Articles: nerve-block.
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Ann Fr Anesth Reanim · Dec 2002
Case Reports[Multitruncular block at the elbow for a major hand trauma for prehospital care].
Upper limb peripheral nerve blocks offer many advantages but they are not widely used in prehospital care. We report the case of a multitroncular block at the elbow made by the emergency department team out of the hospital after a major hand trauma. A successful axillary brachial plexus block was done two hours later, without any problem. This case report allows us to discuss about different analgesia techniques useful in prehospital care.
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Most local anaesthetic blocks are placed blindly, based on a sound knowledge of anatomy. Very often the relationship between the site of deposition of local anaesthetic and the nerve to be blocked is unknown. Large motor neurons may be stimulated with the aid of an electrical current. ⋯ The accuracy of local anaesthetic blocks can be improved by this technique. By using the lowest possible current a needle could be positioned with in 2-5 mm of a nerve. The correct duration of stimulation ensures that stimulation of sensory nerves does not occur The use of electrical nerve stimulation in veterinary medicine is a novel technique that requires further evaluation.
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To review the current recommendations and literature on training in regional anesthesia and suggest an improved model to prepare graduating residents better in the practice of regional anesthesia. ⋯ A structured regional anesthesia rotation, a dedicated team of mentors with training in regional anesthesia, and adequate clinical volume are a pre-requisite for adequate training, but they may not be available in many anesthesia residency training programs. As the demand for regional anesthesia continues to increase in the years to come, it is imperative to ensure adequate education of graduating residents to meet this demand. In order to achieve this goal, the present recommendations should be re-evaluated, and perhaps a proficiency in a core group of widely applicable and relatively simple nerve blocks should be mastered by all graduates.
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Diagnostic blocks are used to obtain information about the source of a patient's pain. As such they differ in principle and in practice from regional anaesthetic blocks. In order to be valid, diagnostic blocks must be precise and target-specific. ⋯ This warns that sympathetic blocks must be controlled in each and every case lest false conclusions be drawn about the response. Medial branch blocks of the lumbar and of the cervical dorsal rami have been extensively investigated in order to establish their validity, diagnostic utility and therapeutic utility. They provide an example and benchmark for how diagnostic blocks can and should be validated.