Articles: nerve-block.
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J Pain Symptom Manage · Dec 2003
Multicenter Study Clinical TrialCeliac plexus block for pancreatic cancer pain: factors influencing pain, symptoms and quality of life.
Neurolytic celiac plexus block (NCPB) is claimed to be an effective method of pain control for pancreatic cancer pain. However, the factors that may influence long-term analgesia, adverse effects, and quality of life after performing NCPB have never been determined. In a prospective multicenter study, 22 patients who underwent NCPB were followed until death. ⋯ The analgesic and symptomatic effect of NCPB is presumably advantageous for about four weeks. A possible factor interfering with long-term outcome includes the capacity of cancer to involve the celiac axis, which can distort the anatomy and prevent neurolytic spread, or modify the pain mechanisms. Outcomes are strongly based on individual variation.
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Anaesth Intensive Care · Dec 2003
Randomized Controlled Trial Clinical TrialCombination of adenosine with prilocaine and lignocaine for brachial plexus block does not prolong postoperative analgesia.
Adenosine analogues have been used by subarachnoid injection for the treatment of inflammatory and neuropathic pain. There is no data on the use of adenosine in peripheral nerve blocks. The aim of the present study was to determine the analgesic efficacy of adenosine in combination with a local anaesthetic solution for brachial plexus (BP) block. ⋯ Time to first pain sensation from block was not significantly longer in the adenosine group (379 +/- 336 min) compared with controls (304 +/- 249 min, mean +/- SD, P = 0.14). Time to first analgesic requirements and analgesic consumption in the first 24 hours were also similar in both study groups. In the present study, the addition of adenosine to local anaesthetic in brachial plexus block did not significantly extend the duration of analgesia.
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We performed a prospective audit of the level of postoperative pain experienced by patients following enucleation with insertion of a primary orbital implant after preincisional regional retrobulbar anaesthesia using bupivacaine 0.75% with 1:100,000 adrenaline. ⋯ Using a preincisional retrobulbar injection of bupivacaine with adrenaline, BS-11 pain scores remained low with no or minimal additional analgesia for up to 4 hours post surgery. In combination with oral analgesia, effective pain control was provided in most cases for up to 8 hours post block.
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The authors present their experience of > 1000 axillary brachial plexus blocks performed over 13 years (1990-2002). Using a technique that involves the location of individual nerves with a nerve stimulator, the overall success rate was 97.9%, ranging from 89.7% in 1990 to 98.4% in 1998. ⋯ The first author, trained and supervised by the second author, achieved similar success rates in half the time taken by the second author. The authors conclude that technique and experience are the keys to success, but that high success rates can be achieved in a short time if anaesthetists are trained by experts in regional anaesthesia.
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Ann Fr Anesth Reanim · Dec 2003
Case Reports[Continuous lumbar plexus block sets in France. Our experience].
The undeniable postoperative analgesia brought by the lumbar plexus block among patients scheduled for major surgery of the hip or knee justifies, the setting of a catheter to allow a continues analgesia more durable. Having drawn aside the difficulties of the daily practice (in allusion to the number of blocks carried out per day) and anatomical variations, the failure of the perineural catheter setting is in direct relationship with the material used by the anaesthesiologists for neurostimulation. The presentation of a case report describes a failure of catheter introduction due to the canula in deep continuous blocks, and the advantages and disadvantages of the various sets of neurostimulation. The authors conclude that the sets with the "catheter through the needle" are to be recommended, particularly the stimulating Tuohy needle.