Articles: nerve-block.
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Anesthesia and analgesia · Jul 1998
Randomized Controlled Trial Clinical TrialPeripheral nerve blocks improve analgesia after total knee replacement surgery.
Total knee replacement (TKR) produces severe postoperative pain. Peripheral nerve blocks can be used as analgesic adjuncts for TKR, but the efficacy of femoral nerve blocks alone is controversial. The sciatic nerve innervates posterior regions of the knee; thus, performance of both sciatic and femoral nerve blocks may be necessary to improve analgesia after TKR. We performed this study to determine whether peripheral nerve blocks improve analgesia after TKR. In a randomized, double-blind fashion, 36 patients undergoing TKR received either femoral, sciatic-femoral, or sham nerve blocks after a standardized spinal anesthetic. Further postoperative analgesia was provided by patient-controlled i.v. morphine and ketorolac. Pain at rest and with physical therapy, morphine use, nausea, pruritus, sedation, and patient satisfaction were assessed. Patients receiving peripheral nerve blocks reported better analgesia at rest for at least 8 h after transfer to the hospital ward (P < 0.05). Morphine use was decreased by approximately 50% in the peripheral nerve block groups until the second postoperative day (P < 0.02). Side effect profiles and patient satisfaction were similar between groups. We conclude that femoral nerve blocks improve analgesia and decrease morphine use after TKR. The addition of a sciatic nerve block to the femoral nerve block did not further improve analgesic efficacy. ⋯ Performance of femoral nerve blocks improves analgesia and decreases the need for morphine after total knee replacement surgery. The addition of a sciatic nerve block to the femoral nerve block does not provide additional benefits.
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Anesthesia and analgesia · Jul 1998
Randomized Controlled Trial Clinical TrialClonidine added to the anesthetic solution enhances analgesia and improves oxygenation after intercostal nerve block for thoracotomy.
We evaluated the effect of adding clonidine to bupivacaine on postoperative pain control and oxygenation after intercostal nerve blockade (ICB) for thoracotomy, and attempted to distinguish a systemic from a local effect of clonidine. ICB with 2 mg/kg 0.5% bupivacaine was performed in 36 patients undergoing thoracotomy. Patients were randomized to one of three groups: 1) a control group that received bupivacaine with saline for ICB and an IM injection of saline, 2) an IM group that received bupivacaine with saline for ICB and an IM injection of 2 micrograms/kg clonidine, and 3) a block group that received bupivacaine with 2 micrograms/kg clonidine for ICB and an IM injection of saline. Blood gases, visual analog scale (VAS) scores, and analgesic demand were determined hourly for 8 h after arrival in the postoperative care unit (PCU). Patients in the block group had significantly lower VAS scores, higher arterial oxygen tension, and lower analgesic demand for the first 4 h in the PCU, compared with the two other groups. No difference was noted thereafter. We conclude that the addition of clonidine to bupivacaine for ICB leads to a short-term effect enhancing postoperative pain control and improving arterial oxygenation, probably mediated by a direct effect on the nerves. ⋯ Severe pain after thoracotomy can lead to impaired ventilation. We studied the effect of adding clonidine to bupivacaine for intercostal nerve blockade after thoracotomy. Clonidine administered directly on the nerves enhanced analgesia and improved oxygenation for a short time compared with systemic administration or control.
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Indian J Chest Dis Allied Sci · Jul 1998
Case ReportsPneumomediastinum: a rare complication of brachial plexus block.
Pneumomediastinum, a rare complication of brachial plexus block in a young male is reported.
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Anesthesia and analgesia · Jul 1998
Randomized Controlled Trial Clinical TrialEffects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia, and continuous three-in-one block on postoperative pain and knee rehabilitation after unilateral total knee arthroplasty.
In this study, we assessed the influence of three analgesic techniques on postoperative knee rehabilitation after total knee arthroplasty (TKA). Forty-five patients scheduled for elective TKA under general anesthesia were randomly divided into three groups. Postoperative analgesia was provided with i.v. patient-controlled analgesia (PCA) with morphine in Group A, continuous 3-in-1 block in Group B, and epidural analgesia in Group C. Immediately after surgery, the three groups started identical physical therapy regimens. Pain scores, supplemental analgesia, side effects, degree of maximal knee flexion, day of first walk, and duration of hospital stay were recorded. Patients in Groups B and C reported significantly lower pain scores than those in Group A. Supplemental analgesia was comparable in the three groups. Compared with Groups A and C, a significantly lower incidence of side effects was noted in Group B. Significantly better knee flexion (until 6 wk after surgery), faster ambulation, and shorter hospital stay were noted in Groups B and C. However, these benefits did not affect outcome at 3 mo. We conclude that, after TKA, continuous 3-in-1 block and epidural analgesia provide better pain relief and faster knee rehabilitation than i.v. PCA with morphine. Because it induces fewer side effects, continuous 3-in-1 block should be considered the technique of choice. ⋯ In this study, we determined that, after total knee arthroplasty, loco-regional analgesic techniques (epidural analgesia or continuous 3-in-1 block) provide better pain relief and faster postoperative knee rehabilitation than i.v. patient-controlled analgesia with morphine. Because it causes fewer side effects than epidural analgesia, continuous 3-in-1 block is the technique of choice.