Articles: nerve-block.
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Case Reports
Brachial plexus block. Unilateral thoraco-abdominal blockade following the supraclavicular approach.
A supraclavicular brachial plexus block was performed which resulted in unilateral sensory and motor blockade of the thoracic and abdominal walls. General anaesthesia was therefore used and postoperatively it was noticed that analgesia of the upper limb had developed. It is likely that the blockade resulted from an intrapleural injection of local anaesthetic.
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Anesthesia and analgesia · Jul 1987
Comparative StudyIncomplete reversal of pancuronium neuromuscular blockade by neostigmine, pyridostigmine, and edrophonium.
Three clinically used anticholinesterases--neostigmine, pyridostigmine, and edrophonium--were tested for their ability to reverse two levels (60% and 95%) of neuromuscular blockade produced by pancuronium. A controlled in vitro environment of the rat diaphragm-phrenic nerve system was used for the studies. Concentrations of anticholinesterases spanned the clinical range and were extended beyond to establish dose-response curves. ⋯ The dose-response curves for all three drugs showed a ceiling effect for reversal of tension and fade. Supraclinical concentrations of drug did not effect complete reversal, especially at 95% block. High concentrations of anticholinesterase led to randomly appearing hyperactivity manifested by spontaneous twitching and repetitive firing with severe fade on stimulation.
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Anatomical study of the brachial plexus of 18 cadavers was undertaken to confirm the presence and significance of "septa" dividing the brachial plexus or axillary sheath. Dissection demonstrated that the sheath consists of multiple layers of thin connective tissue surrounding the various elements of the neurovascular bundle. ⋯ Single injections of methylene blue and Latex solutions into the axillary sheath resulted in immediate dye staining of median, radial, and ulnar nerves, despite the presence of septa. These data demonstrate that there are connections between compartments within the sheath and, therefore, do not support the need for multiple injections when performing an axillary block.
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Comparative Study
Day-case herniotomy in children. A comparison of ilio-inguinal nerve block and wound infiltration for postoperative analgesia.
Forty-nine boys scheduled for day-case inguinal herniotomy were studied to compare ilio-inguinal nerve block and wound infiltration for postoperative analgesia. Both techniques were simple to perform and produced no complications. ⋯ Some children did appear to have pain following discharge but in all cases this responded well to simple analgesics. We conclude that both techniques provide satisfactory analgesia whilst the complications of narcotics are avoided, and suggest that simple infiltration of the wound with local anaesthetic solution should be encouraged in paediatric anaesthesia.