Articles: nerve-block.
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To achieve profound dental local anesthesia, it is necessary for the dentist to have a thorough knowledge of the details of sensory innervation to the maxilla and mandible. Since the early 1970s, dentistry has experienced a resurgence of interest in the neuroanatomical basis of local anesthesia, resulting in numerous scientific reports on the subject. ⋯ An understanding of the potential variations in innervation should help the dentist improve his or her ability to induce profound local anesthesia.
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Major shoulder surgery can be extremely painful. Interscalene brachial plexus catheters provide excellent postoperative analgesia but are technically difficult to place. A new insulated Tuohy needle system for plexus catheterisation is now available. ⋯ Mean [range] catheter insertion time was 3.6 [1-10] min. Decreased block and catheter insertion times were associated with experience with the equipment when comparing the mean (SD) times for the first seven catheters and the last seven catheters inserted (12.1 (4.2) min vs. 7.9 (2.4) min), p < 0.05). It is concluded that the insulated Tuohy needle system for interscalene catheterisation proved easy to use in the hands of someone who had not used it before, and can be recommended.
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Rev Esp Anestesiol Reanim · Jun 2003
[Possibility of nerve lesions related to peripheral nerve blocks. A study of the human sciatic nerve using different needles].
When a needle tip comes too close to a nerve axon, the mechanical effect over the nerve membrane produces paresthesia. We examined the hypothetical mechanical damage of short bevel and long bevel needles over sciatic nerve bundles under scanning electron microscopy. ⋯ Lesions that affect superficially the epineurum can cause paresthesia by compression of nerve fascicles without damaging the axons. If the perineurm is damaged, the lession will also affect the blood-nerve barrier, leading probably to posterior sequels.
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Case Reports
[Incorrect positioning of a catheter for continuous block of the nervus suprascapularis. A case report].
The case of a 55-year-old woman is described where shoulder pain was successfully treated with a suprascapular catheter. During arthroscopy of the shoulder the catheter was detected in the subacromial space. The reasons and consequences of an abnormal position of the suprascapular catheter are discussed.
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The axillary brachial plexus block is a very safe, but sometimes unreliable technique for anaesthesia of the upper extremities. Alternative methods like the infraclavicular block offer a higher success rate, but also the possibility of severe complications. We suggest a modified axillary technique with an injection site medial to the artery, evaluated by clinical experience and anatomical investigations, which could solve the problem of high failure rate, especially in the area of the radial nerve while still maintaining patient safety.