Articles: nerve-block.
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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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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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J. Cardiothorac. Vasc. Anesth. · Aug 1996
Randomized Controlled Trial Comparative Study Clinical TrialComparative effects of plain and epinephrine-containing bupivacaine on the hemodynamic response to cervical plexus anesthesia in patients undergoing carotid endarterectomy.
This study was designed to investigate whether the addition of epinephrine as a vasoconstrictor additive to local anesthetic affects the hemodynamic profile after cervical plexus block in patients presenting for carotid endarterectomy. ⋯ Concerning cervical plexus block with bupivacaine, the use of epinephrine is associated with an increase in heart rate consistent with a beta-adrenergic effect from systemic absorption of the epinephrine. An increase in systolic blood pressure independent of the use of epinephrine also occurs, but epinephrine appears to mitigate against an increase in diastolic blood pressure.
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Randomized Controlled Trial Clinical Trial
Saphenous nerve anaesthesia--a nerve stimulator technique.
This two part study was undertaken to assess both the feasibility of identifying the saphenous nerve with a nerve stimulator and to assess the efficacy of saphenous nerve anaesthesia with electrical isolation of the nerve. ⋯ (Part I): The first part of the study established the feasibility of electrical identification of the saphenous nerve and demonstrated that the NS technique could be utilized to provide superior anaesthesia of the saphenous nerve when compared with a previously validated LOR technique. (Part II): The clinical utility of the NS technique of saphenous nerve block was successfully demonstrated.