Articles: nerve-block.
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Anesthesia and analgesia · Aug 2009
Review Meta AnalysisNeuraxial techniques in obstetric and non-obstetric patients with common bleeding diatheses.
There are few data in the literature regarding the safety of neuraxial techniques in patients with the most common bleeding diatheses, including hemophilia, von Willebrand's disease (vWD), and idiopathic thrombocytopenic purpura (ITP). Neuraxial techniques are not widely used in these populations because of concerns of potential hemorrhagic and/or subsequent neurologic complications. In this article, we review the available literature describing neuraxial techniques in patients with hemophilia, vWD, or ITP with the aim to assist anesthesiologists considering neuraxial techniques in these populations. ⋯ There is a paucity of published data regarding the provision and safety of neuraxial techniques in patients with common bleeding diatheses. The minimum "safe" factor levels and platelet count for neuraxial techniques remain undefined in both the obstetric and general populations, and evidence-based recommendations in the setting of hemophilia, vWD, or ITP cannot be offered.
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Review Meta Analysis Comparative Study
Ultrasound guidance compared with electrical neurostimulation for peripheral nerve block: a systematic review and meta-analysis of randomized controlled trials.
Despite the growing interest in the use of ultrasound (US) imaging to guide performance of regional anaesthetic procedures such as peripheral nerve blocks, controversy still exists as to whether US is superior to previously developed nerve localization techniques such as the use of a peripheral nerve stimulator (PNS). We sought to clarify this issue by performing a systematic review and meta-analysis of all randomized controlled trials that have compared these two methods of nerve localization. ⋯ US improves efficacy of peripheral nerve block compared with techniques that utilize PNS for nerve localization. Larger studies are needed to determine whether or not the use of US can decrease the number of complications such as nerve injury or systemic local anaesthetic toxicity.
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Cochrane Db Syst Rev · Jan 2009
Review Meta AnalysisParacervical local anaesthesia for cervical dilatation and uterine intervention.
Cervical dilatation and uterine intervention can be performed under sedation, local or general anaesthesia for obstetrics and gynaecological conditions. Many gynaecologists use paracervical local anaesthesia (PLA) but its effectiveness is unclear. ⋯ No technique provided reliable pain control in the 17 included studies. Some studies reported that women experienced severe pain (mean scores of 7 to 9 out of 10) during uterine intervention, irrespective of the analgesic technique used. We concluded that the available evidence fails to show whether paracervical block is inferior, equivalent or superior to alternative analgesic techniques, in terms of efficacy and safety, for women undergoing uterine interventions.
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Cochrane Db Syst Rev · Jan 2009
Review Meta AnalysisLocal anaesthetic wound infiltration and abdominal nerves block during caesarean section for postoperative pain relief.
Caesarean section delivery is becoming more frequent. Childbirth is an emotion-filled event and the mother needs to bond with her newborn baby as early as possible. Any intervention that leads to improvement in pain relief is worthy of investigation. Local anaesthetics, either on their own or in combination with opioids or nonsteroidal antiinflammatory drugs, have been employed as an adjunct to other postoperative pain relief strategies. Conflicting reports were noted. ⋯ Local analgesia infiltration and abdominal nerve blocks as adjuncts to regional analgesia and general anaesthesia are of benefit in caesarean section by reducing opioid consumption. Nonsteroidal anti-inflammatory drugs as an adjuvant may confer additional pain relief.
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Review Meta Analysis
Psoas compartment block for lower extremity surgery: a meta-analysis.
Psoas compartment block (PCB) is a potentially useful but controversial technique for lower limb surgery. We have conducted a systematic review of the efficacy and safety of PCB for anaesthesia and postoperative analgesia for hip and knee surgery. Relevant studies were identified within PubMed, EMBASE, and the Cochrane Library. ⋯ Although PCB combined with sciatic nerve block and sedation is an effective technique for minor knee surgery, there is currently insufficient data to recommend the use of this approach for hip and major knee surgery. PCB is a safe and effective alternative for analgesia after hip and knee surgery. More research is required to define its role in the intraoperative setting and confirm potentially beneficial effects on variables such as perioperative haemodynamics and blood loss.