Articles: nerve-block.
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Anesthesia and analgesia · Jun 2004
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialPosttetanic potentiation and fade in the response to tetanic and train-of-four stimulation during succinylcholine-induced block.
We designed this study to confirm anecdotal observations that neuromuscular block after a single administration of succinylcholine is characterized by fade to train-of-four (TOF) or tetanic stimulation, as well as posttetanic potentiation. This prospective, randomized, 2-center observational study involved 100 patients. Patients were allocated to 1 of 5 groups and received 0.1, 0.3, 0.5, 0.75, or 1.0 mg/kg succinylcholine during propofol/fentanyl/nitrous oxide anesthesia. Neuromuscular function was monitored by TOF using mechanomyography. At 10%-20% spontaneous recovery of the first twitch of TOF, the mode of stimulation was changed from TOF to 1-Hz single-twitch stimulation followed by a tetanic stimulus (50 Hz) for 5 s. Three seconds later, the single twitch (1 Hz) was applied again for approximately 30 s followed by TOF stimulation until full recovery of the TOF response. Succinylcholine-induced neuromuscular block had the following characteristics: 1) twitch augmentation before twitch depression, which was seen more frequently in patients given smaller doses (0.1 and 0.3 mg/kg) than in those given larger doses (0.5-1.0 mg/kg); 2) TOF fade during onset and recovery of the block; 3) tetanic fade; and 4) and posttetanic potentiation. Posttetanic potentiation was related to the pretetanic twitch height but was not related to the dose of succinylcholine administered. Some characteristics of Phase II block were detectable during onset and recovery from doses of succinylcholine as small as 0.30 mg/kg. Posttetanic potentiation and fade in response to train-of-four and tetanic stimuli are characteristics of neuromuscular block after bolus administration of different doses of succinylcholine. ⋯ Posttetanic potentiation and fade in response to train-of-four and tetanic stimuli are characteristics of neuromuscular block after bolus administration of different doses of succinylcholine. We also conclude that some characteristics of a Phase II block are evident from an initial dose (i.e., as small as 0.3 mg/kg) of succinylcholine.
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Randomized Controlled Trial Comparative Study Clinical Trial
Phase Ia and Ib study of amitriptyline for ulnar nerve block in humans: side effects and efficacy.
The antidepressant amitriptyline is used as an adjuvant in the treatment of chronic pain conditions. Among its many actions, this drug also blocks ion channels, such as Na channels. Preliminary animal studies suggested that amitripty-line would be a longer-lasting local anesthetic than bupivacaine, with potentially fewer side effects. Therefore, the authors investigated the adverse effects and effectiveness of this drug when given for ulnar nerve blockade in human volunteers. ⋯ Because of the lack of evidence that amitripty-line provides better nerve blockade than current local anesthetics and the potential for neurotoxicity, its use for peripheral nerve blockade in humans seems limited.
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J. Cardiothorac. Vasc. Anesth. · Jun 2004
Randomized Controlled Trial Comparative Study Clinical TrialAnalgesia after thoracotomy: epidural fentanyl/bupivacaine compared with intercostal nerve block plus intravenous morphine.
Intercostal nerve blockade plus intravenous (IV) patient-controlled analgesia (PCA) could be an easier and safer alternative to epidural analgesia for postthoracotomy pain, but information about the efficacy of this technique is scarce. The objective of this randomized study was to compare the quality of analgesia and lung function in 2 groups of patients undergoing pulmonary surgery through a posterolateral thoracotomy. ⋯ The fact that the difference in pain scores is probably not clinically significant shows that an intercostal block with bupivacaine plus IV morphine PCA is a good alternative for postthoracotomy pain management.
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J. Cardiothorac. Vasc. Anesth. · Jun 2004
Randomized Controlled Trial Clinical TrialPostoperative analgesia in video-assisted thoracoscopy: the role of intercostal blockade.
This study examined (1) the opioid and nonopioid requirement of patients undergoing video-assisted thoracoscopy (VATS) as a measure of postoperative pain and (2) whether percutaneous intercostal blockade might reduce morphine requirements and improve analgesia in VATS procedures. ⋯ Postoperative morphine requirements after VATS surgery are considerable, with pleurectomy being the most painful procedure. Intercostal blockade with bupivacaine provided effective pain relief and a dramatic reduction in morphine requirements. This technique is recommended for VATS surgery, especially if day-case procedures are being contemplated.
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Am J Phys Med Rehabil · Jun 2004
Therapeutic selective nerve root block in the nonsurgical treatment of traumatically induced cervical spondylotic radicular pain.
To investigate the outcomes resulting from the use of fluoroscopically guided therapeutic selective nerve root block in the nonsurgical treatment of traumatically induced cervical spondylotic radicular pain. ⋯ These initial and preliminary findings do not support the use of therapeutic selective nerve root block in the treatment of this challenging patient population with traumatically induced spondylotic radicular pain.