Articles: nerve-block.
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Clinical Trial
[Cervical echomyography in cervical dystonia and its application to the monitoring for muscle afferent block (MAB)].
Muscle afferent block (MAB) is an intramuscular injection of 0.5% lidocaine and pure ethanol with a volume ratio of 10:1, introduced as an alternative to botulinum toxin injection for focal dystonia and spasticity. As in the case of botulinum toxin injection, the precise localization of target muscles is crucial to obtain the maximal effect from MAB. For this purpose, we performed ultrasonography of cervical muscles (echomyography) in 20 patients with cervical dystonia (11 men, 9 women; mean age 46.1), with ultrasonograph SSD-5500 (Aloca Co. ⋯ On the other hand, the movement stopped only temporarily after the injection of saline or lidocaine only. In 3 out of 16 patients, some of the uninjected synergists were activated as if to substitute for the treated muscle just after the injection. We conclude that cervical echomyography is useful to investigate the pattern of muscle activity in cervical dystonia and to accurately localize the contracting muscles during MAB.
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This is a prospective study of patients referred to a tertiary care center with permanent alteration in sensation of the inferior alveolar nerves, lingual nerves or both that could have resulted only from an inferior alveolar nerve block. ⋯ Permanent nerve damage can very occasionally occur as a result of an inferior alveolar nerve block. The exact mechanism is unknown, and there is no means of prevention. Knowledge of the risks and complications of local anesthesia is essential.
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Case Reports
[Brachial plexus. Long lasting neurological deficit following interscalene blockade of the brachial plexus].
An interscalene block of the brachial plexus was combined with general anaesthesia for repair of a complex chronic lesion of the shoulder. The localisation of the plexus with electro-stimulation and the injection of Bupivacain 0.5% were accomplished easily and without painful sensations. 48 hours later the block was still partially present. ⋯ The cause could have been due to direct traumatisation during blockade or operation, toxic action of the injected substance (Bupivacain 0.5%, 30 ml), distension of the plexus, a cervical syndrome or an aseptic plexitis, although a definite determination is not possible. However, the pattern of the lesion and the lack of pain during localisation of the plexus and injection favour traumatisation during the acromioplasty.