Articles: nerve-block.
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The effects of increasing the maximum prescribed volume of 50 ml lidocaine 1% to 65 ml in a combined sciatic 3-in-1 block were investigated in 25 adult patients. The goal of the study was (1) to show possible increase in the success rate and (2) to determine if toxic plasma levels of local anaesthetic would be reached. Further more, we wanted to find out if there were any side-effects. ⋯ There were no statistical differences between the three groups. CONCLUSION. Increasing the dosage of lidocaine from 500 to 650 mg makes the block very successful without any toxic side-effects.
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Randomized Controlled Trial Clinical Trial
[The effect of adding clonidine to mepivacaine. Axillary brachial plexus blockade].
Clonidine (Cl) added to local anaesthetics (LA) prolongs the duration of both anaesthesia and analgesia after peripheral nerve blocks. In this study, we investigated the dose-dependent effect of Cl added to mepivacaine (M) on clinical efficacy, onset, and regression time of brachial plexus block. METHODS. ⋯ Neither the onset time nor the number of patients with adequate surgical anaesthesia was influenced by Cl. Considering the M plasma levels, it is unlikely that the prolongation of the block is caused by local vasoconstriction, which is proposed to be the mechanism of action of epinephrine. The mean differences in haemodynamic parameters were not of clinical relevance, but the two dramatic drops in BP and HR, probably caused by Cl, were significant.
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Regional anesthesia · Sep 1992
Brachial plexus block with the nerve stimulator: motor response characteristics at three sites.
Differences in motor response patterns, minimum electrical currents, and success rates using a nerve stimulator for brachial plexus block were determined for the interscalene, supraclavicular, and axillary approaches. ⋯ Localization of the brachial plexus with the nerve stimulator is equally effective at the interscalene, supraclavicular, and axillary sites. Current values in the range reported have no predictive value for success. Advantages of the nerve stimulator for brachial plexus block include an objective endpoint and continuous feedback.
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Anesthesia and analgesia · Sep 1992
Influence of volume on the spread of local anesthetic-methylene blue solution after injection for intercostal block.
The purpose of this study was to evaluate the influence of the volume of methylene blue-local anesthetic on the spread of the injectate along the costal pleura. Twenty patients undergoing elective thoracotomy were studied. Twelve patients received intercostal nerve injection with 10 mL of 0.5% bupivacaine with methylene blue (10-mL group), and eight patients received 5 mL of 0.5% bupivacaine with methylene blue (5-mL group). ⋯ In the 10-mL group, eight patients had bupivacaine-methylene blue spread to two intercostal spaces, three patients to three intercostal spaces, and one patient to four intercostal spaces. In the 5-mL group, seven patients had bupivacaine methylene blue spread confined to one intercostal space and one patient to two intercostal spaces. We conclude that a potential anatomic space exists between the costal pleura and the internal intercostal muscle and that the spread of local anesthetic after intercostal nerve block injection is volume dependent.
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Anesthesia and analgesia · Sep 1992
Interscalene brachial plexus block for shoulder surgery: a proximal paresthesia is effective.
This study was designed to determine whether the location of paresthesias is related to the success of interscalene blocks in providing anesthesia for shoulder surgery. Interscalene blocks were performed in 45 patients presenting for elective shoulder surgery. Interscalene injections of 33-55 mL of 1.5% mepivacaine with epinephrine were performed after the first elicited paresthesia to the shoulder, arm, forearm, or hand. ⋯ The time-course of onset of motor block as evaluated at the shoulder and elbow was not different between patients with shoulder paresthesias and those with more distal paresthesias. Handgrip strength was quantitatively evaluated with a dynamometer, and both paresthesia groups showed similar decrements in hand strength except at the end of the measurement period, when patients with distal paresthesias had a significantly weaker handgrip than patients with shoulder paresthesias. We recommend that paresthesias to the shoulder be accepted in performing interscalene blocks for patients undergoing shoulder surgery.