Articles: nerve-block.
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Tachyphylaxis to local anesthetics has been shown to be promoted by longer interanalgesic intervals between injections. We hypothesized that thermal hyperalgesia also would accelerate the development of tachyphylaxis. The n-methyl-D-aspartate antagonist ((+)-5 methyl-10,11-dihydro-5H-dibenzo (a,d) cyclohepten-5,10-imine, or dizocilpine) (MK-801) has been shown to prevent thermal hyperalgesia. We therefore also hypothesized that MK-801 would prevent tachyphylaxis. ⋯ Thermal hyperalgesia accelerates the development of tachyphylaxis to rat sciatic nerve blockade, and MK-801 prevents tachyphylaxis in this model. n-Methyl-D-aspartate receptor antagonists may have future clinical utility in increasing the duration of effectiveness of prolonged local anesthetic administration.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of intraoral and percutaneous approaches for infraorbital nerve block.
The infraorbital nerve block is frequently used during repair of facial lacerations; both percutaneous and intraoral approaches are used. The authors compared the two techniques for pain of administration and anesthetic effectiveness. ⋯ The intraoral approach to the infraorbital nerve block after adjunctive topical anesthesia appeared at least as effective in producing upper-lip anesthesia as the percutaneous approach without adjunctive topical anesthesia. Although the volunteers subjectively preferred the intraoral approach and visual-analog pain scores were lower for this approach, these differences did not achieve statistical significance. The intraoral approach was associated with a longer duration of upper-lip anesthesia.
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Celiac plexus neurolysis is considered an effective technique for relieving abdominal cancer pain. CT yields accurate anatomical detailing, thus allowing the indirect location of the celiac plexus and the planning of needle trajectory and positioning. September 1992 to December 1993, twenty-eight celiac plexus neurolyses for pain relief were performed in 26 patients (13 men and 13 women), 17 through the anterior and 11 through the posterior access. ⋯ Only transient orthostatic hypotension requiring no treatment developed in all our patients during the first 24 hours after the block. To conclude, we believe celiac plexus alcoholization under CT guidance to be a safe and effective technique for relieving abdominal pain due to cancer or benign conditions. We prefer the anterior approach because it is better accepted by the patients and more easily performed by the operators.
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Randomized Controlled Trial Clinical Trial
Pharmacokinetics of ropivacaine and bupivacaine for bilateral intercostal blockade in healthy male volunteers.
Intercostal blockade produces the highest serum local anesthetic concentrations of all regional anesthetic techniques. The purpose of this study was to determine the pharmacokinetic properties of ropivacaine and bupivacaine after bilateral intercostal blockade. ⋯ The results of this pharmacokinetic study indicate that 0.25% ropivacaine and 0.25% bupivacaine (56 ml, 140 mg) produce peak plasma levels less than those considered toxic when used in bilateral intercostal blockade. Studies of ropivacaine for intercostal blockade in surgical patients are necessary before the optimum concentration for efficacy and anesthetic/analgesic duration is identified.
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Minerva anestesiologica · Nov 1994
Randomized Controlled Trial Clinical Trial[Effects of betamethasone on neuromuscular blockade induced by vecuronium in continuous infusion].
The aim of the study was to determine a possible interaction between a corticosteroid (betamethasone) and vecuronium, a nondepolarizing muscle relaxant. The authors studied 20 patients, ASA I-II, aged 20-54, both sexes, scheduled for abdominal surgery. ⋯ The recovery rate of vecuronium after stopping infusion at 10% recovery was also evaluated. Corticosteroids may interact with non-depolarizing muscle relaxants both in prejunctional and postjunctional acetylcholine receptors by several mechanisms of action.