Articles: nerve-block.
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J. Thorac. Cardiovasc. Surg. · Oct 1983
Case ReportsComplications of intercostal nerve blocks performed under direct vision during thoracotomy: a report of two cases.
Intrathoracic intercostal nerve block is a well-described procedure used to provide postoperative pain relief following thoracotomy. The two cases described present possible complications secondary to such blocks and suggest that the routine use of intrathoracic intercostal nerve blocks should be discouraged.
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Comparative Study
Forum. Femoral neck surgery using a local anaesthetic technique.
Thirty cases of femoral sub-capital fractures, Garden grades 1-4, were reduced and internally fixed with crossed Garden screws using femoral nerve block. In addition, sedation and analgesia was provided by low dose ketamine and diazepam. No deaths or other complications occurred in these patients. In a similar group of patients who received spinal analgesia in the same unit under similar conditions there was one death and two cerebrovascular accidents.
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The differential susceptibility of large and small axons to lidocaine was studied on units in the rabbit vagus nerve. The results classified the units into three groups: 1) myelinated, conduction velocity 37.5-5 m/s, which were blocked by lidocaine 0.4-0.8 mM; 2) slow, unmyelinated axons, conduction velocity 1.2-0.5 m/s, and these axons were not blocked by 0.2, 0.4, or 0.6 mM lidocaine but usually were blocked by 0.8 mM lidocaine; and 3) Axons of intermediate conduction velocity, between 1.2 and 4 m/s. The last group of axons was the most sensitive: some were blocked by as little as 0.2 mM lidocaine. No size-related trend was detected within the groups.
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The rationale, anatomy and technique of transsacral phenol injection are described and the author's results in the treatment of nine patients with intractable perineal pain presented. The technique is recommended as a safe, simple and useful alternative to intrathecal neurolysis in this condition.
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Comparative Study
Penile block for circumcision? A comparison with caudal blockade.
A prospective blind trial was conducted comparing the analgesia and adverse effects produced by caudal extradural blockade (caudal block) with blockade of the dorsal nerves of the penis (penile block) in 38 boys undergoing elective circumcision. Analgesia was assessed by senior nurses using a linear analogue scale and by the response to direct questioning over the first 7 hours after surgery. ⋯ One technical failure occurred in the penile block group. It is concluded that a penile block is a satisfactory alternative to caudal blockade with regard to postoperative analgesia and offers several specific advantages.