Articles: nerve-block.
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Reg Anesth Pain Med · Mar 2004
Diaphragmatic excursion and respiratory function after the modified Raj technique of the infraclavicular plexus block.
The effects of the infraclavicular plexus block using the modified Raj approach on diaphragm and respiratory function have not been investigated. ⋯ Infraclavicular block using the modified Raj technique did not interfere with diaphragmatic excursion or respiratory function.
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Ultrasound is a novel method of nerve localization but its use for lower extremity blocks appears limited with only reports for femoral 3-in-1 blocks. We report a case series of popliteal sciatic nerve blocks using ultrasound guidance to illustrate the clinical usefulness of this technology. ⋯ Our preliminary experience suggests that ultrasound localization of the sciatic nerve in the popliteal fossa is a simple and reliable procedure. It helps guide block needle placement and assess local anesthetic spread pattern at the time of injection.
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Reg Anesth Pain Med · Mar 2004
Case ReportsAn unusual case of painful phantom-limb sensations during regional anesthesia.
The objective of this article is to describe a late-onset phantom-limb pain during a continuous analgesic popliteal nerve block after foot surgery and its alleviation and recurrence when stopping and resuming the local anesthetic infusion. ⋯ This observation suggests that phantom-limb pain can be of late-onset and might occur during a continuous infusion of low-concentration local anesthetic responsible only for an analgesic block, as shown by the fact that only thermal and pinprick sensations, known to depend on Adelta-fibers and C-fibers, were altered. Therefore, this case contradicts the usual belief that a profound block is necessary to elicit phantom-limb pain.
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Reg Anesth Pain Med · Mar 2004
At the cords, the pinkie towards: Interpreting infraclavicular motor responses to neurostimulation.
Identification of elicited muscle twitches while performing infraclavicular block of the brachial plexus is often confusing but is critical for success of the block. An easily defined endpoint when evaluating these motor responses to neurostimulation is essential, as it is necessary to block the appropriate cord or cords. ⋯ If the arm is positioned in the anatomical position, the 5th digit (pinkie) moves laterally (pronation of the forearm) when the lateral cord is stimulated, posteriorly (extension) when the posterior cord is stimulated, and medially (flexion) when the medial cord is stimulated. The pinkie thus moves "toward" the cord that is stimulated.
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Randomized Controlled Trial Clinical Trial
Clonidine added to bupivacaine enhances and prolongs analgesia after brachial plexus block via a local mechanism in healthy volunteers.
The addition of clonidine to local anaesthetics enhances pain relief after peripheral nerve block, but the site of action is unproven. ⋯ The admixture of clonidine to bupivacaine plus epinephrine prolongs and enhances brachial plexus blockade. Lower clonidine plasma concentrations for block treatment strongly suggest a local effect.