Articles: nerve-block.
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Acta Obstet Gynecol Scand · Feb 1995
Clinical TrialParacervical block--a viable alternative for labor pain relief?
Two hundred and forty-eight consecutive deliveries with a 0.25% bupivacaine paracervical block (PCB) using a superficial injection technique were studied prospectively during the progress of labor in the three month study period. Parturients with signs of fetal distress were excluded. Pain level and the maternal, fetal and neonatal effects related to PCB were evaluated. ⋯ PCB in selected parturients with a low-dose superficial technique has been shown to be an effective analgesic modality with minimal fetal and neonatal side-effects, but post-blockade fetal bradycardia cannot be wholly eliminated.
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Anesthesia and analgesia · Feb 1995
Meta AnalysisNeurolytic celiac plexus block for treatment of cancer pain: a meta-analysis.
We performed a meta-analysis of the efficacy and safety of neurolytic celiac plexus block (NCPB) for cancer pain. A literature search yielded 59 papers, but data on NCPB in two or more patients was available in only 24 papers. Twenty-one studies were retrospective, one was prospective, and two were randomized and controlled. ⋯ Patients with pancreatic cancer responded similarly to those with other intraabdominal malignancies. Common adverse effects were transient, including local pain (96%), diarrhea (44%), and hypotension (38%); complications occurred in 2%. This analysis suggests that: 1) NCPB has long-lasting benefit for 70%-90% of patients with pancreatic and other intraabdominal cancers, regardless of the technique used; 2) adverse effects are common but transient and mild; and 3) severe adverse effects are uncommon.
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Anesthesia and analgesia · Feb 1995
Randomized Controlled Trial Clinical TrialThe influence of the duration of control stimulation on the onset and recovery of neuromuscular block.
The onset of action of atracurium 450 micrograms/kg, mivacurium 160 micrograms/kg, and vecuronium 80 micrograms/kg was measured after train-of-four (TOF) stimulation had been applied for 1, 5, 10, 15, or 20 min in groups of 10 patients each during anesthesia with thiopental, nitrous oxide-oxygen, and fentanyl. TOF stimulation was applied to the ulnar nerve at 2 Hz every 12 s and the force of contraction of the adductor pollicis muscle recorded. There was a progressive and significant reduction in the time to onset of maximum block with increasing times of control stimulation with all three relaxants (P < 0.0001). ⋯ The time to recovery of T1 (first response in the TOF stimulation) to 25% of control (duration of clinical relaxation) increased from 33 +/- 5.7 to 52 +/- 13.4 min with atracurium, 25 +/- 7.6 to 38 +/- 9.4 min with vecuronium, and 13 +/- 2.5 to 18 +/- 3.5 min with mivacurium with the period of control stimulation increasing from 1 to 20 min. The differences were significant for atracurium and vecuronium (P < 0.05-0.0001). We conclude that increasing periods of control stimulation are associated with decreasing time to onset of neuromuscular block with atracurium, vecuronium, and mivacurium at the adductor pollicis muscle.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Feb 1995
Randomized Controlled Trial Clinical TrialMonitoring the onset of neuromuscular block at the orbicularis oculi can predict good intubating conditions during atracurium-induced neuromuscular block.
This study was designed to assess whether monitoring the orbicularis oculi (OO) can predict good tracheal intubating conditions. Fifty patients, ASA grade I or II were studied. Anesthesia was induced with thiopental (5 mg/kg) and fentanyl (3 micrograms/kg). ⋯ Endotracheal intubating conditions were comparable in both groups: good or excellent after 0.5 mg/kg. After 0.3 mg/kg, complete block was achieved only 2/20 at the OO and 12/20 at the AP. Intubating conditions were comparable in both groups: poor or inadequate, except in the two patients with complete OO block, for whom conditions were good.(ABSTRACT TRUNCATED AT 250 WORDS)
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Recent case reports suggest there may be an increased risk of abnormally high blockade ("high spinal") from subarachnoid anesthesia if it is performed immediately after epidural anesthesia. We describe two cases of high spinal anesthesia following failed epidural block in obstetric patients scheduled for cesarean delivery. Using a retrospective chart review, we estimate the incidence of high spinal anesthesia to be 11% in patients after prior failed epidural blockade versus fewer than 1% in patients undergoing spinal anesthesia alone.