Articles: nerve-block.
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Randomized Controlled Trial Comparative Study Clinical Trial
Plasma concentrations of bupivacaine following combined sciatic and femoral 3 in 1 nerve blocks in open knee surgery.
We administered combined femoral 3 in 1 and sciatic nerve blocks to provide postoperative pain relief in 22 consecutive patients undergoing elective knee replacement surgery under spinal anaesthesia. The patients were allocated randomly to two groups. In group A (n = 11) the blocks were performed with 0.5% bupivacaine (with adrenaline) 3 mg/kg body weight and in group B (n = 11) 0.5% plain bupivacaine in the same dose was used. ⋯ No significant differences were found between the two groups. There were no clinical signs or symptoms of bupivacaine toxicity in each group. This study demonstrated that, after combined sciatic and 3 in 1 femoral block, concentrations of bupivacaine associated with toxicity were not reached, even though the dose of bupivacaine administered exceeded the manufacturer's recommended dose by 50%.
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Refract Corneal Surg · Mar 1991
Randomized Controlled Trial Comparative Study Clinical TrialSodium bicarbonate reduces pain associated with ophthalmic nerve blocks.
Administration of local nerve blocks for ophthalmic surgical procedures causes pain resulting in an unpleasant and stressful experience for the patient. A prospective, randomized, double-masked study compared injection pain of anesthetic solutions used for facial and retrobulbar nerve blocks. Anesthetic solutions to which sodium bicarbonate had been added were compared with anesthetic solutions without added sodium bicarbonate. Pain on injection of both facial and retrobulbar nerve blocks was significantly less (P = .0009 and P less than .0001 respectively), without diminution of effectiveness of either type of nerve block, in the group using anesthetic solutions to which sodium bicarbonate had been added.
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Case Reports
The effect of intraoperative retrobulbar block on anesthetic management of enucleation under general anesthesia.
This case chronicles the effect of a retrobulbar block on a coincident general anesthetic for enucleation in an elderly man. This ASA II patient had a medical history of insulin-dependent diabetes with few apparent cardiovascular complications and mild chronic obstructive pulmonary disease. Induction of anesthesia was accomplished with small doses of midazolam, droperidol, and alfentanil followed by thiamylal. ⋯ Within 10 minutes the patient suffered a profound decrease in blood pressure and pulse requiring repeated doses of glycopyrrolate, phenylephrine, and ephedrine to maintain effective perfusion. These effects do not appear to have resulted from direct elicitation of the oculocardiac reflex, but rather from the loss of surgical stimuli from the block that essentially resulted in inadequate sympathetic tone. The author concludes that anesthetists in similar circumstances should anticipate the possibility of hypotension and lessened anesthetic requirements following retrobulbar block when coincident general anesthesia is planned.
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J. Cardiothorac. Vasc. Anesth. · Feb 1991
A complete regional anesthesia technique for cardiac pacemaker insertion.
Sixteen consecutive adult patients scheduled for permanent transvenous cardiac pacemaker insertion received as their total anesthetic the combination of a cervical plexus block and blocks of the second, third, and fourth intercostal nerves using a combination of 1% mepivacaine and 0.2% tetracaine with epinephrine, 1:200,000. This technique consistently provided complete surgical anesthesia of the third cervical (C3) through the fourth thoracic (T4) dermatomes, without anesthesia of the brachial plexus. ⋯ In contrast to other reports, this technique provides surgical anesthesia that is adequate for all of the approaches used for transvenous pacemaker implantation, except for placement of a battery in an abdominal pouch. There were no serious complications and/or side effects in any of the patients studied.
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Australian dental journal · Feb 1991
Case ReportsMaxillary nerve block anaesthesia via the greater palatine canal: a modified technique and case reports.
A modification of the technique of maxillary nerve block (via the greater palatine canal) is discussed. This technique has been employed in the Exodontia and Oral Surgery Clinics of the United Dental Hospital of Sydney for more than 40 years. Clinical experience in that time has shown that once the greater palatine canal has been negotiated successfully, the palatal canal approach to the maxillary nerve is safe and reliable. The value of being able to anaesthetize the maxillary nerve and its branches is illustrated by the presentation of two clinical cases where local anaesthesia was achieved and the extractions performed in patients who would otherwise have required a general anaesthetic for the procedures.