Articles: nerve-block.
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Randomized Controlled Trial Comparative Study Clinical Trial
Use of post-tetanic count in assessment of a repetitive vecuronium-induced neuromuscular block.
In order to evaluate the use of the post-tetanic count (PTC) method during repetitive administration of vecuronium, we studied 20 patients allocated randomly to one of two groups: 10 patients received droperidol-fentanyl anaesthesia (control group); 10 other patients were given droperidol-fentanyl anaesthesia modified subsequently by addition of 0.5% isoflurane (isoflurane group). Before tracheal intubation, a bolus dose of vecuronium 0.08 mg kg-1 was given i.v. followed by repeated doses of 0.03 mg kg-1. The twitch response of adductor pollicis was recorded after supramaximal stimulation of the ulnar nerve at the wrist using a Myograph 2000 neuromuscular transmission analyser. ⋯ In the isoflurane group, the relationship between PTC and time to first reaction to TOF stimulation remained unchanged after addition of isoflurane. However, isoflurane caused a significant prolongation of the duration of intense block and a corresponding lower PTC in all patients. We conclude that PTC is a reliable method to evaluate intense neuromuscular block caused by vecuronium, even after repetitive administration of the drug and in combination with 0.5% isoflurane.
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A 58 year old man had been suffering from intractable left ophthalmic post herpetic neuralgia (PHN) for 7 years. He has also been treated for polyarteritis nodosa for 10 years. For pain relief, he was treated initially with frequent (4 times a day) stellate ganglion block (SGB) and peripheral ophthalmic nerve block for a month without relief. ⋯ Several days before the block, electric stimulation to control his pain was tested. Stimulation with the electricity (4.5 mA, 10 cycle and 400 microseconds) brought him complete relief from the pain during the stimulation. Trigeminal SEP showed no response to the stimulation of injured skin.
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A reliable, safe approach to achieving unilateral anesthesia in multiple contiguous thoracic dermatomes would be of great benefit to anesthesiologists in the acute and chronic pain setting. The multidermatomal intercostal technique is one such approach, although the anatomical mechanism of this nerve block is a matter of debate. At our pain clinic, we have used another technique, a modification of the paravertebral block, to achieve multiple segments of unilateral sensory blockade. ⋯ In order to clarify the mechanism of bilateral blockade resulting from a unilateral technique, we injected four fresh cadavers with colored latex solution using the paravertebral-peridural approach. This revealed spread of the latex across the midline prevertebrally to the contralateral paravertebral space. We conclude that the paravertebral-peridural thoracic block is a reliable, safe technique for achieving unilateral anesthesia over multiple dermatomes with a single injection.
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Regional anesthesia · Sep 1990
Clinical Trial Controlled Clinical TrialAlkalinization of mepivacaine accelerates onset of interscalene block for shoulder surgery.
Reports evaluating the effect of alkalinization of mepivacaine on the onset of regional anesthesia have been controversial. The effect of alkalinization of mepivacaine on the onset of interscalene block has not been reported and is the subject of this study. Forty patients received an interscalene block by elicitation of paresthesia with 25-gauge, blunt level needle. ⋯ The duration of block for each observation was determined. The onset was significantly faster for all tested modalities in the pH-adjusted group. No statistically significant differences in the duration of either motor or sensory were found between the study and control groups.