Articles: nerve-block.
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Anesthesia and analgesia · Jul 1991
Randomized Controlled Trial Comparative Study Clinical TrialScalp infiltration with bupivacaine in pediatric brain surgery.
To evaluate whether local anesthetic scalp infiltration blunts hemodynamic responses to craniotomy in anesthetized children (age, 2-18 yr), two concentrations of bupivacaine (0.125% and 0.25%) with vasoconstrictor (epinephrine 1:400,000) were compared with control data when a solution of vasoconstrictor alone was injected. Arterial plasma levels of bupivacaine were measured by high-pressure liquid chromatography. Statistically significant increases in mean arterial pressure and heart rate above baseline measurements occurred in the control group during the period between scalp incision and dural reflection (P less than 0.05). ⋯ These results suggest that bupivacaine infiltration blocks the hemodynamic response to craniotomy. A concentration of 0.125% bupivacaine with 1:400,000 epinephrine is as effective as 0.25% bupivacaine with 1:400,000 epinephrine at reducing the hemodynamic response to craniotomy. Because the lower concentration of bupivacaine produces lower blood levels, we recommend 0.125% bupivacaine with 1:400,000 epinephrine as a useful, safe adjunct to general anesthesia in children undergoing craniotomy.
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Anesthesia and analgesia · Jun 1991
Randomized Controlled Trial Clinical TrialEvaluation of the effect of perineuronal morphine on the quality of postoperative analgesia after axillary plexus block: a randomized double-blind study.
A randomized, double-blind study was performed on 50 patients scheduled for elective hand and forearm surgery under axillary plexus block to evaluate the effect of perineuronal morphine on the quality of postoperative analgesia. Patients were divided into two groups. ⋯ In group B (n = 25), 1.0 mL of 0.9% saline was added to the local anesthetic solution and patients received an intramuscular injection of 5 mg of preservative-free morphine in 1.0 mL of 0.9% saline in the thigh. The addition of morphine to the local anesthetic solution for the axillary block did not shorten the onset time of the block, improve the quality of postoperative pain relief, or provide longer lasting analgesia than that obtained with intramuscular morphine.
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Randomized Controlled Trial Comparative Study Clinical Trial
Antagonism of atracurium with neostigmine. Effect of dose on speed of recovery.
In 36 patients in whom anaesthesia was maintained with nitrous oxide and 0.5% isoflurane an atracurium-induced neuromuscular block was either allowed to recover spontaneously or antagonised with one of four doses of neostigmine (15 micrograms/kg, 35 micrograms/kg, 55 micrograms/kg or 75 micrograms/kg). The recovery times to a train-of-four ratio of 0.5, 0.75 and 0.9 were recorded. In patients given neostigmine, antagonism was at an average T1 of between 8.8% and 14.9%. ⋯ Recovery after neostigmine 15 micrograms/kg was significantly slower than after the higher doses. One patient given neostigmine 75 micrograms/kg showed an unusual bimodal pattern of recovery. There appears to be no benefit in giving a larger dose than 35 micrograms/kg of neostogmine as a single bolus.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of lignocaine with prilocaine in axillary brachial plexus anaesthesia.
Twenty patients received either lignocaine 1.5% with 1/200,000 adrenaline (group L), or prilocaine 1.5% plain (group P) as a brachial plexus block for surgery to the upper limb, in a randomised double-blind study. The two groups were comparable in age, weight and duration of surgery and there were no significant differences between the two groups with regard to onset, pattern or degree of sensory loss. ⋯ All the blocks were performed using the same technique and provided complete surgical anaesthesia. Prilocaine 1.5% plain provides adequate sensory and motor blockade for brachial plexus anaesthesia and is a suitable agent for medium duration surgery to the upper limb.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of lumbar plexus block versus conventional opioid analgesia after total knee replacement.
A randomised controlled study was undertaken to assess the analgesic efficacy of continuous lumbar plexus block for the first 48 hours after total knee replacement surgery. Boluses of 0.5% bupivacaine with adrenaline 1 in 200,000 (0.3 ml/kg) were administered through a cannula inserted into the neurovascular sheath of the femoral nerve. Thirteen patients who received this block required significantly less morphine than a control group of 16 patients. Pain scores were similar and there were no complications related to this technique.