Articles: nerve-block.
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Continuous interscalene brachial plexus blockade can provide anesthesia and analgesia in the shoulder region. Difficulty accessing the interscalene space and premature displacement of interscalene catheters may preclude their use in certain situations. We present two case reports in which a catheter was advanced from the axilla along the brachial plexus sheath to the interscalene space to provide continuous cervicobrachial plexus analgesia. ⋯ In the second case report, a catheter was inserted in a similar fashion from the axillary to the interscalene space to provide 14 days of continuous analgesia in the management of complex regional pain syndrome. We have found that this technique allows us to secure the catheter more easily than with the traditional interscalene approach and thus prevents premature dislodgment. This approach may be a suitable alternative when either an interscalene or an infraclavicular catheter may not be inserted.
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We describe a way of achieving immediate painfree mobilisation after tenolysis or tenosynovectomy in Zone II. Bupivacaine is instilled along the flexor tendon sheath through a thin percutaneous catheter with an antibacterial filter.
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The objective of the study was to devise a method to facilitate catheter placement to perform brachial plexus block in the dog. Lidocaine plus epinephrine was injected through a 3.5 French feeding tube secured in proximity of the brachial plexus. Cutaneous areas for the nerves of the distal forelimb were tested for nociceptive sensation by pinching the skin with hemostats. ⋯ A second blockade was successfully achieved in 2 dogs in which the catheter was not displaced. An indwelling feeding tube is an effective way to provide blockade of the brachial plexus in the dog. The placement and the fixation of the catheter were critical for the production of a full block.
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Classical supraclavicular brachial plexus block was used as the sole anaesthetic technique in 200 children aged between 5 and 12 years undergoing closed reduction of arm fractures. The local anaesthetic used was lidocaine 1.5% with epinephrine. The block was graded as satisfactory if surgical manipulation could be performed without discomfort and unsatisfactory if general anaesthesia had to be given. ⋯ There were few complications, with no incidence of pneumothorax in any patient. The acceptability of the block by the children and the parents was 72 and 85%, respectively. The classical supraclavicular brachial plexus block was found to be acceptable, effective and with a good success rate.