Articles: nerve-block.
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Multicenter Study
A national census of central neuraxial block in the UK: results of the snapshot phase of the Third National Audit Project of the Royal College of Anaesthetists.
The first stage of the Royal College of Anaesthetists Third National Audit Project to assess the incidence of major complications of central neuraxial block in the UK was a 2-week national census of block use. A reporting system was established in the 309 National Health Service hospitals believed to undertake surgical work and data were received from 304, a response rate of 98.7%. ⋯ The total number of procedures reported as being performed in the 2-week period was 27,533: extrapolation using a multiplier of 25 suggests that nearly 700,000 major blocks are performed annually (315,000 spinals, 287,000 cervical, thoracic or lumbar epidurals, 42,000 combined spinal-epidurals and 56,000 caudal epidurals). After the second stage of the project, which will record complications from the same hospitals over a 12-month period, these data will be used as denominators to calculate the incidences of complications.
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Multicenter Study Comparative Study
Regional anaesthesia for carotid endarterectomy: an audit over 10 years.
The aim of this retrospective study was to compare the failure rates and the frequency of anaesthesia-related complications of two different methods of regional anaesthesia used for carotid endarterectomy--cervical epidural (CE) anaesthesia and cervical plexus block (CPB). ⋯ Both methods of regional anaesthesia are acceptable for carotid artery surgery. CPB is associated with a significantly lower frequency of anaesthesia-related complications and should therefore be considered the anaesthetic of choice. CE anaesthesia should not be performed except in extenuating circumstances such as variant anatomy or the requirement for more extensive surgery.
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Ann Fr Anesth Reanim · Sep 2007
Multicenter Study[Peripheral nerve block in orthopaedic surgery: multicentric evaluation of practicing professionals and impact on the activity of the recovery room].
Since the last national survey on evaluation of professional practice in France, many peripheral nerve blocks techniques were developed. The aim of this study was to assess the place of such techniques and their impact on the stay in recovery room after orthopaedic surgery. ⋯ This survey confirms that peripheral nerve block became widely used in orthopaedic surgery. This decreases the medical workload in PACU, especially for distal upper limb surgery. Regional anaesthetic techniques must be well taught during formation cursus of residents.
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Multicenter Study Comparative Study
Prospective evaluation of electroencephalography, carotid artery stump pressure, and neurologic changes during 314 consecutive carotid endarterectomies performed in awake patients.
This study attempted to correlate neurologic changes in awake patients undergoing carotid endarterectomy (CEA) under cervical block anesthesia (CBA) with electroencephalography (EEG) and measurement of carotid artery stump pressure (SP). ⋯ Ten percent of patients required a shunt placement during CEA under CBA. Shunt placement was necessary in 56.8% of patients with SP less than 40 mm Hg. EEG identified cerebral ischemia in only 59.4% of patients needing shunt placement, with a false-positive rate of 1.0% and a false-negative rate of 40.6%. Both SP and EEG as a guide to shunt placement have poor sensitivity. Intraoperative monitoring of the awake patients under regional anesthesia (CBA) is the most sensitive and specific method to identify patients requiring shunt placement.
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Continuous peripheral nerve block (CPNB) is the technique of choice for postoperative analgesia after painful orthopedic surgery. However, the incidence of neurologic and infectious adverse events in the postoperative period are not well established. This issue was the aim of the study. ⋯ CPNB is an effective technique for postoperative analgesia. Minor incidents and bacterial colonization of catheters are frequent, with no adverse clinical consequences in the large majority of cases. Major neurologic and infectious adverse events are rare.