Articles: nerve-block.
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Anesthesia and analgesia · Feb 1997
A common epineural sheath for the nerves in the popliteal fossa and its possible implications for sciatic nerve block.
Sciatic nerve block in the popliteal fossa is associated with a highly variable success rate. Frequently, anesthesia is profound in the distribution of both the tibial (TN) and common peroneal nerves (CPN), although the response to nerve stimulation or paresthesia is obtained in the distribution of one division of the nerve. However, anesthesia in the distribution of only one division of the nerve is also a common occurrence under apparently identical clinical circumstances. ⋯ In a majority of the legs, the dye reached the division of the sciatic nerve in the popliteal fossa, bathing both the TN and CPN. Gross inspection and histologic examination of the sciatic nerve specimens revealed a common epineural sheath enveloping the TN and CPN. The presence of the common epineural sheath and its characteristics may have important clinical implications for sciatic nerve blockade in the popliteal fossa.
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Parascalene block is a technique of blocking the brachial plexus at the lateral border of the anterior scalene muscle superior to the clavicle. The objective of this study was to define the position of the needle in parascalene block with relationship to the brachial plexus and the dome of the pleura, which is important in determining whether this technique minimizes the incidence of pneumothorax. In the first group, 10 patients scheduled for minor upper extremity surgery agreed to parascalene block, which was performed in the computed tomographic examination room. ⋯ The distances from the skin to the interscalene groove and the interscalene groove to the first rib at the level of the needle insertion or the marker in both groups were measured to be 17 +/- 4 mm and 15 +/- 3 mm, respectively. This study suggests that the level of the parascalene needle entry is superior to the dome of the pleura. At this level, the incidence of pneumothorax should be minimized.
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Paediatric anaesthesia · Jan 1997
Para-umbilical block: a new concept for regional anaesthesia in children.
This preliminary study describes a new technique to provide analgesia in children undergoing umbilical hernia repair. The para-umbilical block consists of infiltrating the anterior cutaneous branches of the two tenth spinal roots over and under the rectus sheath far from the operative field. Intra and postoperative analgesia as well as operative conditions were assessed in 11 children 16.7 +/- 31 months old, weighing 8421 +/- 6941 g, the block being performed before surgery under light general anaesthesia. ⋯ The block proved to be safe and on the whole effective in this short series. The study should proceed on a multi-centre basis if possible. Indications can be extended.
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Paediatric anaesthesia · Jan 1997
Case ReportsBilateral continuous paravertebral block used for postoperative analgesia in an infant having bilateral thoracotomy.
We describe the successful postoperative pain management in an 11-month-old infant who underwent bilateral thoracotomy, using continuous infusions of bupivacaine into two directly placed paravertebral catheters. Haemodynamic parameters and pain scores were measured 1-2 h for 60 h while the infusions were continued and, intermittently, blood samples were taken for subsequent measurement of serum bupivacaine concentrations. ⋯ There were no adverse haemodynamic consequences or complications relating to either catheter placement or drug infusions. Serum concentrations of bupivacaine remained below toxic levels throughout the study period, though accumulation did occur.
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Acta Anaesthesiol Belg · Jan 1997
Randomized Controlled Trial Clinical TrialTenoxicam does not enhance the spread of sensory block produced by intrathecal lidocaine.
Systemic opioids enhance the spread of spinal analgesia. This study was designed to determine whether i.v. tenoxicam, a nonsteroidal anti-inflammatory drug (NSAID), affects the spread of sensory block produced by lidocaine. Sixty patients undergoing transurethral procedures were randomly assigned in a double blind design to receive i.v. either 3 ml normal saline (N/S group, n = 20), or 150 micrograms fentanyl (F group, n = 20), or 40 mg tenoxicam (T group, n = 20), 20 minutes after spinal anesthesia. ⋯ The overall change in the level of sensory block 15 minutes after i.v. treatment was -4.6 +/- 6.3 cm in the N/S group, 2.4 +/- 6.0 cm in the F group, and -1.6 +/- 5.8 cm in the T group. The F group differed from the N/S group (P < 0.01). Intravenous administration of tenoxicam does not enhance the level of spinal analgesia produced by lidocaine.