Articles: nerve-block.
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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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Case Reports
Thoracotomy wound exploration in a single lung transplant recipient under extrapleural paravertebral nerve blockade.
Instillation of bupivacaine through a catheter accurately placed in the extrapleural space prior to closure of a thoracotomy incision provides effective, reliable post-operative analgesia. Its usefulness for further surgery in the post-operative period, in this case wound exploration in a lung transplant recipient, is described.
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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 Clinical Trial
The effects of streptomycin/lidocaine block on trigeminal neuralgia: a double blind crossover placebo controlled study.
This study investigated the long term effect of a peripheral sensory block using streptomycin sulphate on trigeminal neuralgia. A total of twenty subjects, thirteen with idiopathic trigeminal neuralgia (ITN) and seven with traumatic trigeminal neuralgia (TTN) were studied. A double-blind placebo controlled randomized design was used. ⋯ The sensory function of the treated nerves was also not affected. Side effects including facial swelling and pain were a common finding in the patients receiving streptomycin. This study demonstrated no beneficial effects of streptomycin blockade for idiopathic and traumatic trigeminal neuralgia.