Articles: nerve-block.
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Anesthesia and analgesia · Mar 2004
Clinical TrialContinuous psoas compartment blocks after major orthopedic surgery in children: a prospective computed tomographic scan and clinical studies.
Femoral shaft or hip surgeries are very painful for children. We conducted both computed tomographic (CT) and clinical prospective studies to define new landmarks in children and to evaluate the effectiveness of continuous psoas compartment blocks (CPCBs) using disposable elastomeric pumps. In a preliminary CT scan study of 20 patients, the plexus depth was correlated to patient age and the optimal point of puncture for CPCB was three-quarters of the distance from the spinous process of L4 to a line parallel to the spinal column passing through the posterior superior iliac spine. In a subsequent prospective series, a CPCB was administered before surgery to 15 children for pain relief after femoral and hip osteotomies. After general anesthesia, a 0.5 mL/kg bolus of a mixture of 1% lidocaine with epinephrine (1/200.000) and 0.5% ropivacaine was injected through the CPCB catheter. After contrast media assessment of the catheter location, a disposable pump (Infusor LV); Baxter, Paris, France) with 0.2% ropivacaine was connected and pump flow was adjusted to the patient's weight (0.2 mg x kg(-1) x h(-1)). Postoperative pain was evaluated using a visual analog scale or the Children and Infants Postoperative Pain Score at hour H1, H6, H12, H18, H24, H36, and H48, and in terms of rescue analgesia, adverse events, and motor blocks. All blocks were effective during surgery. Postoperative analgesia was excellent. The median pain scores were 1 for H1 and 0 beginning H6. The motor blockade was minimal before 24 h and absent thereafter. No major adverse event was noted. Parents of 93% of the children were satisfied. We conclude that postoperative analgesia with CPCB is a very effective technique in children after major proximal lower limb orthopedic surgery. The CT scan landmarks described in this study were more medial than the conventional landmarks used in the literature. ⋯ Continuous psoas compartment blocks provide optimal pain relief in children after major orthopedic surgery without major adverse events. The landmarks used, defined in a preliminary computed tomographic scan study, were more medial than conventional landmarks.
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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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Acta Anaesthesiol Scand · Mar 2004
Case ReportsApplication of a mandibular nerve block using an indwelling catheter for intractable cancer pain.
We report a case in which a mandibular nerve block using an indwelling catheter was employed for pain management in a terminal case of orofacial cancer. The patient was a 74-year-old female weighing 27 kg. She had a 27-month history of mouth floor and tongue cancer. ⋯ Second, a neurolytic block was applied to the mandibular nerve through the catheter. After the neurolytic block, the total dosage of morphine and diclofenac remained unchanged for 2 months. We conclude from the present case that this technique is an excellent means of obtaining long-term pain control in patients with intractable orofacial cancer pain.
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Acta Anaesthesiol Scand · Mar 2004
Tetrodotoxin-induced conduction blockade is prolonged by hyaluronic acid with and without bupivacaine.
In isolated nerves, tetrodotoxin (TTX) blocks nerve conduction longer than bupivacaine. In vivo, however, both substances block nerve conduction to an equal duration, presumably because the hydrophilic TTX binds only weakly to the perineural tissue. High molecular weight hyaluronic acid (HA) prolongs the action of local anaesthetics several-fold. We tested whether admixture of HA enhances the binding of TTX to the perineural tissue and thus induces an ultra-long conduction block after a single application. ⋯ Both HA and HA/bupivacaine prolong the TTX-induced conduction blockade of the aortic nerve of rabbits in vivo. No signs of neurotoxicity were observed.