Articles: nerve-block.
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Regional nerve blocks are a valuable skill for general practitioners and surgeons who perform surgical procedures under local anaesthetic. Once mastered, these injections provide rapid anaesthesia with minimal pain, little distortion of the tissues and improved aesthetic results. This paper describes techniques applicable to lesions of the face, upper and lower limbs, and to achieve anaesthesia after a fractured rib.
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Regional anesthesia · Sep 1996
Anatomic considerations for sciatic nerve block in the popliteal fossa through the lateral approach.
The disadvantage of the classic posterior approach to block of the sciatic nerve at the knee level (popliteal nerve block [PNB]) is the need to position a patient in the prone position for performance of the block. In this study on cadavers, a lateral approach to the popliteal nerve in the supine position was investigated, and some anatomic considerations of relevance to popliteal nerve block were addressed. ⋯ A lateral approach to the popliteal nerve with insertion of the needle at a 30 degrees angle relative to the horizontal plane results in predictable approximation of the needle tip to the popliteal nerve. The results also suggest the existence of a continuous neural sheath encompassing the popliteal nerve and its main branches. This may have clinical implications similar to those in perivascular neuronal block.
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Acta Anaesthesiol. Sin. · Sep 1996
[Clinical experience in interscalene brachial plexus block combined with Ho's method of C3-4 block for shoulder and proximal upper extremity surgeries].
Brachial plexus block, first performed in 1889 by Halsted, has been widely used for surgery of shoulder and upper third of upper extremity. But the level of block is inadequate for surgery of the deeper tissue. If high volume of local anesthetic (40 ml) is used to block C3-4, complications like Horner's syndrome and phenic nerve palsy would be frequent. The landmark of C-3 and C-4 nerve root is difficult to identify. The purpose of this study was to design a new method to block easily the C-3 and C-4 nerve roots for surgery of shoulder deep tissue. ⋯ Interscalene brachial plexus block combined with Ho's method of C3-4 block is technically safe and economical for patients receiving shoulder and proximal third of upper extremity surgery. We must make selection of patients carefully and exclude those whose anatomical landmarks are difficulty identified. As such, good result is expected.
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Anaesth Intensive Care · Aug 1996
Comparative StudyAxillary brachial plexus block in two hundred consecutive patients.
Two hundred consecutive, minimally-sedated patients presenting for upper limb surgery were audited prospectively to determine the overall clinical success rate, extent of cutaneous neural blockade, reliability and complication rate of each indicator of axillary sheath entry, and degree of patient satisfaction. The axillary sheath was identified, using a 22 gauge, short-bevelled needle, by one of four indicators, whichever was elicited first (paraesthesia, arterial or venous puncture, or tethering by the axillary sheath). Alkalinized mepivacaine 1.2%, 50 ml then was injected. ⋯ Complete anaesthesia distal to the elbow was achieved in 85% of patients. Complications were common, but generally mild and transient: mild acute local anaesthetic toxicity, 3.5%; axillary tenderness and bruising, 12%; and dysaesthesias, 12.5%. Despite this, patient satisfaction was high (97%).
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Rev Esp Anestesiol Reanim · Aug 1996
Randomized Controlled Trial Clinical Trial[Comparison of the double burst stimulus with the train-of-four stimuli in monitoring muscle relaxation during anesthesia].
To compare double burst stimulus (DBS) and the train-of-four stimuli (TOF) for monitoring neuromuscular blockade during anesthesia in terms of muscle relaxation requirements, dose of anticholinesterase agents and the possibility of postanesthetic residual relaxation. ⋯ The use of DBS increased the vecuronium dose required during anesthesia and risk in those patients who arrived at the PARU with residual muscle block (T4/T1r < 70%).