Articles: nerve-block.
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Randomized Controlled Trial Clinical Trial
Evaluation of the effects of the addition of morphine sulfate to a standard Bier block solution in peripheral arm surgery.
The purpose of this study was to analyze postoperative pain differences in patients undergoing peripheral arm surgery. Differences between patients' perceived pain who received 2 mg of morphine sulfate added to the standard Bier block solution and the standard Bier block solution without morphine were studied. A quasi-experimental nonequivalent control group design was utilized. ⋯ A larger sample may have yielded different results. Many issues remain undecided regarding the potential role of opioids in various regional anesthetic techniques. Further studies are warranted to investigate the peripheral effects of opioids and to understand the mechanisms of action of opioid analgesics at peripheral sites.
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Anesthesia and analgesia · Oct 1998
Infraclavicular brachial plexus block: parasagittal anatomy important to the coracoid technique.
Infraclavicular brachial plexus block is a technique well suited to prolonged continuous catheter use. We used a coracoid approach to this block to create an easily understood technique. We reviewed the magnetic resonance images of the brachial plexus from 20 male and 20 female patients. Using scout films, the parasagittal section 2 cm medial to the coracoid process was identified. Along this oblique section, we located a point approximately 2 cm caudad to the coracoid process on the skin of the anterior chest wall. From this point, we determined simulated needle direction to contact the neurovascular bundle and measured depth. At the skin entry site, the direct posterior insertion of a needle will make contact with the cords of the brachial plexus where they surround the second part of the axillary artery in all images. The mean (range) distance (depth along the needle shaft) from the skin to the anterior wall of the axillary artery was 4.24 +/- 1.49 cm (2.25-7.75 cm) in men and 4.01 +/- 1.29 cm (2.25-6.5 cm) in women. Hopefully, this study will facilitate the use of this block. ⋯ We sought a consistent, palpable landmark for facilitation of the infraclavicular brachial plexus block. We used magnetic resonance images of the brachial plexus to determine the depth and needle orientation needed to contact the brachial plexus. Hopefully, this study will facilitate the use of this block.
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Recent advances in the application of regional anesthesia to the care of patients undergoing shoulder surgery are discussed. New techniques for the management of postoperative pain are highlighted, with an emphasis on interscalene patient-controlled analgesia and suprascapular block. ⋯ Intraoperative hypotension and bradycardia caused by activation of the Bezold-Jarisch reflex is considered. The ongoing debate regarding the use of paresthesia versus nerve-stimulator techniques is examined.
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Randomized Controlled Trial Comparative Study Clinical Trial
Prospective, randomized comparison of deep or superficial cervical plexus block for carotid endarterectomy surgery.
Carotid endarterectomy may be performed under cervical plexus block with local anesthetic supplementation by the surgeon as necessary during surgery. It is unclear, however, whether deep or superficial cervical plexus block offers the best operating conditions or patient satisfaction. Therefore, the authors compared the two in patients undergoing carotid endarterectomy. ⋯ Carotid endarterectomy may be performed satisfactorily during superficial or deep cervical plexus block placement with no differences in terms of supplemental local anesthetic requirements, although this is influenced by whether paresthesia is elicited during placement of the deep block. Therefore, the clinician's decision to use one block rather than another need not be based on any assumed superiority of one block based on intraoperative conditions or patient satisfaction.
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Digital block anesthesia with epinephrine, ring technique, and digital tourniquet have been implicated in causing finger gangrene. An extensive review of the literature provided no case of finger gangrene attributed solely to the adjunctive use of epinephrine with lidocaine for digital block. By causing vasoconstriction, epinephrine complements the local analgesic by prolonging the duration of action and providing a temporary hemostatic effect. Epinephrine augmentation of digital block anesthesia was used in the treatment of 23 finger injuries without a complication.