Articles: nerve-block.
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Randomized Controlled Trial Clinical Trial
pH adjustment of mepivacaine decreases the incidence of tourniquet pain during axillary brachial plexus anaesthesia.
The effect of pH adjustment of mepivacaine on the incidence of tourniquet pain during axillary brachial plexus anaesthesia was studied. Thirty-nine patients scheduled for hand surgery, during which use of pneumatic tourniquet for longer than 60 min was planned, were randomized into two groups. Both received axillary brachial plexus block with 40 ml, 1.4% mepivacaine, 1:200,000 epinephrine. ⋯ Tourniquet; pain was defined as poorly localized and distinct from an inadequate axillary block by a blinded observer. More tourniquet pain occurred in the control group. The authors conclude that alkalinization of mepivacaine for axillary brachial plexus anaesthesia may be indicated in cases where use of pneumatic tourniquet for long periods is planned.
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Randomized Controlled Trial Comparative Study Clinical Trial
Continuous intercostal nerve block versus epidural morphine for postthoracotomy analgesia.
Twenty patients undergoing elective thoracotomy were randomized into two groups, receiving either lumbar epidural morphine (n = 10) or continuous extrapleural intercostal nerve block (n = 10). Subjective pain relief was assessed on a linear visual analogue scale. Pulmonary function (peak expiratory flow rate, forced expiratory volume in 1 second, and forced vital capacity) was measured on the day before operation and daily for 4 days after operation. ⋯ Vomiting, pruritus, and urinary retention occurred only in the epidural group, whereas nausea occurred significantly less frequently in the extrapleural group. We conclude that after thoracotomy continuous extrapleural intercostal nerve block is as effective as lumbar epidural morphine in reducing postoperative pain and restoring pulmonary mechanics. Because of the significantly lower complication rates we favor continuous extrapleural intercostal nerve block for postthoracotomy analgesia.
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Randomized Controlled Trial Clinical Trial
Continuous intercostal analgesia with 0.5% bupivacaine after thoracotomy: a randomized study.
This study was undertaken to evaluate the effectiveness of 0.5% bupivacaine (360 mg/day) as a continuous infusion through an indwelling intercostal catheter inserted intraoperatively in the management of pain after thoracotomy. Eighty-six patients were randomized into three groups: group 1 = intercostal bupivacaine, group 2 = intercostal saline solution, and group 3 = fixed-schedule intramuscular buprenorphine. Supplementary buprenorphine was given as required. ⋯ No between-group differences in pulmonary function were observed. Respiratory complications occurred in no patients in groups 1 and 3 versus 5 in group 2 (p < 0.05). Continuous intercostal bupivacaine provided similar early pain control as compared with fixed-schedule narcotics but induced better analgesia with fewer complications than on-demand narcotics alone (group 2).
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Anesthesia and analgesia · Feb 1993
Randomized Controlled Trial Clinical TrialOnset, intensity of blockade and somatosensory evoked potential changes of the lumbosacral dermatomes after epidural anesthesia with alkalinized lidocaine.
The onset and intensity of blockade of the lumbosacral dermatomes after epidural anesthesia with alkalinized lidocaine were investigated in a randomized, double-blind study in 26 patients. Control subjects (n = 13) received 20 mL of 1.37% lidocaine (1.5% lidocaine plus 1 mL saline per 10 mL lidocaine) with added 1:200,000 epinephrine; the solution pH was 6.20 +/- 0.08. Patients in the alkalinized lidocaine group (n = 13) were given 20 mL of 1.37% lidocaine plus added bicarbonate (1 mL sodium bicarbonate per 10 mL 1.5% lidocaine) and 1:200,000 epinephrine; the solution pH was 7.18 +/- 0.10. ⋯ Motor blockade was significantly more profound in the alkalinized lidocaine group. Thirteen of 78 PTN and L5 and S1 dermatomal SSEPs were abolished in the alkalinized lidocaine group compared to 4 of 78 SSEPs in the nonalkalinized group. Alkalinization of lidocaine is recommended to shorten the time to block the L5-S1 dermatomes when epidural anesthesia is planned for lower extremity surgery.
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Ann Fr Anesth Reanim · Jan 1993
Randomized Controlled Trial Clinical Trial[Axillary plexus block by simultaneous blockade of several nerves. I. Influence of the volume of the anesthetic solution].
The influence of the volume of local anaesthetic solution on axillary blockade was investigated in a prospective randomized double-blind study including 120 patients presenting for upper limb surgery. A peripheral nerve stimulator was used to carry out the axillary block with a multiple injection technique. The musculocutaneous, radial, median and ulnar nerves were routinely stimulated. ⋯ The data demonstrated that, for a same amount of local anaesthetic, the larger volumes provided better quality sensory blockade than the smaller ones (p < 0.03). However, the volume of solution used affected neither the time of onset nor the duration of anaesthesia, nor the degree of motor blockade. It is concluded that, despite the use of a neurostimulator and simultaneous infiltration of several nerve trunks, the volume required to ensure a reliable degree of sensory block with the technique of axillary block is comprised between 40 and 50 ml (25 ml.m-2).