Articles: nerve-block.
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Eur J Cardiothorac Surg · Jan 1993
Comparative StudyIntercostal nerve block, interpleural analgesia, thoracic epidural block or systemic opioid application for pain relief after thoracotomy?
The purpose of this study was to investigate the effect of different pain-relief methods (regional and systemic) following thoracotomies on the cardiovascular system, pulmonary gas exchange, various endocrine parameters and subjective perception. A further aspect was to evaluate the benefits of interpleural analgesia as a new regional technique against already established regional techniques, such as intercostal nerve block and thoracic epidural block. All postoperative pain methods led to a significant time-dependent reduction of the adrenaline concentrations in plasma while the noradrenaline concentrations did not change significantly. ⋯ The plasma concentrations of the "stress metabolites", such as glucose, free fatty acids and lactate, as well as the haemodynamic (mean arterial pressure, heart rate) and pulmonary parameters (blood gas analyses), showed no significant differences among groups. In contrast to the other pain-relieving methods, interpleural analgesia did not lead to sufficient pain relief in that 7 out of 10 patients needed supplementary systemic opioid therapy. Therefore, interpleural analgesia for pain relief following thoracotomies cannot be recommended.
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Ann Fr Anesth Reanim · Jan 1993
Randomized Controlled Trial Comparative Study Clinical Trial[Axillary plexus block by simultaneous blockade of several nerves. II. Evaluation of lidocaine-bupivacaine combination].
A mixture of carbonated lignocaine and bupivacaine for axillary blocks was assessed prospectively in a randomized double-blind study including 60 patients scheduled for upper limb surgery. A peripheral nerve stimulator was used to carry out the axillary block with a multiple injection technique. The musculocutaneous, radial, median and ulnar nerves were routinely stimulated. ⋯ Adrenaline only affected significantly the duration of anaesthesia in the lignocaine group (252 min vs 135 min with and without adrenaline, respectively) (p < 0.03). In axillary blocks, the mixture of carbonated lignocaine and bupivacaine has a faster onset of action than bupivacaine alone, and a longer duration of action than lignocaine alone. Both agents provided a quality of sensory and motor blockade similar to that obtained with the mixture.
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Comparative Study
A comparison of patient-controlled analgesia and continuous lumbar plexus block after anterior cruciate ligament reconstruction.
Anterior cruciate ligament (ACL) reconstruction is often a painful operation. Fifty-eight patients who underwent ACL reconstruction using patellar tendon autograft received either a lumbar plexus block (LPB) or patient-controlled analgesia (PCA) for pain relief during the first 24 h after surgery. ⋯ The common narcotic analgesic side effects of nausea, pruritus, sedation, and urinary retention were significantly less in the LPB group. The LPB is a safe and effective alternative analgesia after ACL reconstruction.
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Cahiers d'anesthésiologie · Jan 1993
[Loco-regional anesthesia and orthopedic surgery of the shoulder].
Interscalene block can induce by itself anesthesia for shoulder surgery, if the opening does not reach the delto-pectoral site nor the shoulder-blade, but medical indications must be thoroughly talked over on account of the risk of phrenic paralysis with patients suffering from breezing trouble, and the surgical position that may disturb the anesthesiologist in case he has to increase anesthesia. A superficial cervical plexus block is required in anesthesia of the upper part of the shoulder. ⋯ Today we prefer set interscalene block before the patient is anaesthetized, searching for paresthesias with a thin needle: this process does not take long to install, it is relatively painless and provides excellent analgesia during the per and post-surgical period, until the next day with long acting local anesthetics. Not any complication happened in fifty patients for one year.