Articles: nerve-block.
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Postherpetic neuralgia (PHN) remains a difficult pain problem for patients and physicians alike. This review describes the epidemiology and pathophysiology of PHN and discusses proposed mechanisms of pain generation and the various treatments currently available. Evidence is scant for the value of surgical and procedural interventions in general, although there are numerous small studies supporting the use of specific interventions such as nerve blocks, neurosurgical procedures and neuroaugmentation. ⋯ Interventions with low risk, such as TENS are appropriate. Although prevention of postherpetic neuralgia appears to be an appropriate strategy, there is little evidence to support the position that medical or interventional approaches (nerve blocks) will prevent PHN after a patient develops acute herpes zoster (HZ). Although antivirals are appropriate for acute HZ, and the use of neural blockade and sympathetic blockade may be helpful in reducing pain in selected patients with HZ, there is little evidence that these interventions will reduce the likelihood of developing PHN.
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Randomized Controlled Trial Comparative Study Clinical Trial
Sciatic nerve blockade improves early postoperative analgesia after open repair of calcaneus fractures.
To determine the effectiveness of analgesia, with or without sciatic nerve blockade, after open repair of calcaneus fracture. ⋯ Sciatic nerve blockade confers significant benefit over morphine alone for analgesia after open repair of calcaneus fractures. Postsurgical sciatic nerve blockade provides the longest possible postoperative block duration.
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Randomized Controlled Trial Comparative Study Clinical Trial
The radial nerve should be blocked before the ulnar nerve during a brachial plexus block at the humeral canal.
The brachial plexus block through the humeral canal as described by Dupré is indicated in hand and forearm surgery. This block requires a multi-stimulation technique that emphasizes the necessity of a rigorous and safe technique. Nerve injury associated with regional anesthesia can entail significant morbidity for patients. Thus, we investigated the brachial block sequence in terms of unintended nerve stimulation as a surrogate of potential nerve injury. ⋯ Our results indicate that the radial nerve should be blocked before the ulnar nerve when performing a brachial plexus block at the humeral canal.
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Randomized Controlled Trial Clinical Trial
Influence of sensory and proprioceptive impairment on the development of phantom limb syndrome during regional anesthesia.
The relation between impairment of sensorimotor function and occurrence of phantom limb syndrome (PLS) during regional anesthesia has not been described. This study assessed the temporal relation between PLS and the progression of sensorimotor impairment during placement of a brachial plexus nerve block. ⋯ This study provides a better understanding of the determinants of PLS by showing that the final position of PLS is related both to the abolition of proprioception and the initial position of the anesthetized limb.
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Journal of endourology · Apr 2004
ReviewChronic prostatitis/chronic pelvic pain syndrome: is there a role for local drug infiltration therapy?
The clinical syndrome of chronic prostatitis ranges from well-defined chronic bacterial infections to poorly defined chronic pelvic pain syndrome (CPPS), previously referred to as "prostatodynia" or "abacterial prostatitis." Faced with the obscure nature of the disease, its protracted course, and the poor response to oral medication, urologists have considered alternative routes of drug administration. We review the indications and outcomes of local drug infiltration (intraprostatic antibiotic and zinc, intrasphincteric botulinum toxin A, pudendal nerve blocks) and discuss their potential use and benefit in the treatment of chronic prostatitis syndromes.