Articles: nerve-block.
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Anesthesia and analgesia · Jan 1983
Comparative StudyThe extent of blockade following various techniques of brachial plexus block.
The extent of sensory and motor blockades was examined in 195 patients 5 and 20 min after four different techniques of brachial plexus block using 50 ml of 0.5% bupivacaine. The interscalene technique of Winnie (N = 50) resulted in a preferential blockade of the caudad portions of the cervical plexus and the cephalad portions of the brachial plexus. The supraclavicular approach of Kulenkampff (N = 55) and the subclavian perivascular approach of Winnie (N = 56) each resulted in a homogeneous blockade of the nerves of the brachial plexus. ⋯ With all four techniques, motor blockade developed faster than sensory blockade. The difference in results suggests that the approach to be used should depend primarily upon the site of the operation. The perineural space enclosing the brachial plexus greatly facilitates the spread of a local anesthetic when injected; however, it is usually not filled completely or evenly.
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To evaluate the effectiveness of the dorsal penile nerve block in reducing the stress of circumcision upon newborns, physiologic measurements in 30 healthy full-term infants (including transcutaneous oxygen levels, crying time, heart rate, and respiratory rate) were monitored continuously before, during, and after the operation. Infants receiving the dorsal penile nerve block with lidocaine (1% Xylocaine) (N = 20) experienced significantly less stress, as evidenced by smaller decreases in transcutaneous oxygen pressure levels, less time spent crying, and smaller increases in heart rate, than infants circumcised in an identical manner without anesthetic (N = 10). No complications resulted from injection of the local anesthetic or from the circumcision procedure itself. Inasmuch as dorsal penile nerve block has a low complication rate, is simple to learn, and adds little time or expense to the overall procedure, and if it proves to be as effective clinically as the physiologic data indicate, the dorsal penile nerve block should be considered for every infant undergoing circumcision.
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Anesthesia and analgesia · Dec 1982
Brachial plexus block for pain relief after modified radical mastectomy.
Brachial plexus block using an intraclavicular approach was performed at the completion of surgery in 47 patients having modified radical mastectomies. In 48 control patients having similar operations, brachial plexus block was not performed. ⋯ The time elapsed between the end of anesthesia and requirement of the first analgesic was significantly longer when the brachial plexus was blocked (p less than 0.001). The efficacy, simplicity, and safety of blocking the brachial plexus at the completion of surgery following modified mastectomy demonstrate that this technique could be routinely used for the relief of postoperative pain in patients having modified radical mastectomies.
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Comparative Study
The interscalene approach to block of the brachial plexus.
One hundred consecutive cases of interscalene brachial plexus block are presented. The technique is reliable, safe and easy to perform. ⋯ Multiple injections are not necessary. The technique is also highly acceptable to the patient.