Articles: nerve-block.
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Regional anesthesia · Jul 1995
Randomized Controlled Trial Clinical TrialCan pre-emptive interpleural block reduce perioperative anesthetic and analgesic requirements?
The hypothesis that preoperative interpleural block might reduce intraoperative anesthetic and analgesic requirements and modify the intensity of postoperative pain was examined in this double-blind, randomized, saline-controlled study. ⋯ Preoperative interpleural block, during a background isoflurane anesthetic, reduces the hemodynamic response to surgery and the intraoperative anesthetic and analgesic requirements. Preoperative interpleural block with plain bupivacaine results in significant reductions in mean arterial pressure and heart rate, probably related to unilateral sympathetic block and the concomitant use of isoflurane. The timing of interpleural block, that is, pre-emptive versus postoperative, does affect the intensity of postoperative pain or the request for supplementary analgesia.
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Regional anesthesia · Jul 1995
Case ReportsSuprascapular nerve block by catheter for breakthrough shoulder cancer pain.
Incidental shoulder pain due to movement renders pain control difficult because it requires high basal dosages or additional doses of opioids. Shoulder pain can be alleviated by suprascapular nerve block, and the placement of a catheter can permit the injection of local anesthesia as needed. ⋯ Continuous suprascapular nerve block is safe and simple and has proven to be useful in avoiding extra doses of opioids.
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Regional anesthesia · Jul 1995
Randomized Controlled Trial Clinical TrialUltrasound imaging for stellate ganglion block: direct visualization of puncture site and local anesthetic spread. A pilot study.
Stellate ganglion block (SGB) inhibits sympathetic innervation and is a common treatment for reflex sympathetic dystrophy. During the positioning of the needle, there is a risk of injury to the adjacent structures. The aim of the study was to develop an ultrasonographic imaging technique for the performance of SGB. ⋯ Ultrasonographic guided SGB may improve safety and allows the visualization of the local anesthetic depot. Studying the local anesthetic spread might allow the avoidance of side effects as well as typical complications of SGB.
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Int J Obstet Anesth · Jul 1995
Serious complications associated with epidural/spinal blockade in obstetrics: a two-year prospective study.
A prospective study of complications associated with epidural and spinal blockade in obstetrics was carried out during the years 1990 and 1991. 79 obstetric units in the United Kingdom took part. These units had a total of 467 491 deliveries during the two years. 108 133 mothers received epidural blockade and 14856 received spinal blockade. 22% of all mothers received epidural analgesia in labour, and 50% of caesarean sections were performed under either epidural or spinal anaesthesia. 128 complications (not including post dural puncture headache) were reported. Of these, 46 were neuropathies involving a single spinal or peripheral nerve. 26 unexpectedly high blockades were encountered. ⋯ Although resuscitation restored normal cardiac function in both cases, one patient was decerebrate and died some days later. Postmortem examination revealed evidence of amniotic fluid embolus. 20 reports were classified as 'miscellaneous' and presented individual clinical diagnoses. The overall complication rate (excluding post dural puncture headache) was approximately 1 per thousand.
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Randomized Controlled Trial Clinical Trial
Does the addition of morphine to brachial plexus block improve analgesia after shoulder surgery?
We have studied 40 patients undergoing elective shoulder surgery for chronically painful conditions. Patients were allocated randomly to two groups and received interscalene brachial plexus block with 0.5% bupivacaine and adrenaline 1/200,000 40 ml either alone or with the addition of morphine 5 mg. ⋯ The quality of the block, analgesic requirements and any complications or side effects were noted in the intraoperative period and during the 48 h after operation. No significant difference was seen in quality of analgesia or patient satisfaction between the two groups.