Articles: nerve-block.
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Randomized Controlled Trial Clinical Trial
Efficacy of continuous extrapleural intercostal nerve block on post-thoracotomy pain and pulmonary mechanics.
To assess the efficacy of continuous extrapleural intercostal nerve block on postoperative pain and pulmonary function, a prospective, randomized, double-blind, placebo-controlled trial was conducted on 56 patients undergoing elective thoracotomy. Infusion was started before closing the chest and was continued for 5 days. Subjective pain relief was assessed on a linear visual analogue scale. ⋯ Restoration of pulmonary function was superior in the bupivacaine group (P less than 0.01). There were no infusion-related complications. After thoracotomy, continuous intercostal blockade with bupivacaine is a safe and effective method of pain relief which reduces the early loss of postoperative pulmonary function significantly and more rapidly restores respiratory mechanics.
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Thorac Cardiovasc Surg · Feb 1990
Randomized Controlled Trial Comparative Study Clinical TrialIntrapleural bupivacaine for early post-thoracotomy analgesia--comparison with bupivacaine intercostal block and cryofreezing.
54 patients who had posterolateral thoracotomy were prospectively studied to compare the efficacy of intrapleural bupivacaine with that of bupivacaine intercostal block and cryofreezing. Patients were randomized into three groups. The intrapleural catheter group included 16 patients who had intermittent intrapleural instillation of 20 ml of 0.25% bupivacaine for forty-eight hours postoperatively. ⋯ No complications related to the use of the intrapleural catheter or to bupivacaine toxicity were encountered. In conclusion, the technique of intermittent intrapleural bupivacaine is safe and comparable in efficacy to bupivacaine intercostal block and cryofreezing. Narcotic requirements may be reduced when this technique is used.
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Randomized Controlled Trial Clinical Trial
Continuous interscalene brachial plexus block during and after shoulder surgery.
Continuous interscalene brachial plexus block with a single dose of 0.75% bupivacaine (150-210 mg) with adrenaline, continued with an infusion of plain 0.25% bupivacaine 0.25 mg/kg/h, was performed on 20 patients to provide analgesia during shoulder surgery and in the postoperative period. The control group included 20 patients who were given general anaesthesia for surgery after starting a continuous interscalene brachial plexus block; test dose of 0.75% bupivacaine (22.5 mg) with adrenaline, continued with an infusion of 0.25% bupivacaine 0.25 mg/kg/h. Surgery was performed successfully under regional anaesthesia in 16/20 patients; 4/16 were given one dose of fentanyl during the surgery, and diazepam or midazolam as supplementary sedation were given in 13/16 cases. ⋯ There was a statistically significant difference in the mean plasma bupivacaine concentrations between the groups, concentrations in the regional anaesthesia group being higher at 5, 30, 60 min and 3 h (maximum 2.3 micrograms/ml at 60 min), but there was no difference between the values at 24 h. One infusion of local anaesthetic was discontinued because of probable treatment-related side-effects (breathing difficulties, nausea). Mild local anaesthetic toxicity (dizziness, tinnitus) was noticed in four patients.
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Cahiers d'anesthésiologie · Jan 1990
Review[Peripheral neurologic complications of brachial plexus blocks].
Nerve injury can arise as a complication of peripheral nerve block anesthesia. From the review of the literature remain three factors which alone or in combination, are of special etiologic interest: nerve lesion due to the needle or intraneural injection; toxic effects of the agent injected overall when epinephrine is used; ischemic trauma. ⋯ These postanesthetic neuropathies may benefit from specific treatment or even surgical exploration and external neurolysis. The block should be handled with care: rough paresthesia seeking and intraneural injections should be avoided; short bevel needles and plane solutions should be preferred.
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Ann R Coll Surg Engl · Jan 1990
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of postoperative pain relief techniques in orchidopexy.
Fifty consecutive patients admitted to the Western General Hospital for orchidopexy, were randomly allocated to receive either a caudal bupivacaine block or peroperative wound instillation with bupivacaine, to provide postoperative analgesia. Bupivacaine wound instillation reduced the total operating time, gave more efficient postoperative pain relief in hospital and proved both inexpensive and simple in its application.