Articles: nerve-block.
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Somatosensory, motor, and visual sensory blockade were investigated after retrobulbar injection of 3 mL 2% lidocaine, prilocaine, or mepivacaine plus hyaluronidase (15 U/mL) and naphazoline nitrate (1:20,000) in 90 cataract patients (n = 30 per group). Before injection as well as 20 and 90 minutes after injection, and then every 30 minutes, the quality of the retrobulbar blockade was evaluated in terms of the following factors until full recovery of function: (1) corneal sensitivity at the three extraincisional quadrants as determined with an esthesiometer; (2) horizontal and vertical motility, and elevation of the lid; (3) visual acuity on an arbitrary score scale ranging from 0 (no light perception) to 6 (visual acuity > 0.05); and (4) the time required for recovery from retrobulbar anesthesia. The data were analyzed by one- (anesthetic) and two-factor (anesthetic and time) analysis of variance. ⋯ On the average, visual acuity decreased most after mepivacaine and least after lidocaine administration, although the differences between the three anesthetics in this regard were not significant. One patient temporarily lost vision after mepivacaine administration. Overall, the somatosensory and motor blockade were most pronounced after mepivacaine.
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Randomized Controlled Trial Comparative Study Clinical Trial
Modified suprascapular nerve block with bupivacaine alone effectively controls chronic shoulder pain in patients with rheumatoid arthritis.
Chronic shoulder pain is a common and disabling symptom in patients with rheumatoid arthritis (RA). It has been previously shown that a suprascapular nerve block (SSNB) using the standard mixture of bupivacaine and adrenaline (Ba) plus methylprednisolone (P), which is routinely used in pain clinics, results in a considerable improvement in pain relief and range of movement compared with conventional intra-articular steroid injections in such patients. ⋯ Results favoured Ba alone; the differences between the two treatments reached statistical significance for stiffness (at 12 weeks) and active abduction (at one week). It is concluded that the addition of P to the SSNB mixture confers no benefit in these patients.
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Postoperative pain arises largely from distension and sectioning of nerve fibers, which generate a short-lasting but enormous afferent impulse barrage. This causes a long-lasting enlargement of receptive fields and an increase in excitability of dorsal horn neurons sending their axons up to the brain. ⋯ Prostaglandins in the spinal cord facilitate the synaptic transmission from nociceptive afferents. Nonsteroidal anti-inflammatory drugs (NSAIDs) produce relief from postoperative pain by blocking the formation of prostaglandins in the spinal cord, thus abolishing the facilitatory effect of these compounds.
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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.