Articles: nerve-block.
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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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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
Continuous intercostal nerve block versus epidural morphine for postthoracotomy analgesia.
Twenty patients undergoing elective thoracotomy were randomized into two groups, receiving either lumbar epidural morphine (n = 10) or continuous extrapleural intercostal nerve block (n = 10). Subjective pain relief was assessed on a linear visual analogue scale. Pulmonary function (peak expiratory flow rate, forced expiratory volume in 1 second, and forced vital capacity) was measured on the day before operation and daily for 4 days after operation. ⋯ Vomiting, pruritus, and urinary retention occurred only in the epidural group, whereas nausea occurred significantly less frequently in the extrapleural group. We conclude that after thoracotomy continuous extrapleural intercostal nerve block is as effective as lumbar epidural morphine in reducing postoperative pain and restoring pulmonary mechanics. Because of the significantly lower complication rates we favor continuous extrapleural intercostal nerve block for postthoracotomy analgesia.
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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.