Articles: nerve-block.
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Randomized Controlled Trial Clinical Trial
Improved postoperative analgesia with morphine added to axillary block solution.
To determine whether the addition of morphine to the axillary block local anesthetic solution provides improved or prolonged postoperative analgesia. ⋯ The addition of morphine 0.1 mg/kg to the local anesthetic axillary block solution provided improved postoperative analgesia without an increased frequency of side effects or major complications.
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The ability of a target-controlled propofol infusion system to provide sedation for 40 patients undergoing surgery under regional blockade was assessed. Eighty-eight per cent of the total infusion time was at the desired sedation level with little oversedation. ⋯ The pharmacokinetic algorithm performed as well when used for sedation as for total intravenous anaesthesia. The predicted and measured blood propofol concentrations showed a bias of -12% and a precision of 34%.
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Randomized Controlled Trial Comparative Study Clinical Trial
Clinical and radiological comparison of perivascular and transarterial techniques of axillary brachial plexus block.
The perivascular technique of axillary brachial plexus block results in incomplete block of radial and musculocutaneous nerves in 10-20% of patients. With the transarterial technique and a large dose of mepivacaine, success rates of 99% have been reported. We have compared the clinical efficacy of these techniques in 50 patients using 1% mepivacaine 45 ml with adrenaline. ⋯ There were no statistically significant differences in sensory or motor block between the groups at 20 min or in the plasma concentrations of mepivacaine measured 0-45 min after injection. In the CT scans, both proximal and distal spread of the contrast medium were more common after perivascular than after transarterial block. The distribution of the contrast medium was not related to the efficacy of the block.
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Anesthesia and analgesia · Mar 1993
Supraclavicular nerve block: anatomic analysis of a method to prevent pneumothorax.
Supraclavicular nerve blocks are technically easy to perform, but may be associated with pneumothorax. The objective of this study is to define the parasagittal anatomy important to our modified technique of supraclavicular nerve block designed to decrease the incidence of pneumothorax and to determine whether this technique is anatomically sound. Two cadaver specimens were studied. ⋯ MR imaging showed that in no instance using our modified technique was the lung contacted by the simulated needle before entering either the subclavian artery or contacting the brachial plexus. Our technique has been used in more than 110 patients without pneumothorax. The combination of our cadaver and magnetic resonance data suggests that our plumb-bob technique of supraclavicular nerve block is anatomically sound and may minimize the development of pneumothorax during supraclavicular block.