Articles: nerve-block.
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Six patients undergoing paravertebral blocks for chronically painful conditions of the chest wall were thermographically imaged so that the extent of cutaneous vasodilatation and hence sympathetic block could be correlated with the distribution of the somatic block. All blocks were performed by a single experienced operator, with a single percutaneous entry, using 15 ml of 0.5% bupivacaine at a mean level of T9-10 (range T7-8--T10-11), with radiological confirmation of correct needle placement. There was a mean distribution of the somatic block of five dermatomes (range 1-8), as evidenced by loss of pinprick sensation, with upper and lower limits of T6 and L3. ⋯ No significant postural changes in blood pressures were seen, although there was a small but significant decrease in supine heart rate (p = 0.05). This study demonstrates that a large unilateral somatic and sympathetic block is obtainable with a single thoracic percutaneous paravertebral injection. It challenges the suggestions that this method of analgesia is ineffective and hazardous, that a sympathetic component is a rare accompaniment and that the lumbar nerve roots are spared.
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Pipecuronium Bromide (Arduan, Organon, Inc, West Orange) is a long-acting, nondepolarizing neuromuscular blocking agent. The efficacy of pyridostigmine 170 micrograms/kg intravenously (approximately 10 mg/70 kg) for reversing pipecuronium has not been reported. This study was performed to determine the time required to obtain a train-of-four (TOF) ratio of 0.7 after administration of pyridostigmine 140 micrograms/kg at 25% recovery of T1 after pipecuronium-induced neuromuscular blockade. ⋯ Anesthesia was maintained with a nitrous oxide/narcotic technique and the use of potent inhalational anesthetics was avoided. The mean reversal time was found to be 16.14 minutes, with a minimum of 10.3 minutes and a maximum of 24.3 minutes. The standard error was +/- 1.05 minutes with a variance of 17.68 minutes.
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Mivacurium is a relatively new short-acting nondepolarizing neuromuscular blocker. A recommended dose of 0.15-0.2 mg kg-1 provides tracheal intubating conditions within 2.5 min and duration of action of 15-30 min, making it a possible alternative to suxamethonium for short procedures requiring tracheal intubation. However, in common with suxamethonium its metabolism depends primarily on plasma cholinesterase and its duration of action is prolonged in patients with reduced plasma cholinesterase activity. We present a case of unexpected prolonged neuromuscular block in a child with previously undiagnosed plasma cholinesterase deficiency.
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Randomized Controlled Trial Clinical Trial
Post-herniorrhaphy pain in outpatients after pre-incision ilioinguinal-hypogastric nerve block during monitored anaesthesia care.
The objective of this study was to evaluate the effect of an ilioinguinal-hypogastric nerve block (IHNB) with bupivacaine 0.25% on the postoperative analgesic requirement and recovery profile in outpatients undergoing inguinal herniorrhaphy with local anaesthetic infiltration. Thirty consenting healthy men undergoing elective unilateral inguinal herniorrhaphy procedures were randomly assigned to receive an IHNB with either saline or bupivacaine according to a double-blind, IRB-approved protocol. All patients received midazolam, 2 mg iv, and fentanyl 25 microgram iv, prior to injection of 30 ml of either bupivacaine 0.25% or saline through the oblique muscle approximately 1.5 cm medial to the anterior superior iliac spine. ⋯ However, the pain visual analogue score at 30 min after entering the PACU was lower in the bupivacaine (versus saline) group (P < 0.05). Although the times to ambulation (86 +/- 18 vs 99 +/- 27 min) and being judged "fit for discharge" (112 +/- 49 vs 126 +/- 30 min) were similar in the two groups, the bupivacaine-treated (vs saline) patients required less oral analgesic medication after discharge (46% vs 85%). We concluded that the use of an ilioinguinal-hypogastric nerve block with bupivacaine 0.25% as an adjuvant during inguinal herniorrhaphy under monitored anaesthesia care decreased pain in the PACU and oral analgesic requirements after discharge from the day-surgery unit.
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Randomized Controlled Trial Clinical Trial
Local anesthesia for postoperative pain relief after foot surgery: a prospective clinical trial.
A prospective, randomized, controlled clinical trial was set up to test whether the addition of ankle block to general anesthesia was useful in providing postoperative pain relief following forefoot surgery. Forty feet (20 treatment, 20 control) were entered into the trial and all underwent bony operations on the first ray. ⋯ A significant difference was found between the pain scores in the two groups at the 6-hr stage, but there was no difference in any of the other assessments. It is concluded that ankle block is a useful addition to general anesthesia for this type of surgery.