Articles: nerve-block.
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Regional anesthesia · Mar 1993
Randomized Controlled Trial Clinical TrialThe effect of continuous interscalene brachial plexus block with 0.125% bupivacaine plus fentanyl on diaphragmatic motility and ventilatory function.
Continuous interscalene brachial plexus block with 0.25% bupivacaine decreases diaphragmatic motility and ventilatory function. The author studied the effects of 0.125% bupivacaine with and without fentanyl. ⋯ Use of 0.125% bupivacaine for continuous interscalene block did not prevent a deterioration of diaphragmatic motility and ventilatory function. Co-infusion of fentanyl did not significantly potentiate the 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 Clinical Trial
pH adjustment of mepivacaine decreases the incidence of tourniquet pain during axillary brachial plexus anaesthesia.
The effect of pH adjustment of mepivacaine on the incidence of tourniquet pain during axillary brachial plexus anaesthesia was studied. Thirty-nine patients scheduled for hand surgery, during which use of pneumatic tourniquet for longer than 60 min was planned, were randomized into two groups. Both received axillary brachial plexus block with 40 ml, 1.4% mepivacaine, 1:200,000 epinephrine. ⋯ Tourniquet; pain was defined as poorly localized and distinct from an inadequate axillary block by a blinded observer. More tourniquet pain occurred in the control group. The authors conclude that alkalinization of mepivacaine for axillary brachial plexus anaesthesia may be indicated in cases where use of pneumatic tourniquet for long periods is planned.
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Anesthesia and analgesia · Feb 1993
Randomized Controlled Trial Clinical TrialOnset, intensity of blockade and somatosensory evoked potential changes of the lumbosacral dermatomes after epidural anesthesia with alkalinized lidocaine.
The onset and intensity of blockade of the lumbosacral dermatomes after epidural anesthesia with alkalinized lidocaine were investigated in a randomized, double-blind study in 26 patients. Control subjects (n = 13) received 20 mL of 1.37% lidocaine (1.5% lidocaine plus 1 mL saline per 10 mL lidocaine) with added 1:200,000 epinephrine; the solution pH was 6.20 +/- 0.08. Patients in the alkalinized lidocaine group (n = 13) were given 20 mL of 1.37% lidocaine plus added bicarbonate (1 mL sodium bicarbonate per 10 mL 1.5% lidocaine) and 1:200,000 epinephrine; the solution pH was 7.18 +/- 0.10. ⋯ Motor blockade was significantly more profound in the alkalinized lidocaine group. Thirteen of 78 PTN and L5 and S1 dermatomal SSEPs were abolished in the alkalinized lidocaine group compared to 4 of 78 SSEPs in the nonalkalinized group. Alkalinization of lidocaine is recommended to shorten the time to block the L5-S1 dermatomes when epidural anesthesia is planned for lower extremity surgery.