Articles: nerve-block.
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Reg Anesth Pain Med · Jan 2000
Clinical Trial1,001 subclavian perivascular brachial plexus blocks: success with a nerve stimulator.
Among the supraclavicular approaches to the brachial plexus, the subclavian perivascular technique is a well-established method of anesthesia of the upper extremity. Ever since Kulenkampf described his technique, eliciting a paresthesia has been almost mandatory ("no paresthesia, no anesthesia"). Lately, nerve stimulators have become more popular. However, up to the present time, clinical studies involving the nerve stimulator have failed to show success rates comparable to paresthesia techniques. ⋯ The subclavian perivascular block consistently provides an effective block for surgery on the upper extremity. At the site of injection with this technique, the plexus is reduced to its smallest components and the sheath is reduced to its smallest volume, which explains in great part the success obtained with this block. We believe that we have demonstrated a nerve stimulator technique that is both highly successful and safe; no clinical pneumothorax was found nor did any other major complications develop.
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Anesthesia and analgesia · Jan 2000
Randomized Controlled Trial Clinical TrialThree-in-one blocks with ropivacaine: evaluation of sensory onset time and quality of sensory block.
The purpose of this prospective, randomized, double-blinded study was to evaluate the sensory onset time and the quality of sensory block of ropivacaine, a new long-acting local anesthetic, compared with bupivacaine, for 3-in-1 blocks. Fifty ASA physical status I-III patients undergoing hip surgery after trauma were randomly assigned to two study groups of 25 patients each. The two study groups received a 3-in-1 block with either 20 mL of ropivacaine 0.5% or 20 mL of bupivacaine 0.5%. Blocks in both groups were performed using a nerve stimulator. The sensory onset time and the quality of sensory block was assessed by pinprick test in the central sensory region of each of the three nerves and compared with the same stimulation in the contralateral leg. We used a scale from 100% (normal sensation) to 0% (no sensory sensation). We did not find significant differences in sensory onset times between the ropivacaine group and the bupivacaine group (30+/-11 vs 32+/-10 min). The quality of sensory blocks was also comparable between the study groups (19%+/-20% vs 21%+/-15%). We conclude that the sensory onset time and quality of sensory block during 3-in-1 blocks performed with ropivacaine are comparable to those with bupivacaine. Ropivacaine is described as being less potent than bupivacaine, making this local anesthetic promising for 3-in-1 blocks because of its reportedly lower incidence of cardiovascular and central nervous system complications. ⋯ Ropivacaine 0.5% has a sensory onset time and quality of sensory block during 3-in-1 blocks similar to that of bupivacaine 0.5%. Ropivacaine is described as being less potent than bupivacaine, making it a promising local anesthetic for 3-in-1 blocks because of its reportedly lower cardiovascular and central nervous system toxicity.
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Minerva anestesiologica · Jan 2000
Randomized Controlled Trial Comparative Study Clinical TrialInterscalene brachial plexus anesthesia with either 0.5% ropivacaine or 0.5% bupivacaine.
To compare intra- and postoperative clinical properties of interscalene brachial plexus block performed with either 0.5% ropivacaine or 0.5% bupivacaine. ⋯ This study confirmed that 0.5% ropivacaine has clinical properties similar to those of 0.5% bupivacaine, when used for interscalene brachial plexus block, providing similarly long duration in postoperative pain relief. Compared with bupivacaine, ropivacaine has the further advantage of a lower potential for central nervous system and cardiovascular toxicity.
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Paediatric anaesthesia · Jan 2000
Randomized Controlled Trial Clinical TrialThe efficacy of pre- versus postsurgical axillary block on postoperative pain in paediatric patients.
We compared the effects of pre- and postsurgical axillary block on pain after hand and forearm surgery in 55 children in a double-blind randomized study. The successful blocks are reported here (n=49). Children aged 1-11 years and ASA I or II were allocated randomly to receive axillary block with 2 mg.kg-1 of 0.25% bupivacaine, either after induction but before the surgery (presurgical group, n=25) or immediately after surgery, before the end of anaesthesia (postsurgical, n=24). ⋯ Additional analgesic consumption was similar in these patients in both groups. A lower isoflurane concentration was used in the presurgical group (0.68% vs 1.72%, P< 0.001). We did not demonstrate the superiority of preemptive analgesia, but our results indicate that presurgical axillary block with 0.25% bupivacaine allows the use of inhalational anaesthetics at lower concentrations while providing a reasonably painless postoperative period.