Articles: nerve-block.
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A 55-yr-old man received a left supraclavicular brachial plexus block with 0.42% bupivacaine; he had profound motor and sensory block 26 h after injection; complete recovery occurred at 40 h.
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A young female patient is referred to the oral surgery clinic to ligate an impacted upper canine. Shortly following injection, whitening of the skin is noted. The physiopathology is explained according to different hypothesis. The use of different types of syringes is also discussed.
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Acta Anaesthesiol Scand · Oct 1989
Randomized Controlled Trial Comparative Study Clinical TrialEffects of thoracic paravertebral block with bupivacaine versus combined thoracic epidural block with bupivacaine and morphine on pain and pulmonary function after cholecystectomy.
Twenty patients undergoing elective cholecystectomy via a subcostal incision were randomized in a double-blind study to either thoracic paravertebral blockade with bupivacaine 0.5% (15 ml followed by 5 ml/h) or thoracic epidural blockade with bupivacaine 7 ml 0.5% + morphine 2 mg followed by 5 ml/h + 0.2 mg/h, respectively for 8 h postoperatively. Mean initial spread of sensory analgesia on the right side was the same (Th3,4-Th11 versus Th2,6-Th11), but decreased (P less than 0.05) postoperatively in the paravertebral group. All patients in the epidural group had bilateral blockade, compared with three patients in the paravertebral group. ⋯ Pulmonary function estimated by forced vital capacity, forced expiratory volume and peak expiratory flow rate decreased about 50% postoperatively in both groups. In conclusion, the continuous paravertebral bupivacaine infusion used here was insufficient as the only analgesic after cholecystectomy. In contrast, epidural blockade with combined bupivacaine and low dose morphine produced total pain relief in six of ten patients.
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We have examined the in vitro sensitivities of A, B and C fibres in rabbit vagus nerves to local anaesthetic block with a range of local anaesthetic drugs. The nerves were maintained at 37 degrees C and pH 7.4 using an electrolyte solution equilibrated with 5% carbon dioxide. A fibres were the most, and C fibres the least, sensitive to block at low frequency stimulation (0.0167 Hz). ⋯ With stimulation at high frequencies (20 and 40 Hz), C fibres were more sensitive to use-dependent block than A fibres; this effect was more marked with drugs containing an amide than an ester linkage. Molecular size and lipid solubility may inter-react to govern the ability to produce use dependent block. Agents which contain an amide linking group, have a high pKa and are of low lipid solubility, may be used to produce differential C fibre block.