Articles: nerve-block.
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Reg Anesth Pain Med · Mar 2003
Case Reports Clinical TrialContinuous lumbar plexus block: Use of radiography to determine catheter tip location.
The purpose of this article is to document where a lumbar plexus catheter introduced by the posterior approach will track and to evaluate the benefit of using systematic radiographic verification of catheter placement. ⋯ Epidural spread of local anesthetic during lumbar plexus block should be expected to be relatively common. It can be easily identified clinically with fractionated doses of local anesthetic. The catheter tip was identified in the epidural space by radiographic verification in only 1.8% of cases. This expensive procedure is therefore unnecessary except when an unusual location is suspected, but not necessary to confirm a catheter assumed to be correctly positioned.
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Every approach to the sciatic nerve in the buttocks currently requires the identification of pelvic bone structures. The large size of the nerve and its constant trajectory suggest that a simplified approach is possible. ⋯ Because of the intimate relationship of the sciatic nerve to the bony pelvis, the position of this nerve in the buttocks is constant. Caudal to the piriformis muscle the nerve runs vertically between the ischium and the greater trochanter. The location of this narrow passage, not the buttocks' size, determines the position of the nerve. While the size of the buttocks is variable among different individuals and in the same individual at different stages of adult life, the relationship of the sciatic nerve to the pelvis is constant throughout life. Using this relationship to our advantage, a sciatic block in adults can be accomplished at 10 cm lateral to the intergluteal sulcus without a need for identification of buried structures or line tracings.
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Acta Anaesthesiol Scand · Mar 2003
Letter Case ReportsNeuraxial complications after epidural and spinal anaesthesia.
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Reg Anesth Pain Med · Mar 2003
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of a single-stimulation lateral infraclavicular plexus block with a triple-stimulation axillary block.
A single-stimulation infraclavicular brachial plexus block (ICB) is safe and easy to perform, although underused. This technique was compared with a triple-stimulation axillary block (AxB). ⋯ A single shot ICB is equally effective as a triple-nerve stimulation AxB.
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Anesthesiol Clin North America · Mar 2003
ReviewMechanisms and management of an incomplete epidural block for cesarean section.
Epidural blockade is an important option for anesthesia in parturients undergoing abdominal delivery. Despite the multiple benefits of this method, there is at least one significant downside--a relatively high occurrence of unsatisfactory anesthesia that requires intervention. Depending on the presumed mechanism of epidural block failure and other clinically relevant factors (e.g., timing of diagnosis, urgency of the procedure, and so forth), certain effective measures are recommended to successfully manage this demanding situation. ⋯ When inadequate epidural block becomes apparent during surgery there are limited alternatives. Depending on the origin and the pattern of inadequate anesthesia, options may include psychological support, supplementation with a variety of inhalational and intravenous agents, and local anesthetic infiltration. Induction of general anesthesia is typically left as a backup option, but must be strongly considered if the patient continues to have pain/discomfort.