Articles: nerve-block.
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Anesthesia and analgesia · Oct 2000
Randomized Controlled Trial Comparative Study Clinical TrialHyaluronidase as an adjuvant in bupivacaine-lidocaine mixture for retrobulbar/peribulbar block.
Hyaluronidase 7.5 IU/mL added to the local anesthetic improves peribulbar block, but smaller concentrations have not been shown to be effective. In this prospective, double-blinded study, 714 consecutive ocular surgery patients were randomized into three groups: no hyaluronidase (n = 241), hyaluronidase 3.75 IU/mL (n = 244), and hyaluronidase 7.5 IU/mL (n = 229). Retrobulbar/peribulbar block was performed with two injections of a 1:1 mixture of bupivacaine 0.75% and lidocaine 2%, 6-8 mL. Patient data were collected on demographics, initial volume of local anesthetic, need for supplementary block, and akinesia of the anesthetized eye. When hyaluronidase was used (3.75 or 7.5 IU/mL), the initial block was sufficient and the anesthetized eye was akinetic significantly more often than in the group without hyaluronidase. The hyaluronidase groups (3.75 and 7.5 IU/mL) did not differ significantly in any respect. We conclude that the addition of hyaluronidase 3.75 or 7.5 IU/mL improved the success of the initial retrobulbar/peribulbar block and akinesia and reduced the need for supplementary block. ⋯ We conclude that the addition of hyaluronidase 3.75 or 7.5 IU/mL improved the success of the initial retrobulbar/peribulbar block and akinesia and reduced the need for supplementary block.
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Comparative Study Clinical Trial Controlled Clinical Trial
Local anaesthetic for minor oral surgical procedures. Review.
Pain following any surgical procedure is difficult to combat by man. Analgesics can be given for some amount of symptomatic relief. The need for a long lasting local anaesthetic is with the intention to reduce the most severe nature of pain, and decrease the analgesic consumption. ⋯ This is not sufficient since the most severe nature of pain is felt six to eight hours post surgery, where as Bupivacaine has duration of action of seven to eight hours. Hence the post operative pain experienced following administration of bupivacaine was found to be considerably lesser in degree than compared to the lidocaine group. To avoid severe pain and discomfort to the patient following any minor oral surgical, the use of bupivacaine is recommended.
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Randomized Controlled Trial Clinical Trial
Clonidine prolongs the effect of ropivacaine for axillary brachial plexus blockade.
To evaluate the effect of adding clonidine to ropivacaine, for axillary brachial plexus blockade, on the onset and duration of sensory and motor block and duration of analgesia. ⋯ The addition of 150 microg of clonidine to ropivacaine, for brachial plexus blockade, prolongs motor and sensory block and analgesia, without an increased incidence of side effects.
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Review
The advantages and disadvantages of Bier's blocks and haematoma blocks for Colles' fractures in A&E.
In the author's current area of practice the use of either the Bier's block or haematoma block for manipulating distal radial fractures seems to have been based mostly on the A&E consultant's preference. The purpose of this literature review was to determine if there was sufficient evidence on the advantages and disadvantages of each method of regional anaesthesia to advocate the general use of one and the exclusion of the other. When reviewing the literature the author specifically looked in to three key areas to answer this question: 1) the patient's perception of pain experienced during and after the manipulation; 2) patient safety i.e. the documented risks of the anaesthetic type used; and 3) the success of the manipulation as determined by repeat radiographs immediately after the application of a plaster of Paris cast.
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A 72-year-old female with severe heart failure due to rheumatoid myocarditis underwent open reduction of the left femoral neck (trochanteric) fracture. We performed psoas compartment block (PCB) at L3/4 level in the lateral position with the fractured side up, using a 22 G Tuohy needle to inject 10 ml of normal saline and 20 ml of 2% mepivacaine. ⋯ The patient did favorably during and after the operation. We conclude that PCB is useful for surgery of the lower extremity in patients with heart failure.