Articles: nerve-block.
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Comparative Study
Axillary brachial plexus block--an underused technique in the accident and emergency department.
To compare axillary brachial plexus block and Bier's block as methods of providing upper limb anaesthesia. ⋯ Brachial plexus blocks are an alternative form of providing upper limb anaesthesia in the accident and emergency department. They are relatively simple to perform, well tolerated by patients, and have the advantage of providing prolonged analgesia without the need for additional medication.
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We describe a novel supraclavicular approach to the brachial plexus. Designated as the intersternocleidomastoid technique, this new approach was tested in unembalmed cadavers. It was then applied for evaluation to 150 ASA grade I or II patients scheduled for elective surgery or physiotherapy of the upper limb or for treatment of reflex sympathetic dystrophy associated with painful shoulder. ⋯ Postoperative analgesia was provided for 48 h or more in 45 patients and for 24 h in 18 patients. Only minor complications were observed: asymptomatic phrenic nerve block in 89 patients (60%), transient Horner's syndrome in 15 (10%), transient recurrent laryngeal nerve blockade in 2, and misplacement of the catheter into the subclavian vein in 1 patient. No pneumothorax was observed.
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Randomized Controlled Trial Clinical Trial
ORG 9487 neuromuscular block at the adductor pollicis and the laryngeal adductor muscles in humans.
ORG 9487 is a new steroidal nondepolarizing muscle relaxant with a rapid onset of action. This study was designed to determine the neuromuscular blocking profile of ORG 9487 at the adductor muscles of the larynx and the adductor pollicis. ⋯ ORG 9487 has a rapid onset of action at the laryngeal adductor and the adductor pollicis muscles. Onset and duration of action are faster at the vocal cords than at the adductor pollicis muscle. However, the maximum block obtained at the laryngeal muscles was less than at the adductor pollicis, regardless of the dose of ORG 9487.
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A new technique involving the use of a local block to anesthetize the inferior alveolar nerve (V3), a branch of the mandibular division of the trigeminal or fifth cranial nerve, is described. Clinicians fail to administer a successful mandibular block in as many as 15 per cent of all cases. ⋯ A short description of other techniques are presented, some of which should be reserved for isolated cases and not used on a routine basis. By avoiding or eliminating the reasons for mandibular block failure, and using the new block described in this paper, clinicians should be able to reduce the failure rate to much lower levels.