgical procedure that decreases the incidence of dysphagia and dysphonia in patients with vocal cord paralysis. This procedure is best performed in a patient who maintains the ability to phonate. We report a case of medialization thyroplasty in a pediatric patient after bilateral superficial cervical plexus blocks with minimal sedation.
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Anesthesia and analgesia · Jun 2004
Case ReportsPerioperative pain management of a complex orthopedic surgical procedure with double continuous nerve blocks in a burned child.
The use of catheters for continuous nerve blocks has been established in children, although in most series only one catheter was used. We report a case of a 3-yr-old child who underwent a toe-to-finger transfer managed with 2 regional catheters: axillary and sciatic. A pain score of 0 was noted during the entire study period. The total dose of bupivacaine was limited to an acceptable range, and the child recovered completely. This report adds to growing evidence in favor of the safety and efficacy of continuous peripheral nerve blocks in pediatric patients. ⋯ Double continuous nerve blocks allow optimal analgesia in burned children after complex orthopedic surgery without major adverse events. Plasma concentrations of bupivacaine remained small during the study period.
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Comparative Study
Encapsulation of mepivacaine prolongs the analgesia provided by sciatic nerve blockade in mice.
Liposomal formulations of local anesthetics (LA) are able to control drug-delivery in biological systems, prolonging their anesthetic effect. This study aimed to prepare, characterize and evaluate in vivo drug-delivery systems, composed of large unilamellar liposomes (LUV), for bupivacaine (BVC) and mepivacaine (MVC). ⋯ MVC(LUV) provided a LA effect comparable to that of BVC. We propose MVC(LUV) drug delivery as a potentially new therapeutic option for the treatment of acute pain since the formulation enhances the duration of sensory blockade at lower concentrations than those of plain MVC.