Articles: nerve-block.
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The human intercostal space has been studied by excision of the posterior part of the rib cage at autopsy, followed by fixation, decalcification, section and staining. Injection of India ink was used to simulate local anaesthetic. At a point 7 cm from the midline, the distance from the posterior aspect of the rib to the pleura averaged 8 mm. ⋯ An injection of 3 ml will also spread medially to enter the paravertebral space and surround the sympathetic chain. A small clinical study gave excellent analgesia after operation for a mean duration of 12.3 h following unilateral intercostal block with 3 ml of bupivacaine 0.5% (with adrenaline) into each of the intercostal spaces T5-11, before cholecystectomy through a subcostal incision. There were no complications in the series.
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Minerva anestesiologica · Mar 1980
Case Reports[Case of high spinal anesthesia as a complication of an interscalenic brachial plexus block].
A case of high spinal anesthesia complicating an interscalene brachial plexus block is described. After an apparently straightforward location of the plexus with good paresthesias, the injection of 10 ml of local anesthetic caused a high spinal block whose main feature was apnea. The patient retained his consciousness until he was anesthetized with thiopentone and N2O-O2 and had a vivid recollection of the accident. ⋯ The clinical picture compared to previous cases reported in the literature is commented on. A possible subarachnoid spread of the local anesthetic via the perineural space following intraneural injection is discussed. The author advocates the use of needles no longer than 1 inch for the interscalene approach to the brachial plexus.
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The effect of local nerve blockade on the relief of postoperative pain is reported in a series of 167 patients who underwent surgery of the arm, knee or foot. In 80% of cases analgesics were not required within 4 hours postoperatively, and in 39% analgesics were not required within 8 hours. Conventional methods of postoperative pain relief are not always effective. Local nerve blockade can be used to provide complete analgesia after limb surgery and is therefore of great value to postoperative care.