Articles: nerve-block.
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Ann Fr Anesth Reanim · Jan 1996
Review[Three-in-one block or femoral nerve block. What should be done and how?].
The "3 in 1" block and the femoral nerve block are widely used for lower limb surgery and postoperative analgesia. Whether these blocks are in fact a same regional block with two different names or represent definitively two different blocks remains controversial. A large number of anatomical as well as functional variations of the lumbar plexus have been described and complicate a rational analysis of the spread of local anaesthetics following these blocks. ⋯ However, once the "3 in 1" block is well performed, a complete anaesthesia covering the territories of the femoral nerve, the lateral femoral cutaneous nerve, and the obturator nerve occurs. Specific indications of each technique are different: major knee surgery and postoperative analgesia for the "3-in-1" block and leg surgery for femoral nerve block. The best approach for knee arthroscopy remains open for discussion.
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Recent published data suggest that despite apparently satisfactory recovery from nondepolarising block (train-of-four ratios in excess of 0.90), even very small doses of additional relaxant may re-establish significant paralysis. We sought to verify this observation and quantify its magnitude. Twelve adult patients were studied under nitrous oxide-propofol-opioid anaesthesia and neuromuscular block was monitored electromyographically. ⋯ The control ED50 of mivacurium (calculated from the initial dose of mivacurium) averaged 43 micrograms.kg-1. When the same dose of drug was given at 95% recovery of the train-of-four ratio, the ED50 was reduced to 19 micrograms.kg-1 (p < 0.0001). Hence, there remains a considerable reduction in the neuromuscular margin of safety even at a train-of-four ratio of 0.95.
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Anesthesia progress · Jan 1996
Case ReportsProlonged diplopia following a mandibular block injection.
A case is presented in which a 14-yr-old girl developed diplopia after injection of the local anesthetic Xylotox E 80 A (2% lidocaine with 1:80,000 epinephrine). Since the complication had a relatively slow onset and lasted for 24 hr, the commonly suggested explanations based on vascular, lymphatic, and neural route theories do not adequately fit the observations. No treatment, other than reassurance, was necessary, and the patient recovered fully.
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Regional anesthesia · Jan 1996
A trigonometric analysis of needle redirection and needle position during neural block.
Successful regional anesthesia involves a three-dimensional visualization of anatomy and an informed approach to needle placement and repositioning. This study trigonometrically examines the relationship between needle insertion angle and resultant needle position. ⋯ Incremental needle redirection of 5 degrees allows a precise survey of neural and adjacent anatomy and results in approximately one half the change in needle position occurring with a 10 degree angle of redirection. However, a 10 degree angle of redirection may result in walking over the desired neural structure.
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We review the results of 312 cases of sciatic nerve blockade in the poplitea fossa for surgery of the dorsal foot. An atraumatic, insulated needle connected to a neurostimulator was used to make a single puncture using a posterior approach. The anesthetic was 1% mepivacaine (4-5 mg/kg-1). ⋯ Time of analgesia was 6 h 15 min (range 3-16 h). No complications or sequelae were recorded. We conclude that the technique is highly effective and comfortable for patients, as it requires only one puncture and gives good postoperative analgesia with no major side effects.