Articles: nerve-block.
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J. Cardiothorac. Vasc. Anesth. · Dec 1999
Randomized Controlled Trial Clinical TrialPlasma bupivacaine concentrations and effects of epinephrine after superficial cervical plexus blockade in patients undergoing carotid endarterectomy.
To determine if epinephrine (EPI) added to a solution of bupivacaine (BUP) injected for use in superficial cervical plexus blockade (SCPB) lowers plasma BUP concentrations after injection and whether this addition of EPI resulted in tachycardia, cardiac arrhythmias, or both. ⋯ BUP 0.25% consistently produced the lowest plasma BUP concentrations, particularly when EPI was added to the solution. BUP 0.5% without EPI can produce plasma BUP concentrations previously reported to be associated with central nervous system effects. The use of EPI in this setting does not produce untoward cardiac side effects.
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Anesthesia and analgesia · Dec 1999
Randomized Controlled Trial Comparative Study Clinical TrialPharmacokinetics and pharmacodynamics of ropivacaine 2 mg/mL, 5 mg/mL, or 7.5 mg/mL after ilioinguinal blockade for inguinal hernia repair in adults.
The aim of our study was to evaluate the pharmacokinetics and pharmacodynamics of ropivacaine in ilioinguinal-iliohypogastric blocks (IIB). After ethics committee approval and informed consent, 80 male adults scheduled for inguinal hernia repair were enrolled and randomized into four groups. After induction of general anesthesia, an IIB was performed double blinded in Groups 1, 2, and 3 with 0.25 mL/kg ropivacaine 2 mg/mL, 5 mg/mL, or 7.5 mg/mL and with saline in the Control group. Plasma concentration of ropivacaine was determined in venous blood using reversed-phase high-performance liquid chromatography. IIB with ropivacaine resulted in peak plasma concentrations of 0.3+/-0.15 microg/mL (Group 1) (mean +/- SD), 0.75+/-0.45 microg/mL (Group 2), or 1.57+/-0.82 microg/mL (Group 3). These concentrations occurred after 30 (15-60) min, median (range), 30 (10-60) min, and 45 (15-60) min, in the respective groups. Three of 19 patients in Group 1, 6 of 18 in Group 2, and 5 of 20 in Group 3 did not need any additional analgesics within 24 h postoperatively, but all 20 control patients did. Time to the first demand for analgesia was significantly shorter in the Control group (median 0.3 h [range 0-2.8]) compared with 1.5 h (0.5-24 h), 2 h (0.5-24 h), and 2 h (1.0-24 h) in Groups 1, 2, and 3, respectively. Three patients in Group 3 had a postoperative motor block of the femoral nerve. In conclusion, a ropivacaine dose of 0.25 mL/kg of 5 mg/mL seems adequate for IIB accompanying general anesthesia for postoperative pain relief. However, the pharmacokinetic results obtained suggest that even larger doses (0.25 mL/kg of 7.5 mg/mL ropivacaine) for IIB do not result in plasma concentrations in a toxic range. ⋯ Ropivacaine, a new local anesthetic, proved to be effective for pain relief after hernia repair in ilioinguinal blocks accompanying general anesthesia. Plasma concentrations peaked after 30-45 min, and were within safe limits after application of 0.25 mL/kg of 2, 5, or 7.5 mg/mL ropivacaine.
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Am. J. Obstet. Gynecol. · Dec 1999
Randomized Controlled Trial Clinical TrialA randomized, controlled trial of a eutectic mixture of local anesthetic cream (lidocaine and prilocaine) versus penile nerve block for pain relief during circumcision.
We set out to compare a eutectic mixture of local anesthetic cream (lidocaine and prilocaine) to dorsal penile nerve block with lidocaine for anesthesia during circumcision. ⋯ Distress scores and heart rates were significantly higher in infants treated with the anesthetic mixture than in infants treated with lidocaine. Dorsal penile nerve block with lidocaine is a more efficacious means of providing anesthesia for neonatal circumcision than the mixture of local anesthetics.
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Although several anterior approaches to sciatic nerve block have been described, they are used infrequently. The authors describe a new anterior approach that allows access to the sciatic nerve with the patient in the supine position. ⋯ This approach represents an easy and reliable anterior technique for performing sciatic nerve blocks.
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Clin. Orthop. Relat. Res. · Dec 1999
Analgesia with femoral nerve block for anterior cruciate ligament reconstruction.
Anterior cruciate ligament reconstruction is performed routinely as an outpatient surgical procedure despite few studies of patient acceptance or postoperative patient analgesia. This study reports the first series of postoperative femoral nerve blocks as analgesia for outpatient anterior cruciate ligament reconstruction. The authors retrospectively reviewed 161 patients undergoing two incision arthroscopically assisted autograft middle 1/3 patellar tendon anterior cruciate ligament reconstruction on an out-patient basis at the authors' institution during a period of 30 months. ⋯ However, 69% of patients staying overnight cited reasons other than pain as factors in their stay. No significant complications were reported. Based on these results, the administration of a femoral nerve block is recommended for patients undergoing outpatient anterior cruciate ligament reconstruction because it is a highly effective form of analgesia with an excellent degree of patient satisfaction.