Articles: nerve-block.
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Mayo Clinic proceedings · Jun 1991
Comparative StudyBrachial plexus anesthesia in pediatric patients.
Between 1980 and 1988 at our institution, brachial plexus anesthesia (BPA) was used in 109 pediatric patients who underwent 142 surgical procedures on an upper extremity, including 134 axillary blocks. Most patients older than 6 years of age had their blocks and surgical procedures with moderate sedation. The success rate was high--92.4% of axillary blocks and 100% of other blocks were adequate for surgical intervention in patients who required only intravenous sedation. ⋯ Outpatients in the BPA group were less likely to require narcotic analgesics before dismissal than were those in the GA group (12% versus 31%; P less than 0.05). Admission of outpatients was infrequent in both groups (2% for BPA and 9% for GA). No significant difference was noted in 24-hour postoperative narcotic requirements between the BPA and GA groups.
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One-hundred and ninety-two obese patients presented for upper abdominal surgery, of which 110 received general anesthesia with opioid analgesia and 82 patients received general anesthesia with opioid analgesia plus a single-shot intercostal nerve block of 0.5% bupivacaine in 1: 200,000 adrenaline. A significant increase in the time to first post-operative opioid dose and a significant reduction in the number of doses over the first 12 and 24 h periods were noted in the patients receiving intercostal nerve block.
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Trismus may be a complication from local anesthesia. Patients with trismus of unknown cause after dental treatment should be evaluated thoroughly. ⋯ A right lateral pharyngeal space infection developed after a general restorative procedure that involved an inferior alveolar nerve injection on the same side. The patient's severe trismus required awake intubation, incision and drainage while the patient was under general anesthesia, treatment with antibiotics and ten days of hospitalization.
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Anesthesia and analgesia · Jun 1991
Effect of pH of bupivacaine on duration of repeated sciatic nerve blocks in the albino rat. Local Anesthetics for Neuralgia Study Group.
Tachyphylaxis has been ascribed to tissue acidification after repeated injections of acidic local anesthetic solutions. We studied the effect of pH on the duration of action of bupivacaine to determine the validity of this proposed mechanism of tachyphylaxis by injecting bupivacaine solutions adjusted to pH 4.2 or 6.8 into a surgically implanted system created to permit in vivo irrigation of rat sciatic nerves with local anesthetic. Tachyphylaxis developed at both pH values. The results fail to support the acidification hypothesis as there was no statistically significant effect of a 400-fold difference in hydrogen ion concentration on the development of tachyphylaxis or the duration of motor dysfunction.