Articles: nerve-block.
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The technique described by Winnie in 1973 is supposed to provide a regional block of the femoral, femoral cutaneous, and obturator nerves by a single injection within the femoral nerve sheath. This study aimed to assess the diffusion spaces for the local anaesthetic solution used in this technique. The anatomical study included the dissection of 2 adult and 1 foetal cadavers. ⋯ The other type was an external diffusion, in front of the iliacus muscle, the liquid never reaching the internal side of the psoas major muscle, and therefore the obturator nerve. The "3 in 1" block would therefore seem to be useful for those surgical acts requiring only a block of the femoral and femoral cutaneous nerves, i.e. those involving the anterior aspect of the thigh and knee, the femoral shaft, and the patella. On the other hand, its usefulness for surgery of the hip (dislocation, fractured neck of femur) is rather uncertain.
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Success rates and complications were studied in 178 patients scheduled for brachial block. METHODS. Patients of both sexes aged 9 to 79 years received axillary blocks in order to permit typical surgical procedures of the hand an forearm. ⋯ The 90% rate of successful blocks is comparable to the range of 86-98% presented in the literature. The success rate depends on the definition of successful block, the experience of the anesthetist, and the volume and concentration of the anesthetic solution administered. The incidence of systemic cardiovascular complications was similar to that in the literature, but we observed fewer symptoms of cerebral toxicity.(ABSTRACT TRUNCATED AT 250 WORDS)
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Acta Anaesthesiol Scand · Jan 1989
Continuous interscalene brachial plexus block: clinical efficacy, technical problems and bupivacaine plasma concentrations.
Continuous interscalene brachial plexus block with a single dose of 0.5% bupivacaine 1.25 mg/kg, continued with an infusion of 0.25% bupivacaine 0.25 mg/kg/h, was performed on 24 patients to provide analgesia during shoulder surgery and in the postoperative period. The drugs for general anaesthesia included glycopyrrolate, thiopentone, vecuronium, enflurane and N2O/O2. All patients had signs of regional analgesia 30 min after the block without haemodynamic problems. ⋯ During the 24-h period, the alpha 1-acid glycoprotein (AAG) concentration (mean +/- s.e.mean) in plasma rose from 0.41 +/- 0.04 g/l to 0.54 +/- 0.04 g/l (P less than 0.001). The concentration of free bupivacaine was below detectable levels (less than 0.01 micrograms/ml) after the 24-h infusion. The rise in AAG probably increases binding of bupivacaine to plasma proteins, diminishing the risk of systemic toxicity.
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Anesthesia and analgesia · Jan 1989
Paravertebral somatic nerve block: a clinical, radiographic, and computed tomographic study in chronic pain patients.
The spread of solution after a standardized paravertebral injection was studied to determine the precision and predictability of paravertebral spread. The spread of 5 ml of a solution of radiological contrast medium (sodium iothalamate) and local anesthetic mixture after 45 (34 thoracic, 11 lumbar) paravertebral injections was studied in 31 patients by radiography and computed tomography and correlated with the clinical effects. Spread confined to the paravertebral area occurred after only eight (18%) injections. ⋯ The distance from bony landmarks to pleura frequently fell outside the limits recommended by many standard texts. We conclude that the spread of a small volume of solution after paravertebral injection is imprecise and unpredictable. Neurolytic and diagnostic paravertebral injections performed without the aid of radiological imaging and contrast media should be regarded as hazardous and interpreted with extreme caution.
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Ann Fr Anesth Reanim · Jan 1989
[Truncal anesthesia of the foot at the level of the ankle: an additional reference mark for the approach to the posterior tibial nerve].
Nerve trunk blocks at the ankle could be a most interesting technique of regional anaesthesia. Unfortunately the posterior tibial nerve is difficult to locate with the usual recommended anatomical landmarks (the tibialis posterior artery). The use of the flexor hallucis longus tendon as an additional landmark has been tested in 71 patients scheduled for surgery on the foot (emergency trauma surgery, amputations, ingrowing toe-nails, removal of bedsores, verrucas). ⋯ Anaesthesia was obtained in 10 +/- 3 min, lasting from 180 to 240 min. There were 88.7% excellent results (n = 63), with 7% fair (n = 5) and 4.2% bad (n = 3) results. Failure concerned 5 cases of tibial nerve block, often due to landmark difficulties (great toe previously amputated, significant ankle oedema, lack of operator experience) and, in 3 cases, forgetting to block a nerve involved.(ABSTRACT TRUNCATED AT 250 WORDS)