Articles: nerve-block.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Peribulbar anesthesia: comparing 1% ropivacaine and a mixture of 0.5% bupivacaine--2% lidocaine].
To compare the efficacy of 1% ropivacaine with a mixture of 0.5% bupivacaine and 2% lidocaine in peribulbar anesthesia for elective cataract surgery. ⋯ No difference between the groups was noted during the study regarding not only onset time, but also the duration of anesthesia and perioperative analgesia. A greater incidence of pain on injection was significantly reported in group 2 (p<0.001). Patients in group 1 had less need for top-up injection and showed better ocular akinesia (p<0.01).
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Complications of ophthalmologic nerve blocks are rare, but they can have serious life- and sight-threatening consequences. Knowledge of the potential complications is essential for the anesthesiologist who performs ophthalmologic nerve blocks. However, most anesthesiologists are unfamiliar with these complications because the majority have been reported in the ophthalmology literature. We review the complications that may occur during the placement of ophthalmologic blocks and their appropriate prompt treatment.
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The adjustment of local anesthetic dosage for peripheral nerve block must meet two basic requirements: a drug concentration sufficient to inhibit Na+ channels to the point of impulse failure and a volume of drug sufficient to expose a length of nerve longer than the "critical length" for propagation failure. This study examines the lidocaine dosage requirement, in milligrams, for functionally assayed sciatic nerve block in the rat using a fourfold range of volume corresponding to concentrations from 2 to 7 mg/ml and compares these blocks with the intraneural lidocaine content after injection of equipotent doses. ⋯ Blocks of greater depth and longer duration result from injection of smaller volumes and, correspondingly, higher lidocaine concentrations containing the same dose. The corollary is that lower lidocaine doses are required to achieve the same effect when smaller volumes are injected. Curiously, when the equivalent E50 is injected, total drug taken into the nerve is less from the smaller volumes than from the larger volumes, even though the peak functional effects are equal. Total intraneural local anesthetic may not represent the effective drug in the compartment that contains nerve axons, the actual location of neural blockade.
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Clinical Trial
The anterior combined approach via a single skin injection site allows lower limb anesthesia in supine patients.
Lower limb anesthesia (LLA) requires the combination of, at least, three-in-one and sciatic nerve (SCN) blocks. Anterior approaches are easier to perform with minimal discomfort in supine patients, specially for traumatology. Feasibility of a single needle entry combined approach is reported. ⋯ The anterior combined approach via a single needle entry represents a technically easy and reliable technique to perform LLA in the supine patient.