Articles: nerve-block.
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Randomized Controlled Trial Comparative Study Clinical Trial
Does intraarticular morphine improve pain control with femoral nerve block after anterior cruciate ligament reconstruction?
In a prospective, randomized, double-blinded manner, we compared the effects of a preoperative intraarticular injection of morphine (5 mg) or a placebo, combined with a postoperative femoral nerve block, on postoperative pain. Sixty-two patients underwent an arthroscopically assisted anterior cruciate ligament reconstruction using patellar tendon autograft under general anesthesia. No statistical difference between the two groups was evident in terms of age, sex, weight, operative time, volume of bupivacaine received with the femoral nerve block, or tourniquet use or tourniquet time. ⋯ No significant difference in postoperative narcotic medication use was evident in the recovery room or at home. A post hoc power analysis revealed that the study power reached 87%, with a significance level of 5%. The postoperative femoral nerve block was effective, and intraarticular morphine provided no additional benefit.
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The interscalene brachial plexus block with and without a catheter has become an indispensable method for anaesthesia and analgesia in shoulder surgery. Not only thorough knowledge of anatomy, but also accurate indication assessment and discussion with the surgeon regarding the location of access, is essential for the successful practice of this technique. Important and practical tips for implementation should especially help the less experienced, with special emphasis on correct positioning of the patient for surgery to avoid iatrogenic neural damage. Preoperative counselling of inevitable side-effects of the technique enhances the patient's acceptance and satisfaction.
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Celiac plexus neurolysis is an established technique for relieving pain in cancers of the upper abdomen. This article reviews the novel technique of endoscopic ultrasound (EUS)-guided neurolytic celiac plexus block. This recently described procedure is a therapeutic extension of curvilinear array endosonographic fine needle aspiration. ⋯ We believe that where the expertise is available, this procedure can be integrated into the diagnostic EUS of patients with inoperable upper abdominal malignancy. As such, this would be the safest and most cost-effective approach for celiac plexus neurolysis in these patients. The role of EUS-guided celiac plexus block in patients with chronic pancreatitis may be emerging and needs further study.
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Reg Anesth Pain Med · May 2001
Randomized Controlled Trial Comparative Study Clinical TrialRegional block and mexiletine: the effect on pain after cancer breast surgery.
Breast surgery for cancer is associated with chronic pain and sensory abnormalities. The present study investigates the effect of regional block, oral mexiletine, and the combination of both, on acute and chronic pain associated with cancer breast surgery. ⋯ Regional block reduced the analgesic requirements in the early postoperative period, while mexiletine combined with regional block reduced the total analgesic requirements during the next 5 postoperative days. Although chronic pain was not affected by these treatments late-abnormal sensation may be diminished by combination of these treatments. Reg Anesth Pain Med 2001;26:223-228.