Articles: nerve-block.
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In this review, emphasis is placed on adjuvant drugs that are already in clinical use. The list of adjuvants studied during the review period includes adrenaline, clonidine, ketamine, neostigmine, nondepolarizing muscle relaxants, and nonsteroidal antiinflammatory drugs. Some future aspects are considered in a couple of experimental studies on slow-release local anaesthetic formulations. ⋯ Adrenaline and opioids may be regarded as the best investigated and most important adjuvants in regional anaesthesia. Other drugs, such as clonidine and neostigmine, may prolong analgesia in various regional anaesthetic techniques, but possible side effects may limit their clinical application. Further development is needed concerning extra-long acting analgesic formulations.
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Acta Anaesthesiol Scand · Oct 2003
Randomized Controlled Trial Clinical TrialContinuous epidural or intercostal analgesia following thoracotomy: a prospective randomized double-blind clinical trial.
Pain following thoracotomy is frequently associated with clinically important abnormalities of pulmonary function. The aim of the current study was to compare the efficacy of continuous thoracic epidural analgesia (EDA) to continuous intercostal (IC) block for postoperative pain and pulmonary function in a prospective, randomized, double-blinded clinical trial. ⋯ The results of the present study show that following thoracotomy in the early postoperative period continuous EDA is a better pain relieving method than continuous IC block, as indicated by the VAS scores.
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Randomized Controlled Trial Clinical Trial
Comparison of three different volumes of mepivacaine in axillary plexus block using multiple nerve stimulation.
The multiple injection technique for axillary block, in which the four distal nerves of the plexus are located by a nerve stimulator and separately injected, has been shown to provide a high success rate and a short onset time. This randomized double-blind study was conducted to compare the effectiveness of three different volumes of mepivacaine 10 mg x ml(-1) in patients undergoing elective distal upper limb surgery under axillary brachial plexus block with the four-nerve approach. The number of complete sensory blocks was the primary efficacy variable. ⋯ The three volumes (38, 28, and 20 ml) of mepivacaine 10 mg x ml(-1) ensured a similar and high percentage of complete sensory blocks in axillary brachial plexus anaesthesia with nerve stimulation involving the location of four motor responses.
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Spinal and peridural anaesthesia has several advantages over general anaesthesia due to their low influence to endocrine and metabolic activity and their capacity to reduce postoperative surgical complications, intraoperative bleeding and deep venous thromboembolism incidence. Nevertheless, these anaesthesiologic techniques have a high risk of severe neurological events in patients treated with anticoagulant therapies and prophylaxis. However, this complication is rarely found in literature. ⋯ Anaesthetists must know the use and pharmacological properties of anticoagulant drugs in order to be able of giving up or modifying them during perioperative time, evaluating the risk of bleeding episodes and thrombotic events. An analysis of the literature has been made in order to establish favourable conditions, risk factors, international guide-lines and the real incidence of haemorrhagic complications associated to central blocks in patients being treated with drugs that modify their coagulative status. The survey of the literature and the international guide-lines shows that neuraxial anaesthesia should be performed in selected patients, respecting the free intervals of anticoagulant drugs, carrying out a correct postoperative neurological monitoring and evaluating, case by case, the risks and benefits of the procedure.
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Anesthesia and analgesia · Oct 2003
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of psoas compartment block and spinal and general anesthesia for outpatient knee arthroscopy.
The optimal anesthetic technique for outpatient knee arthroscopy remains controversial. In this study, we evaluated surgical operating conditions, patient satisfaction, recovery times, and postoperative analgesic requirements associated with psoas compartment block, general anesthetic, or spinal anesthetic techniques. Sixty patients were randomized to receive a propofol/nitrous oxide/fentanyl general anesthetic, spinal anesthesia with 6 mg of bupivacaine and 15 micro g of fentanyl, or psoas compartment block with 40 mL of 1.5% mepivacaine. All patients received IV ketorolac and intraarticular bupivacaine. The frequency of postanesthesia recovery room admission was 13 (65%) of 20 for patients receiving general anesthesia, compared with 0 of 21 for patients receiving spinal anesthesia and 1 (5%) of 19 for patients receiving psoas block (P < 0.001). The median time from the end of surgery to meeting hospital discharge criteria did not differ across groups (131, 129, and 110 min for general, spinal, and psoas groups, respectively). In the hospital, 45% of general anesthesia patients received opioid analgesics, compared with 14% of spinal anesthesia and 21% of psoas block patients (P = 0.087). There was no difference among groups with respect to the time of first analgesic use or the number of patients requiring opioid analgesia. Pain scores were highest in patients receiving general anesthesia at 30 min (P = 0.032) and at 60, 90, and 120 min (P < 0.001). Patient satisfaction with anesthetic technique (P = 0.025) and pain management (P = 0.009) differed significantly across groups; patients receiving general anesthesia reported lower satisfaction ratings. We conclude that spinal anesthesia or psoas block is superior to general anesthesia for knee arthroscopy when considering resource utilization, patient satisfaction, and postoperative analgesic management. ⋯ Outpatient knee arthroscopy may be performed using a variety of anesthetic techniques. We report that spinal anesthesia and psoas compartment block are superior to general anesthesia when considering resource utilization, patient satisfaction, and postoperative analgesic management.