Articles: nerve-block.
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Anesthesia and analgesia · Oct 2001
Randomized Controlled Trial Comparative Study Clinical TrialA new posterior approach to the sciatic nerve block: a prospective, randomized comparison with the classic posterior approach.
To evaluate the efficacy and acceptance of a new posterior subgluteus approach to the sciatic nerve, as compared with the classic posterior approach, 128 patients undergoing foot orthopedic procedures were randomly allocated to receive either the classic posterior sciatic nerve block (Group Labat, n = 64) or a modified subgluteus posterior approach (Group subgluteus, n = 64). All blocks were performed with the use of a nerve stimulator (stimulation frequency, 2 Hz; intensity, 1-0.5 mA). In Group subgluteus, a line was drawn from the greater trochanter to the ischial tuberosity; then, from the midpoint of this line, a second line was drawn perpendicularly and extended caudally for 4 cm. The end of this line represented the needle entry. In both groups, a proper sciatic stimulation was elicited at 0.5 mA; then 20 mL of 0.75% ropivacaine was injected. The time from needle insertion to successful sciatic nerve stimulation was 60 s (range, 10-180 s) with the Labat's approach and 32 s (range, 5-120 s) with the new subgluteus approach (P = 0.0005). The depth of appropriate sciatic stimulation was 45 +/- 13 mm (mean +/- SD) after 2 (range, 1-7) needle redirections in Group subgluteus and 67 +/- 12 mm after 4 (range, 1-10) needle redirections in Group Labat (P = 0.0001 and P = 0.00001, respectively). The failure rate was similar in both groups. Severe discomfort during the procedure was less frequent and acceptance better in Group subgluteus (5 patients [8%] and 60 patients [94%], respectively) than in Group Labat (20 patients [31%] and 49 patients [77%], respectively) (P = 0.0005 and P = 0.005, respectively). We conclude that this new subgluteus posterior approach to the sciatic nerve is an easy and reliable technique and can be considered an effective alternative to the more traditional Labat's approach. ⋯ Evaluating the efficacy and acceptance of a new approach to the sciatic nerve block, this prospective, randomized study demonstrated that the new subgluteus posterior approach is an easy and reliable technique and can be considered an useful alternative to the more traditional Labat's approach in patients undergoing foot surgery, facilitating the performance of the sciatic nerve blocks.
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Acta Anaesthesiol Scand · Oct 2001
ReviewNerve blocks in chronic pain therapy--are there any indications left?
Although diagnostic imaging is now highly developed, neural blockade provides another opportunity to test for a source of pain that may frequently leave no signature. Likewise, many neuropathic pains can not be tested by neurodiagnostic methods. ⋯ In particular, the example of autonomic blocks and blocks of the axial spine are emphasized. Nerve blocks require an understanding of the anatomy, physiology, pharmacology, and the ability to interpret critically their results.
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Ann Fr Anesth Reanim · Oct 2001
Randomized Controlled Trial Comparative Study Clinical Trial[Comparison between 1.5% lidocaine with adrenaline and 1.5% plain mepivacaine in axillary brachial plexus block].
To evaluate the distribution of sensory blockade, the onset time and the duration of the axillary plexus block obtained after the administration of 40 mL of 1.5% lignocaine with adrenaline or 40 mL of plain 1.5% mepivacaine. ⋯ Following axillary plexus block, 1.5% mepivacaine improves neither the extension nor the duration of sensory blockade achieved by 1.5% lignocaine with adrenaline.
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This is the sixth in our series of regional nerve blocks. Femoral nerve blocks by a lateral approach, have the potential to block the lumbar plexus if sufficient volume is used.