Articles: nerve-block.
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To evaluate the effectiveness and safety of an orbital block using an ultrashort, wide-bore blunt metal cannula to inject local anesthetic agents into the anterior sub-Tenon's space. ⋯ Effective and predictable ocular anesthesia can be achieved using a blunt, ultrashort cannula for sub-Tenon's block. The technique greatly reduces the risks for globe perforation, muscle damage, and other serious complications.
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Am J Phys Med Rehabil · Apr 2004
Case ReportsTibial nerve block with anesthetics resulting in achilles tendon avulsion.
Diagnostic tibial nerve block with anesthetics is a common and safe procedure for the management of the spastic equinovarus foot. Side effects have been rarely reported. We present the case of a hemiplegic patient with a spastic equinovarus foot who presented with an avulsion fracture of the calcaneum at the insertion of the Achilles tendon consecutive to a diagnostic tibial nerve block with anesthetic agents. Although rare, such a complication should be considered when the Achilles tendon is shortened and when the patient is suspected of bone osteoporosis or dystrophy.
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Anesthesia and analgesia · Apr 2004
Randomized Controlled Trial Comparative Study Clinical TrialThe effects of spread of block and adrenaline on cardiac output after epidural anesthesia in young children: a randomized, double-blind, prospective study.
Epidural anesthesia is considered to be without significant hemodynamic consequence in young children. However, conversely to adults, few studies have investigated cardiac output. Using transesophageal Doppler monitoring of cardiac output, we prospectively investigated hemodynamic alterations in 48 children (median age, 22.5 mo) receiving sevoflurane general anesthesia combined with caudal or thoracolumbar epidural anesthesia. They were randomly assigned to receive 0.8 mL/kg of plain local anesthetic mixture (lidocaine 1% + bupivacaine 0.25% (50/50) + 1 microg/mL of fentanyl) or 1 mL/kg of the same mixture with 5 microg/mL of adrenaline. No significant hemodynamic alteration was elicited in caudal and thoracolumbar groups receiving the plain mixture except a moderate decrease in heart rate. Conversely, a mixture with adrenaline added provoked a significant decrease in mean arterial blood pressure by 14% and 17%, in systemic vascular resistance by 24% and 40%, and an increase in cardiac output by 20% and 34% in caudal and thoracolumbar groups, respectively. The adrenaline effect was greater by the thoracolumbar than the caudal approach. In young children, epidural anesthesia induces an increase in cardiac output only when adrenaline is added to local anesthetics, probably through its systemic absorption from the epidural space. ⋯ Epidural anesthesia may induce significant hemodynamic changes, well documented in adults. Using noninvasive hemodynamic monitoring in children, we reported an increase in cardiac output and a decrease in arterial blood pressure only when epinephrine was added to epidurally-injected local anesthetics.
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The high prevalence of persistent neck pain due to involvement of cervical facet joints has been described in controlled studies. Therapeutic interventions utilized in managing chronic neck pain of facet joint origin include intraarticular injections, medial branch nerve blocks, and neurolysis of medial branch nerves by means of radiofrequency. ⋯ Cervical medial branch blocks were an effective modality of treatment in managing chronic neck pain secondary to facet joint involvement confirmed by controlled, comparative local anesthetic blocks.
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Anesthesia and analgesia · Apr 2004
Randomized Controlled Trial Clinical TrialTramadol added to 1.5% mepivacaine for axillary brachial plexus block improves postoperative analgesia dose-dependently.
Adjuncts to local anesthetics for peripheral plexus blockade may enhance the quality and duration of anesthesia and postoperative analgesia. The analgesic, tramadol, has a unique mechanism of action that suggests efficacy as such an adjunct. It displays a central analgesic and peripheral local anesthetic effect. We designed a prospective, randomized, controlled and double-blind clinical trial to assess the effect of tramadol added to brachial plexus anesthesia. One-hundred patients scheduled for carpal tunnel release surgery under brachial plexus anesthesia were randomized into four groups. All patients received 1.5% mepivacaine 40 mL plus a study solution containing either isotonic sodium chloride (Group P, n = 17), tramadol 40 mg (Group T(40), n = 22), tramadol 100 mg (Group T(100), n = 20) or tramadol 200 mg (Group T(200), n = 20). We evaluated the time of onset of anesthesia, duration of sensory and motor blockade, duration and quality of postoperative analgesia, and occurrence of adverse effects. Onset and duration of sensory and motor blocks were not different among groups. The number of patients requesting analgesia in the postoperative period was significantly less in the 3 tramadol groups compared with the placebo group (P = 0.02); this was also noted with the placebo and T(40) groups compared with the T(200) group. No statistical significance was demonstrated between the placebo and the T(40) group or the T(100) group and the T(200) group. Furthermore, there was a significant trend effect among groups applying the Cochran-Armitage tendency test (P = 0.003), suggesting a dose-dependent decrease for additional postoperative analgesia requirements when tramadol was added. Side effects did not differ among groups, although they were more frequently recorded in the T groups. Our study suggests that tramadol added to 1.5% mepivacaine for brachial plexus block enhances in a dose-dependent manner the duration of analgesia with acceptable side effects. However, the safety of tramadol has to be investigated before allowing its use in clinical practice. ⋯ Tramadol's unique mechanism of action suggests efficacy as a local anesthetic adjunct for peripheral plexus blockade. Our study demonstrates that tramadol, added to mepivacaine for brachial plexus anesthesia, extends the duration and improves the quality of postoperative analgesia in a dose dependent fashion with acceptable side effects.