Articles: nerve-block.
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Acta ophthalmologica · Aug 1993
Randomized Controlled Trial Clinical TrialEffects of retrobulbar bupivacaine on post-operative pain and nausea in retinal detachment surgery.
A prospective double-masked clinical trial was conducted to determine whether retrobulbar bupivacaine block had an effect on post-operative pain, nausea and intra- and post-operative use of analgesics in retinal detachment surgery performed under general anaesthesia. Thirty-two patients were randomized to have general anaesthesia with or without retrobulbar bupivacaine. Pain score was documented as 0-10 (0 = no pain. 10 = worst pain ever felt). ⋯ Men complained more about post-operative pain than did women. The patients in the retrobulbar group complained less about nausea. Significantly fewer patients in the retrobulbar group required parenteral pain relief during operation and the first 48 h after.
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Twenty-six patients with extensive gynecologic, colorectal or genitourinary cancer who suffered uncontrolled, incapacitating pelvic pain were enrolled in this study during a 1-year period. All the patients receiving oral opioids who developed poor pain response due to the progression of disease or untoward side effects necessitating other modes of therapy were eligible to participate. Bilateral percutaneous neurolytic superior hypogastric plexus blocks with 10% phenol were performed in every patient, 1 day after receiving successful diagnostic blocks using 0.25% bupivacaine (BUP). ⋯ No complications related to the block were experienced by any patient. In conclusion, neurolytic superior hypogastric plexus block was both effective in relieving pain in 69% of the patients studied (95% confidence interval of 48-85%). Additional neurolytic blocks using higher volumes of the neurolytic agent may be needed in patients with extensive retroperitoneal disease, a group in whom moderate or poor results should be expected.
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Anesthesia and analgesia · Jul 1993
Randomized Controlled Trial Clinical TrialNerve stimulator polarity and brachial plexus block.
To determine whether needle polarity significantly affects nerve stimulation during peripheral nerve block, we performed a randomized double-blinded study of 10 patients undergoing axillary block for upper extremity surgery. Using an insulated needle, we determined the minimum current necessary to elicit muscle contraction with positive and negative needle polarity at two needle placements: (A) where stimulation was first observed and (B) where stimulation was maximal. At Position A, stimulation required significantly more current when the needle was positive (2.32 +/- 0.45 mA, mean +/- SEM) than when it was negative (1.05 +/- 0.23 mA, P < 0.001). ⋯ The mean ratio of positive to negative threshold stimulation current at Position B (3.11 +/- 0.20) was significantly greater than that at Position A (2.37 +/- 0.19, P < 0.05). Our results emphasize the importance of attaching the negative terminal of the nerve stimulator to the stimulating electrode. Use of the positive terminal could lead to abandoning a block if stimulation were not obtained at a low enough current; alternatively, motor contraction might not be observed before neural contact or vascular puncture.
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Regional anesthesia · Jul 1993
Case Reports Comparative StudyRectus block for postoperative pain relief.
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Regional anesthesia · Jul 1993
Randomized Controlled Trial Clinical TrialPulmonary function changes during interscalene brachial plexus block: effects of decreasing local anesthetic injection volume.
During interscalene block, ipsilateral hemidiaphragmatic paresis occurred in all patients who received > 34 ml of local anesthetic in the authors' previous studies. This study was done to determine whether diaphragmatic function could be spared by a smaller local anesthetic volume. ⋯ Reducing the volume of local anesthetic to 20 ml did not prevent the 100% incidence of diaphragmatic paresis or significantly lessen the compromise in pulmonary function that had been reported to occur during interscalene brachial plexus anesthesia.