Articles: nerve-block.
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Anesthesia and analgesia · Apr 2003
Randomized Controlled Trial Clinical TrialThe effect of epidural test dose on motor function after a combined spinal-epidural technique for labor analgesia.
Labor analgesia initiated with intrathecal bupivacaine and fentanyl, without a local anesthetic epidural test dose, provides effective analgesia and allows ambulation. In this study, we sought to determine the effect of a lidocaine-epinephrine test dose administered immediately after the initiation of combined spinal-epidural (CSE) analgesia with bupivacaine 2.5 mg and fentanyl 25 micro g on parturients' hemodynamic stability, posterior column function, motor strength, and subjective ability to walk. Parturients (n = 153) were randomized to receive either 3 mL of epidural saline or lidocaine 1.5% with epinephrine 1:200,000. Hemodynamic variables, proprioception, straight leg raise, and the modified Bromage score were analyzed in 110 parturients who completed the study protocol and were not different between groups. Vibratory sense, the ability to perform a partial deep knee bend and to step up on a stool, and the subjective ability to walk were impaired in a larger number of parturients in the lidocaine-epinephrine group at 30 min (P < 0.05). At 60 min, there were no differences between the groups except that fewer parturients in the lidocaine-epinephrine group could step up on a stool. The straight leg raise against resistance and the modified Bromage scale did not correlate well with other tests of motor strength (Spearman's rho, 0.273-0.405). These data suggest that the test dose should be avoided immediately after initiation of CSE analgesia when early ambulation is desired. ⋯ A lidocaine-epinephrine epidural test dose (3 mL of lidocaine 1.5% with epinephrine 1:200,000), injected immediately after the initiation of combined spinal-epidural labor analgesia with bupivacaine 2.5 mg and fentanyl 25 microg, may interfere with the ability to perform simple tests of motor function and ambulation.
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Comparative Study
Nerve stimulators used for peripheral nerve blocks vary in their electrical characteristics.
Nerve stimulation with a low-intensity electrical current has become a vital part of the performance of peripheral nerve blockade. The purpose of this study was to compare the accuracy and characteristics of peripheral nerve stimulators used in clinical practice in the United States. ⋯ Nerve stimulators used for regional anesthesia vary greatly in accuracy of current output and in manufacturer-selected electrical characteristics (e.g., current duration, stimulating frequency, maximum voltage output).
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This prospective observational study aimed to assess the feasibility and efficacy of bilateral continuous paravertebral blockade combined with general anaesthesia in "on-pump" cardiac surgery. One hundred and eleven elective patients had two paravertebral catheters inserted: one either side of the midline within 2.5 cm of the spinous process of the third or fourth thoracic vertebrae, through which a mixture of ropivacaine and fentanyl was infused during and after surgery. ⋯ In all patients, time to tracheal extubation, length of stay in the intensive care unit and the hospital, morbidity and mortality, and any complication attributable to the regional blockade were recorded. The technique was associated with good haemodynamic stability, good postoperative analgesia and short times to tracheal extubation, with few significant complications.
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Comparative Study
Effect of dexamethasone on motor brachial plexus block with bupivacaine and with bupivacaine-loaded microspheres in a sheep model.
It has been suggested that dexamethasone potentiates the sensory block produced by bupivacaine when both drugs are loaded in microspheres. The aim of the study was to evaluate the effect of dexamethasone on the brachial plexus block obtained with plain bupivacaine and bupivacaine-loaded microspheres. ⋯ Despite the delayed onset of motor block, the incorporation of dexamethasone in bupivacaine-loaded microspheres dramatically increases the duration of action (700 +/- 485-5160 +/- 2136 min), which could be clinically relevant when such a drug-delivery system will be available.