Articles: nerve-block.
-
Anesthesia and analgesia · Dec 1998
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of 0.5% bupivacaine, 0.5% ropivacaine, and 0.75% ropivacaine for interscalene brachial plexus block.
The onset time and duration of action of ropivacaine during an interscalene block are not known. The potentially improved safety profile of ropivacaine may allow the use of higher concentrations to try and speed onset time. We compared bupivacaine and ropivacaine to determine the optimal long-acting local anesthetic and concentration for interscalene brachial plexus block. Seventy-five adult patients scheduled for outpatient shoulder surgery under interscalene block were entered into this double-blind, randomized study. Patients were assigned (n = 25 per group) to receive an interscalene block using 30 mL of 0.5% bupivacaine, 0.5% ropivacaine, or 0.75% ropivacaine. All solutions contained fresh epinephrine in a 1:400,000 concentration. At 1-min intervals after local anesthetic injection, patients were assessed to determine loss of shoulder abduction and loss of pinprick in the C5-6 dermatomes. Before discharge, patients were asked to document the time of first oral narcotic use, when incisional discomfort began, and when full sensation returned to the shoulder. The mean onset time of both motor and sensory blockade was <6 min in all groups. Duration of sensory blockade was similar in all groups as defined by the three recovery measures. We conclude that there is no clinically important difference in times to onset and recovery of interscalene block for bupivacaine 0.5%, ropivacaine 0.5%, and ropivacaine 0.75% when injected in equal volumes. ⋯ In this study, we demonstrated a similar efficacy between equal concentrations of ropivacaine and bupivacaine. In addition, increasing the concentration of ropivacaine from 0.5% to 0.75% fails to improve the onset or duration of interscalene brachial plexus block.
-
AJR Am J Roentgenol · Dec 1998
Anatomy of the normal brachial plexus revealed by sonography and the role of sonographic guidance in anesthesia of the brachial plexus.
The purpose of this study is to describe the sonographic appearance of the normal brachial plexus and to evaluate the use of imaging guidance for brachial plexus anesthesia. ⋯ High-resolution sonography can show normal brachial plexus anatomy and facilitate catheter-based brachial plexus anesthesia without complications.
-
Anesthesia and analgesia · Dec 1998
Blockade of the sciatic nerve in the popliteal fossa: a system for standardization in children.
The sciatic nerve can be blocked at different levels, providing excellent surgical and postoperative anesthesia and analgesia. We report a series of 50 blocks performed via the popliteal fossa in children. Localization of either the tibial or peroneal nerve was facilitated by a nerve stimulator. The local anesthetic solution was injected at the point where nerve stimulation was achieved with 0.4 mA at an impulse width of 1.0 ms. The depth of insertion of the stimulation cannula correlated with the age, weight, and height of the patients. The best predictor for depth of insertion was the patient's weight. The minimal depth of insertion was 13 mm. No failure of blockade was seen in this case series. Blockade of the sciatic nerve can easily be performed in the popliteal fossa even in small children. ⋯ Blockade of the sciatic nerve can easily be performed in the popliteal fossa even in small children. The depth of insertion of the stimulation cannula can best be estimated according to the weight of the patient. The minimal depth required was 13 mm.
-
Clinical Trial
Greater occipital nerve blockade in cervicogenic headache.
Cervicocogenic headache (CeH) is a relatively common disorder. Although on ideal treatment is available so far, blockades in different structures and nerves may be temporarily effective. ⋯ The improvement is less marked during the first two days, a phenomenon we called "tilde pattern". GON blockades may reduce the pool of exaggerated sensory input and antagonize a putative "wind-up-like effect" which may explain the headache improvement.