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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As with any regional technique, practice will improve the success rate as well as ability of the practitioner to provide the blocks. Despite the simplicity of the techniques, one must always keep in mind that such anesthesia blunts or eliminates sophisticated and highly effective airway protection reflexes, potentially leaving the patient at risk for aspiration or obstruction. As with other forms of regional anesthesia, airway blocks will provide the anesthetist with additional tools with which to better treat his/her patients. These tools will prove to be useful not only in the operating room setting, but also in emergency room and intensive care areas as well, and will add to the confidence and abilities of the practitioner.
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Randomized Controlled Trial Comparative Study Clinical Trial
Buffered versus plain lidocaine for digital nerve blocks.
To test whether buffered lidocaine is less painful to administer as a digital nerve block than plain lidocaine. ⋯ Because it causes less pain and is equally efficacious, buffered lidocaine is preferable to plain lidocaine for digital nerve blocks in adults.