Articles: nerve-block.
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Randomized Controlled Trial Clinical Trial
Addition of femoral 3-in-1 blockade to intra-articular ropivacaine 0.2% does not reduce analgesic requirements following arthroscopic knee surgery.
To test the hypothesis that the addition of a preincisional femoral 3-in-1 block to intra-articular instillation with ropivacaine 0.2% at the end of surgery improves postoperative pain control in patients undergoing arthroscopic anterior cruciate ligament reconstruction (ACLR) under general anesthesia. ⋯ We found no effect of a femoral 3-in-1 block with ropivacaine 0.2% on postoperative analgesic consumption, compared to intra-articular instillation with ropivacaine 0.2% alone, in patients undergoing ACLR under general anesthesia.
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Anesthesia and analgesia · Aug 1999
Randomized Controlled Trial Comparative Study Clinical TrialPropofol versus propofol-ketamine sedation for retrobulbar nerve block: comparison of sedation quality, intraocular pressure changes, and recovery profiles.
We compared sedation quality, intraocular pressure (IOP) changes, and recovery profiles in patients who received propofol or propofol-ketamine sedation during placement of the retrobulbar nerve block (RBB). Seventy elderly patients undergoing cataract extraction according to a prospective, randomized, double-blinded protocol were preoperatively evaluated with a Mini-Mental State examination and baseline IOP. A hypnotic dose was provided with either propofol (Group P) or a propofol-ketamine (Group PK) combination. The IOP measurement was repeated, and the surgeon initiated the RBB. Supplemental study drug was given if needed. The level of sedation was considered acceptable if the patient exhibited minimal or no movement and grimacing with needle insertion. Patients were evaluated in terms of quality of sedation, cardiopulmonary stability, and recovery profile. Compared with patients in Group P, patients in Group PK had a significantly faster onset of acceptable sedation (Group P 235 +/- 137 s versus Group PK 164 +/- 67 s) and required significantly less supplemental sedation (Group P 1.1 +/- 1.9 mL versus Group PK 0.15 +/- 0.3 mL). Additionally, none of the Group PK patients required ventilatory assistance, but two patients in Group P required assisted mask ventilation. In conclusion, the addition of ketamine (13.2 +/- 3.3 mg) to propofol (44 +/- 11 mg) decreased the hypnotic requirement and improved the quality of sedation without prolonging recovery. ⋯ Anesthesiologists frequently perform retrobulbar blocks while simultaneously providing sedation. Using ketamine to supplement propofol sedation provided a faster onset and improved the quality of sedation during the retrobulbar block procedure.
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Anticipated technical difficulty is one factor that can influence the anesthesiologist's decision to perform neuraxial (spinal or epidural) blockade. Problems during the procedure may be associated with patient dissatisfaction, neurologic sequelae, or hematoma. We designed this study of 595 neuraxial blocks to determine whether any patient characteristics would be useful in predicting a difficult neuraxial block. Before the procedure, the following data were noted: demographic data, body habitus (normal, thin, muscular, obese), spinal landmarks (good = easily palpable spinous processes, poor = difficult to palpate spinous processes, none = unable to positively identify spinous processes), and spinal anatomy (assessed by inspection and examination as normal or deformed). We noted the technique, approach, needle type, needle gauge, etc. We also recorded whether the procedure was completed at the first (first-level success) or second spinal level and the total number of new skin punctures (attempts) necessary to complete the procedure. Of all the factors considered, the quality of landmarks best correlated with technical difficulty as measured by both first-level success and number of attempts. Abnormal spinal anatomy correlated with difficulty as measured by number of attempts. Body habitus also correlated with difficulty, but only as measured by number of attempts. There was no association between either measure of difficulty and any of the following: age, sex, spinal versus epidural, approach, needle type, needle gauge, or training level of the provider. Thoracic epidurals were less difficult than lumbar epidurals by both measures of difficulty. We conclude that body habitus does not seem to be the best predictor of technical difficulty. An examination of the patient's back for the quality of landmarks and obvious anatomical deformity better predicts the ease or difficulty of neuraxial block. Other factors seem to have little or no influence on the difficulty of neuraxial block procedures. ⋯ We studied a number of factors, including equipment, technique, and patient characteristics, that may indicate the ease or difficulty of performing neuraxial (spinal and epidural) blocks. Of these factors, only patient characteristics had significant predictive value. We found that an examination of the patient's back for the quality of landmarks and obvious anatomical deformity better predicts the ease or difficulty of neuraxial block than does body habitus.
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The mixture of 1% lidocaine and 0.2% tetracaine with 1:200,000 epinephrine, so-called "supercaine," has been used extensively for axillary brachial plexus blockade for several decades. Since the advent of bupivacaine, the supercaine mixture has fallen into relative disuse despite its record of effectiveness and safety. No studies have been done recently to evaluate quality of anesthesia, duration of postoperative analgesia, and degree of patient satisfaction with this mixture when used for axillary brachial plexus blockade. ⋯ Data are reported within a 95% confidence interval. Variables examined and compared were not statistically significant. We concluded that the duration of block supports findings reported in the literature, patients equate duration of sensory block with duration of motor block, differences in duration were probably due to levels of provider experience, and patients were extremely satisfied with the anesthetic.
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Acta Anaesthesiol Scand · Aug 1999
Randomized Controlled Trial Comparative Study Clinical TrialSingle-injection paravertebral block compared to general anaesthesia in breast surgery.
Breast surgery is frequently associated with post-operative nausea, vomiting, pain and painful restricted movement. Paravertebral block may be an alternative to general anaesthesia for this type of surgery. We studied the single-injection paravertebral block at the level of T4 and report a comparison of single-injection paravertebral block to general anaesthesia for breast surgery. ⋯ Single-injection paravertebral block at the level of T4 represents a suitable alternative to general anaesthesia in women undergoing breast surgery.