Articles: nerve-block.
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Anesthesia and analgesia · May 2000
Randomized Controlled Trial Clinical TrialSedation with sufentanil and midazolam decreases pain in patients undergoing upper limb surgery under multiple nerve block.
Multiple nerve blocks may be painful and a source of discomfort. We assessed the efficacy of sufentanil 5 microg combined with midazolam 1 mg in decreasing pain in outpatients after a midhumeral multiple nerve stimulation technique. Visual analog scores for pain were significantly lower in those patients who received sedation before the block, both at the time of block performance (14 +/- 1 vs 27 +/- 2 mm, P < 0.0001) and at discharge (11 +/- 1 vs 24 +/- 2 mm, P < 0. 0001). We conclude that the association of sufentanil and midazolam produced minimal sedation while significantly reducing pain experienced by patients undergoing multiple nerve stimulation.
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Reg Anesth Pain Med · May 2000
Case ReportsComplete brachial plexus palsy after total shoulder arthroplasty done with interscalene block anesthesia.
This report illustrates that brachial plexus palsy can result from either interscalene block or total shoulder arthroplasty. It is often impossible to determine which procedure caused the deficit; therefore, we believe the focus should be placed on treatment of the neurologic deficit. This report provides a suggested algorithm for diagnosis and treatment of postprocedure brachial plexus palsy. ⋯ Proper diagnosis and treatment of postprocedure brachial plexus palsy may improve recovery of function. Several precautions may reduce the likelihood of brachial plexus palsy following interscalene block for total shoulder arthroplasty.
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Anesthesia and analgesia · May 2000
Meta AnalysisNovel analgesic adjuncts for brachial plexus block: a systematic review.
This article reviews current evidence for the efficacy of adding novel analgesic adjuncts to brachial plexus block, the goal of which is to prolong analgesic effect without the disadvantage of systemic side effects or prolonged motor block. It may also allow for a reduction in the total dose of local anesthetic used. Novel adjuncts studied to date include opioids, clonidine, neostigmine, and tramadol. ⋯ Evidence regarding the analgesic benefit of opioid adjuncts remains equivocal and more evidence is required before their routine use can be recommended. Clonidine appears to have significant analgesic benefit and to cause minimal adverse effects when used in doses up to 150 microg. Data regarding other drugs, such as tramadol and neostigmine, are not sufficient to allow for any recommendations, and further studies are required.
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Acta Anaesthesiol Scand · May 2000
Case ReportsTwo instances of central nervous system toxicity in the same patient following repeated ropivacaine-induced brachial plexus block.
We describe two instances of central nervous system (CNS) toxicity in the same patient following repeated brachial plexus blocks induced by high doses of ropivacaine (6 mg x kg(-1) and 4.5 mg x kg(-1), respectively). Although very high total and free plasma concentrations of ropivacaine were found up to 98 min after induction of the blocks, no signs of cardiovascular toxicity apart from hypertension and sinus tachycardia were observed. ⋯ These high doses, however, resulted in severe toxic CNS symptoms. Therefore, it is stressed that the dose in relation to the weight of the patient must be calculated when administering a large volume of local anesthetic.
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Ann Fr Anesth Reanim · May 2000
Case Reports[Acute toxic accident following lumbar plexus block with bupivacaine].
We report the case of a patient who experienced ventricular dysrhythmias and seizure five minutes after the injection of 30 mL of 0.5% bupivacaine with 1:200,000 epinephrine, during a lumbar plexus block performed via the posterior approach described by Winnie. The patient who underwent his total hip arthroplasty was still anaesthetised and under controlled ventilation at the time of bupivacaine administration. ⋯ Normal cardiac activity and stable haemodynamic condition were restored after one hour of resuscitation including 15 electric shocks and administration of epinephrine (40 mg) and clonidine (300 micrograms). The patient was discharged without neurologic sequelae after four days in the ICU.