Articles: nerve-block.
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Case Reports
Paravertebral somatic nerve blocks for breast surgery in a patient with hypertrophic obstructive cardiomyopathy.
Patients with hypertrophic obstructive cardiomyopathy (HOCM), a genetic disorder resulting in idiopathic myocardial thickening, can present the anesthesiologist with significant management difficulties. This report reviews the physiology of this important disease process and describes the use of paravertebral nerve blocks (PVB) in the management of a patient with HOCM who presented for partial mastectomy with axillary lymph node dissection. ⋯ PVB provide excellent analgesia and are a useful alternative anesthetic when faced with the HOCM patient requiring major breast surgery.
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Patients receiving anticoagulants offer a challenge to anaesthesiologists. The issue of spinal haematoma following central neuraxial block in such patients is a contentious issue. Although rare, with an estimated incidence of < 1:150,000 for epidural blocks and 1:220,000 for spinal anaesthetics in patients with normal coagulation status, this is an emergency situation with a potentially grave prognosis. ⋯ Of the 60 cases reported in the literature, 33% occurred following central neuraxial block and, of these, 55% were associated with concomitant use of anticoagulants. The pharmacology of the newer and older anticoagulants is also described. The variety of risk factors and diverse recommendations that have been described in these patients are reviewed.
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Reg Anesth Pain Med · May 2002
Percutaneous electrode guidance: a noninvasive technique for prelocation of peripheral nerves to facilitate peripheral plexus or nerve block.
Typically, peripheral nerve block is done by approximating nerve location, usually by use of anatomical landmarks. Precise nerve location has been done by needle exploration. A new method, percutaneous electrode guidance (PEG) of the block needle, was performed. A transcutaneous stimulating cylindrical electrode was used to indent the skin, locate the underlying nerve, and guide a block needle near it. ⋯ A smooth, metal-tipped electrically shielded skin electrode probe can be used to comfortably and accurately indent the skin over a desired nerve or plexus, define its anatomical course, and subsequently guide a block needle near it.
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Reg Anesth Pain Med · May 2002
Case ReportsMandibular nerve block treatment for trismus associated with hypoxic-ischemic encephalopathy.
We describe the use of mandibular nerve block for the management of bilateral trismus associated with hypoxic-ischemic encephalopathy. ⋯ Mandibular nerve block may be an effective treatment for patients with bilateral trismus due to ischemic-encephalopathy, even when consciousness is impaired.