Articles: nerve-block.
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Randomized Controlled Trial Clinical Trial
Effect of arm position on the effectiveness of perivascular axillary nerve block.
The influence of arm position on the effectiveness of perivascular axillary nerve block with a catheter was assessed prospectively in two groups of patients. Ninety patients were allocated randomly to receive 1% mepivacaine with adrenaline 40 ml with the arm either adducted or abducted. ⋯ There were no statistically significant differences in onset time, spread of analgesia, motor block or success rate between the two groups. Proximal flow of the local anaesthetic-contrast agent mixture was neither facilitated by arm adduction nor was it necessary for the development of a successful block.
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Randomized Controlled Trial Comparative Study Clinical Trial
Antagonism of pancuronium- and pipecuronium-induced neuromuscular block.
We have compared the antagonism of neuromuscular block produced by pipecuronium with pancuronium in 80 anaesthetized surgical patients using mechanomyography and electromyography. Pancuronium 0.1 mg kg-1 or pipecuronium 0.07 mg kg-1 was given after induction of anaesthesia and neuromuscular block was adjusted to 75% twitch depression at the time of antagonism. The following regimens were used: edrophonium 0.5 and 1.0 mg kg-1, neostigmine 0.04 mg kg-1, pyridostigmine 0.3 mg kg-1 and edrophonium 0.25 mg kg-1 with pyridostigmine 0.15 mg kg-1. ⋯ However, TOF fade antagonism was more complete with pyridostigmine, neostigmine and edrophonium 1.0 mg kg-1 than with edrophonium 0.5 mg kg-1. The head lift test indicated somewhat less antagonism with edrophonium 0.5 and 1.0 mg kg-1. Using five monitoring methods, the rank order of reversal potency was: pyridostigmine approximately neostigmine > edrophonium 1.0 mg kg-1 > edrophonium+pyridostigmine > edrophonium 0.5 mg kg-1.
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Randomized Controlled Trial Clinical Trial
Post-tetanic burst: a new monitoring method for intense neuromuscular block.
A new stimulation pattern for evaluation of intense neuromuscular block (post-tetanic burst (PTB)) was compared with post-tetanic twitch (PTT) during spontaneous recovery from vecuronium-induced neuromuscular block. Thirty adult patients were allocated to two equal groups and we measured times from administration of vecuronium 0.1 mg kg-1 to return of PTB and PTT responses, and evoked responses to PTB and PTT stimuli. For PTB stimulation, a 50-Hz tetanus was applied at 50 mA for 5 s, and after a pause of 3 s, a 50-Hz burst stimulation was applied, consisting of three impulses at 50 mA. ⋯ Similarly, PTT consisted of a tetanus, a 3-s pause and one single twitch stimulation repeated every 5 min. Time to return of the PTB response was significantly shorter than that of PTT (mean 23.7 (SD 7.9) compared with 30.7 (7.0) min) (P = 0.0160), although evoked responses to PTB did not differ significantly from those of PTT throughout recovery from vecuronium-induced neuromuscular block. This study suggested that PTB was more sensitive in evaluating intense neuromuscular block than PTT.
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Regional anesthesia · Mar 1995
Randomized Controlled Trial Comparative Study Clinical TrialAddition of bicarbonate to plain bupivacaine does not significantly alter the onset or duration of plexus anesthesia.
In an effort to elucidate further the effect of alkalinization of bupivacaine on its anesthetic effect, a study was undertaken using alkalinized and non-alkalinized bupivacaine for lumbar plexus block and comparing the results with those obtained previously with brachial plexus block. ⋯ The data obtained in the present study indicate that alkalinization of non-epinephrine-containing bupivacaine does not reduce the latency or increase the duration of analgesia or anesthesia after lumbar plexus block. Since most of the studies that do show such an effect of alkalinization were carried out using epinephrine-containing bupivacaine, it is postulated that in those studies alkalinization contributed to the decrease in latency and increase in duration, not so much by providing an increased amount of local anesthetic in the free base form, but by reactivating epinephrine's vasoconstrictor activity, which is inactivated by a low pH.
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Regional anesthesia · Mar 1995
Randomized Controlled Trial Clinical TrialLateral femoral cutaneous nerve block revisited. A nerve stimulator technique.
Regional block of the lateral femoral cutaneous nerve (LFCN) often has disappointing success rates despite the large volumes of local anesthetic used. This study was undertaken to investigate the utility of using a nerve stimulator (NS) to localize and block the LFCN. ⋯ A NS can be used to localize a purely sensory nerve; such as the LFCN, and improve success rates in regional anesthesia.