Articles: nerve-block.
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Interscalene brachial plexus block (ISB) anaesthesia is widely used with or without general anaesthesia in patients undergoing shoulder surgery, which is generally done with the patient in a sitting position. This position affects haemodynamics, and supplementing ISB with general anaesthesia can exaggerate these haemodynamic changes. This study compared ISB combined with general anaesthesia, with ISB alone, in 29 patients undergoing elective shoulder surgery. ⋯ All of the patients were either satisfied or entirely satisfied with their anaesthesia/analgesia. There were no significant differences in side-effects and no severe complications in either group. We advocate using ISB alone for patients undergoing shoulder surgery, but further larger studies are needed to confirm the present results.
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Reg Anesth Pain Med · Sep 2003
Clinical TrialLateral approach to the sciatic nerve block in the popliteal fossa: correlation between evoked motor response and sensory block.
The purpose of this study was to identify which of two motor responses of the foot (plantar flexion versus dorsiflexion) best predicts complete sensory blockade of the sciatic nerve when is used for lateral popliteal sciatic nerve block. ⋯ After stimulation of the sciatic nerve, plantar flexion better predicts complete sensory blockade of the foot than dorsiflexion when using the lateral approach to the popliteal fossa. The findings of the present study apply to a single injection of 30 mL of ropivacaine 0.75%.
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Best Pract Res Clin Anaesthesiol · Sep 2003
Case Reports Comparative StudyIntrathecal neurolytic blocks for the relief of cancer pain.
Intrathecal neurolytic blocks for the treatment of chronic pain were first described by Dogliotti in 1931. Since then, many authors have described the intrathecal injection of various neurolytic substances for the treatment of oncologic pain. In recent years, alcohol and phenol have been the substances most commonly used for this purpose. ⋯ Four cases of cancer patients whose intractable pain was treated by the authors using intrathecal neurolysis are presented. Pertinent literature is reviewed. In this account, the emphasis is on proper selection of patients and techniques.
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Reg Anesth Pain Med · Sep 2003
Clinical TrialRelationship between evoked motor response and sensory paresthesia in interscalene brachial plexus block.
This study sought to define the relationship between a paresthesia and a motor response (MR) to electrical nerve stimulation using a peripheral nerve stimulator (PNS) during interscalene block. We sought to determine if at a low amperage (< or =1.0 mA) a MR would precede a paresthesia. ⋯ MR preceded paresthesia in every patient. The most likely explanation for this observation is that MR can be achieved at a small distance from the nerve, whereas elicitation of mechanical paresthesia requires either nerve contact or more intimate location of the needle's tip relative to the nerve. Another possible explanation is that motor fibers are located in a more superficial position and are therefore encountered first. Motor and sensory responses are separate and discrete phenomena.
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To describe the onset of phantom leg pain in an amputee with the performance of a lumbar plexus block and the subsequent alleviation after the performance of a sciatic nerve block. ⋯ The temporal relationship between the onset of the phantom leg pain and the lumbar plexus block suggests a causal relationship. In this case, it appears that ongoing peripheral input from the lumbar plexus may have been sufficient for the tonic inhibition of phantom pain in the sciatic distribution. The immediate reactivation of the phantom pain and its subsequent relief suggests dynamic processing of peripheral inputs by central neurons, which apparently is rapid and reversible in some cases of phantom pain.