Articles: nerve-block.
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Oral Surg Oral Med O · Aug 2001
Randomized Controlled Trial Comparative Study Clinical TrialAnesthetic efficacy of unilateral and bilateral inferior alveolar nerve blocks to determine cross innervation in anterior teeth.
The purpose of this prospective randomized study was to measure the degree of anesthesia obtained with unilateral and bilateral inferior alveolar nerve blocks to determine whether cross innervation occurs in anterior teeth. ⋯ Cross innervation does seem to occur in mandibular central and lateral incisors. However, the success rates in these teeth with bilateral inferior alveolar nerve blocks were below 75%. The failure of the inferior alveolar nerve blocks to anesthetize the anterior teeth was the overriding reason for failure. Clinically, bilateral inferior alveolar nerve blocks to provide profound pulpal anesthesia in mandibular anterior teeth are not recommended on the basis of the results of this study.
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Case Reports
Ipsilateral thoraco-lumbar anaesthesia and paravertebral spread after low thoracic paravertebral injection.
We report ipsilateral thoraco-lumbar anaesthesia and paravertebral spread of contrast after injection through a thoracic paravertebral catheter that was placed at the right T8-9 spinal level for pain management in a patient with multiple fractured ribs. We review the literature and describe the subendothoracic fascial communication between the thoracic paravertebral space and the retroperitoneal lumbar paravertebral region, which we propose, is the anatomical basis for ipsilateral thoraco-lumbar anaesthesia and paravertebral spread of contrast in our patient.
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Anesthesia and analgesia · Aug 2001
An evaluation of the infraclavicular block via a modified approach of the Raj technique.
Infraclavicular plexus block has recently become a technique of increasing interest. However, no approach has provided easily identifiable landmarks, good conditions for catheter placement, and lack of complications (mainly pneumothorax). We describe a modified approach of the Raj technique based on the identification of the anterior acromial process, jugular notch, and emergence of the axillary artery within the axillary fossa, with the arm abducted to 90 degrees and elevated by approximately 30 degrees. We evaluated the clinical characteristics of this approach by injecting 40 to 50 mL of ropivacaine 0.6% in 150 patients scheduled for elective surgery of the forearm, wrist, or hand. Success was defined as a sensory block of the 5 nerves with territories distal to the elbow within 30 min after performing the block. The success rate was 97% when a distal response (flexion or extension of the wrist or fingers) was elicited and 44% when a proximal (contraction of the triceps, biceps) was obtained using a nerve stimulator. Complications were rare: aspiration of blood was seen in 2% of patients and hematoma was seen at the puncture site in 0.6%; no pneumothorax occurred. Eleven patients (7%) complained of some pain during the procedure. We conclude that the modified approach of the Raj technique for infraclavicular block is very effective when a distal nerve stimulator response is obtained with a small complication rate and a high degree of patient satisfaction. ⋯ We describe a modified approach of the Raj technique for the infraclavicular brachial plexus. The elicitation of a distal nerve stimulator response is associated with a high success rate, a low incidence of complications and a high degree of patient satisfaction.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Aug 2001
Case Reports[Frozen shoulder--MRI-verified continuous block of suprascapular nerve].
Suprascapular nerve block may provide sufficient analgesia in painful immobilisation of the shoulder joint. In the following case report a 41 year old male presenting with adhesive capsulitis (frozen shoulder) has been treated successfully by performing continuous delivery of local anesthetics to the suprascapular nerve via catheter. The location of the catheter has been verified using MRI examination. ⋯ The technique of catheterization using a nerve stimulator and alternative peripheral nerve blocks are discussed. In summary, continuous suprascapular nerve block offers an advantageous alternative for pain relief in patients with frozen shoulder. It may provide better pain control and earlier discharge in the ambulatory setting than repetetive single dose blocks.
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Anesthesia and analgesia · Aug 2001
A study of the paravertebral anatomy for ultrasound-guided posterior lumbar plexus block.
We investigated the feasibility of posterior paravertebral sonography as a basis for ultrasound-guided posterior lumbar plexus blockades. Posterior paravertebral sonography proved to be a reliable as well as accurate imaging procedure for visualization of the lumbar paravertebral region except the lumbar plexus.