Articles: nerve-block.
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Comparative Study Clinical Trial
Outpatient minimally invasive parathyroidectomy: a combination of sestamibi-SPECT localization, cervical block anesthesia, and intraoperative parathyroid hormone assay.
Despite the high cure rate and low morbidity of bilateral neck exploration for primary hyperparathyroidism, there is a movement toward minimizing the process in terms of incision, cost, extent of exploration, and length of hospital stay, while maintaining excellent outcomes. ⋯ Minimally invasive parathyroidectomy is a safe, cost-effective alternative to bilateral exploration and may be the procedure of choice for select patients with primary hyperparathyroidism.
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Clin. Orthop. Relat. Res. · Dec 1999
Analgesia with femoral nerve block for anterior cruciate ligament reconstruction.
Anterior cruciate ligament reconstruction is performed routinely as an outpatient surgical procedure despite few studies of patient acceptance or postoperative patient analgesia. This study reports the first series of postoperative femoral nerve blocks as analgesia for outpatient anterior cruciate ligament reconstruction. The authors retrospectively reviewed 161 patients undergoing two incision arthroscopically assisted autograft middle 1/3 patellar tendon anterior cruciate ligament reconstruction on an out-patient basis at the authors' institution during a period of 30 months. ⋯ However, 69% of patients staying overnight cited reasons other than pain as factors in their stay. No significant complications were reported. Based on these results, the administration of a femoral nerve block is recommended for patients undergoing outpatient anterior cruciate ligament reconstruction because it is a highly effective form of analgesia with an excellent degree of patient satisfaction.
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Although several anterior approaches to sciatic nerve block have been described, they are used infrequently. The authors describe a new anterior approach that allows access to the sciatic nerve with the patient in the supine position. ⋯ This approach represents an easy and reliable anterior technique for performing sciatic nerve blocks.
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Anesthesia and analgesia · Dec 1999
Comparative StudyHyperalgesia caused by nerve transection: long-lasting block prevents early hyperalgesia in the receptive field of the surviving nerve.
The aim of our study was to test the hypothesis that a long-lasting N-butyl tetracaine nerve block (>2 wk) would be much more effective in the prevention of hyperalgesia caused by nerve transection than the short-lasting lidocaine block. The study was performed with the use of the saphenous nerve section model in rats. The saphenous nerve was exposed and injected with saline, lidocaine (37 mM), or N-butyl tetracaine (37 mM). Ten minutes later, the nerve was transected in some of the rats. The development of mechanical hyperalgesia (pressure threshold) of the hindpaw was assessed during a 5-wk period. In rats with saphenous nerve transection without nerve block (saline injection), 3 h after the transection, the pressure threshold decreased by approximately 30% (from 175+/-11 g to 122+/-23 g, P < 0.0001); the threshold increased somewhat the next day, then it remained stable for 2 wk, with a slow process of recovery afterward. N-butyl tetracaine block without nerve transection caused a slow-developing decrease in the pressure threshold with the first statistically significant change at the sixth day. The comparison of the preventive effects of lidocaine and N-butyl tetracaine blocks on early hyperalgesia caused by nerve transection demonstrated that both lidocaine and N-butyl tetracaine prevented hyperalgesia 3 h after the transection. However, the protective effect of lidocaine disappeared the next day. In contrast, N-butyl tetracaine prevented early hyperalgesia for almost a week. The slow-developing late hyperalgesia caused by long-lasting nerve block makes it impossible to study the protective effect of such a block on late hyperalgesia caused by axotomy. As far as early hyperalgesia is concerned, the preventive effect of the N-butyl tetracaine was much longer than that of lidocaine and continued for approximately 1 wk. ⋯ A long-lasting nerve block can prevent early hyperalgesia caused by nerve transection.
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Acta Anaesthesiol Scand · Nov 1999
Randomized Controlled Trial Comparative Study Clinical TrialLateral infraclavicular plexus block vs. axillary block for hand and forearm surgery.
In the last few years infraclavicular plexus block has become a method of increasing interest. However, this block has been associated with high complication incidences and without advantage in the quality of blockade over the axillary approach. We prospectively studied 40 patients (ASA I-III) undergoing surgery of the forearm and hand, and investigated the performance of the lateral infraclavicular plexus block against an axillary paravascular block to evaluate the success rate as well as the extent and quality of blockade. ⋯ Based on the safe landmark and feasibility of this procedure and the additional spectrum of nerve block achieved, the application of lateral infraclavicular technique has to be reconsidered in clinical practice.