Articles: nerve-block.
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Modern techniques available for the relief of pain following major surgical procedures or trauma in childhood receive scant attention in pediatric surgical textbooks. A range of options for pain relief have been offered to children in our hospital, which include: regional analgesia; appropriate use of intermittent intramuscular narcotic injections; and variable-rate intravenous narcotic infusions. Since 1982 regional analgesia has been used in more than 2,000 patients following operations on the penis and in the inguinoscrotal region. ⋯ Assessment of effective pain relief has been made on the basis of observation and comment by parents and patients and by medical and nursing staff. The steady increase in demand for the use of this technique is an index of its value. It is concluded that there is a real need to improve pain relief for children by better education of medical and nursing staff and inclusion of this important subject in pediatric surgical text books.
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One hundred patients had major shoulder surgery with interscalene brachial and cervical plexus block anesthesia. Successful anesthesia was obtained by using this method in 82 patients. Failure was the result of incomplete anesthesia in 16 patients or the presence of a complication. ⋯ The block lasted a mean of eight hours, decreasing the need for postoperative analgesic medications. No postoperative medical complication developed. Ninety-one percent of the patients with successful blocks were satisfied with the procedure.
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The use of a low-power nerve stimulator to aid nerve location during the performance of sciatic nerve block was compared with a conventional anatomically based technique. The success rate, both in terms of the production of an effective block and the duration of postoperative analgesia, was significantly higher in the stimulator groups than in the non-stimulator groups. The implications of the study for both clinical and teaching practice are discussed.
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Randomized Controlled Trial Comparative Study Clinical Trial
Continuous intercostal blockade after cardiac surgery.
The provision of analgesia using continuous bilateral intercostal blockade was compared with that provided by conventional i.v. narcotics for the first 48 h after cardiac surgery. The subjective quality of analgesia was significantly superior with the regional technique. However, pulmonary function tests, gas exchange, lung volume, and radiological and clinical evidence of pulmonary complications were not improved. The failure to reduce morbidity and the potential for complications such as pneumothorax, makes it difficult to recommend the regional analgesia technique in this situation.