Articles: nerve-block.
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Anesthesia and analgesia · Jul 2002
Comparative Study Clinical TrialLevobupivacaine for axillary brachial plexus block: a pharmacokinetic and clinical comparison in patients with normal renal function or renal disease.
We compared the pharmacokinetics and clinical characteristics of 0.5% levobupivacaine for axillary block in patients with normal renal function versus patients with end-stage renal disease (ESRD). Twenty patients with normal renal function and eight patients with ESRD received an axillary block with 50-60 mL of 0.5% levobupivacaine. Patients were evaluated for onset and duration of sensory/motor block. Eleven patients with normal renal function and eight patients with ESRD underwent pharmacokinetic analysis. No differences between groups were found in the onset, duration, or quality of block. The median time to sensory block was 12.5 min and 12.9 min, and mean duration of the block was 19 h and 22 h in normal versus ESRD patients, respectively. No significant differences in noncompartmental pharmacokinetic variables (median) were found between normal and ESRD patients with an AUC(0-t) (microg. h(-1). mL(-1)) of 11 and 13, peak concentration (C(max)) (microg/mL) of 1.2 and 1.6, and a time to peak concentration (T(max)) (min) of 55 and 48, respectively. This study demonstrates the clinical efficacy and equivalence of the pharmacokinetic characteristics of 0.5% levobupivacaine for axillary brachial plexus block in patients with ESRD and normal renal function. ⋯ This study demonstrates the clinical efficacy and equivalence of the pharmacokinetic characteristics of 0.5% levobupivacaine for axillary brachial plexus block in patients with renal disease and normal renal function.
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Endoscopic thoracic sympathectomy or sympathicotomy of the lower part of the stellate ganglion is an efficient method for the treatment of craniofacial hyperhidrosis, but postoperative compensatory sweating may be troublesome in some patients. Needlescopic thoracic sympathetic block by clipping may achieve a similar effect as well as providing a possible reverse operation for patients who suffer from intolerable postoperative compensatory sweating. ⋯ Needlescopic thoracic sympathetic block by clipping is a safe and effective method for the treatment of craniofacial hyperhidrosis; compensatory sweating may be improved after a reverse operation and removal of the endo clips.
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Anesthesia and analgesia · Jul 2002
Case ReportsThe resolution of ST segment depressions after high right thoracic paravertebral block during general anesthesia.
Thoracic epidural, stellate ganglion, and thoracic paravertebral blocks all relieve angina. We report a case of intraoperative resolution of ST segment depression after a right thoracic paravertebral block.
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For correction of a shoulder instability (Bankart's operation) in a 33-year-old woman, a combined regional and general anaesthesia was chosen. An interscalene catheter to block the brachial plexus was placed preoperatively without complication. The following day this resulted in an upper extremity almost without motor function and with complete hypoesthesia of the dermatomes C5-C7. ⋯ Stimulation of the three truncs of the brachial plexus was possible and showed electrophysiological signs of recovery of distal parts of the plexus. After 2 years no clinical corresponding recovery could be observed. Despite all investigations (electroneuromyography, evoked potentials, etc.) no clear etiology could be established to explain this adverse outcome.