Articles: nerve-block.
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Am J Phys Med Rehabil · Apr 1988
Case ReportsDiagnostic peripheral nerve block resulting in compartment syndrome. Case report.
A hemiplegic patient with severe upper extremity spasticity 2 years after a cerebrovascular accident received a diagnostic median nerve block below the elbow with bupivacaine. He had been placed on Coumadin as prophylaxis for cerebrovascular arteriosclerotic disease, and prothrombin time was kept at twice the control value. ⋯ Compartment syndrome has not previously been reported as a complication resulting from a nerve block procedure. We conclude that (1) compartment syndrome may develop after a peripheral nerve block procedure for spasticity, (2) prophylactic anticoagulation may increase the risk for hemorrhagic events resulting from percutaneous injection and (3) early recognition is essential and appropriate decompressive fasciotomy may be indicated if a compartment syndrome develops after a nerve block procedure.
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Regional-Anaesthesie · Apr 1988
[Continuous block of the lumbar plexus with the 3-in-1-block catheter technic in pain therapy].
The evaluation of the test protocols on continuous lumbar plexus blockade using the 3-in-1 block with a lumbar plexus catheter showed the following results: The study included 104 patients. In 91.3% of cases, puncture of the fascial sheath of the femoral nerve proved successful. In 95.7% of cases, the plexus catheter could be positioned and left in place (Table 1). ⋯ All catheters could be left in place without complications until the end of therapy. Changing the catheter is possible at any time, as is the replacement of the catheter hub. Such steps were carried out in 5 cases.
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Regional-Anaesthesie · Apr 1988
Randomized Controlled Trial Comparative Study Clinical Trial[Combined ischiatic/3-in-1-block. II. 1 percent mepivacaine HCl versus 1 percent CO2 mepivacaine].
In a prospective randomized study on 26 patients, the clinical effectiveness CO2-mepivacaine 1% (group 1, 13 patients) and mepivacaine HCl 1% (group 2, 13 patients), was tested in patients having a sciatic-femoral block for surgical procedures of the lower extremity (20 ml for sciatic and 30 ml for 3-in-1 block). Blood levels of mepivacaine were determined for up to 90 min in 8 patients from each group. The onset of sensory and motor blockade was slightly earlier (4-5 min) with CO2-mepivacaine than with the hydrochloride (5-6 min). ⋯ There was a relatively large variance in intensity of blockade that was not necessarily related to the drug employed, but can be explained by individual factors and possibly by slight differences in blocking technique. Nevertheless, the rate of unsuccessful blockade was remarkably higher (38%) with the hydrochloride than with CO2-mepivacaine (7.7%). Determinations of blood levels did show the expected earlier peak (after 20-30 min) and higher blood-levels (means 3.8 micrograms/ml at 30 min) with CO2-mepivacaine 1% as compared to mepivacaine HCl 1%: 2.9 micrograms/ml at 30 min and 3.4 micrograms/ml at 45 min.
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Three groups each of 20 patients scheduled to undergo operations on hand or forearm, received supraclavicular brachial plexus blocks with 25 ml lignocaine 1.5%. Patients in the control group did not suffer from pain and were not asked to do muscular exercise. Patients with acute trauma of the upper limb formed the pain group and showed significantly decreased latency for onset of analgesia, partial and complete muscle paralysis. ⋯ Onset of analgesia, partial and complete muscle paralysis was significantly more rapid than in both control and pain groups. Changes in the duration of block were not significant. It is concluded that pain and muscular exercise enhance the onset of brachial plexus blockade.
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Ugeskrift for laeger · Mar 1988
Letter Case Reports[Iatrogenic femoral nerve neuropathy after lumbar plexus block].