Articles: nerve-block.
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Regional-Anaesthesie · May 1989
[Does the development of methemoglobin in the newborn infant affect the suitability of prilocaine for pudendal anesthesia? A clinical study in the peripartum phase].
Pudendal block is a well established method of achieving analgesia during the second stage of labor. Whenever a large amount of a local anesthetic has to be injected in well vascularized tissue, local anesthetic drugs with low systemic toxicity should be used, to minimize side effects. This means that prilocaine is the drug of choice. ⋯ Formerly prilocaine was judged to be contraindicated in pregnant women during delivery because of the small redox capacity of fetal erythrocytes. Our study, however, demonstrates that 200 mg prilocaine for pudendal block does not induce methemoglobinemia in newborns to any significant extent. One explanation for this may be the increased renal elimination of local anesthetics in newborns and the low fetomaternal ratio.
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The effect of neostigmine on neuromuscular function was examined after spontaneous recovery from an atracurium-induced neuromuscular blockade, which reached a train-of-four ratio of either 0.5 or 0.9. Two doses of neostigmine 2.5 mg were given 5 minutes apart. Neuromuscular recovery was assessed with train-of-four and tetanic stimuli. ⋯ The train-of-four measured mechanically was adversely affected to a small degree, but when measured with the electromyograph no significant change occurred. Neostigmine may adversely affect neuromuscular function after spontaneous recovery from a non-depolarising block. This is unlikely with a single modest dose and any effects are probably short-lived.
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The authors evaluated the efficacy and incidence of side effects from blockade of the femoral nerve with 0.5% bupivacaine in 14 children with fracture of the middle third of the femoral shaft. In nine of these children, a pharmacokinetic analysis was also performed. The onset of analgesia occurred in 8.0 +/- 3.5 minutes after blockade of the femoral nerve. ⋯ The maximum bupivacaine plasma concentration was 0.89 +/- 0.37 microgram/ml, obtained 24.4 +/- 12.6 min after the end of the injection. The femoral nerve blockade with bupivacaine provides prompt, effective, and prolonged analgesia in children suffering from fractures of the femoral shaft, allowing transport, radiographic examination, and application of traction in optimal conditions. Although the sample size was small, the side effects appeared to be rare.