Articles: nerve-block.
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Studies in normal volunteers have demonstrated that the lateral atlanto-axial joints (C1-2) are capable of causing pain in the occiput, but few clinical studies have validated this source of occipital headache. The present study tested the null hypothesis that the lateral atlanto-axial joints are not a common source of occipital headache. ⋯ The clinical features used to select patients for blocks, however, had a positive predictive value of only 60%. Further study of headaches from C1-2 seems justified in order to establish more definitively the prevalence of this condition and how it might become better recognized in practice.
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Anesthesia and analgesia · Feb 2002
Randomized Controlled Trial Comparative Study Clinical TrialParavertebral blockade for minor breast surgery.
Paravertebral blockade (PVB) has been advocated as a useful technique for breast surgery. We prospectively compared the efficacy of PVB via a catheter technique with the efficacy of general anesthesia (GA) for minor breast surgery. Thirty patients were randomized into two groups to receive either PVB or GA. Variables of efficacy were postoperative pain measured on a visual analog scale, postoperative nausea and vomiting (PONV), recovery time, and patient satisfaction. Postoperative visual analog scale scores in the PVB group were significantly lower in the early postoperative period (maximum, 12 vs 45 mm; P < 0.01). In both groups, PONV was nearly absent. There was no difference in recovery time. Patient satisfaction was better in the PVB group (2.8 vs 2.3; scale, 0-3; P < 0.01). There was one inadvertent epidural block and one inadvertent pleural puncture in the PVB group. Although PVB resulted in better postoperative pain relief, the advantages over GA were marginal in this patient group because postoperative pain was relatively mild and the incidence of PONV was small. Considering that the technique has a certain complication rate, we conclude that at present the risk/benefit ratio of PVB does not favor routine use for minor breast surgery. ⋯ This study confirms the previously reported superior pain relief after paravertebral blockade (PVB) for breast surgery. However, considering the relatively mild postoperative pain and therefore the limited advantage of PVB for these patients, the risk/benefit ratio does not favor the routine use of PVB for minor breast surgery.
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Arch Phys Med Rehabil · Feb 2002
Case ReportsPersistent paraplegia after an aqueous 7.5% phenol solution to the anterior motor root for intercostal neurolysis: a case report.
A 55-year-old white man with severe scoliosis and chest deformity was scheduled for an intercostal neurolysis for pain relief with 7.5% aqueous phenol solution. A 20 G needle was inserted 3 to 4cm lateral to the midline of the spine under the 10th right rib. After negative aspiration for blood and alcohol, 6mL of a 7.5% aqueous phenol solution was injected. ⋯ A lumbar puncture done 3.5 hours after the block showed a phenol concentration of 87.5 microg/mL. The most likely explanation is a diffusion of the phenol through the intervertebral foraminae reaching the spinal space and therefore damaging the motor and sensory roots. This case highlights the danger associated with phenol application in the vicinity of the spinal cord.
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Rev Esp Anestesiol Reanim · Feb 2002
Case Reports[Infraclavicular brachial plexus block using a multiple injection technique and an approach in the cranial direction in a patient with anticipated difficulties in tracheal intubation].
A man with a pathologic diaphysial fracture of the middle third of the left humerus underwent emergency surgery for osteosynthesis of the fracture. Preoperative examination revealed that intubation would be difficult due to a history of radical surgery for epidermoid carcinoma of the oropharynx, and local-regional anesthesia was therefore considered. ⋯ Among the various levels of brachial plexus blockade, the infraclavicular option is little known and the least utilized, considering that one of its advantages is that the upper limb does not need to be moved for referencing (giving it an advantage over the axillary block) and that it has a lower incidence of pneumothorax (in comparison with a supraclavicular approach). Combined with a multiple injection technique and puncture in a cephalad direction, this solution allowed proximal surgery to be performed on the arm of a patient in whom intubation would have been difficult.