Articles: nerve-block.
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J. Thorac. Cardiovasc. Surg. · Mar 1975
Treatment of intercostal neuralgia with 10 per cent ammonium sulfate.
Intercostal nerves were injected with 10 per cent annomium sulfate in 41 patients (52 total sets of injections) for management of intercostal neuralgia from radical mastectomy (six blocks), thoracotomy (20 blocks), or unknown etiology (26 blocks). Five patients failed to return for follow-up evaluation and could not be located. Sixty per cent (28/47) of the treatments produced complete or nearly complete (excellent) relief of pain. ⋯ Postblock neuritis never occurred. We conclude that intercostal nerve block with 10 per cent ammonium sulfate effectively relieves intercostal neuralgia and is not associated with postblock neuritis. We therefore believe that ammonium sulfate nerve blocks should be administered for treatment of intercostal neuralgia before phenol or alcohol nerve blocks or a surgical procedure.
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Two cases of multiple sclerosis are described, in both of whom the disease started in yound adult life. This disability gradually progressed to the stage of paraplegia-in-flexion in which the lower limbs were fixed in adduction-and-flexion. Both patients developed painful muscle spasms which made life intolerable. ⋯ The second patient after the block developed a good result in the right leg, but still had mild, but painless spasms in the muscles of the left leg (Figures 4 and 5). However, she was able to use a wheelchair and was discharged to a chronic hospital where she died of bulbar paralysis six months later. Intrathecal phenol thus appears to be a useful method for relieving muscle spasms and pain in the lower extremities in advanced cases of multiple sclerosis.
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Comparative Study
Intercostal nerve block for postoperative somatic pain following surgery of thorax and upper abdomen.
From 1948 to 1973, intercostal nerve block was used 10,941 times or a total of approximately 100,000 individual nerves were blocked. Junior staff (residents) performed 95% of the blocks. The local anaesthetic solution of choice used 0.25 or 0.5% bupivacaine (Marcaine) with adrenaline. ⋯ The duration of the blocks was 9-18 hr. No severe systemic toxic reactions occurred, e.g. disorientation, convulsions, etc. The incidence of pneumothorax was 0.073%.