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1

Ultrasound-guided peripheral nerve blocks for anterior cruciate ligament reconstruction: effect of obturator nerve block during and after surgery.  

UK PubMed Central (United Kingdom)

PURPOSE: Three studies were conducted to determine whether and how the obturator nerve bears relevance to intra- and postoperative pain in patients undergoing anterior cruciate ligament (ACL) reconstruction using a hamstring autograft. METHODS: Patients undergoing arthroscopic ACL reconstruction using a hamstring autograft were enrolled in three studies. In the first study, we studied the analgesic effect of combined posterior lumbar plexus (PLP) and sciatic nerve blocks as well as combined femoral, lateral femoral cutaneous, and sciatic nerve blocks during and for 24 h after surgery. The second study was conducted to compare the analgesic effect of the combination of femoral, lateral femoral cutaneous, and sciatic nerve blocks with and without an obturator nerve block. Finally, we compared a postoperative continuous femoral nerve block and PLP block both during and for 48 h after surgery. RESULTS: In the first study, patients receiving the PLP block required significantly less fentanyl intraoperatively than those given the femoral nerve block. In the second, significantly less fentanyl was required during surgery for patients with the obturator nerve block than for those without. Finally, the continuous postoperative PLP block showed higher visual analog pain scores than those with the continuous femoral nerve block during movement at 48 h. CONCLUSION: The present results suggest the involvement of the obturator nerve in ACL reconstruction using a hamstring autograft. However, although obturator nerve blockade is crucial for intraoperative analgesia, a continuous obturator nerve block is not necessary beyond 24 h postoperatively.

Sakura S; Hara K; Ota J; Tadenuma S

2010-06-01

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The parasacral sciatic nerve block does not induce anesthesia of the obturator nerve.  

UK PubMed Central (United Kingdom)

PURPOSE: The ability of the parasacral sciatic nerve block (PSNB) to induce anesthesia of the obturator nerve remains controversial. Our objective was to evaluate the anesthesia of the obturator nerve after a PSNB. METHODS: Forty patients scheduled to undergo knee surgery (anterior cruciate ligament reconstruction) were included in this prospective, randomized, controlled study. Patients were randomized to receive PSNB alone (control group, n = 20) or PSNB in combination with an obturator nerve block (obturator group, n = 20). After evaluation for 30 min, the two groups received a femoral nerve block, and patients were taken to surgery. The obturator nerve blockade was assessed by measurement of adductor strength at baseline (T0) and every 10 min during the 30-min evaluation (T10, T20, and T30). Pain scores after tourniquet inflation and during surgery were compared between the two groups. The requirement for additional intravenous analgesia and/or sedation was also recorded. RESULTS: The two groups had comparable demographic and surgical characteristics. Four patients were excluded from the study because of PSNB or femoral nerve block failure. The adductor strength values were similar between groups at T0 but were significantly lower in the obturator group at T10, T20, and T30 (p < 0.0001). Patients in the obturator group reported less pain than those in the control group (p < 0.05). They also required less additional intravenous sedation and/or analgesia (p < 0.05). CONCLUSION: This clinical study demonstrated that the PSNB is an unreliable means of inducing anesthesia of the obturator nerve and emphasizes the need to block this nerve separately to induce adequate analgesia during knee surgery.

Aissaoui Y; Serghini I; Qamous Y; Seddiki R; Zoubir M; Boughalem M

2013-02-01

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Combined posterior lumbar plexus–sciatic nerve block versus combined femoral–obturator–sciatic nerve block for ACL reconstruction  

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Ayman I TharwatAin Shams University, Cairo, EgyptBackground: We compared the efficacy of combined posterior lumbar plexus–sciatic nerve block with that of combined femoral–obturator–sciatic nerve block as anesthesia for anterior cruciate ligament reconstruction surgery, because bo...

Ayman I Tharwat

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Combined posterior lumbar plexus–sciatic nerve block versus combined femoral–obturator–sciatic nerve block for ACL reconstruction  

Directory of Open Access Journals (Sweden)

Full Text Available Ayman I TharwatAin Shams University, Cairo, EgyptBackground: We compared the efficacy of combined posterior lumbar plexus–sciatic nerve block with that of combined femoral–obturator–sciatic nerve block as anesthesia for anterior cruciate ligament reconstruction surgery, because both block combinations have been recommended for lower limb arthroscopic and reconstructive surgery.Methods: Forty-eight patients undergoing elective unilateral anterior cruciate ligament reconstruction under local anesthesia were randomized to undergo either combined posterior lumbar plexus–sciatic nerve block (Group 1), or combined femoral–obturator–sciatic nerve block (Group 2). Blocks were performed using nerve stimulation and bupivacaine 0.5% mixed with lignocaine 2%. Systolic and diastolic blood pressure, heart rate, and pulse oximetry were recorded. Quality of anesthesia, motor and sensory block, time to first analgesic use, sedation, and need for general anesthesia were recorded, along with verbal postoperative pain scores, and side effects.Results: No patient in Group 1 and two patients in Group 2 needed general anesthesia. Complete sensory blockade was higher in Group 1 than in Group 2. However, complete motor blockade was similar in both groups. In Group 1, verbal pain scores were lower than in Group 2. Time to first analgesic was similar between the two groups. Total analgesic consumption was lower in Group 1. No significant differences were found for heart rate, pulse oximetry, or systolic and diastolic blood pressure between the groups, and no signs of toxicity were encountered.Conclusion: Combined posterior lumbar plexus–sciatic nerve block provided more comfortable intraoperative anesthesia and better postoperative analgesia than combined femoral–obturator–sciatic nerve block for anterior cruciate ligament reconstruction surgery.Keywords: anterior cruciate ligament reconstruction, local anesthetic, nerve block 

Ayman I Tharwat

2011-01-01

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Efficacy of ultrasound-guided obturator nerve block in transurethral surgery  

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Full Text Available Background: During transurethral resection surgery (TUR), accidental stimulation of the obturator nerve can cause violent adductor contraction, leading to serious intraoperative complications. General anesthesia with muscle relaxation is currently the preferred technique for TUR surgery. Spinal anesthesia combined with obturator nerve block has also been used for TUR surgery in geriatric population. Blind, anatomical methods for identifying the obturator nerve are often unsatisfactory. Therefore, we conducted this prospective study to validate the efficacy of ultrasound-guided obturator nerve block (USONB) during TUR procedures. Methods: Eighteen male patients undergoing TURP surgery under spinal anesthesia were included in the study. Bilateral USONB with maximum 20 ml of 1% lidocaine per patient was performed. An independent observer was present to monitor any adduction movements during the operation and to record patient and surgeon satisfactions. Results: In all patients, obturator nerve was visualized from the first attempt, requiring an average of 4.3 min for blocking of each side. USONB was successful (97.2%) in preventing an adductor spasm in all except one patient. Patient?s and surgeon?s satisfaction were appropriate. In all patients, adductor muscle strength recovered fully within 2 h following the surgical procedure. Conclusions: USONB is safe and effective during TUR surgery. It provides optimal intra-and postoperative conditions.

Thallaj Ahmed; Rabah Dany

2011-01-01

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Ultrasound-guided obturator nerve block: a preliminary report of a case series.  

UK PubMed Central (United Kingdom)

BACKGROUND AND OBJECTIVES: Obturator-nerve block improves analgesia for knee surgery. Traditional techniques rely on surface landmarks, which can be variable and result in excessive performance times and multiple needle passes. The objective of this study was to evaluate a novel ultrasound-guided technique for localizing the obturator nerve. METHODS: A total of 22 patients undergoing anterior cruciate ligament repair had ultrasound-guided obturator-nerve blocks. Needles were directed under real-time ultrasound guidance. Endpoint for injection consisted of identifying contact of the tip of an insulated needle to nerve confirmed by adductor muscles' contraction. Local anesthetic was injected, and block was evaluated within 30 minutes. After that, ultrasound-guided sciatic-femoral blocks were placed for surgical purposes. Data collected included: time required for nerve identification, minimum stimulating current, number of attempts for correct identification, preblock and postblock adductor muscles' strength, sensory-nerve block, and quality of surgical anesthesia. RESULTS: In 91% of cases, the obturator nerve was correctly identified on first attempt within 30 +/- 23 seconds, as a hyperechoic flat or lip-shaped structure with internal hypoechoic dots. Minimal intensity of current to nerve stimulation was 0.30 +/- 0.08 mA. All patients exhibited decreases in adductor strength. Sensory territories were variable, with no cutaneous distribution in 32% of the patients. Small-dose opioid supplementation was required in 14% of the patients, but none required general anesthesia to complete surgery. CONCLUSIONS: These preliminary data suggest that ultrasound-guided obturator-nerve identification and block are technically easy and highly successful.

Helayel PE; da Conceição DB; Pavei P; Knaesel JA; de Oliveira Filho GR

2007-05-01

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CT-guided obturator nerve block for diagnosis and treatment of painful conditions of the hip  

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Obturator nerve blocks (ONB) have been performed by anaesthesiologists mainly to eliminate the obturator reflex during transurethral resections. An effect on hip pain has also been described. However, being a time-consuming and operator-dependent procedure if performed manually, it has not been widely used for chronic hip pain. The purpose of this pilot study was to check whether CT guidance could improve reproducibility of the block (= immediate effect) and to test its potential value for treatment of chronic hip pain. Fifteen chronically ill patients with osteoarthritis underwent a single ONB. Sixteen millilitres of Lidocaine 1 % mixed with 2 ml Iopramide was injected into the obturator canal. The patients were followed up to 9 months after the intervention. With a single injection pain relief was achieved for 1-8 weeks in 7 of 15 patients. Excellent pain relief for 3-11 months was achieved in another 4 patients. Reasons for a mid-term or even long-term effect based on a single injection of local anaesthetic are not exactly known. The CT-guided ONB is a fast, easy and safe procedure that may be useful for mid-term (weeks) and sometimes even long-term (months) treatment of hip pain. (orig.)

Heywang-Koebrunner, S.H.; Amaya, B.; Pickuth, D.; Spielmann, R.P. [Dept. of Diagnostic Radiology, Martin-Luther University Halle-Wittenberg (Germany); Okoniewski, M. [Dept. of Orthopaedics, Martin-Luther University Halle-Wittenberg (Germany)

2001-06-01

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CT-guided obturator nerve block for diagnosis and treatment of painful conditions of the hip  

International Nuclear Information System (INIS)

Obturator nerve blocks (ONB) have been performed by anaesthesiologists mainly to eliminate the obturator reflex during transurethral resections. An effect on hip pain has also been described. However, being a time-consuming and operator-dependent procedure if performed manually, it has not been widely used for chronic hip pain. The purpose of this pilot study was to check whether CT guidance could improve reproducibility of the block (= immediate effect) and to test its potential value for treatment of chronic hip pain. Fifteen chronically ill patients with osteoarthritis underwent a single ONB. Sixteen millilitres of Lidocaine 1 % mixed with 2 ml Iopramide was injected into the obturator canal. The patients were followed up to 9 months after the intervention. With a single injection pain relief was achieved for 1-8 weeks in 7 of 15 patients. Excellent pain relief for 3-11 months was achieved in another 4 patients. Reasons for a mid-term or even long-term effect based on a single injection of local anaesthetic are not exactly known. The CT-guided ONB is a fast, easy and safe procedure that may be useful for mid-term (weeks) and sometimes even long-term (months) treatment of hip pain. (orig.)

2001-01-01

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Obturator nerve schwannoma presenting as an adnexal mass: case report  

Energy Technology Data Exchange (ETDEWEB)

Schwannomas are relatively common, benign nerve-sheath tumours. They arise most commonly from either cranial nerves or the dorsal root of spinal nerves. Schwannomas have also been reported to occur in peripheral nerve-root trunks, although this location is much less common. We report a case of a 45-year-old woman with a large pelvic mass originally believed to be an ovarian tumour. Following surgical excision, the tumour was found to be a schwannoma of the obturator nerve. To our knowledge, there are no reported cases of an obturator nerve schwannoma. The imaging features of schwannomas are reviewed. (author)

Mehta, M.; Thurston, W.A.; Merchant, N. [The Toronto Hospital, Dept. of Medical Imaging, Toronto, Ontario (Canada); Murphy, K.J. [The Toronto Hospital, Dept. of Obstetrics and Gynecology, Toronto, Ontario (Canada)

1999-02-01

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[The conflict between obturator nerve and ovary: a cadaveric and radioanatomic study].  

UK PubMed Central (United Kingdom)

The aim of this study was to describe the anatomical relationships between the ovary and the obturator nerve in its intrapelvic portion. Seven embalmed cadavers were dissected; 20 MRIs were then analyzed. The main distance between the lateral pole of the ovary and the obturator nerve was 29 mm. The authors describe various etiologies responsible for obturator neuralgia. An underdiagnosed cause is gonadal hypertrophy.

Jendrzejewski F; Peltier J; Havet E; Page C; Foulon P; Gondry J; Le Gars D

2013-06-01

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The role of succinylcholine in the prevention of the obturator nerve reflex during transurethral resection of bladder tumors  

International Nuclear Information System (INIS)

Objective was to present our 8 year experience in the prevention of the obturator nerve reflex during transurethral resection of bladder tumors. This study was performed in Ataturk University Hospital between 1999 and 2007. We retrospectively reviewed the records of 89 patients with inferolateral bladder tumors, who underwent transurethral resection under epidural or general anesthesia and requested obturator nerve reflex inhibition. Epidural anesthesia was administered to 57 patients, while the remaining 32 patients underwent general anesthesia via mask; and succinylcholine was administered prior to resection. Of the 57 patients received epidural anesthesia, 18 were diagnosed as inferolateral bladder tumors during endoscopy and had to undergo general anesthesia. Obturator nerve block was attempted preoperatively in 39 patients. However, a nerve identification failure, hematoma and 4 obturator nerve reflex events, despite the block, were observed and these patients were subjected to general anesthesia with succinylcholine. Fifty-six patients (32 patients initially had general anesthesia and 24 converted from epidural to general anesthesia) were all given succinylcholine prior to resection. Due to its mechanisms of action, succinylcholine is completely effective and represents a simple alternative to obturator nerve block. No contraction was observed in any patient given succinylcholine. (author)

2008-01-01

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[The conflict between obturator nerve and ovary: a cadaveric and radioanatomic study].  

Science.gov (United States)

The aim of this study was to describe the anatomical relationships between the ovary and the obturator nerve in its intrapelvic portion. Seven embalmed cadavers were dissected; 20 MRIs were then analyzed. The main distance between the lateral pole of the ovary and the obturator nerve was 29 mm. The authors describe various etiologies responsible for obturator neuralgia. An underdiagnosed cause is gonadal hypertrophy. PMID:23796698

Jendrzejewski, F; Peltier, J; Havet, E; Page, C; Foulon, P; Gondry, J; Le Gars, D

2013-06-21

13

Laparoscopic excision of endometriosis of the obturator nerve: a case report.  

Science.gov (United States)

Endometriosis, a common cause of cyclic and chronic pelvic pain in women, can present with a multitude of symptoms. Numerous case reports exist describing the involvement of the sciatic nerve with endometriosis; however, there are few reported cases of infiltration of the other pelvic nerves such as the obturator nerve. To our knowledge, this is the first case of laparoscopic management of symptomatic endometriosis of the obturator nerve. PMID:17980341

Ekpo, Geraldine; Senapati, Sangeeta; Advincula, Arnold P

14

Lower extremity nerve blocks.  

UK PubMed Central (United Kingdom)

PURPOSE OF REVIEW: The purpose of this review is to present the most important recent studies into the clinical use of peripheral nerve blocks for anesthesia and postoperative analgesia of the lower limb surgery. RECENT FINDINGS: There is increasing interest in lower extremity peripheral nerve blocks because of their potential advantages and concerns over interactions of centroneuraxis blocks and anticoagulants. Several authors have studied different approaches to the blockade of peripheral nerves with their advantages or disadvantages. Continuous peripheral nerve blocks have showed prolonged analgesia and great patient satisfaction with low side effects. Recent imaging techniques (e.g. ultrasound, magnetic resonance, tomography scans) have been developed to improve the performance of lower peripheral nerve blocks. Finally, complications of these techniques have been examined. SUMMARY: Introduction of new methods and techniques are increasing and improving the use of lower peripheral nerve blocks. These techniques are gaining interest after the important increase of the lower molecular weigh heparins.

Taboada M; Atanassoff PG

2004-10-01

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Laparoscopic injury of the obturator nerve during fertility-sparing procedure for cervical cancer  

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Full Text Available Abstract Background Intraoperative injury of the obturator nerve has rarely been reported in patients with gynecological malignancies undergoing extensive radical surgeries. Irreversible damage of this nerve causes thigh paresthesia and claudication. Intraoperative repair may be done by end-to-end anastomosis or grafting when achieving tension-free anastomosis is not possible. Case presentation A 28-year-old woman with stage IB cervical cancer underwent fertility–sparing surgery, including conization and bilateral pelvic lymphadenectomy. The left obturator nerve was damaged intraoperatively during pelvic dissection. Conclusion Immediate laparoscopic repair was successful and there was no functional deficit in the left thigh for six months postoperatively.

Ricciardi Enzo; Jakimovska Marina; Maniglio Paolo; Schimberni Mauro; Frega Antonio; Kobal Borut; Moscarini Massimo

2012-01-01

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Femoral and obturator nerves palsy caused by pelvic cement extrusion after hip arthroplasty.  

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Cement extrusion into the pelvis with subsequent palsy of the obturator and femoral nerves is a rare entity after hip replacement surgery. Cemented fixation of the acetabular cup has been considered as a safe and reliable standard procedure with very good long term results. We present a case of fift...

Pawel Zwolak; Peer Eysel; Joern William-Patrick Michael

17

Functional recovery of severe obturator and femoral nerve injuries after lateral retroperitoneal transpsoas surgery.  

UK PubMed Central (United Kingdom)

The minimally invasive lateral retroperitoneal transpsoas approach is a popular fusion technique. However, potential complications include injury to the lumbar plexus nerves, bowel, and vasculature, the most common of which are injuries to the lumbar plexus. The femoral nerve is particularly vulnerable because of its size and location; injury to the femoral nerve has significant clinical implications because of its extensive sensory and motor innervation of the lower extremities. The authors present an interesting case of a 49-year-old male patient in whom femoral and obturator nerve functional recovery unexpectedly occurred 364 days after the nerves had been injured during lateral retroperitoneal transpsoas surgery. Chronological video and electrodiagnostic findings demonstrate evidence of recovery. Classification and mechanisms of nerve injury and nerve regeneration are discussed.

Ahmadian A; Abel N; Uribe JS

2013-04-01

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Arterial and venous plasma levels of bupivacaine following peripheral nerve blocks.  

UK PubMed Central (United Kingdom)

Mean arterial plasma (MAP) and peripheral mean venous plasma (MVP) levels of bupivacaine were ascertained in 3 groups of 10 patients each for: (1) intercostal nerve block, 400 mg; (2) block of the sciatic, femoral, and lateral femoral cutaneous nerves, with or without block of the obturator nerve, 400 mg; and (3) supraclavicular brachial plexus block, 300 mg. MAP levels were consistently higher than simultaneously sampled MVP levels, the highest levels occurring from bilateral intercostal nerve block. No evidence of systemic toxicity was observed. The results suggest that bupivacaine has a much wider margin of safety in humans than is now stated.

Moore DC; Mather LE; Bridenbaugh LD; Balfour RI; Lysons DF; Horton WG

1976-11-01

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The Effectiveness of Massage in Therapy for Obturator Nerve Dysfunction as Complication of Hip Joint Alloplasty-Case Report.  

UK PubMed Central (United Kingdom)

The purpose of our case presentation was to reveal effectiveness of medical massage in the therapy for obturator nerve dysfunction as a complication of hip joint alloplasty. DESIGN: Medical massage was carried out in a 58-year-old man after hip joint alloplasty. The aim was to normalize tension of muscle-ligament-fascia apparatus within pelvic girdle and reconstruct correct structural conditions in the course of obturator nerve. METHODS: The methodology included correct positioning and medical massage with individually designed procedures. FINDINGS: Full normalization of muscular tone and subsidence of pain complaints were obtained. CONCLUSIONS: Massage has a positive influence on subsidence of pain complaints; however, effectiveness of the procedure depends on an appropriate methodology. CLINICAL RELEVANCE: The presented massage procedure is an effective therapy in obturator nerve dysfunction as complication after alloplasty and it can be one of elements of complex improvement after surgical joint procedures within the scope of nursing rehabilitation.

Kassolik K; Kurpas D; Wilk I; Uchmanowicz I; Hy?y J; Andrzejewski W

2013-06-01

20

Ultrasound-guided nerve blocks.  

UK PubMed Central (United Kingdom)

BACKGROUND AND OBJECTIVES: Ultrasound-guided nerve blocks are based on the direct visualization of nerve structures, needle, and adjacent anatomic structures. Thus, it is possible to place the local anesthetic precisely around the nerves and follow its dispersion in real time, obtaining, therefore, more effective blockades, reduced dependency on anatomic references, decreased anesthetic volume, and increased safety. CONTENTS: The aim of this paper was to review the physical mechanisms of image formation, ultrasound anatomy of the neuro axis and of the brachial and lumbosacral plexuses, equipment and materials used in the blockades, settings of the ultrasound equipment to improve the image, planes of visualization of the needles, the techniques, and training in ultrasound-guided nerve blocks. CONCLUSIONS: The steps for a successful regional block include the identification of the exact position of the nerves, the precise localization of the needle, without causing injuries to adjacent structures, and, finally, the careful administration of the local anesthetic close to the nerves. Although neurostimulation is very useful in identifying nerves, it does not fulfill all those requirements. Therefore, it is believed that ultrasound-guided nerve blocks will be the technique of choice in regional anesthesia in a not too distant future.

Helayel PE; da Conceição DB; de Oliveira Filho GR

2007-02-01

 
 
 
 
21

Continuous peripheral nerve blocks.  

UK PubMed Central (United Kingdom)

Sophisticated regional anesthesia techniques have experienced substantial growth throughout the past 5 years for acute and chronic pain management. The recognition that regional anesthesia leads to superior postoperative outcomes in acute pain management and to an increased understanding of the pathogenesis of chronic pain has led to increased use of continuous peripheral nerve catheters. Furthermore, the availability of new equipment and techniques specifically designed to facilitate effective catheter placement has increased interest and adoption of peripheral nerve catheters to manage painful conditions. This has become particularly relevant as the scope of ambulatory surgery continues to grow. To maximize success rates with continuous peripheral nerve catheters, clinicians must be intimately aware of the pertinent regional anatomy and technical issues surrounding placement and maintenance of continuous nerve blockade. The recent development of outpatient infusion systems and novel anesthetics has been exciting and is likely to lead to an increase in the use of continuous peripheral catheter techniques. The consistent recognition that these techniques dramatically increase patient satisfaction should dictate an increasing presence in the field of pain management throughout the next several years.

Shinaman RC; Mackey S

2005-02-01

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Obturator Nerve Palsy in a Patient with Fascio Scapulo Humeral Dystrophy Undergoing Scapulopexy in Prone Position: A Rare Occurrence  

Directory of Open Access Journals (Sweden)

Full Text Available All surgical positions carry some degree of position-related risks. The most common serious positional injuries are peripheral nerve injuries. We present a case of 23 years old man with obturator nerve injury with clinically evident sequelae following a scapulopexy of the right shoulder in prone position. Basis on our knowledge, no similar cases have been described in the literature. The purpose of this report is to increase awareness of this unreported potential complication in the prone position.

Hussain Khan Zahid; Soleimani Ali Akbar; Mortazavi Mohammad Javad

2009-01-01

23

OBTURATOR TIPS  

UK PubMed Central (United Kingdom)

A trocar assembly for use in minimally invasive surgical procedures includes a cannula subassembly and an obturator subassembly. The obturator assembly includes an obturator shaft member defining a longitudinal axis and an obturator tip configured to be removable from the obturator shaft member or, alternatively, constructed with the obturator member as a single unit. Various designs of the obturator tip are contemplated.

SMITH ROBERT C

24

Neurolytic phenol blockade of the obturator nerve for severe adductor spasticity.  

UK PubMed Central (United Kingdom)

BACKGROUND: In this study, we present the 3-month follow-up results of a retrospective analysis of obturator nerve (ON) phenol neurolysis performed between 2000 and 2007 in patients with adductor spasticity. METHODS: The study was performed by retrospective investigation of the clinical follow-up results of 80 ON phenol treatments in 62 patients. Neurolysis using 5-10 ml 6% phenol was applied with the guidance of fluoroscopy and a peripheral nerve stimulator. Pain, spasticity and hygiene were evaluated and the hip abduction range of motion (ROM) was measured at the end of the first week and in the first, second and third months following the intervention. RESULTS: The visual analogue scale scores decreased significantly in the first week, first month and the second month, but reached their initial values in the third month. A drastic increase in the ROM values was shown in hip abduction in the first week, first month and second month. An increase in the Ashworth Scale values was observed in the second and third months, but they did not reach their initial values. The hygiene score decreased drastically in the first week and the first and second months, but worsened in the third month. The success rate in nerve localization during ON neurolysis was 100%. CONCLUSION: ON phenol blockade with fluoroscopy and peripheral nerve stimulator guidance in patients with adductor spasticity led to a decrease in spasticity and pain with an increase in the ROM of the hip and better hygiene with an efficacy lasting for about 3 months.

Akkaya T; Unlu E; Alptekin A; Gumus HI; Umay E; Cakci A

2010-01-01

25

Continuous peripheral nerve blocks in children.  

UK PubMed Central (United Kingdom)

In recent years, regional anaesthesia in children has generated increasing interest. Continuous peripheral nerve blocks have an important role in the anaesthetic arsenal, allowing effective, safe and prolonged postoperative pain management. Indications for continuous peripheral nerve blocks depend on benefits/risks analysis of each technique for each patient. The indications include surgery associated with intense postoperative pain, surgery requiring painful physical therapy, and complex regional pain syndrome. Continuous peripheral nerve blocks are usually performed under general anaesthesia or sedation, and require appropriate equipment in order to decrease the risk of nerve injury. New techniques, such as transcutaneous stimulation or ultrasound guidance, appear to facilitate nerve and plexus identification in paediatric patients. Nevertheless, continuous peripheral nerve block may mask compartment syndrome in certain surgical procedure or trauma. Finally, ropivacaine appears to be the best local anaesthetic for continuous peripheral nerve blocks in children, requiring low flow rate with low concentration of the local anaesthetic.

Dadure C; Capdevila X

2005-06-01

26

Use of Ultrasound and Fluoroscopy Guidance in Percutaneous Radiofrequency Lesioning of the Sensory Branches of the Femoral and Obturator Nerves.  

UK PubMed Central (United Kingdom)

Hip pain is a common condition that is often seen in patients with multiple comorbidities. Often surgery is not an option due to these comorbidities. Percutaneous radiofrequency lesioning of the articular branches of the obturator and femoral nerves is an alternative treatment for hip pain. Traditionally, fluoroscopy is used to guide needle placement. We report a case where a novel approach was used with ultrasound guidance to visualize vascular and soft tissue structures in real time. The use of ultrasound might help to guide the needle to avoid vascular complications due to anatomical variation between patients.

Chaiban G; Paradis T; Atallah J

2013-05-01

27

Continuous peripheral nerve blocks in clinical practice.  

UK PubMed Central (United Kingdom)

PURPOSE OF REVIEW: The present review highlights new insights into indications and guidance during procedures for continuous peripheral nerve blocks. RECENT FINDINGS: Continuous peripheral nerve blocks consistently provide better analgesia than traditional systemic opioid-based analgesia. The literature shows that continuous peripheral nerve blocks prolong site-specific local anesthetic delivery in the outpatient setting, allow optimal analgesia, have minimal side effects, and avoid premature regression of an analgesic block. Furthermore, an improvement in patients' health-related quality of life or outcome benefits has been demonstrated. It appears that continuous peripheral nerve blocks are generally superior to intraarticular local anesthetic infusion for immediate postoperative pain, but new data demonstrate that, apart from a multimodal analgesia regimen, periarticular and intraarticular application of local anesthetics can improve early postoperative analgesia and mobilization. Finally, it seems that, only for interscalene and popliteal sciatic nerve blocks, the use of stimulating catheters slightly decreases visual analog scale scores for postoperative pain and intravenous opioid rescue analgesia. Ultrasound guidance offers the potential advantage to confirm catheter tip location. SUMMARY: Continuous peripheral nerve blocks are essential in the perioperative anesthetic management of in-hospital or ambulatory patients. Ultrasound guidance and stimulating catheters can help anesthetists during the procedure.

Capdevila X; Ponrouch M; Choquet O

2008-10-01

28

Myoclonus following a Peripheral Nerve Block.  

UK PubMed Central (United Kingdom)

Myoclonus is an extremely rare perioperative complication following neuraxial anesthesia. It has also been reported to occur due to peripheral nerve lesions. We report a case of self-limiting myoclonus following a routine peripheral nerve block in an otherwise healthy patient.

Hudson AJ; Guthmiller KB; Hyatt MN

2013-01-01

29

Continuous peripheral nerve blocks with stimulating catheters.  

UK PubMed Central (United Kingdom)

BACKGROUND AND OBJECTIVES: This study evaluated the efficacy of stimulating catheters used for continuous peripheral nerve blocks as a means of immediate verification and confirmation of correct catheter position. METHODS: This observational study presents our experience with 130 stimulating catheters used in 40 intersternocleidomastoid, 24 axillary, 47 femoral, and 19 lateral midfemoral sciatic nerve blocks. Placement characteristics (amperage, depth of introducer needle or catheter insertion, elicited motor responses), subsequent postoperative analgesia, and catheter position evaluated with the radiopaque dye analysis were all studied. RESULTS: Except in femoral blocks, characteristics of motor responses elicited (1 Hz, 0,1 ms) by the introducer assembly and catheter differed. The amperage required to elicit motor responses typically was higher with the catheter than with the introducer needle (1.6 [0.2 to 4 mA] v 0.5 [0.4 to 1 mA] P <.0001). The ability to elicit a motor response with the stimulating catheter correlated with successful clinical anesthesia in 124 cases. Opacified radiography showed no aberrant position in these cases. Three catheters for upper limb block failed to stimulate, provided poor anesthesia, and had radiologic evidence of aberrant position. Even though they failed to stimulate, 3 catheters for sciatic block functioned well, and the opacified radiography showed correct position. CONCLUSION: The ability to electrostimulate nerves using an in situ catheter increases success rate in catheter placement for continuous peripheral nerve blocks. Further controlled investigations are necessary to compare this technique with more conventional methods in terms of cost and utility for various peripheral nerve blocks.

Pham-Dang C; Kick O; Collet T; Gouin F; Pinaud M

2003-03-01

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PROJECTIONS IN THE DORSAL COLUMN NUCLEI OF FEMORAL AND OBTURATOR NERVES IN THE RAT  

Directory of Open Access Journals (Sweden)

Full Text Available The central projections of primary afferent fibers of the femoral and abturator nerves to the dorsal columnnuclei studies in the albino rat. Horseradish perxidase (HRP) labeled terminations were observed throughmost of the caudorostral extent of the ipsilateal gracile nucleus. This formed an oblique band whose longaxis was directed in a dorsolateral and ventromedial direction in cases of femoral nerve while in case ofobturator nerve, the terminations occupied a central area in gracile nucleus. No labeling was observed incuneate nuclei.

Zubia Athar

1997-01-01

31

Morphometry of the iliolumbar artery and the iliolumbar veins and their correlations with the lumbosacral trunk and the obturator nerve.  

Science.gov (United States)

Objectives: To reveal the variations of the iliolumbar artery and the iliolumabar veins and their correlation with the surrounding important structures. Methods: We dissected the iliolumbar region bilaterally in 20 formalin-fixed adult cadavers. The diameter of the iliolumbar artery at its origin, its length up to the branching point, the distance between the iliolumbar artery and the inferior margin of the fifth lumbar vertebra and the distance between the iliolumbar artery and the bifurcation point of the common iliac artery, were measured. The pattern of drainage, the dimensions, the points of confluence with the common iliac vein and the obliquity of the iliolumbar vein were noted. The correlation between the iliolumbar artery and the veins to the obturator nerve and the lumbosacral trunk was recorded. Results: The iliolumbar artery originated from the posterior trunk of the internal iliac artery or from the internal iliac artery. The mean diameter of the iliolumbar artery, at its origin, was 3.5±0.5 mm. The mean distance between the origin of the iliolumbar artery and the bifurcation point to the iliac and the lumbar branches was 12.2±5.5 mm. The distance between the origin of the iliolumbar artery and the lower edge of the fifth lumbar vertebra was 43.2±11.6 mm. The distance between the origin of the iliolumbar artery and the bifurcation point of the common iliac artery was 38.7±10.6 mm. The mean distance of the iliolumbar veins from the inferior vena cava, overall, was 35± 9.9 mm. The mean width of the mouth of the iliolumbar vein was10.7 ± 5.1 mm and the mean angle of obliquity of the vein with respect to the long axis of the common iliac vein was 75.50. The tributaries which drained into the main iliolumbar vein were variable. The iliolumbar artery passed anterior in 70% and it passed posterior to the obturator nerve in 30%. The veins were lying anterior to the obturator nerve in 45% and they were lying posterior in 55%. The multiple tributaries which drained into the iliolumbar vein relation of the tributaries were variable, few passed anterior and few passed posterior. The iliolumbar artery was seen anterior to the lumbosacral trunk in 30%, it was posterior in 54%, it was cleaved in 8% and the branches of the artery were passing on either side of the lumbosacral trunk to enclose it like a clasp in 8%. The veins were anterior to the lumbosacral trunk in 40% and they were posterior in 60%. Conclusion: The anatomical features of the iliolumbar artery, the iliolumbar veins and their correlation with the anatomical landmarks, which were presented here, would be helpful in decreasing the iatrogenic trauma to the neurovascular structures in the iliolumbar region. PMID:23634388

Teli, Chandrika Gurulingappa; Kate, Nilesh Netaji; Kothandaraman, Usha

2013-03-01

32

Morphometry of the iliolumbar artery and the iliolumbar veins and their correlations with the lumbosacral trunk and the obturator nerve.  

UK PubMed Central (United Kingdom)

Objectives: To reveal the variations of the iliolumbar artery and the iliolumabar veins and their correlation with the surrounding important structures. Methods: We dissected the iliolumbar region bilaterally in 20 formalin-fixed adult cadavers. The diameter of the iliolumbar artery at its origin, its length up to the branching point, the distance between the iliolumbar artery and the inferior margin of the fifth lumbar vertebra and the distance between the iliolumbar artery and the bifurcation point of the common iliac artery, were measured. The pattern of drainage, the dimensions, the points of confluence with the common iliac vein and the obliquity of the iliolumbar vein were noted. The correlation between the iliolumbar artery and the veins to the obturator nerve and the lumbosacral trunk was recorded. Results: The iliolumbar artery originated from the posterior trunk of the internal iliac artery or from the internal iliac artery. The mean diameter of the iliolumbar artery, at its origin, was 3.5±0.5 mm. The mean distance between the origin of the iliolumbar artery and the bifurcation point to the iliac and the lumbar branches was 12.2±5.5 mm. The distance between the origin of the iliolumbar artery and the lower edge of the fifth lumbar vertebra was 43.2±11.6 mm. The distance between the origin of the iliolumbar artery and the bifurcation point of the common iliac artery was 38.7±10.6 mm. The mean distance of the iliolumbar veins from the inferior vena cava, overall, was 35± 9.9 mm. The mean width of the mouth of the iliolumbar vein was10.7 ± 5.1 mm and the mean angle of obliquity of the vein with respect to the long axis of the common iliac vein was 75.50. The tributaries which drained into the main iliolumbar vein were variable. The iliolumbar artery passed anterior in 70% and it passed posterior to the obturator nerve in 30%. The veins were lying anterior to the obturator nerve in 45% and they were lying posterior in 55%. The multiple tributaries which drained into the iliolumbar vein relation of the tributaries were variable, few passed anterior and few passed posterior. The iliolumbar artery was seen anterior to the lumbosacral trunk in 30%, it was posterior in 54%, it was cleaved in 8% and the branches of the artery were passing on either side of the lumbosacral trunk to enclose it like a clasp in 8%. The veins were anterior to the lumbosacral trunk in 40% and they were posterior in 60%. Conclusion: The anatomical features of the iliolumbar artery, the iliolumbar veins and their correlation with the anatomical landmarks, which were presented here, would be helpful in decreasing the iatrogenic trauma to the neurovascular structures in the iliolumbar region.

Teli CG; Kate NN; Kothandaraman U

2013-03-01

33

Morphometry of the Iliolumbar Artery and the Iliolumbar Veins and Their Correlations with the Lumbosacral Trunk and the Obturator Nerve  

Science.gov (United States)

Objectives: To reveal the variations of the iliolumbar artery and the iliolumabar veins and their correlation with the surrounding important structures. Methods: We dissected the iliolumbar region bilaterally in 20 formalin-fixed adult cadavers. The diameter of the iliolumbar artery at its origin, its length up to the branching point, the distance between the iliolumbar artery and the inferior margin of the fifth lumbar vertebra and the distance between the iliolumbar artery and the bifurcation point of the common iliac artery, were measured. The pattern of drainage, the dimensions, the points of confluence with the common iliac vein and the obliquity of the iliolumbar vein were noted. The correlation between the iliolumbar artery and the veins to the obturator nerve and the lumbosacral trunk was recorded. Results: The iliolumbar artery originated from the posterior trunk of the internal iliac artery or from the internal iliac artery. The mean diameter of the iliolumbar artery, at its origin, was 3.5±0.5 mm. The mean distance between the origin of the iliolumbar artery and the bifurcation point to the iliac and the lumbar branches was 12.2±5.5 mm. The distance between the origin of the iliolumbar artery and the lower edge of the fifth lumbar vertebra was 43.2±11.6 mm. The distance between the origin of the iliolumbar artery and the bifurcation point of the common iliac artery was 38.7±10.6 mm. The mean distance of the iliolumbar veins from the inferior vena cava, overall, was 35± 9.9 mm. The mean width of the mouth of the iliolumbar vein was10.7 ± 5.1 mm and the mean angle of obliquity of the vein with respect to the long axis of the common iliac vein was 75.50. The tributaries which drained into the main iliolumbar vein were variable. The iliolumbar artery passed anterior in 70% and it passed posterior to the obturator nerve in 30%. The veins were lying anterior to the obturator nerve in 45% and they were lying posterior in 55%. The multiple tributaries which drained into the iliolumbar vein relation of the tributaries were variable, few passed anterior and few passed posterior. The iliolumbar artery was seen anterior to the lumbosacral trunk in 30%, it was posterior in 54%, it was cleaved in 8% and the branches of the artery were passing on either side of the lumbosacral trunk to enclose it like a clasp in 8%. The veins were anterior to the lumbosacral trunk in 40% and they were posterior in 60%. Conclusion: The anatomical features of the iliolumbar artery, the iliolumbar veins and their correlation with the anatomical landmarks, which were presented here, would be helpful in decreasing the iatrogenic trauma to the neurovascular structures in the iliolumbar region.

Teli, Chandrika Gurulingappa; Kate, Nilesh Netaji; Kothandaraman, Usha

2013-01-01

34

Occipital Nerve Block for Surgery on the Posterior Scalp  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Patients that present with scalp lesions within the distribution of cranial and spinal nerves may benefit considerably from regional nerve blocks, in this case, an occipital nerve in combination with spinal anesthesia for lower ext...

Saad Mohammad; Ng Marilyn; Fitzpatrick Daniel; D. Kaufman; Alexander Apostol

35

Peripheral nerve block techniques for ambulatory surgery.  

UK PubMed Central (United Kingdom)

Peripheral nerve blocks (PNBs) have an increasingly important role in ambulatory anesthesia and have many characteristics of the ideal outpatient anesthetic: surgical anesthesia, prolonged postoperative analgesia, and facilitated discharge. Critically evaluating the potential benefits and supporting evidence is essential to appropriate technique selection. When PNBs are used for upper extremity procedures, there is consistent opioid sparing and fewer treatment-related side effects when compared with general anesthesia. This has been demonstrated in the immediate perioperative period but has not been extensively investigated after discharge. Lower extremity PNBs are particularly useful for procedures resulting in greater tissue trauma when the benefits of dense analgesia appear to be magnified, as evidenced by less hospital readmission. The majority of current studies do not support the concept that a patient will have difficulty coping with pain when their block resolves at home. Initial investigations of outpatient continuous peripheral nerve blocks demonstrate analgesic potential beyond that obtained with single-injection blocks and offer promise for extending the duration of postoperative analgesia. The encouraging results of these studies will have to be balanced with the resources needed to safely manage catheters at home. Despite supportive data for ambulatory PNBs, most studies have been either case series or relatively small prospective trials, with a narrow focus on analgesia, opioids, and immediate side effects. Ultimately, having larger prospective data with a broader focus on outcome benefits would be more persuasive for anesthesiologists to perform procedures that are still viewed by many as technically challenging.

Klein SM; Evans H; Nielsen KC; Tucker MS; Warner DS; Steele SM

2005-12-01

36

[Basics of ultrasound-guided nerve block].  

Science.gov (United States)

The ultrasound waves (> 20 kHz) are high-frequency sound waves that are not audible to the human ear. As the ultrasound waves move through body tissues of different acoustic impedances, they are attenuated, reflected, or scattered. Reflected waves are transformed back into an electrical signal that is processed by the ultrasound machine to generate an image on the screen. In practice, an ultrasound probe emits and receives ultrasound waves, functioning both as a speaker and a microphone. The recent advance of ultrasonography has provided close-sectional images of the body in real time. Ultrasound imaging has been useful to visualize neural anatomical structures and the surrounding structures, and navigate the needle toward the target nerves. This review introduces the theories and practices of ultrasonography for the peripheral nerve blocks. PMID:18516881

Yamada, Masaki; Seo, Norimasa

2008-05-01

37

Variations in selective nerve root block technique.  

UK PubMed Central (United Kingdom)

INTRODUCTION: Much literature reports on selective nerve root blocks (SNRBs) in cases of lumbosacral radiculopathy. Unfortunately, authors only inconsistently reveal the exact needle tip position relative to the causative pathology at the time of injection. Different injection sites may provide different symptomatic benefits. We investigated the variation in injection techniques of practitioners working in the UK. METHODS: A clinical scenario was devised depicting a patient with radiculopathy secondary to an L4/5 vertebral disc prolapse. Participants were questioned on their chosen management of this patient, focusing particularly on SNRB technique. Questionnaires were sent to spinal surgeons, pain management specialists and musculoskeletal radiologists. RESULTS: A total of 100 responses were detailed enough for inclusion. The majority (83%) of respondents reported they would inject local anaesthetic and steroids, 4% would inject local anaesthetic alone and 13% would inject a different substance. Over half (53%) would target the L5 nerve root, 26% the L4 nerve root, 12% the prolapsed disc itself and 9% two separate vertebral levels. Variation was also noted in needle tip location relative to the neural sheath. CONCLUSIONS: When treating lumbar radiculopathy, there are apparent variations in the use and positioning of SNRBs for a given level of disc pathology. Needle tip position may have a direct influence on clinical outcome following SNRBs. Caution is therefore required when considering the validity of previously published studies investigating SNRBs and different injectates.

Eastley NC; Spiteri V; Newey ML

2013-10-01

38

Different clinical electrodes achieve similar electrical nerve conduction block.  

UK PubMed Central (United Kingdom)

Objective. We aim to evaluate the suitability of four electrodes previously used in clinical experiments for peripheral nerve electrical block applications. Approach. We evaluated peripheral nerve electrical block using three such clinical nerve cuff electrodes (the Huntington helix, the Case self-sizing Spiral and the flat interface nerve electrode) and one clinical intramuscular electrode (the Memberg electrode) in five cats. Amplitude thresholds for the block using 12 or 25 kHz voltage-controlled stimulation, onset response, and stimulation thresholds before and after block testing were determined. Main results. Complete nerve block was achieved reliably and the onset response to blocking stimulation was similar for all electrodes. Amplitude thresholds for the block were lowest for the Case Spiral electrode (4 ± 1 Vpp) and lower for the nerve cuff electrodes (7 ± 3 Vpp) than for the intramuscular electrode (26 ± 10 Vpp). A minor elevation in stimulation threshold and reduction in stimulus-evoked urethral pressure was observed during testing, but the effect was temporary and did not vary between electrodes. Significance. Multiple clinical electrodes appear suitable for neuroprostheses using peripheral nerve electrical block. The freedom to choose electrodes based on secondary criteria such as ease of implantation or cost should ease translation of electrical nerve block to clinical practice.

Boger A; Bhadra N; Gustafson KJ

2013-08-01

39

Cost-effectiveness of ultrasound vs nerve stimulation guidance for continuous sciatic nerve block  

DEFF Research Database (Denmark)

This study assessed the cost-effectiveness of ultrasound (US) vs nerve stimulation (NS) guidance for continuous sciatic nerve block in Danish elective patients undergoing major foot and ankle surgery.

Ehlers, L; Jensen, J M

2012-01-01

40

The role of continuous peripheral nerve blocks.  

UK PubMed Central (United Kingdom)

A continuous peripheral nerve block (cPNB) is provided in the hospital and ambulatory setting. The most common use of CPNBs is in the peri- and postoperative period but different indications have been described like the treatment of chronic pain such as cancer-induced pain, complex regional pain syndrome or phantom limb pain. The documented benefits strongly depend on the analgesia quality and include decreasing baseline/dynamic pain, reducing additional analgesic requirements, decrease of postoperative joint inflammation and inflammatory markers, sleep disturbances and opioid-related side effects, increase of patient satisfaction and ambulation/functioning improvement, an accelerated resumption of passive joint range-of-motion, reducing time until discharge readiness, decrease in blood loss/blood transfusions, potential reduction of the incidence of postsurgical chronic pain and reduction of costs. Evidence deriving from randomized controlled trials suggests that in some situations there are also prolonged benefits of regional anesthesia after catheter removal in addition to the immediate postoperative effects. Unfortunately, there are only few data demonstrating benefits after catheter removal and the evidence of medium- or long-term improvements in health-related quality of life measures is still lacking. This review will give an overview of the advantages and adverse effects of cPNBs.

Aguirre J; Del Moral A; Cobo I; Borgeat A; Blumenthal S

2012-01-01

 
 
 
 
41

The incidence and aetiology of phrenic nerve blockade associated with supraclavicular brachial plexus block.  

UK PubMed Central (United Kingdom)

A trial to ascertain the true incidence of inadvertent phrenic nerve block with brachial plexus block via the supraclavicular approach was carried out. Phrenic nerve block was monitored by x-ray screening of the diaphragm. There was an incidence of phrenic nerve block of 67% (10 cases of diaphragmatic paralysis in 15 brachial blocks). The possible causes of phrenic nerve block with brachial block are discussed. It is concluded that the phrenic nerve is blocked peripherally in front of the scalenus anterior.

Knoblanche GE

1979-11-01

42

[Perioperative analgesia with continuous peripheral nerve blocks in children  

UK PubMed Central (United Kingdom)

Recently, regional anaesthesia in children has generated increasing interest. But single injection techniques have a limited duration of postoperative analgesia. Then, continuous peripheral nerve blocks have taken an important position in the anaesthetic arsenal, allowing an effective, safe and prolonged postoperative pain management. As adults, indications for continuous peripheral nerve blocks depend on the analysis of individual benefits/risks ratio. Main indications are intense postoperative pain surgical procedures, with or without postoperative rehabilitation, and complex regional pain syndrome. Contraindications to these procedures are rather similar to those in adults, plus parental and/or children refusal. Continuous peripheral nerve blocks are usually performed under general anaesthesia or sedation in children, and require appropriate equipment in order to decrease the risk of nerve injury. New techniques, such as transcutaneous nerve stimulation or ultrasound guidance, appeared to facilitate nerve and plexus approach identification in paediatric patients. Nevertheless, continuous peripheral nerve block may theoretically mask a compartment syndrome after trauma surgical procedures. Finally, ropivacaine appears to be the most appropriate drug for continuous peripheral nerve blocks in children, requiring low flow rates and concentrations of local anaesthetic. These techniques may facilitate early ambulation by an improved pain management or even postoperative analgesia at home with disposable pumps. One might infer from the current review that excellent pain relief coupled with a reduction of side effects would contribute to improve the quality of life and to decrease the frequency of disabling behavioural modifications in children, sometimes psychologically injured by hospital stay and postoperative pain.

Dadure C; Capdevila X

2007-02-01

43

Ultrasound-guided nerve blocks in the emergency department  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Peripheral nerve blocks preclude the need for procedural sedation and provide adequate anesthesia during painful procedures. This technique can be performed in the emergency department with the aid of ultrasound imaging to identify target nerves. We describe eight cases of upper and lower extremity ...

Bhoi Sanjeev; Chandra Amit; Galwankar Sagar

44

Obturator neuropathy. An anatomic perspective.  

Science.gov (United States)

Entrapment of the anterior division of the obturator nerve is a recently described cause of medial groin pain. This anatomic study examines the extrapelvic course of the nerve and related fascia in the adductor region to provide an anatomic basis for the syndrome and to aid in surgical treatment. Twelve anatomic specimen limbs were dissected to document the extrapelvic course of the obturator nerve, the myofascial arrangement, and the vasculature. A thirteenth limb was prepared with intraarterial glycerin to examine the vessels in more detail. A distinct fascial plane was found deep to the adductor longus and pectineus overlying the anterior division of the obturator nerve. The arterial supply to the adductor muscles is related intimately to the nerve and its branches, with associated local thickening of the fascial connective tissue. The relationship between the nerve, vessels, and fascia appears sufficient to result in an entrapment syndrome. The anatomic findings from this series will help plan the surgical treatment of this condition. PMID:10379324

Harvey, G; Bell, S

1999-06-01

45

Ultrasound-guided nerve blocks in the emergency department  

Directory of Open Access Journals (Sweden)

Full Text Available Peripheral nerve blocks preclude the need for procedural sedation and provide adequate anesthesia during painful procedures. This technique can be performed in the emergency department with the aid of ultrasound imaging to identify target nerves. We describe eight cases of upper and lower extremity nerve blocks performed under ultrasound guidance in the emergency department of the Jai Prakash Narayan Trauma Centre, All India Institute of Medical Sciences, New Delhi. Only two of the patients, both with extensive injuries, required any additional anesthesia during the subsequent procedures and all of them reported significant pain control and muscle relaxation.

Bhoi Sanjeev; Chandra Amit; Galwankar Sagar

2010-01-01

46

Ultrasound-guided nerve blocks in the emergency department.  

UK PubMed Central (United Kingdom)

Peripheral nerve blocks preclude the need for procedural sedation and provide adequate anesthesia during painful procedures. This technique can be performed in the emergency department with the aid of ultrasound imaging to identify target nerves. We describe eight cases of upper and lower extremity nerve blocks performed under ultrasound guidance in the emergency department of the Jai Prakash Narayan Trauma Centre, All India Institute of Medical Sciences, New Delhi. Only two of the patients, both with extensive injuries, required any additional anesthesia during the subsequent procedures and all of them reported significant pain control and muscle relaxation.

Bhoi S; Chandra A; Galwankar S

2010-01-01

47

Ultrasound-guided peripheral nerve blocks: what are the benefits?  

DEFF Research Database (Denmark)

BACKGROUND: Use of ultrasound by anaesthesiologists performing regional blocks is rapidly gaining popularity. The aims of this review were to summarize and update accumulating evidence on ultrasound-guided nerve blocks, with an emphasis on the clinical relevance of the results and to critically appraise changing standards in regional anaesthesia. METHODS: A search of MEDLINE and EMBASE (1966 to 31 December 2007) was conducted using the following free terms: 'ultrasound and regional anesthesia', 'ultrasound and peripheral block' and 'ultrasound and nerve and block'. These were combined with the MESH terms 'nerve block' and 'ultrasonography'. The following limits were applied: studies with abstracts, only in humans, published in core clinical journals. Trial type: meta-analysis, randomized-controlled trial and clinical trial. RESULTS: When peripheral nerves are adequately imaged by ultrasound, the concomitant use of nerve stimulation offers no further advantage. However, several studies reported problems with obtaining satisfactory images in some patients. Ultrasound guidance significantly shortened the block performance time and/or reduced the number of needle passes to reach the target in all comparative studies. The occurrence of paraesthesia during block performance was also reduced, but not the incidence of short-lasting post-operative neuropraxia. The frequency of accidental vascular punctures may be lower, but the data are contradictory. Block onset time was significantly shortened. Block duration was longer in children, but not in adults. Ultrasound also allowed dose reduction of the local anaesthetic (LA). CONCLUSIONS: Ultrasound guidance shortens the block performance time, reduces the number of needle passes and shortens the block onset time. Blocks may be performed using lower LA doses Udgivelsesdato: 2008/7

Nielsen, Zbigniew Jerzy Koscielniak

2008-01-01

48

Lidocaine use in ultrasound-guided femoral nerve block: what is the minimum effective anaesthetic concentration (MEAC90)?  

UK PubMed Central (United Kingdom)

BACKGROUND: This study aimed to estimate the minimum effective anaesthetic concentrations of lidocaine required to block the femoral nerve under ultrasound (US) guidance in 90% (MEAC90) of patients. METHODS: A minimum of 45 patients who had undergone knee arthroscopy were included in this observational study. All the patients received US-guided sciatic, obturator, and femoral nerve blocks. The femoral nerve block was performed using 15 ml of lidocaine. The lidocaine concentration given to a patient was determined by the response of the previous patient (a biased-coin design up-down sequential method). If a patient had a negative response, the lidocaine concentration was increased by 0.1% w/v in the next patient. If a patient had a positive response, the next patient was randomized to receive the same lidocaine concentration (with a probability of 0.89) or to receive a concentration 0.1% w/v less (with a probability of 0.11). A positive response was defined as complete sensory and motor block. The patients' responses were analysed to calculate the mean MEAC90. RESULTS: Fifty-two patients were required to complete the study; 45 had a positive response and seven had a negative response. The mean MEAC90 was estimated to be 0.93% w/v [95% confidence interval (CI), 0.8-1.03%]. Lidocaine 0.93% w/v was estimated to produce a successful block in 89% (95% CI, 78-100%) of patients. CONCLUSIONS: Perineural injection of 15 ml of lidocaine 0.93% w/v under US guidance could provide successful femoral nerve block in 90% of patients.

Taha AM; Abd-Elmaksoud AM

2013-06-01

49

[Cancer pain treatment with nerve blocks and neuroablative procedures].  

Science.gov (United States)

The management of opioid resistant cancer pain is a significant issue for palliative medicine. Certain types of pain can be relieved effectively using nerve blocks without exacerbating and sometimes improving daily activity as long as proper patient selection and technique are employed. Continuous epidural and subarachnoid block, celiac plexus block, superior hypogastric plexus block, subarachnoid phenol block and percutaneous cervical cordotomy are common pain treatment procedures. In our pain clinic, these procedures were performed on about 20% of cancer pain patients, most of whom experienced pain relief without serious complications. Proper use of nerve blocks and neuroablative procedures can undoubtedly improve the management of cancer pain and should be a significant component of the strategy for cancer pain relief. PMID:17233424

Nagaro, Takumi; Tsubota, Shinzo

2007-01-01

50

Response to pudendal nerve block in women with pudendal neuralgia.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To examine the evolution of pain and the duration of numbness after neural blockade of the pudendal nerve in women with pudendal neuralgia and correlate with clinical and historical data. DESIGN: Prospective, single arm, open label study. SETTING: University hospital and outpatient clinic. SUBJECTS: Eighty-two adult female patients were recruited from November 8, 2008 to February 14, 2010. Patients were selected based on the presence of spontaneous or provoked pain in the distribution of the pudendal nerve. INTERVENTIONS: Subjects underwent a standardized pudendal nerve block. OUTCOME MEASURES: Visual analog pain scores and the presence of numbness were recorded before and for 64 hours after the pudendal nerve block. A complete clinical history and examination were documented. RESULTS: Sixty-six patients completed the study. About 86.9% had a reduction in one or more pain symptom, while 44.3% found that more than one of their pain symptoms did not return. About 69.7% of patients reported numbness lasting up to 16 hours or longer. Previous gynecological surgery was recorded in 75.8%, previous traumatic obstetric events in 47.0% of cases. Prolonged history of pain correlated with a reduced chance of positive outcome of the pudendal nerve block. CONCLUSION: In patients with pudendal neuralgia, the pudendal nerve block has a variable response, but may have a beneficial effect in a subset of women. Surgical and obstetrical trauma are common historical antecedents.

Vancaillie T; Eggermont J; Armstrong G; Jarvis S; Liu J; Beg N

2012-04-01

51

Continuous peripheral nerve blocks: state of the art.  

UK PubMed Central (United Kingdom)

PURPOSE OF REVIEW: This review was performed through a Medline research to evaluate articles published between January 2004 and April 2005. Technical procedures, indications, drugs, infusion regimens, and complications of continuous peripheral nerve blocks were considered. RECENT FINDINGS: A total of 27 articles were reviewed. With respect to technical procedures, the authors focused on advantages of stimulating catheters or ultrasound guidance. With the help of these techniques, a correct catheter placement as close to the targeted nerve as possible was obtained. The total amount of local anesthetic administered was thereby reduced. Using ultrasound needle guidance, the spread of local anesthetic around the nerve could be visualized. Articles dealing with the choice of local anesthetic showed equianalgesia and equipotency of continuous perineural infusion of levobupivacaine 0.125% and ropivacaine 0.2%. The best infusion regimen for postoperative analgesia appears to be a combination of a preset basal rate administered together with small bolus doses in almost all continuous peripheral nerve blocks. Overall, complications such as infections, local anesthetic toxic plasma levels, hematoma formation, or nerve injury seem to be rare in continuous peripheral nerve blockade. SUMMARY: Continuous peripheral nerve blockade is an effective and safe technique for postoperative analgesia, even when administered at home. To optimize this technique, further studies are needed to help minimize the risk of side effects, improve techniques to locate the targeted nerve (stimulating catheters or ultrasound imaging) and choose less toxic drugs (levobupivacaine and ropivacaine) with more effective infusion regimens.

Grossi P; Allegri M

2005-10-01

52

Continuous peripheral nerve blocks in the hospital and at home.  

UK PubMed Central (United Kingdom)

A single-injection peripheral nerve block using long-acting local anesthetic provides analgesia for 12 to 24 hours; however, many surgical procedures result in pain that lasts far longer. One relatively new option is a continuous peripheral nerve block (CPNB): local anesthetic is perfused via a perineural catheter directly adjacent to the peripheral nerve(s) supplying the surgical site, providing potent, site-specific analgesia. CPNB results in decreased pain, opioid requirements, opioid-related side effects, and sleep disturbances; in some cases, accelerating resumption of tolerated passive joint range-of-motion and increasing patient satisfaction. Ambulatory perineural infusion may be provided using a portable infusion pump, in some cases resulting in decreased hospitalization duration and related costs. Serious complications are rare, but may result in significant morbidity.

Ilfeld BM

2011-06-01

53

Continuous peripheral nerve blocks in acute pain management.  

UK PubMed Central (United Kingdom)

The indications for continuous nerve blocks for the perioperative pain management in hospitalized and ambulatory patients have extended well beyond orthopaedics. These techniques are not only used to control pain in patients undergoing major upper and lower extremity surgery, but also to provide perioperative analgesia in patients undergoing abdominal, plastic, urological, gynaecological, thoracic, and trauma surgeries. Infusion regimens of local anaesthetics and supplements must take into consideration the condition of the patient before and after surgery, the nature and intensity of the surgical stress associated with the surgery, and the possible need for immediate functional recovery. Continuous nerve blocks have proved safe and effective in reducing opioid consumption and related side-effects, accelerating recovery, and in many patients reducing the length of hospital stay. Continuous nerve blocks provide a safer alternative to epidural analgesia in patients receiving thromboprophylaxis, especially with low molecular-weight heparin.

Chelly JE; Ghisi D; Fanelli A

2010-12-01

54

Suprascapular nerve block for the treatment of frozen shoulder.  

UK PubMed Central (United Kingdom)

AIMS: The aim of our study was to compare the effects of suprascapular nerve block in patients with frozen shoulder and diabetes mellitus unresponsive to intraarticular steroid injections. SETTINGS AND DESIGN: Ten patients without improvement of sign and symptoms after intraarticular injections were made a suprascapular nerve block. METHODS: Pain levels and active range of movement of patients were recorded at initial attendance and after 1, 4, and 12 weeks. All patients' simple pain scores, total pain scores, and range of motion of their shoulders were improved significantly after suprascapular nerve block. STATISTICAL ANALYSIS: In this study, the statistical analyses were performed by using the SPSS 8.0 program (SPSS Software, SPSS Inc., USA). To compare pre- and post-injection results of simple pain score, total pain score, shoulder abduction and external rotation, Wilcoxon test was used. RESULTS: Patient's simple pain scores, total pain scores also abduction, external rotation and internal rotation angles were improved significantly after suprascapular nerve block. CONCLUSION: Effective results after suprascapular nerve blockage was obtained for the treatment of refractory frozen shoulder cases.

Ozkan K; Ozcekic AN; Sarar S; Cift H; Ozkan FU; Unay K

2012-01-01

55

Humeral head translation after a suprascapular nerve block.  

UK PubMed Central (United Kingdom)

Subacromial impingement syndrome is the most common shoulder disorder. Abnormal superior translation of the humeral head is believed to be a major cause of this pathology. The first purpose of the study was to examine the effects of suprascapular nerve block on superior translation of the humeral head and scapular upward rotation during dynamic shoulder elevation. The secondary purpose was to assess muscle activation patterns during these motions. Twenty healthy subjects participated in the study. Using fluoroscopy and electromyography, humeral head translation and muscle activation were measured before and after a suprascapular nerve block. The humeral head was superiorly located at 60 degrees of humeral elevation, and the scapula was more upwardly rotated from 30 to 90 degrees of humeral elevation after the block. The differences were observed during midrange of motion. In addition, the deltoid muscle group demonstrated increased muscle activation after the nerve block. The study's results showed a compensatory increase in humeral head translation, scapular upward rotation, and deltoid muscle activation due to the nerve block. These outcomes suggest that increasing muscular strength and endurance of the supraspinatus and infraspinatus muscles could prevent any increased superior humeral head translation. This may be beneficial in reducing shoulder impingement or rotator cuff tears over time.

San Juan JG; Kosek P; Karduna AR

2013-08-01

56

Humeral head translation after a suprascapular nerve block.  

Science.gov (United States)

Subacromial impingement syndrome is the most common shoulder disorder. Abnormal superior translation of the humeral head is believed to be a major cause of this pathology. The first purpose of the study was to examine the effects of suprascapular nerve block on superior translation of the humeral head and scapular upward rotation during dynamic shoulder elevation. The secondary purpose was to assess muscle activation patterns during these motions. Twenty healthy subjects participated in the study. Using fluoroscopy and electromyography, humeral head translation and muscle activation were measured before and after a suprascapular nerve block. The humeral head was superiorly located at 60 degrees of humeral elevation, and the scapula was more upwardly rotated from 30 to 90 degrees of humeral elevation after the block. The differences were observed during midrange of motion. In addition, the deltoid muscle group demonstrated increased muscle activation after the nerve block. The study's results showed a compensatory increase in humeral head translation, scapular upward rotation, and deltoid muscle activation due to the nerve block. These outcomes suggest that increasing muscular strength and endurance of the supraspinatus and infraspinatus muscles could prevent any increased superior humeral head translation. This may be beneficial in reducing shoulder impingement or rotator cuff tears over time. PMID:22927503

San Juan, Jun G; Kosek, Peter; Karduna, Andrew R

2012-08-22

57

A comparison of pudendal block vs dorsal penile nerve block for circumcision in children: a randomised controlled trial.  

Science.gov (United States)

We compared the analgesic and anaesthetic efficacy of pudendal nerve block with that of dorsal penile nerve block in male patients aged 3-5 years of age, undergoing elective circumcision. Thirty patients had a nerve stimulator-guided pudendal nerve block with two separate injection points 1.5-2 cm from the centre of the anus, and thirty patients received a dorsal penile nerve block. The same total anaesthetic volume of 0.3 ml.kg(-1) was used in both groups. The pudendal nerve group showed significantly lower postoperative pain scores than the dorsal group (SD) (p < 0.05), and significantly fewer patients consumed analgesics in the pudendal group than the dorsal group: 0 vs 5 (17%) at 0 and 6 h, respectively. This study demonstrates the effectiveness of pudendal nerve block in comparison to the dorsal nerve block, with improved postoperative outcomes in children undergoing circumcision. PMID:21790518

Naja, Z; Al-Tannir, M A; Faysal, W; Daoud, N; Ziade, F; El-Rajab, M

2011-07-25

58

Delayed appearance of hypaesthesia and paralysis after femoral nerve block  

Directory of Open Access Journals (Sweden)

Full Text Available We report on a female patient who underwent an arthroscopy of the right knee and was given a continuous femoral nerve block catheter. The postoperative course was initially unremarkable, but when postoperative mobilisation was commenced, 18 hours after removal of the catheter, the patient noticed paralysis and hypaesthesia. Examination confirmed the diagnosis of femoral nerve dysfunction. Colour duplex sonography of the femoral artery and computed tomography of the lumbar spine and pelvis yielded no pathological findings. Overnight the neurological deficits decreased without therapy and were finally no longer detectable. We speculate that during the administration of the local anaesthetic a depot formed, localised in the medial femoral intermuscular septa, which was leaked after first mobilisation. To our knowledge no similar case has been published up to now. We conclude that patients who are treated with a nerve block should be informed and physician should be aware that delayed neurological deficits are possible.

Stefan Landgraeber; Thomas Albrecht; Ulrich Reischuck; Marius von Knoch

2012-01-01

59

PHRENIC NERVE PALSY AFTER SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK  

Directory of Open Access Journals (Sweden)

Full Text Available A 67 year old male patient was scheduled for implant removal from right upper limb under supraclavicular block. During procedure patient develops right phrenic nerve palsy & complains of dyspnea which was managed conservatively and no intervention done except chest x-ray for confirming the diagnosis. Surgeons completed the implant removal without any invasive intervention or interruption.

Gupta A K; Divekar D S; Dhulkhed V K; Madhur; Shrivastav V

2009-01-01

60

Femoral nerve blocks : a comparison of neonatal and adult anatomy  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The femoral nerve (FN) block is regarded as the quickest and most effective method of pain relief for femoral shaft fractures when general anaesthesia is contra-indicated. Correct placement of the needle relies heavily on the pulse of the femoral artery (FA) however, and in times where this pulse is...

Van Schoor, A.; Bosman, M.C.; Bosenberg, A.T.

 
 
 
 
61

Ventricular pneumocephalus with meningitis after lumbar nerve root block.  

UK PubMed Central (United Kingdom)

Lumbar nerve root block is a common modality used in the management of radiculopathy. Its complications are rare and usually minor. Despite its low morbidity, significant acute events can occur. Pneumocephalus is an accumulation of air in the intracranial space. It indicates a violation of the dura or the presence of infection. The object of this report is to describe the case of a patient with intraventricular pneumocephalus and bacterial meningitis after lumbar nerve root block. A 70-year-old female was brought into emergency department with severe headache and vomiting which developed during her sleep. She had received lumbar nerve block for her radiculopathy one day before her presentation. Cranial computed tomography scan revealed a few hypodense lesions in her left lateral ventricle frontal horn and basal cistern indicating ventricular pneumocephalus. Five hours later, she developed sudden hearing loss. Cerebrospinal fluid analysis showed bacterial meningitis, and she was treated with high dose steroid and antibiotics. However, her impaired hearing as a sequela from meningitis was persistent, and she is still in follow-up. Intracranial complications of lumbar nerve root block including meningitis and pneumocephalus can occur and should be considered as high-risk conditions that require prompt intervention.

Ahn S; Ko YS; Lim KS

2013-01-01

62

Serum Ropivacaine Concentrations and Systemic Local Anesthetic Toxicity in Trauma Patients Receiving Long-Term Continuous Peripheral Nerve Block Catheters.  

Science.gov (United States)

Ropivacaine is a long-acting local anesthetic used frequently for peripheral nerve blocks and continuous peripheral nerve block catheters. Combat trauma patients at Walter Reed Army Medical Center often receive continuous peripheral nerve block catheters ...

A. Dragovich G. McKnight K. H. Kwon L. L. Bleckner S. Bina

2010-01-01

63

Ultrasound-guided block of the axillary nerve : a case series of potential clinical applications  

DEFF Research Database (Denmark)

The specific blocking of the axillary nerve has never been investigated clinically. We present four cases illustrating potential applications of the axillary nerve block in the perioperative setting and discuss possible directions for future research in this area. The axillary nerve blocks were all performed using a newly developed in-plane ultrasound-guided technique. In one patient undergoing arthroscopic shoulder surgery, we used the axillary nerve block as the only analgesic combined with propofol sedation and spontaneous breathing. Chronic shoulder pain was eliminated after the axillary nerve block in two patients. The pain score after arthroscopic shoulder surgery in these two patients remained low until termination of the nerve block. In a fourth patient, severe post-operative pain after osteosynthesis of a displaced proximal humerus fracture was almost eliminated after performing an axillary nerve block. These findings warrant larger clinical trials that investigate the pain-mediating role of the axillary nerve in the perioperative setting.

Rothe, C; Lund, J

2012-01-01

64

Epidural steroid injections and selective nerve root blocks.  

UK PubMed Central (United Kingdom)

Epidural steroid injections and lumbar nerve root block/steroid injection are commonly performed interventional treatments for spine-related pain. These procedures are the foundation of any image-guided spine pain management practice. While more generic and not target-specific, epidural steroid injections are highly effective in a large proportion of patients, including patients with axial pain (neck or low back pain), radiculopathy, or spinal stenosis with neurogenic claudication. When isolated lumbar nerve root irritation is more clearly suspected, transforaminal nerve root blocks can provide useful diagnostic information as well as deliver more specifically targeted steroid treatment. Sustained pain relief can be achieved in a substantial number of patients with both types of procedure. Here we review the clinical indications and technical approach to these fundamental image-guided procedures. Fluoroscopy can be the routine approach to all injections. Computed tomography or computed tomographic fluoroscopy can be used as the primary approach in lumbar epidural or nerve root injections or be used as an alternative technique in unique cases. While the basic technical approach to epidural steroid administration in the cervical, thoracic, and lumbar regions is similar, each region has unique issues that must be addressed.

Eckel TS; Bartynski WS

2009-03-01

65

Effectiveness of nasopalatine nerve block for anesthesia of maxillary central incisors after failure of the anterior superior alveolar nerve block technique.  

UK PubMed Central (United Kingdom)

The purpose of this study was to assess the effectiveness of nasopalatine nerve block for anesthesia of maxillary central incisors after failure of the anterior superior alveolar nerve (ASAN) block technique. Secondarily, the possible innervation of the maxillary central incisors by the nasopalatine nerve was also investigated. Twenty-seven healthy, young adult volunteers (age: 17-26 years; gender: 9 males and 18 females) were enrolled in this study. All participants were undergraduate dental students of the University of Vale do Rio Verde de Três Corações. The volunteers had the anterior superior alveolar nerves anesthetized and a thermal sensitivity test (cold) was performed on the maxillary central incisors. The volunteers that responded positively to cold stimulus received a nasopalatine nerve block and the thermal sensitivity test was repeated. All participants were anesthetized by a single operator. Three patients presented sensitivity after both types of bilateral blocks and were excluded from the percentage calculations. In the remaining 24 patients, 16 had their maxillary central incisors anesthetized by the anterior superior alveolar block and 8 remained with sensitivity after the ASAN block. All these 8 patients had their maxillary central incisors successfully anesthetized by the nasopalatine block. In this study, 33.3% of the subjects had the innervation of one or both maxillary central incisors derived from the nasopalatine nerve, whilst most subjects (66.7%) had such teeth innervated by the anterior superior alveolar nerve. The nasopalatine nerve block was effective in anesthetizing the maxillary central incisors when the anterior superior alveolar nerve block failed.

Meyer TN; Lemos LL; Nascimento CN; Lellis WR

2007-01-01

66

Differential nerve blocking activity of amino-ester local anaesthetics.  

Science.gov (United States)

The in vitro sensitivities to local anaesthetic blockade of A, B and C nerve fibres in rabbit vagus nerves were examined using a series of structurally similar amino-ester agents which varied in lipid solubility and anaesthetic potency. A fibres were found to be the most sensitive and C fibres the least sensitive to conduction blockade with all the agents, provided that equilibrium blockade was allowed to develop. A correlation existed between the intrinsic anaesthetic potency of the various agents and their lipid solubilities. Equipotent concentrations of the drugs blocked C fibres at approximately the same rate, but there were marked variations in the rate at which A fibres were blocked. Amethocaine, an agent of high lipid solubility, blocked A fibres more quickly than C. As lipid solubility decreased through the series studied, so the onset of conduction blockade of A fibres was prolonged. It is suggested that this related to decreasing ability to penetrate the lipid diffusion barriers around A fibres. The traditional view that C fibres were more sensitive to block may have arisen because of confusion between absolute sensitivity and rate of development of conduction blockade. PMID:4005099

Wildsmith, J A; Gissen, A J; Gregus, J; Covino, B G

1985-06-01

67

Continuous peripheral nerve blocks: a review of the published evidence.  

UK PubMed Central (United Kingdom)

A continuous peripheral nerve block, also termed "perineural local anesthetic infusion," involves the percutaneous insertion of a catheter adjacent to a peripheral nerve, followed by local anesthetic administration via the catheter, providing anesthesia/analgesia for multiple days or even months. Continuous peripheral nerve blocks may be provided in the hospital setting, but the use of lightweight, portable pumps permits ambulatory infusion as well. This technique's most common application is providing analgesia after surgical procedures. However, additional indications include treating intractable hiccups; inducing a sympathectomy and vasodilation to increase blood flow after a vascular accident, digit transfer/replantation, or limb salvage; alleviating vasospasm of Raynaud disease; and treating peripheral embolism and chronic pain such as complex regional pain syndrome, phantom limb pain, trigeminal neuralgia, and cancer-induced pain. After trauma, perineural infusion can provide analgesia during transportation to a distant treatment center, or while simply awaiting surgical repair. Catheter insertion may be accomplished using many possible modalities, including nerve stimulation, ultrasound guidance, paresthesia induction, fluoroscopic imaging, and simple tactile perceptions ("facial click"). Either a nonstimulating epidural-type catheter may be used, or a "stimulating catheter" that delivers electrical current to its tip. Administered infusate generally includes exclusively long-acting, dilute, local anesthetic delivered as a bolus only, basal only, or basal-bolus combination. Documented benefits appear to be dependent on successfully improving analgesia, and include decreasing baseline/breakthrough/dynamic pain, supplemental analgesic requirements, opioid-related side effects, and sleep disturbances. In some cases, patient satisfaction and ambulation/functioning may be improved; an accelerated resumption of passive joint range-of-motion realized; and the time until discharge readiness as well as actual discharge from the hospital or rehabilitation center achieved. Lastly, postoperative joint inflammation and inflammatory markers may be decreased. Nearly all benefits occur during the infusion itself, but several randomized controlled trials suggest that in some situations there are prolonged benefits after catheter removal as well. Easily rectified minor complications occur somewhat frequently, but major risks including clinically relevant infection and nerve injury are relatively rare. This article is an evidence-based review of the published literature involving continuous peripheral nerve blocks.

Ilfeld BM

2011-10-01

68

Can bilateral bronchospasm be a sign of unilateral phrenic nerve palsy after supraclavicular brachial plexus block?  

UK PubMed Central (United Kingdom)

Ultrasound-guided peripheral nerve blocks facilitate ambulatory anesthesia for upper limb surgeries. Unilateral phrenic nerve blockade is a common complication after interscalene brachial plexus block, rather than the supraclavicular block. We report a case of severe respiratory distress and bilateral bronchospasm following ultrasound-guided supraclavicular brachial plexus block. Patient did not have clinical features of pneumothorax or drug allergy and was managed with oxygen therapy and salbutamol nebulization. Chest X-ray revealed elevated right hemidiaphragm confirming unilateral phrenic nerve paresis.

Chaudhuri S; Gopalkrishna M; Paul C; Kundu R

2012-04-01

69

Ilioinguinal and iliohypogastric nerves cannot be selectively blocked by using ultrasound guidance: a volunteer study.  

UK PubMed Central (United Kingdom)

BACKGROUND: Ilioinguinal (IL) and iliohypogastric (IH) nerve blocks are used in patients with chronic postherniorrhaphy pain. The present study tested the hypothesis that our method, previously developed in cadavers, blocks the nerves separately and selectively in human volunteers. METHODS: We blocked the IL and the IH nerves in 16 volunteers in a single-blinded randomized cross-over setting under direct ultrasound visualization, by injecting two times the ED95 volume of 1% mepivacaine needed to block a peripheral nerve. The anaesthetized skin areas were tested by pinprick and marked on the skin. A digital photo was taken. For further analysis, the parameterized picture data were transformed into a standardized and unified coordinate system to compare and calculate the overlap of the anaesthetized skin areas of the two nerves on each side. An overlap <25% was defined as selective block. RESULTS: Fifty nerve blocks could be analysed. The mean volume injected to block a single nerve was 0.9 ml. Using ultrasound, we observed spread from one nerve to the other in 12% of cases. The overlap of the anaesthetized skin areas of the nerves was 60.3% and did not differ after exclusion of the cases with visible spread of local anaesthetic from one nerve to the other. CONCLUSIONS: The IL and IH nerves cannot be selectively blocked even if volumes below 1 ml are used. The most likely explanation is the spread of local anaesthetic from one nerve to the other, although this could not be directly observed in most cases.

Schmutz M; Schumacher PM; Luyet C; Curatolo M; Eichenberger U

2013-08-01

70

Continuous Lesser Palatine Nerve Block for Postoperative Analgesia After Uvulopalatopharyngoplasty.  

UK PubMed Central (United Kingdom)

OBJECTIVES:: Uvulopalatopharyngoplasty (UPPP) is a commonly performed surgical intervention used to treat obstructive sleep apnea (OSA) syndrome. Continuous peripheral nerve blocks have been shown to reduce postoperative pain and opioid requirements for other surgical procedures but have not been described previously for palate surgery. We present the use of a continuous lesser palatine nerve block catheter as a part of the multimodal postoperative pain management for UPPP. CASE REPORT:: Three patients were scheduled to undergo elective UPPP and tonsillectomy for OSA with scheduled postoperative hospital admission. Each patient gave written consent to share the details of his or her case. Upon completion of the surgical procedure, but before emergence from general anesthesia, a 20-G multiorifice epidural catheter was inserted into the left nasal passage, passed into the oropharynx, and either tunneled posteriorly within the anterior portion of the soft palate with the aid of a 16-G angiocatheter or placed submucosally within the soft palate by the surgeon. Each catheter was secured using clear adhesive dressings along the cheek and anchored to the ipsilateral shoulder. A continuous infusion of ropivacaine 0.2% at 2 mL/h was delivered using a disposable infusion device postoperatively, in addition to the prescribed oral and intravenous opioids. No immediate or long-term complications due to catheter placement were identified during the patient follow-up. DISCUSSION:: Continuous lesser palatine nerve block may be a useful regional anesthetic technique in the multimodal postoperative pain management of opioid-sensitive OSA patients undergoing UPPP and deserves further study.

Ponstein NA; Kim TW; Hsia J; Goode R; Borges P; Mariano ER

2013-05-01

71

Continuous Lesser Palatine Nerve Block for Postoperative Analgesia After Uvulopalatopharyngoplasty.  

Science.gov (United States)

OBJECTIVES:: Uvulopalatopharyngoplasty (UPPP) is a commonly performed surgical intervention used to treat obstructive sleep apnea (OSA) syndrome. Continuous peripheral nerve blocks have been shown to reduce postoperative pain and opioid requirements for other surgical procedures but have not been described previously for palate surgery. We present the use of a continuous lesser palatine nerve block catheter as a part of the multimodal postoperative pain management for UPPP. CASE REPORT:: Three patients were scheduled to undergo elective UPPP and tonsillectomy for OSA with scheduled postoperative hospital admission. Each patient gave written consent to share the details of his or her case. Upon completion of the surgical procedure, but before emergence from general anesthesia, a 20-G multiorifice epidural catheter was inserted into the left nasal passage, passed into the oropharynx, and either tunneled posteriorly within the anterior portion of the soft palate with the aid of a 16-G angiocatheter or placed submucosally within the soft palate by the surgeon. Each catheter was secured using clear adhesive dressings along the cheek and anchored to the ipsilateral shoulder. A continuous infusion of ropivacaine 0.2% at 2 mL/h was delivered using a disposable infusion device postoperatively, in addition to the prescribed oral and intravenous opioids. No immediate or long-term complications due to catheter placement were identified during the patient follow-up. DISCUSSION:: Continuous lesser palatine nerve block may be a useful regional anesthetic technique in the multimodal postoperative pain management of opioid-sensitive OSA patients undergoing UPPP and deserves further study. PMID:23669453

Ponstein, Nathaniel A; Kim, Tae-Wu Edward; Hsia, Jennifer; Goode, Richard; Borges, Paula; Mariano, Edward R

2013-05-01

72

Combination of spinal anesthesia and peripheral nerve block: Case report  

Directory of Open Access Journals (Sweden)

Full Text Available Regional anaesthesia has advantages such as, control of postoperative pain, early mobilization, and does not affect respiratory function. In recent years, regional anaesthesia had improved by the application of the peripheral nerve stimulator and ultrasound guided blocks, new local anaesthetic drugs with the use of additional adjunctive agents. Especially in emergency conditions, combination of regional anaesthesia may avoid the complications of general anesthesia in patients with chronic disease who suffer from upper and lower extremity injuries. In this paper, we present two cases who underwent combined regional anaesthesia techniques for the lower and upper extremity surgery.

Feyzi Çelik; Adnan Tüfek; Haktan Karaman; Sedat Kaya; Gönül Ölmez Kavak; Vildan Temel

2010-01-01

73

Continuous peripheral nerve blocks at home: a review.  

UK PubMed Central (United Kingdom)

Postoperative analgesia is generally limited to 12-16 h or less after single-injection regional nerve blocks. Postoperative analgesia may be provided with a local anesthetic infusion via a perineural catheter after initial regional block resolution. This technique may now be used in the outpatient setting with the relatively recent introduction of reliable, portable infusion pumps. In this review article, we summarize the available published data related to this new analgesic technique and highlight important issues related specifically to perineural infusion provided in patients' own homes. Topics include infusion benefits and risks, indications and patient selection criteria, catheter, infusion pump, dosing regimen, and infusate selection, and issues related specifically to home-care.

Ilfeld BM; Enneking FK

2005-06-01

74

Can bilateral bronchospasm be a sign of unilateral phrenic nerve palsy after supraclavicular brachial plexus block?  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Ultrasound-guided peripheral nerve blocks facilitate ambulatory anesthesia for upper limb surgeries. Unilateral phrenic nerve blockade is a common complication after interscalene brachial plexus block, rather than the supraclavicular block. We report a case of severe respiratory distress and bilater...

Chaudhuri, Souvik; Gopalkrishna, MD; Paul, Cherish; Kundu, Ratul

75

Peripheral nerve blocks for outpatient surgery: evidence-based indications.  

UK PubMed Central (United Kingdom)

PURPOSE OF REVIEW: There has been an increasing use of peripheral nerve blocks (PNBs) in ambulatory surgery. Several recent reports have contributed to our understanding of the optimal PNB technique for specific surgical procedures in this setting. In this review, we have summarized the available literature on indications of PNBs for outpatient surgery of the upper extremity. RECENT FINDINGS: Although many of the recent studies focus on technical aspects of PNBs, few center on evidence-based indications or their utility in the ambulatory setting. The available literature suggests that although multiple techniques have been reported for outpatient shoulder surgery, interscalene brachial plexus block (ISBPB) is currently the most preferred technique. Supraclavicular, infraclavicular, and axillary brachial plexus blocks, however, are all commonly used and effective PNBs for outpatient surgery and analgesia of the arm, forearm, and hand. SUMMARY: ISBPB is currently the most beneficial PNB for outpatient shoulder surgery. Supraclavicular block functionally can be considered an alternative to the traditional ISBPB; however, additional studies are required before routine use can be recommended. Although the review identified several reports with benefits of one PNB technique over the others, the existing literature suggests that many of these techniques may be interchangeable with regards to procedures of the distal upper extremity. Future studies are indicated to help standardize the techniques, selection, and postoperative management of PNBs for specific surgical indications.

Lin E; Choi J; Hadzic A

2013-08-01

76

Combined use of axillary block and lateral femoral cutaneous nerve block in upper-extremity injuries requiring large skin grafts.  

UK PubMed Central (United Kingdom)

An axillary block and lateral femoral cutaneous nerve block combination was used in 11 patients with upper-extremity injuries requiring large skin grafts. In our experience, this block combination was highly successful. All but one of the patients obtained excellent pain relief (mean visual analog pain scores, 0.2) that required no narcotic analgesics or sedatives. There were no systemic or neurologic side effects attributed to the local anesthetic drugs. We believe that combining an axillary block and a lateral femoral cutaneous nerve block is a clinically useful and effective technique and an excellent anesthetic alternative for procedures requiring large grafts for the upper extremity.

Karacalar A; Karacalar S; Uçkunkaya N; Sahin S; Ozcan B

1998-11-01

77

[Comparison of transarterial and multiple nerve stimulation techniques for axillary block using lidocaine with epinephrine.].  

UK PubMed Central (United Kingdom)

BACKGROUND AND OBJECTIVES: High-dose transarterial technique results in highly effective axillary block. The multiple nerve stimulation technique (MNS) requires more time and experience. This prospective study aimed at comparing onset and success rate of multiple-injection axillary brachial plexus block using two methods of nerve location: transarterial or multiple nerve stimulation technique. METHODS: Axillary block was initially induced with 800 mg lidocaine with epinephrine. The transarterial group received deeply injected 30 mL of 1.6% lidocaine with epinephrine, and 20 mL superficially to the axillary artery. For the multiple nerve stimulation group, three terminal motor nerves were electrolocated and blocked with 20 mL, 20 mL and 10 mL. Blockade was considered effective when analgesia was present in all sensory nerves distal to the elbow. RESULTS: Onset (8.8 +/- 2.3 min versus 10.2 +/- 2.4 min; p-value = 0.010) was significantly shorter in the transarterial group. Complete sensory block of all four nerves (median, ulnar, radial and musculocutaneus) was achieved in 92.5% versus 83.3% for multiple nerve stimulation group and transarterial group, respectively, without significant difference (p = 0.68). Musculocutaneous nerve was significantly easier to be blocked with the aid of peripheral nerve stimulator (p = 0.034). CONCLUSIONS: Both MNS technique for axillary block with nerve stimulator (3 injections) and transarterial technique (2 injections) promote similar results. Musculocutaneous nerve is more easily blocked with the aid of peripheral nerve stimulator. MNS technique has required less supplementary blocks and has delayed beginning of surgery.

Imbelloni LE; Beato L; Cordeiro JA

2005-02-01

78

Different Learning Curves for Axillary Brachial Plexus Block: Ultrasound Guidance versus Nerve Stimulation  

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Little is known about the learning of the skills needed to perform ultrasound- or nerve stimulator-guided peripheral nerve blocks. The aim of this study was to compare the learning curves of residents trained in ultrasound guidance versus residents trained in nerve stimulation for axillary brachial ...

Luyet, C.; Schüpfer, G.; Wipfli, M.; Greif, R.; Luginbühl, M.; Eichenberger, U.

79

Sensitivities of rat primary sensory afferent nerves to magnesium: implications for differential nerve blocks.  

UK PubMed Central (United Kingdom)

CONTEXT: Contrasting findings have been published regarding the role of magnesium sulphate used as an additive to local anaesthetics in peripheral nerve blocks. OBJECTIVE: To clarify the effect of magnesium sulphate on nerve excitability. SETTING: C and A? compound action potentials were recorded extracellularly in vitro in saphenous nerves from adult rats. ANIMALS: Saphenous nerves (n = 30) from male Wistar rats (n = 19), 12 to 16 weeks old. INTERVENTION: Primary sensory afferents were tested with a computerised threshold tracking program (QTRAC) with a supramaximal 1 ms current pulse either alone or after 300 ms of conditioning polarising ramp currents in the presence and absence of 10 mmol?l magnesium sulphate, 80 ?mol?l lidocaine and a combination of both. MAIN OUTCOME MEASURES: Changes in current thresholds to elicit compound action potential amplitudes of 40% of the maximal response. RESULTS: Magnesium sulphate increased excitability thresholds to a greater extent in A? fibres than in C fibres. It enhanced the effects of lidocaine in both A? fibres [mixture 0.470 mA (SD 0.105) versus lidocaine 0.358 mA (SD 0.080), P < 0.001] and C fibres [mixture 2.531 mA (SD 0.752) versus lidocaine 2.385 mA (SD 0.656), P = 0.008]. Preconditioning experiments also showed that magnesium sulphate had an enhancing effect with lidocaine in A? fibres [mixture 0.620 mA (SD 0.281) versus lidocaine 0.543 mA (SD 0.315), P = 0.005], but not in C fibres [mixture 2.412 mA (SD 0.641), lidocaine 2.461 mA (SD 0.693), P = 0.17]. CONCLUSION: These results suggest that the binding of magnesium ions depends on both the type and conformational state of voltage-gated sodium channels. They also may help to explain the conflicting reports regarding the clinical effects of magnesium sulphate as an additive to lidocaine in peripheral nerve blocks.

Vastani N; Seifert B; Spahn DR; Maurer K

2013-01-01

80

A comparison of epidural anesthesia and lumbar plexus-sciatic nerve blocks for knee surgery  

Scientific Electronic Library Online (English)

Full Text Available Abstract in english OBJECTIVES: The efficacy of combined lumbar plexus-sciatic nerve blocks was compared to epidural anesthesia in patients undergoing total knee surgery. PATIENTS AND METHODS: The study included 80 American Society of Anesthesiologists (ASA) Physical Status I-III patients (age range 18 to 65) undergoing knee surgery. The patients were randomly divided into one of two groups. Epidural anesthesia was performed in the epidural anesthesia (EA) group (n=40), and the lumbar plexus (more) and sciatic nerves were blockedin the lumbar plexus-sciatic nerve blocks (LPSB) group (n=40). For each patient, onset of sensory and motor block, degree of motor block, sign of sensory block in the contralateral lower limb for the lumbar plexus-sciatic nerve blocks group, success in providing adequate anesthesia, hemodynamic changes, time of first analgesic request, and patient and surgeon satisfaction with the anesthetic technique were recorded. RESULTS: One patient in the epidural anesthesia group and three patients in the lumbar plexus-sciatic nerve blocks group required general anesthesia due to failed block. There were no significant differences between the two groups regarding the success of providing adequate anesthesia. Eight patients in the lumbar plexus-sciatic nerve blocks group developed contralateral spread. The onset of sensory-motor block and the time of the first analgesic request were significantly later in the lumbar plexus-sciatic nerve blocks group than in the epidural anesthesia group. Although there were no significant differences regarding patient satisfaction with the anesthetic technique between the two groups, surgeon satisfaction was significantly higher in the lumbar plexus-sciatic nerve blocks group than in the epidural anesthesia group. CONCLUSION: The lumbar plexus -sciatic nerve blocks provide effective unilateral anesthesia and may offer a beneficial alternative to epidural anesthesia in patients undergoing total knee surgery.

Horasanli, Eyup; Gamli, Mehmet; Pala, Yasar; Erol, Mustafa; Sahin, Fazilet; Dikmen, Bayazit

2010-01-01

 
 
 
 
81

A comparison of epidural anesthesia and lumbar plexus-sciatic nerve blocks for knee surgery  

Directory of Open Access Journals (Sweden)

Full Text Available OBJECTIVES: The efficacy of combined lumbar plexus-sciatic nerve blocks was compared to epidural anesthesia in patients undergoing total knee surgery. PATIENTS AND METHODS: The study included 80 American Society of Anesthesiologists (ASA) Physical Status I-III patients (age range 18 to 65) undergoing knee surgery. The patients were randomly divided into one of two groups. Epidural anesthesia was performed in the epidural anesthesia (EA) group (n=40), and the lumbar plexus and sciatic nerves were blockedin the lumbar plexus-sciatic nerve blocks (LPSB) group (n=40). For each patient, onset of sensory and motor block, degree of motor block, sign of sensory block in the contralateral lower limb for the lumbar plexus-sciatic nerve blocks group, success in providing adequate anesthesia, hemodynamic changes, time of first analgesic request, and patient and surgeon satisfaction with the anesthetic technique were recorded. RESULTS: One patient in the epidural anesthesia group and three patients in the lumbar plexus-sciatic nerve blocks group required general anesthesia due to failed block. There were no significant differences between the two groups regarding the success of providing adequate anesthesia. Eight patients in the lumbar plexus-sciatic nerve blocks group developed contralateral spread. The onset of sensory-motor block and the time of the first analgesic request were significantly later in the lumbar plexus-sciatic nerve blocks group than in the epidural anesthesia group. Although there were no significant differences regarding patient satisfaction with the anesthetic technique between the two groups, surgeon satisfaction was significantly higher in the lumbar plexus-sciatic nerve blocks group than in the epidural anesthesia group. CONCLUSION: The lumbar plexus -sciatic nerve blocks provide effective unilateral anesthesia and may offer a beneficial alternative to epidural anesthesia in patients undergoing total knee surgery.

Eyup Horasanli; Mehmet Gamli; Yasar Pala; Mustafa Erol; Fazilet Sahin; Bayazit Dikmen

2010-01-01

82

Anatomical Study of The Sacum for Transsacral Block of Sacral Nerves  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Inroduction: For transsacral block of sacral nerves in analgesia and anesthesia of the rectal, anal or urethral region the dorsal sacral foramina are used.To find solution of this by identifying additional anatomical landmarks and measurements of dorsal sacral foramina for transsacral nerve block. M...

D S Patil; H R Jadav; K B Chauhan; C R Bhatt; R Brahmbhatt

83

The Efficacy of Ilioinguinal and Iliohypogastric Nerve Block for Postoperative Pain After Caesarean Section  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Background:: The effect of ilioinguinal and iliohypogastric (II-IH) nerve block on postoperative pain is well documented when applied before Caesarean section but the efficacy remains unclear when applied after the surgical procedure. Therefore we investigated the effect of II-IH nerve block on post...

Melike Sakall?; Ay?egül Ceyhan; Hale Yarkan Uysal; I??n Yaz?c?; Hülya Ba?ar

84

Incidence of genitofemoral nerve block during lumbar sympathetic block: comparison of two lumbar injection sites.  

UK PubMed Central (United Kingdom)

BACKGROUND AND OBJECTIVES: Genitofemoral nerve (GFN) block is a known side effect of a lumbar sympathetic block (LSB), although the incidence has not been well documented. Furthermore, genitofemoral neuralgia can occur following neurolytic LSB. Because the level at which the GFN exits the psoas sheath varies, this study was designed to identify differences in the incidence of GFN block following LSB at the level of the second versus the fourth lumbar vertebrae. METHODS: Patients requiring LSB to evaluate chronic lower extremity pain were prospectively studied. Patients were injected at the second lumbar (L2 group) or fourth lumbar (L4 group) vertebral body depending on the location of the pain syndrome in the lower extremity. Lumbar sympathetic blocks were performed using 10 mL of a 0.5% bupivacaine solution with radiocontrast; spread of injectate was verified using fluoroscopy. An observer evaluating for presence of GFN block was blinded to the lumbar level of injection. RESULTS: Thirty patients were enrolled (L2 group, n = 15; L4 group, n = 15). Spread of local anesthetic/radiocontrast solution was limited to approximately one vertebral body above and one below the target level. There was no difference in the ability to achieve a LSB; success rates were 66% and 73% using L2 and L4, respectively. The incidence of GFN block was 0% (0/15) in the L2 group versus 40% (6/15) in the L4 group; this was statistically significant (P = .017, Fisher's exact test). CONCLUSIONS: The GFN is less likely to be blocked when the LSB is performed near the second lumbar vertebra as compared with the fourth lumbar vertebra.

Sayson SC; Ramamurthy S; Hoffman J

1997-11-01

85

Levobupivacaine for postoperative pain management in circumcision: caudal blocks or dorsal penile nerve block.  

UK PubMed Central (United Kingdom)

OBJECTIVES: In this study, we evaluated the analgesic efficacy and adverse effect profile of levobupivacaine in caudal and DPNB in postcircumcision pediatric patients. METHODS: Sixty boys between 2-10 years of age undergoing circumcision were enrolled. The patients were divided into two groups: Group C (n=30) and Group P (n=30) were applied caudal block or dorsal penile nerve block (DPNB), respectively. Blocks were performed before surgery as a supplement to general anesthesia with 1 mL kg(-1) 0.25% levobupivacaine. Postoperative pain and sedation scores were assessed on the 10th and 30th minutes, and hours 1-6. The number of pain free patients in the first 6 hours, the duration of analgesia, time to first analgesic administration, walking, micturition, and total paracetamol demands, and length of stay were recorded. RESULTS: Demographic data were similar between groups. The number of children who spent the first 6 hours pain-free was larger in Group C than Group P (p=0.0001). The time to first analgesic (p=0.000033) and walking (p=0.004) were longer in Group C. There were 14 patients with motor block in Group C (p=0.00007). In view of AUC, FPRS, OPS and MPOPS were significantly better in Group C on the first postoperative 6 hours. CONCLUSION: Caudal block done using levobupivacaine for postoperative pain management in circumcision is more successful than penile block, however there is a significant delay in time to first walking and as might be expected there is an increased risk of motor block.

Kazak Bengisun Z; Ekmekci P; Halilo?lu AH

2012-10-01

86

Can bilateral bronchospasm be a sign of unilateral phrenic nerve palsy after supraclavicular brachial plexus block?  

Science.gov (United States)

Ultrasound-guided peripheral nerve blocks facilitate ambulatory anesthesia for upper limb surgeries. Unilateral phrenic nerve blockade is a common complication after interscalene brachial plexus block, rather than the supraclavicular block. We report a case of severe respiratory distress and bilateral bronchospasm following ultrasound-guided supraclavicular brachial plexus block. Patient did not have clinical features of pneumothorax or drug allergy and was managed with oxygen therapy and salbutamol nebulization. Chest X-ray revealed elevated right hemidiaphragm confirming unilateral phrenic nerve paresis. PMID:22557755

Chaudhuri, Souvik; Gopalkrishna, Md; Paul, Cherish; Kundu, Ratul

2012-04-01

87

Femoral nerve block: a novel psoas compartment lateral pre-iliac approach in dogs.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To describe a new approach to block the femoral nerve and to evaluate the distribution of a dye injected into the psoas compartment using a new femoral nerve block approach; to assess its clinical application, when combined with a sciatic nerve block, for surgical anaesthesia/analgesia of the pelvic limb in dogs. STUDY DESIGN: Prospective anatomical, research and clinical study. ANIMALS: Two dog cadavers; two dogs that had to be euthanized for reasons unrelated to this study, and 15 dogs undergoing pelvic limb orthopaedic surgery. METHODS: Phase 1: anatomical dissections were performed to determine a simple method to approach the femoral nerve within the psoas compartment. Phase 2: 0.1 mL kg(-1) of a lidocaine-new methylene blue solution was injected bilaterally after successful electrolocation of the femoral nerve in two anaesthetized dogs. Colorant spread was evaluated through femoral nerve dissections after euthanasia. Phase 3: in 15 dogs undergoing pelvic limb orthopaedic surgery under light general anaesthesia with isoflurane, intra-operative analgesic effect (cardiovascular responses) and early post-operative pain score, of the novel femoral nerve block combined with a sciatic nerve block as the sole analgesic protocol, were evaluated. RESULTS: Phase 1: a needle inserted from the lateral aspect of the lumbar muscles, cranially to the iliac crest and with a 30-45° caudo-medial direction, reaches the femoral nerve in the caudal portion of the psoas compartment. Phase 2: Four femoral nerves were stained >2 cm. Phase 3: this novel lateral pre-iliac approach, combined with the sciatic nerve block, blunted the intra-operative cardiovascular response to surgical stimulation in 13 out of 15 anaesthetized dogs. In addition, rescue analgesia was not required in the early post-operative 2-hour period. CONCLUSION AND CLINICAL RELEVANCE: The lateral pre-iliac femoral nerve block technique may provide adequate intra- and early post-operative pain relief in dogs undergoing pelvic limb surgery.

Portela DA; Otero PE; Briganti A; Romano M; Corletto F; Breghi G

2013-03-01

88

A Study to Evaluate the Effectiveness of Phenol Blocks to Peripheral Nerves in Reducing Spasticity in Patients with Paraplegia and Brain Injury  

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Full Text Available Primary objective: To evaluate effectiveness of phenol blocks of peripheral nerves in reducing spasticitybrain injured and spinal cord injured patients.Secondary objectives: To measure the change in the range of motion after phenol blocks to peripheralnerves, to identify the electrophysiological changes and to study the cost effectiveness and side effects ofphenol blocks.Study design: Descriptive studySetting: Tertiary referral centre, India.Methods: This study was conducted from March 2000 to January 2002 among 20 patients with spasticity.Spasticity was measured by modified Ashworth scale and range of motion was measured with a standardgoniometer on 1st, 7th, 14th and 21st days of the study. Nerve conduction studies, gait analysis, and functionalindependence measure was measured on 1st and 21st day of the study. Nerve blocks were done on 7th and14th day of the study with 0.5% bupivacaine and 6% phenol in water respectively.Results: 20 patients were included in the study, out of which 85% had spinal cord injury and 15% patientshad brain injury sequelae. Spasticity measured by modified Ashworth scale, showed a statistically significantreduction with neurolysis. Following obturator neurolysis abduction of hip joint improved significantly andwith posterior tibial neurolysis there was significant improvement in dorsiflexion and plantar flexion rangeof the ankle joint. Functional improvement measured with the FIM score also showed statistically significantimprovement after neurolysis. H reflex amplitude was significantly reduced following neurolysis. Therewas a statistically significant reduction in the consumption of systemic medications for spasticity followingthe injection.Conclusion: Range of motion in neighboring joints improved significantly after blockade of spasticity usingPhenol neurolysis. There was statistically significant reduction in the amplitude of the H reflex. Therewere no major adverse effects following neurolysis with phenol and it was found to be significantly costeffective when compared to systemic antispastic medications.

Kumar ER; Venugopal K; Tharion G; Bhattacharji S

2008-01-01

89

Ultrasound guidance improves a continuous popliteal sciatic nerve block when compared with nerve stimulation  

DEFF Research Database (Denmark)

Continuous sciatic nerve blockade at the popliteal level effectively alleviates postoperative pain after major foot and ankle surgery. No randomized controlled trials have previously compared the success rate of continuous sciatic nerve sensory blockade between ultrasound and nerve stimulation guidance. In the current study, we tested the hypothesis that ultrasound-guided catheter placement improves the success rate of continuous sciatic nerve sensory blockade compared with catheter placement with nerve stimulation guidance.

Bendtsen, Thomas F; Nielsen, Thomas D

2011-01-01

90

Technical communication: First robotic ultrasound-guided nerve blocks in humans using the Magellan system.  

UK PubMed Central (United Kingdom)

BACKGROUND: Ultrasound-guided nerve blocks are becoming a standard of modern anesthesia. We developed a robotic system, Magellan, to perform nerve blocks using a remote control center. METHODS: Thirteen patients were enrolled in this pilot study. The Magellan system consists of 3 main components: a joystick, a robotic arm, and a software control system. The joystick allows simulation of wrist or arm movements of the proceduralist. After localization of the sciatic nerve, 35 mL of bupivacaine 0.25% was injected. The success rate of sciatic nerve blocks and block performance times (performance time=interval of time from the start of the ultrasound search for the nerve to the end of the injection of the drug; robotic time=interval of time from the identification of the nerve to the end of the injection of the drug) were determined. Data are presented as median (25th, 75th; minimal, maximal) and categorical data. RESULTS: Eight men and 5 women aged 34 years were included in this study. Nerve blocks were successful in all patients. A successful attempt was defined as the introduction of the needle into the nerve sheath; motor or sensory block was not used to determine the success rate. The nerve performance time was 189 seconds (150, 233; 90, 305), whereas the robotic time was 164 seconds (121, 210; 73, 271). CONCLUSIONS: We present the first human testing of a robotic ultrasound-guided nerve block system. The success rate was 100%. The total performance time was approximately 3 minutes to 4 minutes.

Hemmerling TM; Taddei R; Wehbe M; Cyr S; Zaouter C; Morse J

2013-02-01

91

Incidence and severity of complications due to femoral nerve blocks performed for knee surgery.  

UK PubMed Central (United Kingdom)

BACKGROUND: While single shot femoral nerve blocks and indwelling femoral nerve catheters provide significant peri-operative analgesia, there are small but serious risks of neurovascular complications. We aimed to determine the incidence and characterise the nature of neural complications arising from femoral nerve blocks performed for knee surgery. METHODS: One thousand eight hundred and two patients receiving a femoral nerve block for knee surgery during the study period were screened. Patients with possible neurological symptoms were evaluated with a detailed physical examination and self-report questionnaires. Also measures of depression, anxiety and tension/stress were collected. RESULTS: In the patients screened, an incidence of 1.94% was found. Of the 24 patients available for testing, 4 had bilateral symptoms following bilateral nerve blocks. All had sensory abnormalities in the distribution of the femoral nerve. The incidence was significantly higher in females (females=2.5%, males=0.83% p=0.01) and in patients receiving a single shot block (single shot=2.66%, femoral catheter=0.93, p=0.01). CONCLUSIONS: The incidence of neurological complication after FNB was higher in this series than typically reported and the symptoms significantly influenced the quality of life in the affected cases. The decision to include a femoral nerve block in the peri-operative analgesic regimen should be made on an individual basis considering the risks and benefits.

Widmer B; Lustig S; Scholes CJ; Molloy A; Leo SP; Coolican MR; Parker DA

2013-06-01

92

Ultrasound-guided ankle block for forefoot surgery: the contribution of the saphenous nerve.  

UK PubMed Central (United Kingdom)

BACKGROUND: Ankle blocks typically include the block of 5 nerves, the 4 branches that trace their origin back to the sciatic nerve plus the saphenous nerve (SaN). The sensory area of the SaN in the foot is variable. Based on our clinical experience, we decided to study the sensory distribution of the SaN in the foot and determine whether the block of this nerve is necessary as a component of an ultrasound-guided ankle block for bunion surgery. METHODS: One hundred patients scheduled for bunion surgery under ankle block were prospectively studied. We performed ultrasound-guided individual blocks of the tibial, deep peroneal, superficial peroneal, and sural nerves. After obtaining complete sensory block of these nerves, we mapped the SaN sensory territory as such area without anesthesia on the medial side of the foot. RESULTS: Every nerve block was successful within 10 minutes of injection. The saphenous territory extended into the foot to 57 ± 13 mm distal to the medial malleolus. This distal margin was 22 ± 11 mm proximal to the first tarsometatarsal joint. The proximal end of the surgical incision was located 1 cm distal to the first tarsometatarsal joint. In only 3 patients (3%), the area of SaN innervation reached the proximal end of the planned incision. CONCLUSIONS: Ultrasound-guided ankle block is a highly effective technique for bunion surgery. The sensory territory of the SaN in the foot seems to extend only to the midfoot. According to our sample, 97% of the patients undergoing bunion surgery under an ankle block would not benefit from having a SaN block.

López AM; Sala-Blanch X; Magaldi M; Poggio D; Asuncion J; Franco CD

2012-09-01

93

Systematic ultrasound identification of the dorsal scapular and long thoracic nerves during interscalene block.  

UK PubMed Central (United Kingdom)

BACKGROUND AND OBJECTIVES: The use of ultrasound for in-plane interscalene block shifts needle insertion to a more posterior approach through the middle scalene muscle, when compared with classic nerve stimulator techniques. Branches from the brachial plexus, including the dorsal scapular and long thoracic nerves, are often anatomically located within the middle scalene muscle. The aim of this study was to use ultrasound to identify and characterize the frequency and position of the dorsal scapular and long thoracic nerves located in the middle scalene muscle. METHODS: We recruited 50 subjects who presented for shoulder surgery. Before block placement, ultrasound was used to evaluate the area posterior to the brachial plexus for visible segments of the long thoracic and dorsal scapular nerves. If nerves were identified, a stimulating Tuohy needle was advanced in close proximity. Current was then applied through the needle, and motor response confirmed the visualized nerve as being either the dorsal scapular nerve or long thoracic nerve. RESULTS: Ninety percent of the subjects had a nerve visible under ultrasound assessment within or superficial to the middle scalene muscle. The nerves were located at similar depth as the perceived C6 nerve root, at 1.1 ± 0.4 cm from skin and 0.7 ± 0.4 cm posterior from the brachial plexus. Stimulation revealed that the nerve identified on ultrasound was the dorsal scapular nerve (77%) or the long thoracic nerve (23%). CONCLUSIONS: This descriptive study revealed that the dorsal scapular and long thoracic nerves routinely could be identified with ultrasound.

Hanson NA; Auyong DB

2013-01-01

94

Effect of sympathetic nerve block on acute inflammatory pain and hyperalgesia.  

DEFF Research Database (Denmark)

BACKGROUND: Sympathetic nerve blocks relieve pain in certain chronic pain states, but the role of the sympathetic pathways in acute pain is unclear. Thus the authors wanted to determine whether a sympathetic block could reduce acute pain and hyperalgesia after a heat injury in healthy volunteers. METHODS: The study was made as a randomized, single blinded investigation, in which the volunteers served as their own controls. A lumbar sympathetic nerve block and a contralateral placebo block were performed in 24 persons by injecting 10 ml bupivacaine (0.5%) and 10 ml saline, respectively. The duration and quality of blocks were evaluated by the sympatogalvanic skin response and skin temperature. Bilateral heat injuries were produced on the medial surfaces of the calves with a 50 x 25 mm thermode (47 degrees C, 7 min) 45 min after the blocks. Pain intensity induced by heat, pain thresholds to thermal and mechanical stimulation, and secondary hyperalgesia were assessed before block, after block, and 1, 2, 4, and 6 h after the heat injuries. RESULTS: Of the 24 volunteers, eight were excluded because of somatic block or incomplete sympathetic block. The study revealed no significant differences between sympathetic block and placebo for pain or mechanical allodynia during injury, or pain thresholds, pain responses to heat, or areas of secondary hyperalgesia after the injury. The comparisons were done for the period when the block was effective. CONCLUSION: Sympathetic nerve block did not change acute inflammatory pain or hyperalgesia after a heat injury in human skin.

Pedersen, J L; Rung, G W

1997-01-01

95

Recognition of local anesthetic maldistribution in axillary brachial plexus block guided by ultrasound and nerve stimulation.  

UK PubMed Central (United Kingdom)

Nerve stimulation may occur despite the presence of a fascial barrier between the needle tip and the nerve, which may prevent appropriate flow or distribution of local anesthetic solution. During an axillary nerve block, ultrasound (US) guidance was used to identify the median nerve. Insertion of a needle with US and nerve stimulator guidance resulted in the appearance of the needle tip in contact with the nerve. However, as local anesthetic injection was begun, it was clear that the injectate was accumulating superficial to the investing fascia of the neurovascular bundle. No injectate was seen below the fascia. With US guidance, the needle was repositioned at a greater depth. Repeat injection of local anesthetic clearly flowed around the nerve.

Veneziano GC; Rao VK; Orebaugh SL

2012-03-01

96

Recognition of local anesthetic maldistribution in axillary brachial plexus block guided by ultrasound and nerve stimulation.  

Science.gov (United States)

Nerve stimulation may occur despite the presence of a fascial barrier between the needle tip and the nerve, which may prevent appropriate flow or distribution of local anesthetic solution. During an axillary nerve block, ultrasound (US) guidance was used to identify the median nerve. Insertion of a needle with US and nerve stimulator guidance resulted in the appearance of the needle tip in contact with the nerve. However, as local anesthetic injection was begun, it was clear that the injectate was accumulating superficial to the investing fascia of the neurovascular bundle. No injectate was seen below the fascia. With US guidance, the needle was repositioned at a greater depth. Repeat injection of local anesthetic clearly flowed around the nerve. PMID:22414707

Veneziano, Giorgio C; Rao, Vidya K; Orebaugh, Steven L

2012-03-01

97

Effects of median nerve block on radial artery diameter and peak velocity  

Directory of Open Access Journals (Sweden)

Full Text Available John J Badal, Annie Kiesau, Patrick BoyleUniversity of Arizona, Department of Anesthesiology, Tucson, AZ, USAAbstract: Peripheral artery cannulation is a common procedure but can sometimes be difficult. Our goal was to determine if a median nerve block would increase the diameter and flow of the radial artery. Radial artery diameter and peak velocity was measured using a SonoSite Ultrasound System. Using ultrasound guidance, a median nerve block was performed with lidocaine. Subsequent measurements of the radial artery and peak velocity were again made at 5 minutes post-block and 10 minutes post-block. Mean radial artery diameter measured vertically was 0.23 ± 0.06 cm pre-block, 0.23 ± 0.05 cm at 5 minutes post-block, and 0.23 ± 0.05 cm 10 minutes post-block. Mean radial artery diameter measured horizontally was 0.26 ± 0.05 cm pre-block, 0.27 ± 0.06 cm at 5 minutes post-block, and 0.27 ± 0.08 cm 10 minutes post-block. Peak velocities were 11.3 ± 6.9 cm/s pre-block, increased to 15.0 ± 6.9 cm/s 5 minutes postblock (P = 0.005), and finally increased to 17.7 ± 7.8 cm/s 10 minutes post-block (P = 0.01). This study set out to measure the effects of median nerve blockade on the radial artery. We found a significant increase in peak velocities post-median nerve blockade.Keywords: radial artery, median nerve block, sympathetic

John J Badal; Annie Kiesau; Patrick Boyle

2010-01-01

98

Nerve injury complicating ultrasound/electrostimulation-guided supraclavicular brachial plexus block.  

UK PubMed Central (United Kingdom)

BACKGROUND AND OBJECTIVES: Neurologic complications after peripheral nerve blocks (PNBs) are relatively uncommon. It has been postulated that real-time, needle-nerve visualization during ultrasound guided PNBs might further reduce the risk of neurologic or vascular complications. CASE REPORT: In this report, we describe the occurrence of a severe brachial plexus injury after combined ultrasound and nerve stimulator-guided supraclavicular brachial plexus block. CONCLUSIONS: Ultrasound guidance should not preclude development of additional monitoring and protocols to decrease the risk of complications with PNBs.

Reiss W; Kurapati S; Shariat A; Hadzic A

2010-07-01

99

Comparison of subgluteal sciatic nerve block duration in type 2 diabetic and non-diabetic patients.  

UK PubMed Central (United Kingdom)

BACKGROUND: Although animal studies demonstrated delayed recovery after nerve block in laboratory models of diabetes, the duration of the action of sciatic nerve blocks clinically in patients with diabetes remains to be determined. We studied the duration of a sciatic nerve block in type 2 diabetic patients compared with non-diabetic patients. METHODS: We prospectively included consecutive patients aged 50-80 yr, with type 2 diabetes with minor nerve injury (confirmed with 5.07 at 10 g monofilament test, n=23) and non-diabetic patients (n=49) scheduled for distal lower limb surgery. Before surgery, a subgluteal sciatic nerve block (20 ml of ropivacaine 4.75 mg ml(-1)) was performed with an ultrasound approach coupled with nerve stimulation. The primary endpoint was the sensory block duration. RESULTS: There was no significant difference between groups for age, but haemoglobin A1c and creatinine values were significantly higher in the diabetic group. There was no difference in 5.07 (10 g) monofilament testing, but the diabetic group had lower scores for the 0.4 and 0.07 g tests (P<0.01). There was no significant difference in the median onset time for the sensory block (25 vs 25 min, NS), but the median duration of the sensory block (21 vs 17 h, P<0.01) and the motor block (16 vs 12 h, P<0.01) were higher in the diabetic group. No complication occurred in either group. CONCLUSIONS: These findings demonstrate that diabetic patients with pre-existing incipient neuropathy exhibit delayed recovery from the block with ropivacaine, confirming animal studies. Clinical trial registration ClinicalTrials.gov, NCT01704612.

Cuvillon P; Reubrecht V; Zoric L; Lemoine L; Belin M; Ducombs O; Birenbaum A; Riou B; Langeron O

2013-05-01

100

Ultrasound-guided block of the axillary nerve: a volunteer study of a new method  

DEFF Research Database (Denmark)

Interscalene brachial plexus block (IBPB) is the gold standard for perioperative pain management in shoulder surgery. However, a more distal technique would be desirable to avoid the side effects and potential serious complications of IBPB. Therefore, the aim of the present study was to develop and describe a new method to perform an ultrasound-guided specific axillary nerve block.

Rothe, C; Asghar, S

2011-01-01

 
 
 
 
101

Double-injection method using peripheral nerve stimulator is superior to single injection in axillary plexus block.  

UK PubMed Central (United Kingdom)

BACKGROUND AND OBJECTIVES: Axillary block using a single-injection method does not always provide effective analgesia. This study examined whether a double axillary block injection technique is superior to a single injection axillary block. METHOD: Fifty patients were randomly allocated to two groups. In group I (single injection), the whole volume of local anesthetic (0.7 mL/kg) was injected after locating only one of the median, radial, or ulnar nerves. In group 2 (double injection), half of the volume was injected after locating one nerve and the other half after locating another peripheral nerve. Bupivacaine 0.5% and prilocaine 1% (1:1 volumes) were used as local anesthetic. A peripheral nerve stimulator was used to identify the nerves. Sensory block of seven nerves and motor block of four nerves were tested after 40 minutes. RESULTS: Complete sensory and motor block (scores 2 or 3 on scale 0-3) in all four main nerves (median, ulnar, radial, musculocutaneous) was achieved in 3 (12%) versus 20 (80%) patients in groups 1 and 2, respectively (P = .000001). Primary success rate (no need for supplemental nerve block) was 52% in group 1 and 92% in group 2 (P = .0016). CONCLUSIONS: A double-injection method in axillary block provides excellent analgesia and motor block compared with a single-injection method. Moreover, the need for supplemental nerve blocks is significantly decreased.

Inberg P; Annila I; Annila P

1999-11-01

102

Symptomatic phrenic nerve palsy after supraclavicular block in an obese man.  

Science.gov (United States)

Regional anesthesia has an expanding role in upper extremity surgery. Brachial plexus blocks offer several advantages including providing effective analgesia, reducing narcotic requirements, and facilitating ambulatory care surgery. Despite the popularity of nerve blocks, the surgeon must not forget the complications associated with regional anesthesia. This article describes a case of symptomatic phrenic nerve palsy after supraclavicular brachial plexus block in an obese man. A 46-year-old obese man underwent a left-sided supraclavicular block in preparation for decompression of Guyon's canal for ulnar mononeuropathy at the wrist. The patient experienced acute-onset dyspnea, chest discomfort, and anxiety, and physical examination demonstrated reduced breath sounds in the left hemithorax. Chest radiographs documented elevation of the left hemidiaphragm consistent with an iatrogenic phrenic nerve palsy. The patient was admitted for 23-hour observation and underwent an uncomplicated ulnar nerve decompression under Bier block anesthesia 1 week later. No long-term sequelae have been identified; however, there was a delay in surgical care, admission to the hospital, and transient pulmonary symptoms. We attribute this complication to significant abdominal obesity causing compromised pulmonary reserve and poor tolerance of transient hemidiaphragmatic paresis. In recent studies, waist circumference and abdominal height were inversely related to pulmonary function. We suspect that the incidence of symptomatic phrenic nerve palsy associated with brachial plexus blocks will increase as the prevalence of obesity increases in this country. PMID:19472948

Erickson, John M; Louis, Dean S; Naughton, Norah N

2009-05-01

103

Symptomatic phrenic nerve palsy after supraclavicular block in an obese man.  

UK PubMed Central (United Kingdom)

Regional anesthesia has an expanding role in upper extremity surgery. Brachial plexus blocks offer several advantages including providing effective analgesia, reducing narcotic requirements, and facilitating ambulatory care surgery. Despite the popularity of nerve blocks, the surgeon must not forget the complications associated with regional anesthesia. This article describes a case of symptomatic phrenic nerve palsy after supraclavicular brachial plexus block in an obese man. A 46-year-old obese man underwent a left-sided supraclavicular block in preparation for decompression of Guyon's canal for ulnar mononeuropathy at the wrist. The patient experienced acute-onset dyspnea, chest discomfort, and anxiety, and physical examination demonstrated reduced breath sounds in the left hemithorax. Chest radiographs documented elevation of the left hemidiaphragm consistent with an iatrogenic phrenic nerve palsy. The patient was admitted for 23-hour observation and underwent an uncomplicated ulnar nerve decompression under Bier block anesthesia 1 week later. No long-term sequelae have been identified; however, there was a delay in surgical care, admission to the hospital, and transient pulmonary symptoms. We attribute this complication to significant abdominal obesity causing compromised pulmonary reserve and poor tolerance of transient hemidiaphragmatic paresis. In recent studies, waist circumference and abdominal height were inversely related to pulmonary function. We suspect that the incidence of symptomatic phrenic nerve palsy associated with brachial plexus blocks will increase as the prevalence of obesity increases in this country.

Erickson JM; Louis DS; Naughton NN

2009-05-01

104

Severe cast burn after bunionectomy in a patient who received peripheral nerve blocks for postoperative analgesia  

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Full Text Available Patrick K Boyle, John J Badal, Joelle W BoeveDepartment of Anesthesiology, Arizona Health Sciences Center, Tucson, AZ, USAAbstract: Although regional anesthesia offers advantages for intraoperative and postoperative pain relief, it is not possible without complications. A case of a significant burn injury after splint placement is described after a peripheral nerve block was performed for postoperative pain management. It is our hope that this case alerts physicians and others involved in the management of postoperative patients to the challenges of managing a blocked extremity after thermal cast placement and offers solutions that can be standardized.Keywords: Peripheral nerve block, cast burn, postoperative complication

Patrick K Boyle; John J Badal; Joelle W Boeve

2011-01-01

105

[Prehospital analgesia with femoral nerve block following lower extremity injury. A 107 cases survey].  

UK PubMed Central (United Kingdom)

OBJECTIVE: Femoral Nerve Block (FNB) has been proposed for femoral fracture analgesia in a prehospital setting. METHODS: Descriptive case-series survey. All suspected femoral fractures that were managed by our extrahospital service and had a femoral block were prospectively included. The physician was free to choose any block technique (paravascular femoral block [BFPV], nerve stimulation femoral block [BFNS], or fascia iliaca block [BFI]), as well as local anesthetic mixture and volume. Pain was assessed using a simplified verbal scale (0-4) before (T0), 10minutes after block (T1), and at hospital arrival (T2). Demographic values, actual trauma diagnosis, the technique used, the local anesthetic mixture and volume, incidents and complications were recorded. RESULTS: One hundred and seven blocks were included. Eighty-six percent of the blocks were performed by an anesthesiologist, although they represent 50% of the prehospital physician staff. Pain on the simplified verbal scale (EVS) decreased from T0 to both T1 and T2 for the whole population and also in each technique subgroup (eight BFPV, 36 BFNS, and 63 BFI). Two BFI blocks required a re-injection to be successful. Ten blocks failed (eight BFI, and two BFNS). Among those 10 failed blocks, two were first wrongly quoted as successful and two successful BFNS blocks appeared inadequate with regard to the trauma location outside the femoral dermatoma. No complication was observed. CONCLUSION: Prehospital FNB appeared to be efficacious in routine practice. Teaching FNB to non-anesthesiologist physicians is challenging.

Gros T; Viel E; Ripart J; Delire V; Eledjam JJ; Sebbane M

2012-11-01

106

Postoperative analgesia for the surgical correction of congenital clubfoot: comparison between peripheral nerve block and caudal epidural block.  

UK PubMed Central (United Kingdom)

BACKGROUND AND OBJECTIVES: Correction of congenital clubfoot (CCF) is associated with severe postoperative pain. Caudal epidural block associated with general anesthesia is the anesthetic technique used more often in children, but it is limited by the short duration of the postoperative analgesia. Peripheral nerve blocks are associated with a low incidence of complications and prolonged analgesia. The objective of this study was to compare the duration of analgesia in peripheral nerve blocks and caudal block, as well as morphine consumption in the first 24 hours after correction of CCF in children. METHODS: This is a randomized, double-blind study with children undergoing surgeries for posteromedial release of CCF, who were divided in four groups according to the anesthetic technique: caudal (ACa), sciatic and femoral block (IF), sciatic and saphenous block (IS), and sciatic block and local anesthesia (IL), associated with general anesthesia. In the first 24 hours, patients received oral dypirone and acetaminophen, and they were evaluated by anesthesiologists who were unaware of the technique used. Oral morphine (0.19 mg x kg(1) per day) was administered according to the scores of the CHIPPS (Children's and infants' postoperative pain scale) scale. RESULTS: One hundred and eighteen children separated into four groups: ACa (30), IF (32), IS (28), and IL (28) participated in this study. The mean time between the blockade and the first dose of morphine was 6.16 hours in group ACa, 7.05 hours in group IF, 7.58 in IS, and 8.18 hours in IL. Morphine consumption was 0.3 mg.kg-1 per day in all four groups. Significant differences were not observed among the groups. CONCLUSIONS: peripheral nerve blocks did not promote longer lasting analgesia or a decrease in morphine consumption in the first 24 hours in children undergoing CCF correction when compared to caudal epidural block.

Rodrigues MR; Paes FC; Duarte LT; Nunes LG; Costa VV; Saraiva RA

2009-11-01

107

Effectiveness of nasopalatine nerve block for anesthesia of maxillary central incisors after failure of the anterior superior alveolar nerve block technique  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese O objetivo deste estudo foi avaliar a eficácia do bloqueio do nervo nasopalatino após falha na anestesia dos incisivos centrais superiores pelo bloqueio no nervo alveolar superior anterior (NASA). Secundariamente, investigou-se a possível inervação do incisivo central superior por ramos do nervo nasopalatino (NNP). Foram avaliados 27 voluntários saudáveis, adultos jovens (idade: 17-26 anos; sexo: 9 homens e 18 mulheres). Todos eram estudantes de Odontologia da Facu (more) ldade do Vale do Rio Verde de Três Corações. Os voluntários tiveram os nervos alveolares anteriores superiores anestesiados e em seguida foram submetidos a um teste de sensibilidade térmica nos incisivos centrais superiores. Aqueles pacientes que ainda apresentavam sensibilidade após o bloqueio do NASA receberam bloqueio do NNP e então o teste térmico foi repetido. Todos os pacientes foram anestesiados por um único operador. Três pacientes ainda apresentaram sensibilidade após ambos os bloqueios bilaterais (NASA e NNP) e foram excluídos das análises de percentagem. Dos 24 pacientes restantes, 16 tiveram seus incisivos centrais superiores anestesiados pelo bloqueio do NASA e 8 permaneceram com sensibilidade após este procedimento. Estes 8 pacientes submeteram-se ao bloqueio do NNP, o que resultou em sucesso na anestesia dos incisivos centrais superiores. Neste estudo, 33,3% dos pacientes tinham a inervação de um ou de ambos os incisivos centrais superiores derivada do nervo nasopalatino, enquanto a maioria dos pacientes (66,7%) tinha tais dentes inervados pelo nervo alveolar superior anterior. O bloqueio do NNP foi eficaz para anestesiar os incisivos centrais superiores, nos casos em que falhou o bloqueio do NASA. Abstract in english The purpose of this study was to assess the effectiveness of nasopalatine nerve block for anesthesia of maxillary central incisors after failure of the anterior superior alveolar nerve (ASAN) block technique. Secondarily, the possible innervation of the maxillary central incisors by the nasopalatine nerve was also investigated. Twenty-seven healthy, young adult volunteers (age: 17-26 years; gender: 9 males and 18 females) were enrolled in this study. All participants were (more) undergraduate dental students of the University of Vale do Rio Verde de Três Corações. The volunteers had the anterior superior alveolar nerves anesthetized and a thermal sensitivity test (cold) was performed on the maxillary central incisors. The volunteers that responded positively to cold stimulus received a nasopalatine nerve block and the thermal sensitivity test was repeated. All participants were anesthetized by a single operator. Three patients presented sensitivity after both types of bilateral blocks and were excluded from the percentage calculations. In the remaining 24 patients, 16 had their maxillary central incisors anesthetized by the anterior superior alveolar block and 8 remained with sensitivity after the ASAN block. All these 8 patients had their maxillary central incisors successfully anesthetized by the nasopalatine block. In this study, 33.3% of the subjects had the innervation of one or both maxillary central incisors derived from the nasopalatine nerve, whilst most subjects (66.7%) had such teeth innervated by the anterior superior alveolar nerve. The nasopalatine nerve block was effective in anesthetizing the maxillary central incisors when the anterior superior alveolar nerve block failed.

Meyer, Tufi Neder; Lemos, Leonardo Lima; Nascimento, Carolina Neder Matuck do; Lellis, William Ricardo Ribeiro de

2007-01-01

108

Does using a femoral nerve block for total knee replacement decrease postoperative delirium?  

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Full Text Available Abstract Background The effect of peripheral nerve blocks on postoperative delirium in older patients has not been studied. Peripheral nerve blocks may reduce the incidence of postoperative opioid use and its side effects such as delirium via opioid-sparing effect. Methods A prospective cohort study was conducted in patients who underwent total knee replacement. Baseline cognitive function was assessed using the Telephone Interview for Cognitive Status. Postoperative delirium was measured using the Confusion Assessment Method postoperatively. Incidence of postoperative delirium was compared in two postoperative management groups: femoral nerve block ± patient-controlled analgesia and patient-controlled analgesia only. In addition, pain levels (using numeric rating scales) and opioid use were compared in two groups. Results 85 patients were studied. The overall incidence of postoperative delirium either on postoperative day one or day two was 48.1%. Incidence of postoperative delirium in the femoral nerve block group was lower than patient controlled analgesia only group (25% vs. 61%, P = 0.002). However, there was no significant difference between the groups with respect to postoperative pain level or the amount of intravenous opioid use. Conclusions Femoral nerve block reduces the incidence of postoperative delirium. These results suggest that a larger randomized control trial is necessary to confirm these preliminary findings.

Kinjo Sakura; Lim Eunjung; Sands Laura P; Bozic Kevin J; Leung Jacqueline M

2012-01-01

109

Urinary incontinence after bilateral parasacral sciatic-nerve block: report of two cases.  

UK PubMed Central (United Kingdom)

OBJECTIVE: The authors describe the occurrence of urinary incontinence after bilateral parasacral sciatic-nerve blocks. CASE REPORT: Two female patients scheduled for bilateral hallux valgus corrective surgery under bilateral parasacral sciatic-nerve block developed urinary incontinence manifested by 3 episodes of enuresis in the first 5 hours after surgery. Physical examination revealed bilateral perineal and gluteal anesthesia and no bladder distention in both patients. Ten hours after block placement, both patients had recovered perineal sensibility and were able to control micturition. CONCLUSION: Given the anatomic relations between the sacral plexus and the autonomic and somatic afferent and efferent innervation of the bladder and urethra, the urinary incontinence observed in our 2 patients could be explained by loss of afferent activity by spread of the local-anesthetic solution to pelvic nerves, loss of the efferent innervation of the posterior urethral sphincter by spread of the local-anesthetic solution to the urethral branches of the hypogastric plexus, and loss of external urethral sphincter tonus by block of the pudendal nerves. Anesthesiologists should consider the possibility of occurrence of urinary incontinence when performing bilateral parasacral sciatic-nerve blocks.

Helayel PE; Ceccon MS; Knaesel JA; Conceição DB; de Oliveira Filho GR

2006-07-01

110

Visual obturator with tip openings  

UK PubMed Central (United Kingdom)

The present disclosure relates to an optical obturator that facilitates the visualization of tissue therethrough during use. The optical obturator disclosed herein includes a housing that is disposed at a proximal end thereof, an elongate member that extends distally from the housing, a distal end formed of a substantially opaque material with one or more openings formed therein, and a shield member.

SMITH ROBERT C

111

VISUAL OBTURATOR WITH TIP OPENINGS  

UK PubMed Central (United Kingdom)

The present disclosure relates to an optical obturator that facilitates the visualization of tissue therethrough during use. The optical obturator disclosed herein includes a housing that is disposed at a proximal end thereof, an elongate member that extends distally from the housing, a distal end formed of a substantially opaque material with one or more openings formed therein, and a shield member.

SMITH ROBERT C

112

Supraclavicular brachial plexus block with the aid of a nerve stimulator.  

UK PubMed Central (United Kingdom)

Hundred supraclavicular brachial plexus blocks according to the subclavian perivascular technique were performed with the aid of a nerve stimulator Neutracer in order to verify the value of the technique and the acceptance by the patients. The technique is extensively described and the results and complications are presented. The rationale for the use of the supraclavicular approach and the advantages of the use of a nerve stimulator in regional anesthesia are discussed.

Eeckelaert JP; Filliers E; Alleman JJ; Hanegreefs G

1984-03-01

113

Tumescent infiltration versus femoral nerve block for skin graft harvest-a prospective randomized study  

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Full Text Available In this prospective, randomized study, 60 patients requiring a single sheet of graft were randomized into 2 groups. Tumescent infiltration was used for anesthesia in one group and femoral nerve block in the other. The pain during administration of anesthesia, the time required for onset of action, the pain during graft harvest and the failure rates were recorded. Statistical comparison was done using Fischers Exact probability test for the failure rates and Mann Whitney- U test for the other parameters. The pain during administration was significantly higher for tumescent infiltration. The time for onset of action was significantly faster with femoral nerve block. The pain during harvest and the failure rates did not show any significant difference. We conclude that tumescent infiltration is more painful than femoral nerve block but equally effective as anesthesia with no difference in the failure and complication rates.

Mathew J; Varghese S; Jagadeesh S

2005-01-01

114

Ultrasound does not shorten the duration of procedure but provides a faster sensory and motor block onset in comparison to nerve stimulator in infraclavicular brachial plexus block.  

UK PubMed Central (United Kingdom)

BACKGROUND: Infraclaviculr Brachial plexus (ICBP) block is useful for upper extremity surgery. The aim of this study was to compare the ultrasound (US) technique with the nerve stimulation (NS) technique in their success rates and times to perform ICBP block. METHODS: 60 patients undergoing surgery of the upper limb were randomly allocated into two groups (n = 30 per group). Group 1; US, and Group 2; NS. Procedure time (including time for initial ultrasound examination), the success rate and the onset time of sensory and motor blockade were assessed. RESULTS: The time needed to perform the ICBP block is similar in both groups (220 seconds ± 130 in US group versus 281 ± 134 seconds in NS group; P = 0.74). The success rate of all the nerve blocks in the US group was 100%. The success rate in the NS group was 73.3%, 76.7%, 76.7% and 100% for radial, ulnar, medial, and musculocutaneous nerve, respectively. A significantly faster onset of sensory block for the radial, ulnar, median, musculocutaneous, and the four nerves considered together were observed. The onset of motor block for the radial, ulnar, and medial nerves was faster in the US group. However, the onset of motor block for the musculocutaneous nerve and the four nerves considered together was comparable between the two groups. CONCLUSIONS: The ultrasound-guided infraclavicular brachial plexus block is a significantly efficacious method with faster onset but similar procedure time compared to the nerve stimulation technique.

Trabelsi W; Amor MB; Lebbi MA; Romdhani C; Dhahri S; Ferjani M

2013-04-01

115

Combined use of ultrasound guided infraclavicular block and lateral femoral cutaneous nerve block in upper extremity reconstruction requiring large skin graft: case report.  

UK PubMed Central (United Kingdom)

Combined nerve blocks of the upper extremity and lower limb in same operation rarely performed due to the risk of systemic toxicity of local anesthetics. Therefore, general anesthesia is generally preferred in this operations. However, use of ultrasound allows reliable deposition of the anesthetic around the nerves, potentially lowering the local anesthetic requirement. In this case report, we present a 44-year-old, ASA physical status I, male patient who was operated for upper extremity reconstruction requiring skin graft from anterolateral thigh region under ultrasound-guided infraclavicular brachial plexus block and lateral femoral cutaneous nerve block. The block was successful and no block-related complications were noted. We think that combining an ultrasound guided infraclavicular brachial plexus block and a lateral femoral cutaneous nerve block is a clinically useful and safe technique and an alternative anesthetic method for procedures requiring skin grafts for the upper extremity.

K?l?çaslan A; Erol A; Topal A; Selimo?lu MN; Otelcio?lu S

2013-07-01

116

Evaluation of Effect of Pudendal Nerve Block on Post Hemmorrhoidectomy Pain  

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Full Text Available Introduction & Objective: Hemorrhoid is one of the most common anorectal disease which presents with pain, bleeding and mass protrusion from anus. One of the most important reasons to avoid operation in these patients fears of the pain. Pain control specially during the first 24 hour postoperation period results in decreasing urinary retension and constipation as well as increasing patients pleasant. In this study we assisted the effect of pudendal nerve block to reduce pain in posthemorrhoidectomy period and compared with those patients without pudendal nerve block.Materials & Methods: We randomized 120 patients with average age of 37.7 year who referred to the hospitals of Ahwaz university for hemorrhoidectomy into 2 groups (N1: 60 N2:60). In the first group pudendal nerve block was done but in the second group we didn't. Then pain scores by analogue scale method were calculated in each group at 2, 6, 12& 24 hours after operations. The scores were matched with Chi- Square test. Also we calculated and compared the dosages of injected narcotics.Results: The average pain scores at 2, 6, 12, 24 hours after operation in the first group (with nerve block). Were 2.53, 2.4, 1.91, 2.7, 2.38, and in the second group (without nerve block) were 3.43, 3.23, 2.98, 2.81, 3.11. The average of narcotic dosage in the first group was 0.69 and in the second group was 1.3. P-value in two groups in those times were 0.001, 0.002, 0.001, 0.66. P-value for comparison of two groups was 0.01. P-value for comparison of narcotic consumption was 0.003Conclusions: In this study, we showed that pudendal nerve block in post hemorrhoidectomy period, reduced pain significantly and decreased narcotic consumption as well.

M.H. Sarmast Shoshtari; A. Talaiezadeh; A. Alaie

2008-01-01

117

Paramedic-performed digital nerve block to facilitate field reduction of a dislocated finger.  

UK PubMed Central (United Kingdom)

This short report describes the use of digital nerve block by a paramedic to facilitate the reduction of a dislocated finger in the prehospital setting. The finger was successfully reduced at the scene without requiring administration of parenteral opioids. The patient was reluctant to visit an emergency department, but was able to be referred to a local primary care practice for postreduction imaging and further care. Paramedic-performed local and regional anesthesia has not been previously described in the emergency medicine or emergency medical services literature. With appropriate training, prehospital digital nerve blocks may be a feasible option to supplement existing paramedic analgesic options.

Simpson PM; McCabe B; Bendall JC; Cone DC; Middleton PM

2012-07-01

118

Bilateral sciatic nerve block after orthopedic surgery in a pediatric patient  

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Full Text Available Early postoperative pain is one of the most important problems in pediatric orthopedic surgery. Introduction of the use of ultrasound (US) has led to very important developments in pediatric regional anesthesia. We aimed to present with the literature data about that we applied the bilateral US-guided sciatic nerve block to the patient who was operated under bilateral knee disarticulation because of congenital tibia agenesis and talipes equinovarus. In conclusion we entertain that US-guided peripheral nerve blocks are effective and safety for postoperative pain in pediatric orthopedic surgery.

Levent ?ahin; Mehrican ?ahin; Rauf Gül

2011-01-01

119

Posterior brachial plexus block with nerve stimulator and 0.5% ropivacaine.  

UK PubMed Central (United Kingdom)

BACKGROUND AND OBJECTIVES: There are several approaches to the brachial plexus depending on the experience of the anesthesiologist and the site of the surgery. Posterior brachial plexus block may be an alternative for shoulder, clavicle and proximal humerus surgery. This study aims at presenting the results of patients submitted to posterior brachial plexus block with 0.5% ropivacaine and the aid of nerve stimulator. METHODS: Participated in this study 22 patients aged 17 to 76 years, physical status ASA I and II, scheduled for shoulder, clavicle and proximal humerus surgery, who were submitted to posterior brachial plexus block with the aid of a nerve stimulator starting at 1 mA. When adequate muscle contraction was obtained, the current was decreased to 0.5 mA. If the response persisted, 40 mL of 0.5% ropivacaine was injected. The following parameters were evaluated: block onset, analgesia and motor block duration, complications and side effects. RESULTS: Blockade was effective in 20 out of 22 patients, mean onset time was 15.52 min, mean surgical duration was 1.61 h. Mean analgesia duration was 15.85 h and mean motor block duration was 11.16 h. There were no clinical signs or symptoms of toxic effects of local anesthetics and no patient presented side effects. CONCLUSIONS: Posterior brachial plexus block with the aid of nerve stimulator provides effective anesthesia, is very comfortable for patients and easy to perform.

Beato L; Camocardi G; Imbelloni LE

2005-08-01

120

The Incidence of Intravascular Needle Entrance during Inferior Alveolar Nerve Block Injection  

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Full Text Available Background and aims. Dentists administer thousands of local anesthetic injections every day. Injection to a highly vascular area such as pterygomandibular space during an inferior alveolar nerve block has a high risk of intravascular needle entrance. Accidental intravascular injection of local anesthetic agent with vasoconstrictor may result in cardiovascular and central nervous system toxicity, as well as tachycardia and hypertension. There are reports that indicate aspiration is not performed in every injection. The aim of the present study was to assess the incidence of intravascular needle entrance in inferior alveolar nerve block injections. Materials and methods. Three experienced oral and maxillofacial surgeons performed 359 inferior alveolar nerve block injections using direct or indirect techniques, and reported the results of aspiration. Aspirable syringes and 27 gauge long needles were used, and the method of aspiration was similar in all cases. Data were analyzed using t-test. Results. 15.3% of inferior alveolar nerve block injections were aspiration positive. Intravascular needle entrance was seen in 14.2% of cases using direct and 23.3% of cases using indirect block injection techniques. Of all injections, 15.8% were intravascular on the right side and 14.8% were intravascular on the left. There were no statistically significant differences between direct or indirect block injection techniques (P = 0.127) and between right and left injection sites (P = 0.778). Conclusion. According to our findings, the incidence of intravascular needle entrance during inferior alveolar nerve block injection was relatively high. It seems that technique and maneuver of injection have no considerable effect in incidence of intravascular needle entrance.

Ali Taghavi Zenouz; Hooman Ebrahimi; Masoumeh Mahdipour; Sara Pourshahidi; Parisa Amini; Mahdi Vatankhah

2008-01-01

 
 
 
 
121

Reversible conduction block in isolated toad sciatic nerve by emulsified isoflurane.  

UK PubMed Central (United Kingdom)

BACKGROUND: Studies have shown that the local use of volatile anesthetics can produce local anesthetic effects. We designed this study to evaluate the characteristics of nerve conduction block of emulsified isoflurane (EI) and compare its nerve blockade with 1%lidocaine, by measuring compound nerve action potential (CNAP) parameters in isolated toad sciatic nerve. METHODS: One hundred isolated toad sciatic nerves were selected and randomly assigned to 10 groups of 10 each, administered 2% to 8% EI (v/v) (EI(8) group, etc.), 1% lidocaine, 30% Intralipid(R) (Huarui Pharmacy, Wuxi, Jiangsu, China), and Ringer solution (RS) for 10 minutes, respectively. All nerves were then washed and soaked with RS for 10 minutes and 30 minutes. The nerve conduction block effect was represented by CNAP parameters that were recorded by an extracellular recording technique per minute. RESULTS: The results showed that the negative amplitudes of CNAP were decreased by EI and lidocaine (P < 0.05), and the conduction velocities of CNAP were also decreased at some time points (D7-W3) (P < 0.05). After RS washing, the 2 parameters recovered gradually. The changes in the 2 parameters induced by EI had slower onset rates and faster recoveries than those produced by lidocaine (7 minutes vs 1 minute and 9 minutes vs 30 minutes). The nerve blockade induced by EI was dose dependent (P < 0.05), and the half maximal inhibition concentration of EI was 5.46%. CONCLUSIONS: EI produced completely reversible and dose-dependent nerve conduction inhibition, which had slower onset and faster recovery compared with those produced by lidocaine.

Li Z; Yang J; Liu J; Gong CY; Gan J; Zhang X; Luo WJ; Li GH

2010-04-01

122

Obturator hernia: A diagnostic challenge  

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INTRODUCTION Obturator hernia is an extremely rare type of hernia with relatively high mortality and morbidity. Its early diagnosis is challenging since the signs and symptoms are non specific. PRESENTATION OF CASE Here in we present a case of 70 years old women who presented with complaints of intermittent colicky abdominal pain and vomiting. Plain radiograph of abdomen showed acute dilatation of stomach. Ultrasonography showed small bowel obstruction at the mid ileal level with evidence of coiled loops of ileum in pelvis. On exploration, Right Obstructed Obturator hernia was found. The obstructed Intestine was reduced and resected and the obturator foramen was closed with simple sutures. Postoperative period was uneventful. DISCUSSION Obturator hernia is a rare pelvic hernia and poses a diagnostic challenge. Obturator hernia occurs when there is protrusion of intra-abdominal contents through the obturator foramen in the pelvis. The signs and symptoms are non specific and generally the diagnosis is made during exploration for the intestinal obstruction, one of the four cardinal features. Others are pain on the medial aspect of thigh called as Howship Rombergs sign, repeated attacks of Intestinal Obstruction and palpable mass on the medial aspect of thigh. CONCLUSION Obturator hernia is a rare but significant cause of intestinal obstruction especially in emaciated elderly woman and a diagnostic challenge for the Doctors. CT scan is valuable to establish preoperative diagnosis. Surgery either open or laproscopic, is the only treatment. The need for the awareness is stressed and CT scan can be helpful.

Kulkarni, Sanjeev R.; Punamiya, Aditya R.; Naniwadekar, Ramchandra G.; Janugade, Hemant B.; Chotai, Tejas D.; Vimal Singh, T.; Natchair, Arafath

2013-01-01

123

Severe cast burn after bunionectomy in a patient who received peripheral nerve blocks for postoperative analgesia.  

Science.gov (United States)

Although regional anesthesia offers advantages for intraoperative and postoperative pain relief, it is not possible without complications. A case of a significant burn injury after splint placement is described after a peripheral nerve block was performed for postoperative pain management. It is our hope that this case alerts physicians and others involved in the management of postoperative patients to the challenges of managing a blocked extremity after thermal cast placement and offers solutions that can be standardized. PMID:22915886

Boyle, Patrick K; Badal, John J; Boeve, Joelle W

2011-03-11

124

Severe cast burn after bunionectomy in a patient who received peripheral nerve blocks for postoperative analgesia.  

UK PubMed Central (United Kingdom)

Although regional anesthesia offers advantages for intraoperative and postoperative pain relief, it is not possible without complications. A case of a significant burn injury after splint placement is described after a peripheral nerve block was performed for postoperative pain management. It is our hope that this case alerts physicians and others involved in the management of postoperative patients to the challenges of managing a blocked extremity after thermal cast placement and offers solutions that can be standardized.

Boyle PK; Badal JJ; Boeve JW

2011-01-01

125

[Sciatic nerve block at the popliteal fossa for foot surgery  

UK PubMed Central (United Kingdom)

We review the results of 312 cases of sciatic nerve blockade in the poplitea fossa for surgery of the dorsal foot. An atraumatic, insulated needle connected to a neurostimulator was used to make a single puncture using a posterior approach. The anesthetic was 1% mepivacaine (4-5 mg/kg-1). Mean latency was 12.4 min. Efficacy was very high (86% excellent, 10% adequate, 4% failed). Time of analgesia was 6 h 15 min (range 3-16 h). No complications or sequelae were recorded. We conclude that the technique is highly effective and comfortable for patients, as it requires only one puncture and gives good postoperative analgesia with no major side effects.

Monsó A; Santaliestra J; Barbal F; Fitó F; Riudeubás J

1996-01-01

126

A conduction block in sciatic nerves can be detected by magnetic motor root stimulation.  

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Useful diagnostic techniques for the acute phase of sciatic nerve palsy, an entrapment neuropathy, are not well established. The aim of this paper is to demonstrate the diagnostic utility of magnetic sacral motor root stimulation for sciatic nerve palsy. We analyzed the peripheral nerves innervating the abductor hallucis muscle using both electrical stimulations at the ankle and knee and magnetic stimulations at the neuro-foramina and conus medullaris levels in a patient with sciatic nerve palsy at the level of the piriformis muscle due to gluteal compression related to alcohol consumption. On the fourth day after onset, magnetic sacral motor root stimulation using a MATS coil (the MATS coil stimulation method) clearly revealed a conduction block between the knee and the sacral neuro-foramina. Two weeks after onset, needle electromyography supported the existence of the focal lesion. The MATS coil stimulation method clearly revealed a conduction block in the sciatic nerve and is therefore a useful diagnostic tool for the abnormal neurophysiological findings associated with sciatic nerve palsy even at the acute phase. PMID:23809191

Matsumoto, Hideyuki; Konoma, Yuko; Fujii, Kengo; Hanajima, Ritsuko; Terao, Yasuo; Ugawa, Yoshikazu

2013-06-25

127

A conduction block in sciatic nerves can be detected by magnetic motor root stimulation.  

UK PubMed Central (United Kingdom)

Useful diagnostic techniques for the acute phase of sciatic nerve palsy, an entrapment neuropathy, are not well established. The aim of this paper is to demonstrate the diagnostic utility of magnetic sacral motor root stimulation for sciatic nerve palsy. We analyzed the peripheral nerves innervating the abductor hallucis muscle using both electrical stimulations at the ankle and knee and magnetic stimulations at the neuro-foramina and conus medullaris levels in a patient with sciatic nerve palsy at the level of the piriformis muscle due to gluteal compression related to alcohol consumption. On the fourth day after onset, magnetic sacral motor root stimulation using a MATS coil (the MATS coil stimulation method) clearly revealed a conduction block between the knee and the sacral neuro-foramina. Two weeks after onset, needle electromyography supported the existence of the focal lesion. The MATS coil stimulation method clearly revealed a conduction block in the sciatic nerve and is therefore a useful diagnostic tool for the abnormal neurophysiological findings associated with sciatic nerve palsy even at the acute phase.

Matsumoto H; Konoma Y; Fujii K; Hanajima R; Terao Y; Ugawa Y

2013-08-01

128

Severe cast burn after bunionectomy in a patient who received peripheral nerve blocks for postoperative analgesia  

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Although regional anesthesia offers advantages for intraoperative and postoperative pain relief, it is not possible without complications. A case of a significant burn injury after splint placement is described after a peripheral nerve block was performed for postoperative pain management. It is our...

Boyle, Patrick K; Badal, John J; Boeve, Joelle W

129

Virtual reality-based regional anaesthesia simulator for axillary nerve blocks.  

UK PubMed Central (United Kingdom)

In this paper, we present a simulator for regional anaesthesia for nerve blocks in the axillary plexus region. We use a novel approach based on electric distance to simulate electronic impulse transmission through soft tissue. The traversal of electrons emitted from the needle tip is calculated by modified pathfinding algorithms. Kinematic algorithms visualize the motor response of the forearm by skeletal animation.

Ullrich S; Frommen T; Rossaint R; Kuhlen T

2009-01-01

130

Virtual reality-based regional anaesthesia simulator for axillary nerve blocks.  

Science.gov (United States)

In this paper, we present a simulator for regional anaesthesia for nerve blocks in the axillary plexus region. We use a novel approach based on electric distance to simulate electronic impulse transmission through soft tissue. The traversal of electrons emitted from the needle tip is calculated by modified pathfinding algorithms. Kinematic algorithms visualize the motor response of the forearm by skeletal animation. PMID:19377191

Ullrich, Sebastian; Frommen, Thorsten; Rossaint, Rolf; Kuhlen, Torsten

2009-01-01

131

Ultrasound-Guided Continuous Superficial Peroneal Nerve Block below the Knee for the Treatment of Nerve Injury.  

UK PubMed Central (United Kingdom)

(CRPS) describes a constellation of symptoms including pain, trophic changes, hyperesthesia, allodynia, and dysregulation of local blood flow often following trauma. It is often confined to the extremities. Treatment of this disorder consists of a variety of modalities including systemic pharmacotherapy, local anesthetic injections or infusions, psychological nonpharmacotherapy, physical rehabilitation, and surgical intervention. Chronic pain not related to CRPS can also be treated with similar interventions. Despite the array of available therapies, it can still be difficult to manage. We report a case of a 19-year-old patient diagnosed by her surgeon as having CRPS Type II, secondary to foot trauma, which was treated with a continuous infusion of local anesthetic at the superficial peroneal nerve (SPN). While placement of peripheral nerve block catheters to augment chronic pain therapy is not novel, the application of a perineural catheter at the SPN has not been previously described.

Jaffe JD; Henshaw DS; Nagle PC

2013-09-01

132

Ultrasound-Guided Continuous Superficial Peroneal Nerve Block below the Knee for the Treatment of Nerve Injury.  

Science.gov (United States)

(CRPS) describes a constellation of symptoms including pain, trophic changes, hyperesthesia, allodynia, and dysregulation of local blood flow often following trauma. It is often confined to the extremities. Treatment of this disorder consists of a variety of modalities including systemic pharmacotherapy, local anesthetic injections or infusions, psychological nonpharmacotherapy, physical rehabilitation, and surgical intervention. Chronic pain not related to CRPS can also be treated with similar interventions. Despite the array of available therapies, it can still be difficult to manage. We report a case of a 19-year-old patient diagnosed by her surgeon as having CRPS Type II, secondary to foot trauma, which was treated with a continuous infusion of local anesthetic at the superficial peroneal nerve (SPN). While placement of peripheral nerve block catheters to augment chronic pain therapy is not novel, the application of a perineural catheter at the SPN has not been previously described. PMID:23241230

Jaffe, J Douglas; Henshaw, Daryl S; Nagle, Pamela C

2012-12-13

133

Fabricating a hollow bulb obturator  

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Full Text Available Obturators are generally used in the rehabilitation of the maxillectomy defects. Ideally, obturators should be light, properly fit and construction should be made easily. By decreasing the weight of the prosthesis, the retention and stability may be optimized to allow the obturator for function comfortably during mastication, phonation, and deglutition. In this case, a 65-year-old male patient underwent surgical removal of left part of the maxilla due to the squamous cell carcinoma. In this technique fabrication of a hollow bulb obturator prosthesis as a single unit in heat-cured acrylic resin using a single-step flasking procedure was described. The patient’s functional and esthetic expectations were satisfied.

Fatih Sari; Ali R?za Tunçdemir

2012-01-01

134

Fabricating a hollow bulb obturator  

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Full Text Available Obturators are generally used in the rehabilitation of the maxillectomy defects. Ideally, obturators should be light, properly fit and construction should be made easily. By decreasing the weight of the prosthesis, the retention and stability may be optimized to allow the obturator for function comfortably during mastication, phonation, and deglutition. In this case, a 65-year-old male patient underwent surgical removal of left part of the maxilla due to the squamous cell carcinoma. In this technique fabrication of a hollow bulb obturator prosthesis as a single unit in heat-cured acrylic resin using a single-step flasking procedure was described. The patient’s functional and esthetic expectations were satisfied.

Ali R?za Tunçdemir; Fatih Sari

2013-01-01

135

High-resolution magnetic resonance-guided posterior femoral cutaneous nerve blocks.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To assess the feasibility, technical success, and effectiveness of high-resolution magnetic resonance (MR)-guided posterior femoral cutaneous nerve (PFCN) blocks. MATERIALS AND METHODS: A retrospective analysis of 12 posterior femoral cutaneous nerve blocks in 8 patients [6 (75%) female, 2 (25%) male; mean age, 47 years; range, 42-84 years] with chronic perineal pain suggesting PFCN neuropathy was performed. Procedures were performed with a clinical wide-bore 1.5-T MR imaging system. High-resolution MR imaging was utilized for visualization and targeting of the PFCN. Commercially available, MR-compatible 20-G needles were used for drug delivery. Variables assessed were technical success (defined as injectant surrounding the targeted PFCN on post-intervention MR images) effectiveness, (defined as post-interventional regional anesthesia of the target area innervation downstream from the posterior femoral cutaneous nerve block), rate of complications, and length of procedure time. RESULTS: MR-guided PFCN injections were technically successful in 12/12 cases (100%) with uniform perineural distribution of the injectant. All blocks were effective and resulted in post-interventional regional anesthesia of the expected areas (12/12, 100%). No complications occurred during the procedure or during follow-up. The average total procedure time was 45 min (30-70) min. CONCLUSIONS: Our initial results demonstrate that this technique of selective MR-guided PFCN blocks is feasible and suggest high technical success and effectiveness. Larger studies are needed to confirm our initial results.

Fritz J; Bizzell C; Kathuria S; Flammang AJ; Williams EH; Belzberg AJ; Carrino JA; Chhabra A

2013-04-01

136

Anterior approach to the sciatic nerve block: adaptation to the patient's height.  

UK PubMed Central (United Kingdom)

UNLABELLED: To improve the incidence of block of the posterior femoral cutaneous nerve (PFCN) when using an anterior approach as described recently, we hypothesized that the distance between the inguinal line and the puncture site depends on the patient's height. A preliminary radiological study performed in 13 patients established a formula describing the relationships between the patient's height and the puncture site "S." A line was drawn between the anterior iliac spine and the superior angle of the pubic tubercle (inguinal line) and another line from the midpoint of the inguinal line to the puncture site "S." "S" was calculated from the midpoint of the inguinal line as "S" = (height in cm--100)/10. A prospective study was conducted in 53 patients. Results are presented as median (range, 0.25-0.75). Two minutes were required to locate the sciatic nerve at a depth of 12 cm (10.5-13.0 cm). Complete sciatic and PFCN blocks were observed in 92% of the patients. We conclude that consideration should be given to the patient's height when the sciatic nerve is blocked using an anterior approach. This technique seems to improve the success of block of the PFCN, essential to tolerate a thigh tourniquet. IMPLICATIONS: This prospective but noncomparative work was performed to evaluate a new anterior technique of sciatic block, an adaptation of the anatomic landmarks described by Chelly and Delaunay, to patient height.

Barbero C; Fuzier R; Samii K

2004-06-01

137

Long-term ambulatory continuous nerve blocks for terminally ill patients: a case series.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Intolerable side effects and dissatisfactory pain control with traditional analgesics prompted the utilization of long-term, ambulatory, continuous peripheral nerve blocks (CPNBs) in terminally ill patients for palliative care. DESIGN: Case series. SETTING: Continuous peripheral nerve catheters were placed in terminally ill patients in an ambulatory setting. The patients were managed at their homes, with nursing services available to manage the infusions and provide routine monitoring and care. PATIENTS: This is a case series of patients with severe peripheral pain and a terminal diagnosis in whom the goals of care were aimed at palliation. All three cases had an unfavorable coagulation status; case 2 had a prior pneumonectomy on the contralateral side and a large tumor on the ipsilateral lung of the continuous brachial plexus block. INTERVENTIONS: Interventions included CPNBs, with infusion of local anesthetic. Specific techniques used include cervical paravertebral block and lumbar paravertebral block. RESULTS: After infusion and titration of local anesthetic doses, oral opioid medication was significantly reduced, which resulted in an improved quality of life. The nerve blocks did not hasten death in any of the patients despite their coexisting conditions. CONCLUSIONS: CPNBs are a reasonably effective modality to decrease opioid usage when side effects are undesirable for end-of-life care. The risk of unfavorable coagulation status, poor lung function, and risk of infection was outweighed by the benefit in this patient population.

Esch AT; Esch A; Knorr JL; Boezaart AP

2010-08-01

138

[Effectiveness of intercostal nerve block with ropivacaine in analgesia of patients undergoing emergency open cholecystectomy under general anesthesia].  

UK PubMed Central (United Kingdom)

Introduction: Postoperative pain after open cholecystectomy is associated with reduced respiratory function, longer recovery period before deambulation and oral food intake, and prolonged hospital stay. Intercostal nerve block provides satisfactory analgesia and ropivacaine is the most widely used local anesthetic agent in intercostal nerve block due to its excellent effectiveness, lower cardiovascular toxicity, and longer half-life. Aims: To evaluate intercostal nerve block effectiveness with ropivacaine in patients undergoing emergency open cholecystectomy under general anesthesia compared with conventional management. Material and methods: A controlled clinical trial was carried out on 50 patients undergoing open cholecystectomy, 25 patients without intercostal nerve block versus 25 patients with intercostal nerve block using ropivacaine at 0.5% combined with epinephrine. Intraoperative minimum alveolar concentration and inhalation anesthetic use were evaluated. Tramadol as rescue analgesic agent and pain were evaluated during immediate postoperative period by means of the Visual Analog Scale at 8, 16, and 24 hours. Results: Mean inhalation anesthetic use was lower in the intercostal nerve block group with 13% vs 37% in the group without intercostal nerve block (p= 0.01). Rescue tramadol requirement was lower in the intercostal nerve block group than in the group without intercostal nerve block at 8 hours (8% vs 67%), 16 hours (0% vs 83%), and 24 hours (12% vs 79%) (p<0.0001). Visual Analog Scale for Pain results were similar in both groups. Conclusions: Intercostal nerve block reduces intraoperative inhalation anesthetic use, immediate postoperative pain, and tramadol intake as rescue analgesic agent in patients undergoing open cholecystectomy.

Vizcarra-Román MA; Bahena-Aponte JA; Cruz-Jarquín A; Vázquez-García JC; Cárdenas-Lailson LE

2012-01-01

139

[Continuous peripheral nerve block with a catheter placed under ultrasound guidance for analgesia after major orthopedic surgery].  

UK PubMed Central (United Kingdom)

BACKGROUND: This prospective study was conducted to investigate the effects and complications of continuous peripheral nerve blocks after major orthopedic surgery using a catheter placed under ultrasound guidance. METHODS: We studied 182 adult patients who underwent one of three types of major orthopedic surgery and received peripheral nerve blocks with one or two perineural catheters: continuous femoral nerve block after reconstruction of the anterior cruciate ligament, n=93; continuous femoral with or without sciatic nerve block after total knee arthroplasty, n=39; and continuous brachial plexus block after arthroscopic surgery of the shoulder, n=50. All the patients received additional single peripheral nerve block and/or general anesthesia for surgery. A continuous injection of 0.2-0.25% ropivacaine was started immediately after surgery at a rate of 4-6 ml x hr(-1), with a 3 ml patient-controlled bolus available every 30 min, and lasted for at least 48hr. Pain was evaluated at rest and during movement, RESULTS: Despite large inter-individual variation, continuous peripheral nerve block produced satisfactory postoperative analgesia without any apparent major complications. CONCLUSIONS: Peripheral nerve block and catheter placement under ultrasound guidance may help manage postoperative analgesia after orthopedic surgery easily, reliably and safely.

Kono F; Sakura S; Hara K; Tadenuma S; Saito Y

2010-10-01

140

[Contribution of ultrasound guidance to the performance of the axillary brachial plexus block with multiple nerve stimulation  

UK PubMed Central (United Kingdom)

OBJECTIVE: To evaluate whether ultrasound imaging of vascular nerve structures improves anesthetic block quality and decreases the incidence of vascular puncture in the performance of an axillary brachial plexus block with multiple nerve stimulation. PATIENTS AND METHODS: Randomized trial enrolling 129 patients assigned to 2 groups. In group 1, axillary brachial plexus nerves were located by nerve stimulation with ultrasound guidance. In group 2, only conventional multiple nerve stimulation was used. We analyzed the number of nerves located, time required to perform the block, anesthetic quality, and the number of accidental vascular punctures. RESULTS: Four nerves were located in 43% of the patients in group 1 and 38% of those in group 2. More time was taken in performing the block in group 1 than in group 2 (mean [SD] of 350 [40] seconds vs. 291 [58] seconds, respectively; P < .05). The incidence of vascular puncture was significantly lower in group 1 (8%) than in group 2 (28%) (odds ratio, 4 [95% confidence interval, 2-13]; P < .01). Ten and 20 minutes after puncture, the quality of sensory and motor blockade was significantly better in group 1. Block success was similar in the 2 groups (98.5% and 94% respectively). CONCLUSIONS: Combining ultrasound guidance with nerve stimulation improves the anesthetic quality of an axillary brachial plexus block, decreases the likelihood of vascular puncture, and slightly increases the amount of time required to perform the procedure.

Morros C; Pérez-Cuenca MD; Sala-Blanch X; Cedó F

2009-02-01

 
 
 
 
141

Our experience of combined femoral sciatic nerve block in the lower extremity surgery  

Directory of Open Access Journals (Sweden)

Full Text Available Objectives: In this study, the effectiveness of the combine femoral and sciatic nerve block in lower-extremity surgery was aimed to be investigated.Materals and methods: The patients with ASA I-III group, aged between 18-70 years, who underwent combinede sciatic femoral nerve block in lower-extremity surgery, were retrospectively evaluated.The study included 110 patients. The patients were divided into four groups according to the local anesthetic drugs used; Group I: 30 ml 0.5% Bupivacaine + 10 ml 0.9% NaCl, Group II: 30 ml 0.5% Levobupivacaine + 10 ml 0.9% NaCl, Group III: 30 ml 0.5% Levobupivacaine +10 ml 2% prilocaine HCl, GrupIV: 20 ml 0.5% Bupivacaine + 2 ml 2% Lidocaine HCl. The demographic data, clinical diagnosis, dose and volume of used local anesthetics, application time of the technique, duration of surgery, rates of block success, hemodynamic parameters before and after intervention, the first postoperative analgesic requirements (the first postoperative analgesic need, the amount of analgesic consumption of postoperative first 24 hours, developing complications during and after the process, patient’s and surgical satisfaction data of were recorded.Results: The demographic data of patient group were similar. No significant differences were found in terms of quality of surgical anesthesia and postoperative analgesia between different groups. The combined sciatic femoral nerve block was most frequently performed for ankle surgery. Different local anesthetics doses administered to patients were provided adequate anesthesia. Success of process was found to be 96%.Conclusion: The combined femoral sciatic nerve block applied with the success rate of 96%. The mean duration of adequate anesthesia and postoperative analgesia was 426 minutes. J Clin Exp Invest 2011; 2 (4): 375-379

Feyzi Çelik; Adnan Tüfek; Zeynep B.Y?ld?r?m; Orhan Tokgöz; Haktan Karaman; Celil Alemdar; Ramazan Atiç; Taner Çiftçi; Gönül Ölmez Kavak

2011-01-01

142

[Peribulbar anesthesia versus retrobulbar anesthesia with facial nerve block. Techniques, local anesthetics and additives, akinesia and sensory block, complications].  

UK PubMed Central (United Kingdom)

BACKGROUND: Retrobulbar anesthesia (RETRO), combined with a facial block, is the most frequently employed method of anesthesia in cataract surgery. There is, however, an increasing tendency to use peribulbar anesthesia (PERI), which is claimed to provide the same degree of anesthesia and akinesia as RETRO while reducing many of the complications. OBJECTIVES OF THE STUDY: Survey of the principal techniques of RETRO, facial block and PERI as well as of the most important local anesthetics and additives; quantitative investigation of resulting akinesia and sensory blockade; comparison of systemic and local complications (literature review). TECHNIQUES OF LOCAL ANESTHESIA: A) RETRO: 1) Atkinson technique: injection within the orbital muscle cone, superonasal eye position during injection; 2) Unsöld technique: primary eye position during injection (advantage: lower risk of optic nerve lesion). - B) Facial block: 1) O'Brien technique: injection anterior to the tragus of the ear, just above the condyloid process of the mandible (disadvantage: frequently blockade of the upper portion only of the peripheral facial nerve); 2) Nadbath/Rehman technique (modified O'Brien block): injection just inferior to the earlobe (advantage: better orbicularis akinesia due to blockade of upper and lower portions of peripheral facial nerve); 3) van Lint technique: infiltration anesthesia at the temporal orbital margin, aiming at the short zygomatic branches of the facial nerve (disadvantage: bad orbicularis akinesia). - C) PERI: 1) Technique with two injections outside the muscle cone (inferotemporally and superonasally), just past the equator; 2) one-injection technique, mostly inferotemporally (disadvantage: worse akinesia). LOCAL ANESTHETICS: A) Short and weak action: lidocaine and prilocaine; advantages: good tissue penetration, low toxicity. - B) Intermediate duration and potency of action: mepivacaine; advantage: pronounced vasoconstrictor activity, alternative to adrenaline. - C) Long and strong action: 1) etidocaine; advantage: pronounced motor blockade, particularly suitable for facial block; 2) bupivacaine; advantage: pronounced sensory blockade, excellent postoperative analgesia; disadvantage: relatively toxic (cave: cardiac and respiratory arrest). - D) Mixtures of local anesthetics: mostly lidocaine-bupivacaine mixture; combines the advantages short-onset action (lidocaine) and long-duration action (bupivacaine). ADDITIVES TO LOCAL ANESTHETICS: Adrenaline: prolongs the action of local anesthetics with short and intermediate duration of action, reduces the incidence of hemorrhages and of intraoperative vitreous bulging. - Hyaluronidase: highly effective for prevention of vitreous bulging. AKINESIA AND SENSORY BLOCKADE: In randomized order, 160 cataract patients received PERI (technique with 2 injections) with 6, 8 or 10 ml of a bupivacaine-lidocaine-hyaluronidase mixture (without facial block) or RETRO (Unsöld technique) with 5 ml of the above mixture, combined with a Nadbath/Rehman facial nerve block (5 ml etidocaine-lidocaine mixture). Measured 20 min after injection (intervening period of oculopression), the smallest ocular motility (Kestenbaum limbus test) was left after RETRO. After administration of PERI - even with a volume of 10 ml - the range of residual ocular motility was always higher, i.e., there was a less reliable globe akinesia than after RETRO. The lid closure force (Straub technique) averaged zero after all methods of anesthesia; however, the smallest spread (highest reliability) was observed after PERI. Complete corneal anesthesia (Draeger esthesiometer) was found in nearly all cases, i.e., RETRO and PERI are comparably effective concerning sensory blockade...

Hessemer V

1994-02-01

143

Analgesic effects of preoperative peripheral nerve block in patients with trigeminal neuralgia undergoing radiofrequency thermocoagulation of gasserian ganglion.  

UK PubMed Central (United Kingdom)

Trigeminal neuralgia is the worst pain that human beings have ever experienced. Surgery might be the only solution for some patients because no other way can relieve their severe pain. They experience intolerable pain before operation and during radiofrequency thermocoagulation of the gasserian ganglion. The aim of the current study was to prospectively evaluate the preoperative and perioperative analgesic effects of preoperative single peripheral nerve block. Sixty patients with classic trigeminal neuralgia who were scheduled to undergo radiofrequency thermocoagulation of the gasserian ganglion were randomly divided into a control group (n = 30) and a nerve block group (n = 30). Patients in the nerve block group were treated with single peripheral nerve block using 1% lidocaine and betamethasone on the day of admission. Average pain, worst pain, quality of sleep, and analgesia satisfaction were evaluated before surgery. The incidence and intensity of perioperative episodic pain were determined before the needle reached the gasserian ganglion. Compared with the control group, a single peripheral nerve block significantly attenuated average pain (P < 0.01) and worst pain (P < 0.01), ameliorated the quality of sleep (P < 0.01), and increased analgesia satisfaction (P < 0.01). Moreover, patients in the nerve block group experienced a decrease in incidence (P < 0.01) and intensity (P < 0.01) of episodic pain during surgery as compared with the participants in the control group. These results demonstrate that a single peripheral nerve block may be an effective way to relieve preoperative and perioperative intolerable pain of trigeminal neuralgia.

Weng Z; Halawa MA; Liu X; Zhou X; Yao S

2013-03-01

144

Development of an ultrasound-guided technique for pudendal nerve block in cat cadavers.  

Science.gov (United States)

The objective of this prospective experimental cadaveric study was to develop an ultrasound-guided technique to perform an anaesthetic pudendal nerve block in male cats. Fifteen fresh cadavers were used for this trial. A detailed anatomical dissection was performed on one cat in order to scrutinise the pudendal nerve and its ramifications. In a second step, the cadavers of six cats were used to test three different ultrasonographic approaches to the pudendal nerve: the deep dorso-lateral, the superficial dorso-lateral and the median transperineal. Although none of the approaches allowed direct ultrasonographical identification of the pudendal nerve branches, the deep dorso-lateral was found to be the most advantageous one in terms of practicability and ability to identify useful and reliable landmarks. Based on these findings, the deep dorso-lateral approach was selected as technique of choice for tracer injections (0.1 ml 1% methylene blue injected bilaterally) in six cat cadavers distinct from those used for the ultrasonographical study. Anatomical dissection revealed a homogeneous spread of the tracer around the pudendal nerve sensory branches in all six cadavers. Finally, computed tomography was performed in two additional cadavers after injection of 0.3 ml/kg (0.15 ml/kg per each injection sites, left and right) contrast medium through the deep dorso-lateral approach in order to obtain a model of volume distribution applicable to local anaesthetics. Our findings in cat cadavers indicate that ultrasound-guided pudendal nerve block is feasible and could be proposed to provide peri-operative analgesia in clinical patients undergoing perineal urethrostomy. PMID:23599255

Adami, Chiara; Angeli, Giovanni; Haenssgen, Kati; Stoffel, Michael H; Spadavecchia, Claudia

2013-04-18

145

Femoral nerve block versus fentanyl: Analgesia for positioning patients with fractured femur  

Directory of Open Access Journals (Sweden)

Full Text Available Arissara Iamaroon, Manee Raksakietisak, Pathom Halilamien, Jitaporn Hongsawad, Kwankamol BoonsararuxsapongDepartment of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, ThailandPurpose: Fracture of femur is a painful bone injury, worsened by any movement. This prospective study was performed to compare the analgesic effects of femoral nerve block (FNB) with intravenous (IV) fentanyl prior to positioning patients with fractured femur for spinal block.Patients and methods: Sixty-four ASA I–III patients aged 18–80 years undergoing surgery for femur fracture were randomized into two groups. Fifteen minutes before spinal block, the FNB group received nerve stimulator-assisted FNB with a mixture of 20 mL bupivacaine 0.5% and 10 mL normal saline 0.9%, and the fentanyl group received two doses of IV fentanyl 0.5 ?g/kg with a five-minute interval between doses. Numeric rating pain scores were compared. During positioning, fentanyl in 0.5 ?g/kg increments was given every five minutes until pain scores were ?4.Results: There were no statistically significant differences between the groups according to pain scores, need for additional fentanyl, and satisfaction with positioning before spinal block. Conclusion: We were unable to demonstrate a benefit of FNB over IV fentanyl for patient positioning before spinal block. However, FNB can provide postoperative pain relief, whereas side effects of fentanyl must be considered, and analgesic dosing should be titrated based on pain scores. A multimodal approach (FNB + IV fentanyl) may be a possible option.Keywords: femoral nerve block, bupivacaine, fentanyl, pain on positioning

Arissara Iamaroon; Manee Raksakietisak; Pathom Halilamien; et al

2010-01-01

146

Brief reports: nerve stimulator evoked motor response predicting a successful supraclavicular brachial plexus block.  

UK PubMed Central (United Kingdom)

BACKGROUND: We examined the success rate of supraclavicular brachial plexus block after the different evoked motor responses to nerve stimulation. METHODS: This multicenter observational study included 377 patients. For each block, the evoked motor response elicited at 0.25 mA for 2 milliseconds was recorded, 30 mL bupivacaine 0.25% was injected, and the block was observed for success or failure. RESULTS: Complete anesthesia occurred in 317 cases (84.1%). The success rate was 100% when the evoked motor response was simultaneous flexion of the third and fourth digits or flexion of all 4 digits (digits 2-5) with or without thumb opposition. CONCLUSION: Simultaneous flexion of the third and fourth digits with or without other digits is associated with the highest success rate of supraclavicular brachial plexus block.

Haleem S; Siddiqui AK; Mowafi HA; Ismail SA; Ali QA

2010-06-01

147

Supraclavicular brachial plexus block using a nerve stimulator and an insulated needle.  

UK PubMed Central (United Kingdom)

A technique employing a nerve stimulator and an insulated needle was used for supraclavicular brachial plexus block in 71 patients using 0.5% plain bupivacaine 15-20 ml. The mean minimal stimulating current to produce paraesthesia was 0.09 mA. The plexus was identified at a mean depth of 27 mm below the skin. The block was successful in 98% of patients when the stimulation was felt in the index, middle or ring finger, but was often incomplete when felt in the thumb or little finger.

Yasuda I; Hirano T; Ojima T; Ohira N; Kaneko T; Yamamuro M

1980-04-01

148

Compartment syndrome diagnosed in due time by breakthrough pain despite continuous peripheral nerve block.  

UK PubMed Central (United Kingdom)

We here present a paediatric case with development of acute compartment syndrome in the lower leg secondary to a tibial shaft fracture. The patient was diagnosed in time because of breakthrough pain, despite a well-functioning continuous peripheral nerve block with ropivacaine infusion. Compartment syndrome is a potentially devastating complication to trauma, typically fractures of the tibial shaft and the forearm because of the relatively tight facias and small volume of these compartments.

Munk-Andersen H; Laustrup TK

2013-09-01

149

Contralateral Obturator Hernia Immediately after a Right Obturator Herniorrhaphy: A Case Report  

International Nuclear Information System (INIS)

An obturator hernia is a very rare condition that occurs in elderly debilitated women and its nonspecific symptoms delay the diagnosis. Computed tomography is a useful tool for the early diagnosis of an obturator hernia. Previous studies report that bilateral obturator hernias comprise approximately 6% of all obturator hernias is 6%. To the best of our knowledge, there is no reported case of a contralateral obturator hernia immediately after a herniorrhaphy. We report a case of contralateral obturator hernia that occurred immediately after a right obturator herniorrhaphy

2010-01-01

150

What is the ED95 of prilocaine for femoral nerve block using ultrasound?  

UK PubMed Central (United Kingdom)

BACKGROUND: Our aim was to estimate the ED95 of prilocaine 1% w/v for femoral nerve block. METHODS: This two-stage dose-finding sequential clinical trial followed an adaptive design based on the continual reassessment method (CRM). Adult patients undergoing Vastus medialis muscle biopsy under ultrasound-guided femoral nerve block were recruited. Data from previously published studies and our own previous experience were used to set the dose levels and their guesstimate probabilities of response. RESULTS: Forty patients were recruited in the trial (n=26 in the first stage and n=14 in the second stage). Using the CRM, the estimated response probabilities with 13 and 17 ml prilocaine 1% w/v were 90.4% (95% credibility interval: 68-98%) and 99.1% (95% credibility interval: 89-100%), respectively. CONCLUSION: Our study demonstrates that the dose closest to the ED(95) of prilocaine 1% w/v for ultrasound-guided femoral nerve block is 17 ml. The study also illustrates the value of CRM in dose-finding experiments.

Gupta PK; Chevret S; Zohar S; Hopkins PM

2013-05-01

151

Sciatic nerve palsy after total hip arthroplasty in a patient receiving continuous lumbar plexus block.  

UK PubMed Central (United Kingdom)

UNLABELLED: We report a case of late-onset postoperative sciatic palsy after total hip arthroplasty in a 30-yr-old man with congenital hip dysplasia. The patient was receiving continuous lumbar plexus blockade and had received low-molecular-weight heparin 3 h before the onset of symptoms. Anatomic distinction between the nerve block and the sciatic palsy facilitated rapid diagnosis and treatment of a periarticular hematoma, with resulting neurologic recovery. This case illustrates that, with the expanded role of regional anesthetic techniques in acute pain management, the finding of a new postoperative deficit must be jointly investigated by both anesthesiologists and surgeons. Timely and open communication between services is critical because rapid intervention may be essential to achieving full recovery of an affected nerve. IMPLICATIONS: A case is presented of sciatic palsy developing after total hip arthroplasty in a patient receiving a continuous lumbar plexus block. The case highlights various issues in the use of continuous peripheral nerve blocks for postoperative analgesia.

Ben-David B; Joshi R; Chelly JE

2003-10-01

152

Glossopharyngeal Nerve Block versus Lidocaine Spray to Improve Tolerance in Upper Gastrointestinal Endoscopy  

Science.gov (United States)

Aim of the Study. To compare the effect of glossopharyngeal nerve block with topical anesthesia on the tolerance of patients to upper gastrointestinal endoscopy. Methods. We performed a clinical trial in one hundred patients undergoing upper gastrointestinal endoscopy. Subjects were randomly assigned to one of the following two groups: (1) treatment with bilateral glossopharyngeal nerve block (GFNB) and intravenous midazolam or (2) treatment with topical anesthetic (TASS) and intravenous midazolam. We evaluated sedation, tolerance to the procedure, hemodynamic stability, and adverse symptoms. Results. We studied 46 men and 54 women, from 17 to 78 years of age. The procedure was reported without discomfort in 48 patients (88%) in the GFNB group and 32 (64%) in the TAAS group; 6 patients (12%) in GFNB group and 18 (36%) in TAAS group reported the procedure as little discomfort (?2 = 3.95, P = 0.04). There was no difference in frequency of nausea (4% in both groups) and retching, 4% versus 8% for GFNB and TASS group, respectively (P = 0.55). Conclusions. The use of glossopharyngeal nerve block provides greater comfort and tolerance to the patient undergoing upper gastrointestinal endoscopy. It also reduces the need for sedation.

Ortega Ramirez, Moises; Linares Segovia, Benigno; Garcia Cuevas, Marco Antonio; Sanchez Romero, Jorge Luis; Botello Buenrostro, Illich; Amador Licona, Norma; Guizar Mendoza, Juan Manuel; Guerrero Romero, Jesus Francisco; Vazquez Zarate, Victor Manuel

2013-01-01

153

Comparative study of the novel and conventional injection approach for inferior alveolar nerve block.  

UK PubMed Central (United Kingdom)

This study aimed to evaluate the efficacy of anesthesia obtained with a novel injection approach for inferior alveolar nerve block compared with the conventional injection approach. 40 patients in good health, randomly received each of two injection approaches of local anesthetic on each side of the mandible at two separate appointments. A sharp probe and an electric pulp tester were used to test anesthesia before injection, after injection when the patients' sensation changed, and 5 min after injection. This study comprised positive aspiration and intravascular injection 5% and neurovascular bundle injection 7.5% in the conventional inferior alveolar nerve block, but without occurrence in the novel injection approach. A visual analog scale (VAS) pain assessment was used during injection and surgery. The significance level used in the statistical analysis was p<0.05. For the novel injection approach compared with the conventional injection approach, no significant difference was found on the subjective onset, objective onset, operation time, duration of anesthesia and VAS pain score during operation, but the VAS pain score during injection was significantly different. The efficacy of inferior alveolar nerve block by the novel injection approach provided adequate anesthesia and caused less pain and greater safety during injection.

Boonsiriseth K; Sirintawat N; Arunakul K; Wongsirichat N

2013-07-01

154

Glossopharyngeal Nerve Block versus Lidocaine Spray to Improve Tolerance in Upper Gastrointestinal Endoscopy.  

UK PubMed Central (United Kingdom)

Aim of the Study. To compare the effect of glossopharyngeal nerve block with topical anesthesia on the tolerance of patients to upper gastrointestinal endoscopy. Methods. We performed a clinical trial in one hundred patients undergoing upper gastrointestinal endoscopy. Subjects were randomly assigned to one of the following two groups: (1) treatment with bilateral glossopharyngeal nerve block (GFNB) and intravenous midazolam or (2) treatment with topical anesthetic (TASS) and intravenous midazolam. We evaluated sedation, tolerance to the procedure, hemodynamic stability, and adverse symptoms. Results. We studied 46 men and 54 women, from 17 to 78 years of age. The procedure was reported without discomfort in 48 patients (88%) in the GFNB group and 32 (64%) in the TAAS group; 6 patients (12%) in GFNB group and 18 (36%) in TAAS group reported the procedure as little discomfort (? (2) = 3.95, P = 0.04). There was no difference in frequency of nausea (4% in both groups) and retching, 4% versus 8% for GFNB and TASS group, respectively (P = 0.55). Conclusions. The use of glossopharyngeal nerve block provides greater comfort and tolerance to the patient undergoing upper gastrointestinal endoscopy. It also reduces the need for sedation.

Ortega Ramírez M; Linares Segovia B; García Cuevas MA; Sánchez Romero JL; Botello Buenrostro I; Amador Licona N; Guízar Mendoza JM; Guerrero Romero JF; Vázquez Zárate VM

2013-01-01

155

Ultrasound-guided infragluteal sciatic nerve block: a comparison between four different techniques.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Ultrasound guided sciatic block can be performed by different techniques. We compared namely short or long axis views of the sciatic nerve with in-plane or out-of-plane needle insertion techniques for the infragluteal sciatic nerve block (ISNB). METHODS: One hundred twenty patients with American Society of Anesthesiologists physical status I-III, scheduled for foot surgery were assigned into four groups. Group SI: patients received ultrasound-guided SNB using short axis (S) view of the SN and in-plane (I) insertion of needle. Group LI: patients received SNB using long axis (L) view of SN and (I) insertion of the needle. Group SO: patients received SNB using (S) view of SN and out-of-plane (O) insertion of the needle. Group LO: patients received SNB using (L) view of SN and (O) insertion of the needle. Primary outcomes included the time to perform the block (recognition and performance time) and the level of patient discomfort during block placement. RESULTS: The recognition time and performance time were shortest in LI group (51 ± 16.4 and 87.7 ± 14.8 s), while they were longest in LO group (138.7 ± 21.4 and 160.3 ± 17.5 s). There were no significant differences between the groups as regards the number of attempts and needle redirections to elicit sciatic motor response. The level of patient discomfort was significantly less in the LI group in comparison with the SI and LO groups. CONCLUSION: The LI approach required less time to complete the infragluteal sciatic nerve block procedure and it was more comfortable for the patients in comparison to the SO, SI and LO approaches.

Tammam TF

2013-02-01

156

[Effects of intramuscular and perineural clonidine on sciatic nerve block with 0.5% ropivacaine.].  

UK PubMed Central (United Kingdom)

BACKGROUND AND OBJECTIVES: This study evaluated the effects of clonidine on anesthesia onset, quality and duration of analgesia of sciatic nerve block using 0.5% ropivacaine. METHODS: Forty adult patients scheduled for foot or lateral aspect of the ankle procedures under combined anterior femoral/sciatic nerves block were randomly assigned to group 1, receiving 25 mL of 0.5% ropivacaine plus placebo perineurally, group 2, receiving intramuscular 2 microg.kg-1 clonidine and perineural 25 mL of 0.5% ropivacaine and group 3, receiving perineural 2 microg.kg-1 clonidine and 25 mL of 0.5% ropivacaine injected after motor responses were obtained with stimulations between 0.2 and 0.5 mA. Sensory and motor blocks were assessed for 30 minutes after blockade. A total block effectiveness score was calculated. The quality of surgical anesthesia was classified as success or failure according to the need for systemic intraoperative supplementation. Duration of anesthesia was defined as time from blockade placement until the first analgesic request. RESULTS: Median onset times were 5, 12.5, and 17.5 minutes for groups 1, 2 and 3, respectively (p = 0.11). Success rates were 100%, 93% and 75% (p = 0.12), and postoperative analgesia duration was 14.5, 13.5 and 13.75 hours (p = 0.15) for groups 1, 2 and 3, respectively. CONCLUSIONS: Intramuscular or perineural clonidine has not affected anesthetic onset, quality or the duration of postoperative analgesia of 0.5% ropivacaine-induced sciatic nerve block.

Helayel PE; Kroth L; Boos GL; Jahns MT; Oliveira Filho GR

2005-10-01

157

Percutaneous sciatic nerve block with tramadol induces analgesia and motor blockade in two animal pain models  

Scientific Electronic Library Online (English)

Full Text Available Abstract in english Local anesthetic efficacy of tramadol has been reported following intradermal application. Our aim was to investigate the effect of perineural tramadol as the sole analgesic in two pain models. Male Wistar rats (280-380 g; N = 5/group) were used in these experiments. A neurostimulation-guided sciatic nerve block was performed and 2% lidocaine or tramadol (1.25 and 5 mg) was perineurally injected in two different animal pain models. In the flinching behavior test, the numb (more) er of flinches was evaluated and in the plantar incision model, mechanical and heat thresholds were measured. Motor effects of lidocaine and tramadol were quantified and a motor block score elaborated. Tramadol, 1.25 mg, completely blocked the first and reduced the second phase of the flinching behavior test. In the plantar incision model, tramadol (1.25 mg) increased both paw withdrawal latency in response to radiant heat (8.3 ± 1.1, 12.7 ± 1.8, 8.4 ± 0.8, and 11.1 ± 3.3 s) and mechanical threshold in response to von Frey filaments (459 ± 82.8, 447.5 ± 91.7, 320.1 ± 120, 126.43 ± 92.8 mN) at 5, 15, 30, and 60 min, respectively. Sham block or contralateral sciatic nerve block did not differ from perineural saline injection throughout the study in either model. The effect of tramadol was not antagonized by intraperitoneal naloxone. High dose tramadol (5 mg) blocked motor function as well as 2% lidocaine. In conclusion, tramadol blocks nociception and motor function in vivo similar to local anesthetics.

Sousa, A.M.; Ashmawi, H.A.; Costa, L.S.; Posso, I.P.; Slullitel, A.

2012-02-01

158

Excitation block in a nerve fibre model owing to potassium-dependent changes in myelin resistance  

DEFF Research Database (Denmark)

The myelinated nerve fibre is formed by an axon and Schwann cells or oligodendrocytes that sheath the axon by winding around it in tight myelin layers. Repetitive stimulation of a fibre is known to result in accumulation of extracellular potassium ions, especially between the axon and the myelin. Uptake of potassium leads to Schwann cell swelling and myelin restructuring that impacts the electrical properties of the myelin. In order to further understand the dynamic interaction that takes place between the myelin and the axon, we have modelled submyelin potassium accumulation and related changes in myelin resistance during prolonged high-frequency stimulation. We predict that potassium-mediated decrease in myelin resistance leads to a functional excitation block with various patterns of altered spike trains. The patterns are found to depend on stimulation frequency and amplitude and to range from no block (less than 100 Hz) to a complete block (greater than 500 Hz). The transitional patterns include intermittent periodic block with interleaved spiking and non-spiking intervals of different relative duration as well as an unstable regime with chaotic switching between the spiking and non-spiking states. Intermittent conduction blocks are accompanied by oscillations of extracellular potassium. The mechanism of conductance block based on myelin restructuring complements the already known and modelled block via hyperpolarization mediated by the axonal sodium pump and potassium depolarization.

Brazhe, A.R.; Maksimov, G.V.

2011-01-01

159

Excitation block in a nerve fibre model owing to potassium-dependent changes in myelin resistance.  

Science.gov (United States)

The myelinated nerve fibre is formed by an axon and Schwann cells or oligodendrocytes that sheath the axon by winding around it in tight myelin layers. Repetitive stimulation of a fibre is known to result in accumulation of extracellular potassium ions, especially between the axon and the myelin. Uptake of potassium leads to Schwann cell swelling and myelin restructuring that impacts the electrical properties of the myelin. In order to further understand the dynamic interaction that takes place between the myelin and the axon, we have modelled submyelin potassium accumulation and related changes in myelin resistance during prolonged high-frequency stimulation. We predict that potassium-mediated decrease in myelin resistance leads to a functional excitation block with various patterns of altered spike trains. The patterns are found to depend on stimulation frequency and amplitude and to range from no block (less than 100 Hz) to a complete block (greater than 500 Hz). The transitional patterns include intermittent periodic block with interleaved spiking and non-spiking intervals of different relative duration as well as an unstable regime with chaotic switching between the spiking and non-spiking states. Intermittent conduction blocks are accompanied by oscillations of extracellular potassium. The mechanism of conductance block based on myelin restructuring complements the already known and modelled block via hyperpolarization mediated by the axonal sodium pump and potassium depolarization. PMID:22419976

Brazhe, A R; Maksimov, G V; Mosekilde, E; Sosnovtseva, O V

2010-12-01

160

Excitation block in a nerve fibre model owing to potassium-dependent changes in myelin resistance.  

UK PubMed Central (United Kingdom)

The myelinated nerve fibre is formed by an axon and Schwann cells or oligodendrocytes that sheath the axon by winding around it in tight myelin layers. Repetitive stimulation of a fibre is known to result in accumulation of extracellular potassium ions, especially between the axon and the myelin. Uptake of potassium leads to Schwann cell swelling and myelin restructuring that impacts the electrical properties of the myelin. In order to further understand the dynamic interaction that takes place between the myelin and the axon, we have modelled submyelin potassium accumulation and related changes in myelin resistance during prolonged high-frequency stimulation. We predict that potassium-mediated decrease in myelin resistance leads to a functional excitation block with various patterns of altered spike trains. The patterns are found to depend on stimulation frequency and amplitude and to range from no block (less than 100 Hz) to a complete block (greater than 500 Hz). The transitional patterns include intermittent periodic block with interleaved spiking and non-spiking intervals of different relative duration as well as an unstable regime with chaotic switching between the spiking and non-spiking states. Intermittent conduction blocks are accompanied by oscillations of extracellular potassium. The mechanism of conductance block based on myelin restructuring complements the already known and modelled block via hyperpolarization mediated by the axonal sodium pump and potassium depolarization.

Brazhe AR; Maksimov GV; Mosekilde E; Sosnovtseva OV

2011-02-01

 
 
 
 
161

[Effects of a beta-adrenergic blocking drug, atenolol, on efferent renal nerve activity in rabbits (author's transl)  

UK PubMed Central (United Kingdom)

Postganglionic sympathetic nerve activity (renal nerve) decreased significantly during i.v. infusion of a beta-adrenergic blocking drug, atenolol, in anesthetized rabbits. This phenomenon, at least in part reflex in nature, may contribute to the hypotensive effect of atenolol.

Friggi A; Chevalier-Cholat AM; Bodard H

1977-09-01

162

[Partial blocking of the tibial nerve with phenol as treatment of gait disorders due to pes equinus in central paralysis  

UK PubMed Central (United Kingdom)

Partial chemical neurolysis by means of a peripheral nerve block induced with a phenol solution can result in decreasing local muscle hypertonia of central origin. In case of a walking disability resulting from a spastic or dystonic equinovarus position of the ankle the phenol block of the tibial nerve may be a valuable treatment that improves walking ability. The technique of the procedure is explained. A phenol block is induced only after a favourable result of a trial block with a local anaesthetic. In the group of 19 patients who underwent tibial nerve block given by the author in the period 1987-1989 there appears to exist a correlation between the functional results and the extent to which the patient had been active in walking prior to the nerve block. A group of 6 'sitters' and 'hardly walking' patients had poor to moderate results, a group of 13 'walkers' had moderate, good and excellent results. The difference in functional outcome is ascribed by the author to a better possibility to actually utilise a muscular balance improved by the phenol block. In the early--recovery--phase of stroke rehabilitation a phenol block of the tibial nerve may well be useful in cases with equinovarus position of the ankle which interferes with therapeutic exercise and functional progress.

Wichers MJ

1991-04-01

163

Continuous peripheral nerve block compared with single-injection peripheral nerve block: a systematic review and meta-analysis of randomized controlled trials.  

UK PubMed Central (United Kingdom)

BACKGROUND AND OBJECTIVES: Many practitioners consider continuous peripheral nerve blocks (cPNBs) to be superior to single-injection peripheral nerve blocks (siPNBs). Several randomized controlled trials have demonstrated improved pain control, patient satisfaction, and other outcomes for patients with cPNBs compared with patients with siPNBs, whereas other trials have not shown significant differences. We sought to clarify any potential advantages of cPNBs over siPNBs. METHODS: We conducted a systematic review and meta-analysis of all prospective, randomized trials comparing cPNBs with siPNBs. We used a validated systematic search strategy to identify potentially eligible studies. For studies meeting inclusion criteria, methodologic quality was scored independently by 2 reviewers. Data from the studies were abstracted and pooled for meta-analysis. RESULTS: Compared with siPNBs, cPNBs were associated with a decreased rating of worst pain on postoperative day 0 (effect size [ES], -1.29; 95% confidence interval [CI], -2.19 to -0.40; P = 0.005), postoperative day 1 (ES, -1.87; 95% CI, -2.44 to -1.31; P < 0.001), and postoperative day 2 (ES, -2.03; 95% CI, -2.78 to -1.290; P < 0.001); decreased overall opioid use (ES, -15.70; 95% CI, -21.84 to -9.55; P < 0.001); less nausea (ES, 0.633; 95% CI, 0.407-0.983; P = 0.043); and higher patient satisfaction scores (weighted mean difference, -2.04; 95% CI, 1.24-2.85; P < 0.001). CONCLUSIONS: Compared with siPNBs, cPNBs were associated with improved pain control, decreased need for opioid analgesics, less nausea, and greater patient satisfaction. The effect of cPNBs on other clinically relevant outcomes, such as complications, long-term functional outcomes, or costs, remains unclear.

Bingham AE; Fu R; Horn JL; Abrahams MS

2012-11-01

164

Obturator hernia of the fallopian tube.  

UK PubMed Central (United Kingdom)

Obturator hernia of the fallopian tube is extremely rare. Multidetector computed tomography of a 43-year-old nulliparous woman with sudden onset lower right abdominal pain showed a low-density mass in the right obturator canal suspected of being an obturator hernia of the uterine adnexa. She was diagnosed as having an incarcerated obturator hernia of the fallopian tube at operation and treated with prosthetic mesh. Obturator hernia of the fallopian tube is very rare, and all cases reported in the literature were localized on the right side, perhaps due to the lesser mobility of the left than the right fallopian tube.

Karasaki T; Nakagawa T; Tanaka N

2013-06-01

165

[Operative management in axillary brachial plexus blocks: comparison of ultrasound and nerve stimulation  

UK PubMed Central (United Kingdom)

Given a case-by-case accounting system, the analysis of medical performance becomes increasingly important. Quality of treatment and the time effort attached play an important role. Anaesthesia procedures require a high level of quality and safety. Moreover, they are personnel intensive. In the area of regional anaesthesia, new procedures such as the use of high definition ultrasonography for nerve blocks, allow a possible time gain as well as improved quality. The aim of this investigation was to analyze the impact on time and results when using ultrasonography or nerve stimulation for axillary brachial plexus blocks. Therefore, over a time period of 9 months, the ultrasound-guided plexus anaesthesia (Sono) and the neurostimulation methods (NStim) were investigated based upon the anaesthesia documentation of patients undergoing hand surgery. Only those cases were included where an axillary brachial plexus block had been performed, incomplete protocols were excluded and 1.5% mepivacaine was used as medication. Overall, a total of 130 cases fulfilled these criteria. The success rates, time consumption and timelines were evaluated. All data was stored on an Excel-sheet and statistically evaluated. The results revealed a significant increase in the success rate for the patient group where ultrasound was used (98.2% Sono vs 83.1% NStim) and the operation could begin 15 min earlier in the Sono group (5 min vs. 20 min, p<0.001). Furthermore, the duration of anaesthesia was significantly shorter (85 min vs. 120 min, p<0.001) and the necessity for post-operative observation was less (5.4% vs. 32.4%, p<0.001). The data provided in the study indicate that the use of ultrasound for the identification of the nerves can clearly improve quality and time-scales of axillary brachial plexus blocks.

Schwemmer U; Schleppers A; Markus C; Kredel M; Kirschner S; Roewer N

2006-04-01

166

Use of ultrasound to facilitate accurate femoral nerve block in the emergency department.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To compare the accuracy of ultrasound (US)-assisted femoral nerve blocks (FNB) with the fascial pop (FP) technique, examining the rates of success and complications. METHODS: This is a prospective unblinded pseudo-randomized controlled trial of US-assisted versus FP FNB techniques. The primary outcome measure was nerve block stratified to level of blockade (intact, partial or complete) with FNB assessed by skin sensation. Participants were assessed at 15 and 60 min post nerve block. RESULTS: Sixty-seven patients were enrolled. Thirty-four (50.7% [95% CI 44.7-56.8]) underwent the US-assisted technique whereas thirty-three (49.2% [95% CI 43.4-55.2]) underwent the FP technique. At 15 min, FNB using US was intact, partial or complete for 9 (26.5% [95% CI 22.5-30.4]), 15 (44.1% [95% CI 36.8-51.5]) and 10 (29.4% [95% CI 24.9-33.9]) patients, respectively, compared with 14 (42.4% [95% CI 35.3-49.6]), 17 (51.5% [95% CI 42.7-60.3]) and 2 (6.1% [95% CI 5.6-6.6]) patients, respectively (P = 0.038). There was no difference at 60 min. Complete block at 15 min was achieved in 10/34 patients (29% [95% CI 14.1-44.7]) in the US group and 2/33 patients (6% [95% CI -2.1-14.2]) in the FP group (P = 0.029); no difference was seen at 60 min. No complications were recorded in either group. CONCLUSIONS: A more complete blockade is achieved earlier using the US-assisted technique. The US-assisted technique will become the technique of choice for FNB in this department.

Reid N; Stella J; Ryan M; Ragg M

2009-04-01

167

The hyperthermic effect of a distal volar forearm nerve block: a possible treatment of acute digital frostbite injuries?  

UK PubMed Central (United Kingdom)

BACKGROUND: The authors have observed that carpal tunnel surgery nerve blocks consisting of subfascial distal volar forearm injection of 10 cc of 1% lidocaine with epinephrine result in fingers that appear hyperemic, warm, and numb in both median and ulnar nerve distributions. The purposes of this study were to (1) determine whether forearm nerve blocks in patients undergoing carpal tunnel releases result in an objective increase in finger temperature, and (2) document the location and duration of finger anesthesia. METHODS: Thirty-nine patients undergoing unilateral carpal tunnel release were studied prospectively. An infrared thermometer was used to measure the temperature in the fingers of operative and nonoperative hands before and after injection of local anesthetic. The distal volar forearm block was performed using 10 cc of 1% lidocaine with 1:100,000 epinephrine deep to the forearm fascia between the median and ulnar nerves 1 cm proximal to the wrist crease. Before and after carpal tunnel release, bilateral finger temperatures were measured at hourly intervals. Statistical analysis included a one-sample test of proportions. RESULTS: The finger temperature of the operative hand was significantly warmer than the unoperated hand over the first 2 hours after the nerve block. Seventy-four percent of patients had a statistically significant increase in temperature. On average, the nerve block lasted 6.27 hours in the median nerve distribution and 5.78 hours in the ulnar nerve distribution. CONCLUSIONS: Forearm nerve blocks produce a chemical sympathectomy that provides a significant increase in skin temperature as a result of vasodilatation in most patients. They also provide prolonged finger numbness. This could be of clinical benefit in patients with acute finger frostbite injuries.

Chandran GJ; Chung B; Lalonde J; Lalonde DH

2010-09-01

168

Comparative study between combined sciatic-femoral nerve block, via a single skin injection, and spinal block anesthesia for unilateral surgery of the lower limb.  

UK PubMed Central (United Kingdom)

BACKGROUND AND OBJECTIVES: Unilateral spinal anesthesia has advantages when used in outpatient basis. The objective of the present study was to compare unilateral spinal anesthesia with combined sciatic-femoral nerve block in unilateral orthopedic surgeries in outpatients. METHODS: Sixty patients were randomly divided into two groups of 30 patients to receive 6 mg of hyperbaric or hypobaric bupivacaine (RQ group) in left lateral decubitus, or 800 mg of 1.6% lidocaine with epinephrine on sciatic and femoral nerves (CFI group) in dorsal decubitus. A 150-mm needle connected to a neurostimulator, inserted in the middle point between both classical approaches, was used for the nerve block, with the injection of 15 mL on the femoral nerve and 35 mL on the sciatic nerve. The time for the blockades and their duration were evaluated. After twenty minutes, patients were evaluated regarding the sensorial and motor blockades. RESULTS: Time for performance of spinal anesthesia was substantially lower than for combined sciatic-femoral nerve block. Unilateral blockade was achieved in 90% of the patients in the RQ group, and 100% in the CFI group. Bradycardia or hypotension was not observed. CONCLUSIONS: This study concluded that combined sciatic-femoral nerve block is technically easy to perform and it can be an alternative for unilateral blockade of the lower limbs. Unilateral spinal anesthesia with low doses of bupivacaine resulted in shorter time to perform it, lower number of attempts, and earlier recovery than combined sciatic-femoral nerve block, but with the same efficacy.

Imbelloni LE; de Rezende GV; Ganem EM; Cordeiro JA

2010-11-01

169

[Pyomyositis of hip obturator muscles  

UK PubMed Central (United Kingdom)

Obturator internus muscle abscess (pyomyositis) is extremely rare in temperate environments, although there has been a recent reported increase in prevalence. There usually is a delay in diagnosis and onset of treatment. In addition to our case, we reviewed all cases of pyomyositis of hip muscles found in a review of the recent medical literature.

Downey Carmona FJ; Farrington Rueda D

2006-10-01

170

[Pyomyositis of hip obturator muscles].  

Science.gov (United States)

Obturator internus muscle abscess (pyomyositis) is extremely rare in temperate environments, although there has been a recent reported increase in prevalence. There usually is a delay in diagnosis and onset of treatment. In addition to our case, we reviewed all cases of pyomyositis of hip muscles found in a review of the recent medical literature. PMID:17352115

Downey Carmona, F J; Farrington Rueda, D

2006-10-01

171

Cerebellar and brainstem infarction as a complication of CT-guided transforaminal cervical nerve root block  

Energy Technology Data Exchange (ETDEWEB)

A 60-year-old man with a 4-year history of intractable neck pain and radicular pain in the C5 nerve root distribution presented to our department for a CT-guided transforaminal left C5 nerve root block. He had had a similar procedure on the right 2 months previously, and had significant improvement of his symptoms with considerable pain relief. On this occasion he was again accepted for the procedure after the risks and potential complications had been explained. Under CT guidance, a 25G spinal needle was introduced and after confirmation of the position of the needle, steroid was injected. Immediately the patient became unresponsive, and later developed a MR-proven infarct affecting the left vertebral artery (VA) territory. This is the first report of a major complication of a cervical root injection under CT guidance reported in the literature. We present this case report and the literature review of the potential complications of this procedure. (orig.)

Suresh, S. [The Royal National Orthopaedic Hospital NHS Trust, London (United Kingdom); Berman, J. [The Royal National Orthopaedic Hospital NHS Trust, Anaesthetic Department, London (United Kingdom); Connell, David A. [The Royal National Orthopaedic Hospital NHS Trust, Department of Radiology, London (United Kingdom)

2007-05-15

172

Single-injection or Continuous Femoral Nerve Block for Total Knee Arthroplasty?  

UK PubMed Central (United Kingdom)

BACKGROUND: The ideal local anesthetic regime for femoral nerve block that balances analgesia with mobility after total knee arthroplasty (TKA) remains undefined. QUESTIONS/PURPOSES: We compared two volumes and concentrations of a fixed dose of ropivacaine for continuous femoral nerve block after TKA to a single injection femoral nerve block with ropivacaine to determine (1) time to discharge readiness; (2) early pain scores and analgesic consumption; and (3) functional outcomes, including range of motion and WOMAC scores at the time of recovery. METHODS: Ninety-nine patients were allocated to one of three continuous femoral nerve block groups for this randomized, placebo-controlled, double-blind trial: a high concentration group (ropivacaine 0.2% infusion), a low concentration group (ropivacaine 0.1% infusion), or a placebo infusion group (saline 0.9% infusion). Infusions were discontinued on postoperative Day (POD) 2. The primary outcome was time to discharge readiness. Secondary outcomes included opioid consumption, pain, and functional outcomes. Ninety-three patients completed the study protocol; the study was halted early because of unanticipated changes to pain protocols at the host institution, by which time only 61% of the required number of patients had been enrolled. RESULTS: With the numbers available, the mean time to discharge readiness was not different between groups (high concentration group, 62 hours [95% confidence interval [CI], 51-72 hours]; low concentration group, 73 hours [95% CI, 63-83 hours]; placebo infusion group 65 hours [95% CI, 56-75 hours]; p = 0.27). Patients in the low concentration group consumed significantly less morphine during the period of infusion (POD 1, high concentration group, 56 mg [95% CI, 42-70 mg]; low concentration group, 35 mg [95% CI, 27-43 mg]; placebo infusion group, 48 mg [95% CI, 38-59 mg], p = 0.02; POD 2, high concentration group, 50 mg [95% CI, 41-60 mg]; low concentration group, 33 mg [95% CI, 24-42 mg]; placebo infusion group, 39 mg [95% CI, 30-48 mg], p = 0.04); however, there were no important differences in pain scores or opioid-related side effects with the numbers available. Likewise, there were no important differences in functional outcomes between groups. CONCLUSIONS: Based on this study, which was terminated prematurely before the desired sample size could be achieved, we were unable to demonstrate that varying the concentration and volume of a fixed-dose ropivacaine infusion for continuous femoral nerve block influences time to discharge readiness when compared with a conventional single-injection femoral nerve block after TKA. A low concentration of ropivacaine infusion can reduce postoperative opioid consumption but without any important differences in pain scores, side effects, or functional outcomes. These pilot data may be used to inform the statistical power of future randomized trials. LEVEL OF EVIDENCE: Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Albrecht E; Morfey D; Chan V; Gandhi R; Koshkin A; Chin KJ; Robinson S; Frascarolo P; Brull R

2013-08-01

173

A New Anterior Approach for Fluoroscopy-guided Suprascapular Nerve Block - A Preliminary Report -.  

UK PubMed Central (United Kingdom)

BACKGROUND: The aim of the study was to investigate the feasibility of fluoroscopy-guided anterior approach for suprascapular nerve block (SSNB). METHODS: Twenty patients with chronic shoulder pain were included in the study. All of the nerve blocks were performed with patients in a supine position. Fluoroscopy was tilted medially to obtain the best view of the scapular notch (medial angle) and caudally to put the base of coracoid process and scapular spine on same line (caudal angle). SSNB was performed by introducing a 100-mm, 21-gauge needle to the scapular notch with tunnel view technique. Following negative aspiration, 1.0 ml of contrast was injected to confirm the scapular notch, and 1 % mepivacaine 2 ml was slowly injected. The success of SSNB was assessed by numerical rating scale (NRS) before and after the block. RESULTS: The average NRS was decreased from 4.8 ± 0.6 to 0.6 ± 0.5 after the procedure (P < 0.05). The best view of the scapular notch was obtained in a medial angle of 15.1 ± 2.2 (11-19°) and a caudal angle of 15.4 ± 1.7° (12-18°). The average distance from the skin to the scapular notch was 5.8 ± 0.6 cm. None of the complications such as pneumothorax, intravascular injection, and hematoma formation was found except one case of partial brachial plexus block. CONCLUSIONS: SSNB by fluoroscopy-guided anterior approach is a feasible technique. The advantage of using a fluoroscopy resulted in an effective block with a small dose of local anesthetics by an accurate placement of a tip of needle in the scapular notch while avoiding pneumothorax.

Kang SS; Jung JW; Song CK; Yoon YJ; Shin KM

2012-07-01

174

Dexmedetomidine as an adjuvant to ropivacaine prolongs peripheral nerve block: a volunteer study.  

UK PubMed Central (United Kingdom)

BACKGROUND: Dexmedetomidine is an ?-2-receptor agonist which might be used as an additive to local anaesthetics for various regional anaesthetic techniques. We therefore designed this prospective, double-blinded, controlled volunteer study to investigate the effects of dexmedetomidine as an adjuvant to ropivacaine on peripheral nerve block. METHODS: Ultrasound-guided ulnar nerve block (UNB) was performed in 36 volunteers with either 3 ml ropivacaine 0.75% (R), 3 ml ropivacaine 0.75% plus 20 µg dexmedetomidine (RpD), or 3 ml ropivacaine 0.75% plus systemic 20 µg dexmedetomidine (RsD). UNB-related sensory and motor scores were evaluated. RESULTS: Sensory onset time of UNB was not different between the study groups, whereas motor onset time was significantly faster in Group RpD when compared with the other study groups [mean (sd)] [21 (15) vs 43 (25) min in Group RsD and 47 (36) min in Group R, P<0.05 Group RpD vs other groups]. The duration of sensory block was 350 (54) min in Group R, 555 (118) min in Group RpD, and 395 (40) min in Group RsD (P<0.01 Group RpD vs other groups, P<0.05 Group RsD vs Group R). Motor block duration was similar to the duration of sensory block. CONCLUSIONS: A profound prolongation of UNB of ?60% was detected with perineural dexmedetomidine when added to 0.75% ropivacaine. The systemic administration of 20 µg dexmedetomidine resulted in a prolongation of ?10% during UNB with 0.75% ropivacaine. Eudra-CT No.: 2012-000030-19.

Marhofer D; Kettner SC; Marhofer P; Pils S; Weber M; Zeitlinger M

2013-03-01

175

Age-dependent bupivacaine-induced muscle toxicity during continuous peripheral nerve block in rats.  

UK PubMed Central (United Kingdom)

BACKGROUND: Regional blocks improve postoperative analgesia and postoperative rehabilitation in children and adult patients. Continuous peripheral nerve blocks have been proposed as safe and effective techniques for postoperative pain relief and chronic pain therapy, particularly in small children. Few clinical reports have described myotoxicity induced by bupivacaine in these young patients, in contrast with a larger number of observations in adults. Here, the authors addressed this issue by a comparative evaluation of bupivacaine-induced myotoxicity in young versus adult rats. METHODS: Femoral nerve block catheters were inserted in male Wistar rats. Young (3-week-old) and adult (12-week-old) rats were randomly assigned to received seven injections (1 ml/kg) of 0.25% bupivacaine (n = 6 per experiment) or isotonic saline (n = 6 per experiment) at 8-h intervals. Rats were killed 8 h after the last injection. Psoas muscle adjacent to the femoral nerve was quickly dissected. Oxygen consumption rates were measured in saponin-skinned fibers, mitochondrial adenosine triphosphate synthesis rates were determined by bioluminescence, and citrate synthase activity was determined by spectrophotometry. Muscle ultrastructural damage was also examined and scored as normal, focal disruption, moderate disruption, or extreme disruption of the sarcomeres. RESULTS: Bupivacaine caused a reduction of mitochondrial adenosine triphosphate synthesis rate, a decrease of citrate synthase activity, and muscle ultrastructural damages. Young rats treated with bupivacaine showed more severe alterations of mitochondrial bioenergetics and muscle ultrastructure. CONCLUSIONS: These findings demonstrate that bupivacaine-induced myotoxicity can be explained by mitochondrial bioenergetics alterations, which are more severe in young rats.

Nouette-Gaulain K; Dadure C; Morau D; Pertuiset C; Galbes O; Hayot M; Mercier J; Sztark F; Rossignol R; Capdevila X

2009-11-01

176

Development and validation of an equine nerve block simulator to supplement practical skills training in undergraduate veterinary students.  

UK PubMed Central (United Kingdom)

Lameness is the most common presenting complaint in equine practice. Performing diagnostic nerve blocks is an integral part of any lameness work-up, and is therefore an essential skill for equine practitioners. However, the opportunities for veterinary students to practice this skill are limited. The aim of this study was to design and validate an equine nerve block simulator. It was hypothesised that the simulator would improve students' ability and enhance their confidence in performing nerve blocks. A simulator was built using an equine forelimb skeleton and building foam. Wire wool targets were placed under the foam in the positions corresponding to the anatomical location of the most palmar digital, abaxial and low four-point nerve blocks and attached to an electrical circuit. The circuit became complete when the operator placed a needle in the correct position and immediate audible feedback with a buzzer was provided. To validate the simulator, it was compared with two established teaching methods: cadaver training and theoretical training with a hand-out. Cadaver-trained students achieved the best results (73 per cent correct blocks), compared with simulator-trained students (71 per cent correct blocks), and a hand-out trained group (58 per cent correct blocks). Feedback obtained with a questionnaire showed that students enjoyed simulator training more, and that they felt more confident in performing diagnostic nerve blocks than the other two groups. The equine nerve block simulator provides a safe, cost-effective method to supplement the teaching of diagnostic analgesia to undergraduate veterinary students.

Gunning P; Smith A; Fox V; Bolt DM; Lowe J; Sinclair C; Witte TH; Weller R

2013-04-01

177

Perioperative continuous peripheral nerve blocks with disposable infusion pumps in children: a prospective descriptive study.  

UK PubMed Central (United Kingdom)

Continuous peripheral nerve blocks (CPNB) after pediatric major orthopedic surgery are not widely used. We conducted a prospective descriptive study to evaluate the effectiveness of disposable elastomeric pumps for CPNB in children. After inducing general anesthesia, 25 consecutive children scheduled for major orthopedic surgery received a 0.5-mL/kg bolus of a mixture of 1% lidocaine with epinephrine and 0.25% bupivacaine in axillary, femoral, or popliteal catheters. After surgery, disposable pumps with 0.2% ropivacaine were connected. Pump flows were adjusted to the patient's weight. Postoperative pain was evaluated using a visual analog scale or Children and Infants Postoperative Pain Scale scores at H1, H6, H12, H24, and H48, as well as amounts of rescue analgesia, adverse events, and motor and sensory block. An ambulation score for the children was also evaluated. Eleven popliteal, nine femoral, and five axillary continuous blocks were performed. All the blocks were effective for surgery. The mean total dose consumption of 0.2% ropivacaine was 10.1 mg/kg. Disposable pump flow varied from -9.61% to +8.6% compared with the theoretical one. Postoperative analgesia was excellent. The median of pain score was zero at each period studied. Sensory and motor block were noted at H1 and decreased from the sixth hour. No adverse events were noted. We concluded that the use of elastomeric disposable pumps for CPNB in children was an effective technique.

Dadure C; Pirat P; Raux O; Troncin R; Rochette A; Ricard C; Capdevila X

2003-09-01

178

Alternating block polyurethanes based on PCL and PEG as potential nerve regeneration materials.  

UK PubMed Central (United Kingdom)

Polyurethanes with regular and controlled block arrangement, i.e. alternating block polyurethanes (abbreviated as PUCL-alt-PEG) based on poly(?-caprolactone) (PCL-diol) and poly(ethylene glycol) (PEG) was prepared via selectively coupling reaction between PCL-diol and diisocyanate end-capped PEG. Chemical structure, molecular weight, distribution and thermal properties were systematically characterized by FTIR, (1) H NMR, GPC, DSC and TGA. Hydrophilicity was studied by static contact angle of H2 O and CH2 I2 . Film surface was observed by scanning electron microscope (SEM) and atomic force microscopy (AFM), and mechanical properties were assessed by universal test machine. Results show that alternating block polyurethanes give higher crystal degree, higher mechanical properties and more hydrophilic and rougher (deep ravine) surface than their random counterpart, due to regular and controlled structure. Platelet adhesion illustrated that PUCL-alt-PEG has better hemocompatibility and the hemacompatibility was affected significantly by PEG content. Excellent hemocompatibility was obtained with high PEG content. CCK-8 assay and SEM observation revealed much better cell compatibility of fibroblast L929 and rat glial cells on the alternating block polyurethanes than that on random counterpart. Alternating block polyurethane PUC20-a-E4 with optimized composition, mechanical, surface properties, hemacompatibility and highest cell growth and proliferation was achieved for potential use in nerve regeneration.

Li G; Li D; Niu Y; He T; Chen KC; Xu K

2013-03-01

179

Ultrasound-guided supraclavicular brachial plexus nerve block vs procedural sedation for the treatment of upper extremity emergencies.  

UK PubMed Central (United Kingdom)

BACKGROUND: Emergency physicians often treat patients who require procedural sedation for the management of upper extremity fractures, dislocations, and abscesses (upper extremity emergencies). Unfortunately, procedural sedation is associated with several rare but potentially serious adverse effects and requires continuous hemodynamic monitoring and several dedicated staff members. The purpose of this study was to determine the role of ultrasound-guided supraclavicular brachial plexus nerve blocks in the emergency department (ED) as an alternative to procedural sedation for the management of upper extremity emergencies. METHODS: In a prospective trial, a convenience sample of ED patients with upper extremity emergencies that would normally require procedural sedation were assigned to receive either procedural sedation or an ultrasound-guided supraclavicular brachial plexus nerve block. Emergency department length of stay (ED LOS) was the primary outcome measure and was analyzed using a paired 2-tailed Student t test. RESULTS: A total of 12 subjects were enrolled. Average ED LOS for subjects receiving the brachial plexus nerve block was 106 minutes (95% confidence interval, 57-155 minutes). Average ED LOS for subjects receiving procedural sedation was 285 minutes (95% confidence interval, 228-343 minutes). The ED LOS was significantly shorter in the nerve block group (P < .0005). Patient satisfaction was high in both groups, and no significant complications occurred in either group. CONCLUSIONS: In our population, ultrasound-guided brachial plexus nerve blocks resulted in shorter ED LOS compared to procedural sedation for patients with upper extremity fractures, dislocations, or abscesses.

Stone MB; Wang R; Price DD

2008-07-01

180

Prospective, double-blind, randomized controlled trial of electrophysiologically guided femoral nerve block in total knee arthroplasty  

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Full Text Available Yoon Seok Youm,1 Sung Do Cho,1 Chang Ho Hwang21Department of Orthopedic Surgery, 2Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of KoreaBackground: The purpose of this study was to compare electrophysiologically guided and traditional nerve stimulator analgesia femoral nerve block after total knee arthroplasty.Methods: Patients scheduled for unilateral total knee arthroplasty were randomized to electrophysiologically guided or traditional nerve stimulator analgesia by pre-emptive single injection femoral nerve block with corresponding assistance. We assessed pain scores using a visual analog scale (VAS, 0 = no pain, 100 = the worst pain) and the volumes of morphine consumed at 4, 24, 48, and 72 hours after total knee arthroplasty.Results: Of the 60 patients enrolled, eight withdrew from the study. The remaining 52 patients were randomized to the electrophysiologically guided group (n = 27) or traditional nerve stimulator analgesia (n = 25) group. Four hours after total knee arthroplasty, VAS scores were significantly lower in the electrophysiologically guided group than in the traditional nerve stimulator group at rest (4.8 ± 1.4 versus 5.9 ± 0.8, P < 0.01) and while moving (6.2 ± 1.1 versus 6.9 ± 0.9, P < 0.01). The total volumes of morphine injected at 24, 48, and 72 hours were significantly decreased in the electrophysiologically guided group (P < 0.05 each). Variable × time interaction of VAS was significant in the electrophysiologically guided group (P < 0.05), with each VAS score at 24, 48, and 72 hours being significantly lower than the baseline score (P < 0.05). VAS scores at every time point were significantly lower in the electrophysiologically group guided than in the traditional nerve stimulator group (P < 0.05).Conclusion: Electrophysiologically guided single injection femoral nerve block may provide better postoperative analgesia and a greater reduction in the demand for pain killers than femoral nerve block using traditional nerve stimulator analgesia.Keywords: femoral nerve, nerve block, electrophysiologic concepts, arthroplasty, knee, ropivacaine

Youm YS; Cho SD; Hwang CH

2013-01-01

 
 
 
 
181

Continuous femoral nerve blocks: decreasing local anesthetic concentration to minimize quadriceps femoris weakness.  

UK PubMed Central (United Kingdom)

BACKGROUND: Whether decreasing the local anesthetic concentration during a continuous femoral nerve block results in less quadriceps weakness remains unknown. METHODS: Preoperatively, bilateral femoral perineural catheters were inserted in subjects undergoing bilateral knee arthroplasty (n = 36) at a single clinical center. Postoperatively, right-sided catheters were randomly assigned to receive perineural ropivacaine of either 0.1% (basal 12 ml/h; bolus 4 ml) or 0.4% (basal 3 ml/h; bolus 1 ml), with the left catheter receiving the alternative concentration/rate in an observer- and subject-masked fashion. The primary endpoint was the maximum voluntary isometric contraction of the quadriceps femoris muscles the morning of postoperative day 2. Equivalence of treatments would be concluded if the 95% CI for the difference fell within the interval -20%-20%. Secondary endpoints included active knee extension, passive knee flexion, tolerance to cutaneous electrical current applied over the distal quadriceps tendon, dynamic pain scores, opioid requirements, and ropivacaine consumption. RESULTS: Quadriceps maximum voluntary isometric contraction for limbs receiving 0.1% ropivacaine was a mean (SD) of 13 (8) N · m, versus 12 (8) N · m for limbs receiving 0.4% [intrasubject difference of 3 (40) percentage points; 95% CI -10-17; P = 0.63]. Because the 95% CI fell within prespecified tolerances, we conclude that the effect of the two concentrations were equivalent. Similarly, there were no statistically significant differences in secondary endpoints. CONCLUSIONS: For continuous femoral nerve blocks, we found no evidence that local anesthetic concentration and volume influence block characteristics, suggesting that local anesthetic dose (mass) is the primary determinant of perineural infusion effects.

Bauer M; Wang L; Onibonoje OK; Parrett C; Sessler DI; Mounir-Soliman L; Zaky S; Krebs V; Buller LT; Donohue MC; Stevens-Lapsley JE; Ilfeld BM

2012-03-01

182

Perioperative pain management of a complex orthopedic surgical procedure with double continuous nerve blocks in a burned child.  

UK PubMed Central (United Kingdom)

UNLABELLED: The use of catheters for continuous nerve blocks has been established in children, although in most series only one catheter was used. We report a case of a 3-yr-old child who underwent a toe-to-finger transfer managed with 2 regional catheters: axillary and sciatic. A pain score of 0 was noted during the entire study period. The total dose of bupivacaine was limited to an acceptable range, and the child recovered completely. This report adds to growing evidence in favor of the safety and efficacy of continuous peripheral nerve blocks in pediatric patients. IMPLICATIONS: Double continuous nerve blocks allow optimal analgesia in burned children after complex orthopedic surgery without major adverse events. Plasma concentrations of bupivacaine remained small during the study period.

Dadure C; Acosta C; Capdevila X

2004-06-01

183

High volume local infiltration analgesia compared to peripheral nerve block for hip and knee arthroplasty-what is the evidence?  

UK PubMed Central (United Kingdom)

Since being reported in 2008, high volume local infiltration analgesia (HVLIA) has rapidly gained popularity for patients undergoing hip and knee replacement. We undertook this review to investigate whether there was evidence for equivalence of HVLIA compared to peripheral nerve block techniques with respect to early postoperative analgesia and functional recovery, or for other outcomes such as cost and process efficiency, persistent postsurgical pain and arthroplasty revision rate. We found that despite the popularity of HVLIA, supporting evidence for its use is currently limited. HVLIA certainly provides postoperative analgesia, but it is not clear whether it is equivalent to contemporary peripheral nerve block techniques in terms of either analgesia or early or later functional outcome in the context of a modern, comprehensive enhanced recovery program. Nor is it possible to state whether HVLIA provides benefits in terms of persistent postsurgical pain or cost and process efficiency. Well designed trials directly comparing peripheral nerve block with a standardised HVLIA technique are urgently required.

Fowler SJ; Christelis N

2013-07-01

184

Low cost continuous femoral nerve block for relief of acute severe cancer related pain due to pathological fracture femur.  

UK PubMed Central (United Kingdom)

Pathological fractures in cancer patient cause severe pain that is difficult to control pharmacologically. Even with good pain relief at rest, breakthrough and incident pain can be unmanageable. Continuous regional nerve blocks have a definite role in controlling such intractable pain. We describe two such cases where severe pain was adequately relieved in the acute phase. Continuous femoral nerve block was used as an efficient, cheap and safe method of pain relief for two of our patients with pathological fracture femur. This method was proved to be quite efficient in decreasing the fracture-related pain and improving the level of well being.

Koshy RC; Padmakumar G; Rajasree O

2010-09-01

185

Low cost continuous femoral nerve block for relief of acute severe cancer related pain due to pathological fracture femur.  

Science.gov (United States)

Pathological fractures in cancer patient cause severe pain that is difficult to control pharmacologically. Even with good pain relief at rest, breakthrough and incident pain can be unmanageable. Continuous regional nerve blocks have a definite role in controlling such intractable pain. We describe two such cases where severe pain was adequately relieved in the acute phase. Continuous femoral nerve block was used as an efficient, cheap and safe method of pain relief for two of our patients with pathological fracture femur. This method was proved to be quite efficient in decreasing the fracture-related pain and improving the level of well being. PMID:21218010

Koshy, Rachel Cherian; Padmakumar, G; Rajasree, O

2010-09-01

186

Low cost continuous femoral nerve block for relief of acute severe cancer related pain due to pathological fracture femur  

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Full Text Available Pathological fractures in cancer patient cause severe pain that is difficult to control pharmacologically. Even with good pain relief at rest, breakthrough and incident pain can be unmanageable. Continuous regional nerve blocks have a definite role in controlling such intractable pain. We describe two such cases where severe pain was adequately relieved in the acute phase. Continuous femoral nerve block was used as an efficient, cheap and safe method of pain relief for two of our patients with pathological fracture femur. This method was proved to be quite efficient in decreasing the fracture-related pain and improving the level of well being.

Koshy Rachel; Padmakumar G; Rajasree O

2010-01-01

187

Ultrasound-guided combined intermediate and deep cervical plexus nerve block for regional anaesthesia in oral and maxillofacial surgery.  

UK PubMed Central (United Kingdom)

OBJECTIVES: We examined the application of an ultrasound-guided combined intermediate and deep cervical plexus nerve block for regional anaesthesia in patients undergoing oral and maxillofacial surgery. METHODS: A total of 19 patients receiving ultrasound-guided combined intermediate and deep cervical plexus anaesthesia followed by neck surgery were examined prospectively. The sternocleidomastoid and the levator of the scapula muscles as well as the cervical transverse processes were used as easily depicted ultrasound landmarks for the injection of local anaesthetics. Under ultrasound guidance, a needle was advanced in the fascial band between the sternocleidomastoid and the levator of the scapula muscles and 15 ml of ropivacaine 0.75% was injected. Afterwards, the needle was advanced between the levator of the scapula and the hyperechoic contour of the cervical transverse processes and a further 15 ml of ropivacaine 0.75% was injected. The sensory block of the cervical nerve plexus, the analgesic efficacy of the block within 24 h after injection and potential block-related complications were assessed. RESULTS: All patients showed a complete cervical plexus nerve block. No patient required analgesics within the first 24 h after anaesthesia. Two cases of blood aspiration were recorded. No further cervical plexus block-related complications were observed. CONCLUSIONS: Ultrasound-guided combined intermediate and deep cervical plexus block is a feasible, effective and safe method for oral and maxillofacial surgical procedures.

Perisanidis C; Saranteas T; Kostopanagiotou G

2013-01-01

188

Experimental study of carotid sinus nerve block in prevention and treatment of hemodynamics instability caused by carotid sinus stimulation  

International Nuclear Information System (INIS)

Objective: To evaluate the role of carotid sinus nerve block in prevention and treatment of hemodynamics instability caused by carotid sinus stimulation. Methods: Twenty-four Japanese white rabbits were randomized into three groups (8 in each). Respectively, one side of their carotid sinus nerves were blocked by normal saline (NS) (group A1), lidocaine (group A2) and both side were blocked by lidocaine (group A3), and then the blood pressure (BP) and heart rate (HR) were measured in two hours. 7 days later, the 24 rabbits were randomized into 2 groups averagely. The first 12 rabbits were randomized into 2 subgroups (6 in each). After blocking carotid sinus nerve with NS (group B1) or lidocaine (group B2), in two hours, the carotid sinus was stimulated repeatedly by stretching the common carotid artery (CCA), and contrasted the change of BP. The second 12 were randomized into two subgroups too (6 in each). One of each rabbit's CCA was continuously stretched. 3 minutes later, the carotid sinus nerves were blocked with NS (group C1) or lidocaine (group C2). BP in 60 minutes was contrasted between the two groups. Results: BP had no significant change in group A1 and A2 (F 0.31, P > 0.05; F = 0.65, P > 0.05), but BP rose significantly and transiently in group A3 (In 10 minutes all t > 2.60, P 0.05). Each stimulation could lead to BP downfall in group B1 (At all stimulating times t > 2.63, P 0.05). After the block with NS or lidocaine, hypotension had lasted for 17 minutes in group C1 (All t > 1.98, P 0.05). Conclusion: Mono-side carotid sinus nerve block has no significant influence on hemodynamics of normal rabbits, but has reliable preventional and therapeutic role on hemodynamics instability caused by carotid sinus stimulation

2003-01-01

189

Femoral fracture repair and sciatic and femoral nerve blocks in a guinea pig.  

UK PubMed Central (United Kingdom)

A four-month-old, entire male guinea pig was presented for surgical repair of a closed oblique femoral fracture. Analgesia was provided with 30?µg/kg?buprenorphine intramuscularly (im) four times a day and 0?·?3?mg/kg meloxicam subcutaneously once a day. The following day, anaesthesia was induced and maintained with 100?µg/kg medetomidine im, 20?mg/kg ketamine im, 30?µg/kg buprenorphine im and isoflurane in oxygen. Femoral and sciatic nerve blocks were performed with bupivacaine. The fracture was reduced and aligned using an intramedullary 1?·?4?mm?K-wire and a 3 metric polydioxanone cerclage. Three weeks postoperatively remodelling and callus formation was documented, with no evidence of complications. Complete union was present 14?weeks postoperatively.

Aguiar J; Mogridge G; Hall J

2013-02-01

190

Managing pain on the battlefield: an introduction to continuous peripheral nerve blocks.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To determine the strength of evidence supporting the battlefield use of Continual Peripheral Nerve Blocks (CPNBs). METHODS: Publication review identifying 380 potentially relevant papers. RESULTS: CPNBs have been well trialled and are used routinely in civilian hospitals. The procedure is not without acute and chronic complications related to agents used, catheters themselves and infection risks. These techniques are being used increasingly in military field hospitals to manage pain, however research concerning their use on the battlefield is limited and further trials are required to confidently conclude efficacy. CONCLUSION: CPNBs are just one component within military medicine of a rapidly evolving polymodal system of pain management. Common combat wounds, namely traumatic amputations, are compatible with this technique, however current evidence concerning their battlefield use is limited. Extensive UK military trials are ongoing and the results of which are expected to clarify questions regarding complication rate and efficacy.

Hunter JG

2010-12-01

191

Thermal hyperalgesia after sciatic nerve block in rat is transient and clinically insignificant.  

UK PubMed Central (United Kingdom)

Ropivacaine has been associated with transient heat hyperalgesia in sciatic nerve blocks in rat. The goal of the present study was to evaluate the hypothesized presence of transient heat hyperalgesia after perineural injection of ropivacaine with a secondary subanalysis of 2 published studies. Paw withdrawal latency was used to assess the duration of sensory blockade and presence of heat hyperalgesia at 210, 240, 270, and 300 minutes and 24 hours after injection. The analysis revealed hyperalgesia at a single time point (240 minutes after injection; mean difference, -0.60 seconds; P = 0.012) that resolved within 30 minutes, and there was no other significant hyperalgesia at other time points. Although statistically significant, the single time point measurement represented only an 11% change from baseline and was no longer present 30 minutes later. These data support the need for a reevaluation of the interpretation that pain can be worsened by perineural ropivacaine injection.

Janda A; Lydic R; Welch KB; Brummett CM

2013-03-01

192

Complications and adverse effects associated with continuous peripheral nerve blocks in orthopedic patients.  

UK PubMed Central (United Kingdom)

BACKGROUND: The increasing popularity of continuous peripheral nerve blocks (CPNBs) warrants further study of their adverse effects and complications. METHODS: Anterior sciatic, femoral, and interscalene brachial plexus CPNBs were performed preoperatively using standardized catheter techniques in orthopedic patients prior to general or spinal anesthesia. Complications and adverse effects related to CPNBs were prospectively evaluated. RESULTS: We analyzed 1398 CPNBs in 849 consecutive patients (mean age 65 +/- 13 yr) between 2002 and 2004. Two-hundred-twenty-one patients received interscalene, 628 patients femoral, and 549 sciatic CPNBs, respectively. In all the latter patients, we performed both femoral and sciatic CPNBs. Overall, there were 9 cases of local inflammation at the insertion site (0.6%), and 3 local infections (pustule) (0.2%, all femoral CPNBs). In one patient undergoing a femoral technique, a retroperitoneal hematoma led to compression injury of the femoral nerve. Complete denervation of the quadriceps femoris muscle was confirmed by electroneuromyography. No other major neurological complications were noted. There was one case of methemoglobinemia associated with an interscalene CPNB. Vascular puncture occurred in approximately 6% of patients undergoing femoral and sciatic CPNBs. Catheter rupture was noted in one patient. CONCLUSIONS: Our results add to the evidence that major complications from CPNBs are rare. However, minor adverse effects associated with CPNBs may be more common.

Wiegel M; Gottschaldt U; Hennebach R; Hirschberg T; Reske A

2007-06-01

193

Continuous Adductor Canal Blocks Are Superior to Continuous Femoral Nerve Blocks in Promoting Early Ambulation After TKA.  

UK PubMed Central (United Kingdom)

BACKGROUND: Femoral continuous peripheral nerve blocks (CPNBs) provide effective analgesia after TKA but have been associated with quadriceps weakness and delayed ambulation. A promising alternative is adductor canal CPNB that delivers a primarily sensory blockade; however, the differential effects of these two techniques on functional outcomes after TKA are not well established. QUESTIONS/PURPOSES: We determined whether, after TKA, patients with adductor canal CPNB versus patients with femoral CPNB demonstrated (1) greater total ambulation distance on Postoperative Day (POD) 1 and 2 and (2) decreased daily opioid consumption, pain scores, and hospital length of stay. METHODS: Between October 2011 and October 2012, 180 patients underwent primary TKA at our practice site, of whom 93% (n = 168) had CPNBs. In this sequential series, the first 102 patients had femoral CPNBs, and the next 66 had adductor canal CPNBs. The change resulted from a modification to our clinical pathway, which involved only a change to the block. An evaluator not involved in the patients' care reviewed their medical records to record the parameters noted above. RESULTS: Ambulation distances were higher in the adductor canal group than in the femoral group on POD 1 (median [10(th)-90(th) percentiles]: 37 m [0-90 m] versus 6 m [0-51 m]; p < 0.001) and POD 2 (60 m [0-120 m] versus 21 m [0-78 m]; p = 0.003). Adjusted linear regression confirmed the association between adductor canal catheter use and ambulation distance on POD 1 (B = 23; 95% CI = 14-33; p < 0.001) and POD 2 (B = 19; 95% CI = 5-33; p = 0.008). Pain scores, daily opioid consumption, and hospital length of stay were similar between groups. CONCLUSIONS: Adductor canal CPNB may promote greater early postoperative ambulation compared to femoral CPNB after TKA without a reduction in analgesia. Future randomized studies are needed to validate our major findings. LEVEL OF EVIDENCE: Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

Mudumbai SC; Kim TE; Howard SK; Workman JJ; Giori N; Woolson S; Ganaway T; King R; Mariano ER

2013-07-01

194

A randomized comparative study of efficacy of axillary and infraclavicular approaches for brachial plexus block for upper limb surgery using peripheral nerve stimulator  

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Full Text Available Brachial plexus block via the axillary approach is problematic in patients with limited arm mobility. In such cases, the infraclavicular approach may be a valuable alternative. The purpose of our study was to compare axillary and infraclavicular techniques for brachial plexus block in patients undergoing forearm and hand surgeries. After obtaining institutional approval and written informed consent, 60 patients of American Society of Anaesthesiologists grade I or II scheduled for forearm and hand surgeries were included in the study and were randomly allocated into two groups. Brachial plexus block was performed via the vertical infraclavicular approach (VIB) in patients of Group I and axillary approach in Group A using a peripheral nerve stimulator. Sensory block in the distribution of individual nerves supplying the arm, motor block, duration of sensory block, incidence of successful block and various complications were recorded. Successful block was achieved in 90% of the patients in group I and in 87% of patients in group A. Intercostobrachial nerve blockade was significantly higher in group I. No statistically significant difference was found in sensory and motor blockade of other nerves. Both the approaches are comparable, but the VIB scores ahead of axillary block in terms of its ability to block more nerves. The VIB because of its easily identifiable landmarks, a comfortable patient position during the block procedure and the ability to block a larger spectrum of nerves should thus be considered as an effective alternative to the axillary approach.

Lahori Vikram; Raina Anjana; Gulati Smriti; Kumar Dinesh; Gupta Satya

2011-01-01

195

[Postoperative analgesia for orthopedic surgeries of the hip and femur: a comparison between psoas compartment and inguinal paravascular blocks.].  

UK PubMed Central (United Kingdom)

BACKGROUND AND OBJECTIVES: This study evaluated the efficacy of a single injection of 0.25% bupivacaine in the psoas compartment or inguinal paravascular for postoperative analgesia in patients undergoing orthopedic surgeries using a peripheral nerve stimulator. METHODS: One hundred patients who had a lumbar plexus block through the psoas compartment were compared to 100 patients who had an inguinal paravascular block, using a peripheral nerve stimulator, with 40 mL of 0.25% bupivacaine. The analgesia of the ilioinguinal, genitofemoral, lateral femoral cutaneous, femoral, and obturator nerves was assessed 4, 8, 12, 16, 20, and 24 hours after the end of the surgical procedure. Pain severity was also evaluated in the same period. The amount of opioids administered in the postoperative period was recorded. A radiological study with non-ionic contrast was done in five patients in each group to evaluate the dispersion of the anesthetic. RESULTS: The ilioinguinal, genitofemoral, lateral femoral cutaneous, femoral, and obturator nerves were blocked in 92% of the patients with psoas compartment block versus 62% in those with inguinal paravascular block. Lumbar plexus block reduced the need for opioids, and 42% of the patients who underwent psoas compartment block and 36% of the patients who underwent inguinal paravascular block did not need additional analgesics in the postoperative period. Analgesia lasted for approximately 21 hours in the psoas compartment block and 15 hours in the inguinal paravascular block. CONCLUSIONS: Psoas compartment block and inguinal paravascular block are excellent techniques for postoperative analgesia in orthopedic surgeries, decreasing the need for opioids. This study showed that the injection in the psoas compartment was easier and more effective in blocking the five nerves of the lumbar plexus.

Imbelloni LE; Beato L; Beato C; Cordeiro JA

2006-12-01

196

A comparison between acute pressure block of the sciatic nerve and acupressure: methodology, analgesia, and mechanism involved.  

UK PubMed Central (United Kingdom)

Acupressure is an alternative medicine methodology that originated in ancient China. Treatment effects are achieved by stimulating acupuncture points using acute pressure. Acute pressure block of the sciatic nerve is a newly reported analgesic method based on a current neuroscience concept: stimulation of the peripheral nerves increases the pain threshold. Both methods use pressure as an intervention method. Herein, we compare the methodology and mechanism of these two methods, which exhibit several similarities and differences. Acupressure entails variation in the duration of manipulation, and the analgesic effect achieved can be short-or long-term. The acute effect attained with acupressure presents a scope that is very different from that of the chronic effect attained after long-term treatment. This acute effect appears to have some similarities to that achieved with acute pressure block of the sciatic nerve, both in methodology and mechanism. More evidence is needed to determine whether there is a relationship between the two methods.

Luo D; Wang X; He J

2013-01-01

197

A comparison between acute pressure block of the sciatic nerve and acupressure: methodology, analgesia, and mechanism involved.  

Science.gov (United States)

Acupressure is an alternative medicine methodology that originated in ancient China. Treatment effects are achieved by stimulating acupuncture points using acute pressure. Acute pressure block of the sciatic nerve is a newly reported analgesic method based on a current neuroscience concept: stimulation of the peripheral nerves increases the pain threshold. Both methods use pressure as an intervention method. Herein, we compare the methodology and mechanism of these two methods, which exhibit several similarities and differences. Acupressure entails variation in the duration of manipulation, and the analgesic effect achieved can be short-or long-term. The acute effect attained with acupressure presents a scope that is very different from that of the chronic effect attained after long-term treatment. This acute effect appears to have some similarities to that achieved with acute pressure block of the sciatic nerve, both in methodology and mechanism. More evidence is needed to determine whether there is a relationship between the two methods. PMID:23983488

Luo, Danping; Wang, Xiaolin; He, Jiman

2013-07-26

198

Phrenic nerve block with ultrasound-guidance for treatment of hiccups: a case report  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Introduction Persistent hiccups can be more than a simple and short-lived nuisance and therefore sometimes call for serious consideration. Hiccupping episodes that last only a few minutes may be annoying, but persistent hiccups may initiate many major complications. Case presentation A 72-year-old Caucasian man with spinal stenosis presented for L4-5 laminectomy under spinal anesthesia. The surgery and anesthesia, as well as the perioperative period, passed without any incident, except for persistent postoperative hiccups not responding to conservative and pharmacological treatment. Hiccups resulted in a prolonged hospital stay as they lasted until the seventh postoperative day. On that day, a right-sided ultrasound-guided phrenic nerve block with 5 ml of bupivacaine 5 mg/ml with epinephrine was performed successfully with a single-injection technique. Ten minutes after the procedure the hiccups vanished and a partial sensomotoric block of his right shoulder developed. No adverse effect occurred; our patient could be discharged on the same day and the hiccups did not return. Conclusion Ultrasound provides us with non-invasive information regarding anatomy and allows anesthesiologists to visualize needle insertion, to identify the exact location of the injected solution and to avoid such structures as arteries or veins. As such, this method should be actively utilized. In cases where both pharmacological and non-pharmacological treatments prove to be ineffective when treating persistent hiccups, a single-shot ultrasound-guided technique should be considered before the patient becomes exhausted.

Kuusniemi Kristiina; Pyylampi Ville

2011-01-01

199

Adverse effect profile of lidocaine injections for occipital nerve block in occipital neuralgia.  

UK PubMed Central (United Kingdom)

To determine whether there are differences in the adverse effect profile between 1, 2 and 5% Lidocaine when used for occipital nerve blocks (ONB) in patients with occipital neuralgia. Occipital neuralgia is an uncommon cause of headaches. Little is known regarding the safety of Lidocaine injections for treatment in larger series of patients. Retrospective chart analysis of all ONB was performed at our headache clinic during a 6-year period on occipital neuralgia patients. 89 consecutive patients with occipital neuralgia underwent a total of 315 ONB. All the patients fulfilled the IHS criteria for Occipital Neuralgia. Demographic data were collected including age, gender, and ethnicity. The average age of this cohort was 53.25 years, and the majority of patients were females 69 (78%). Ethnicity of patients was diverse, with Caucasian 48(54%), Hispanics 31(35%), and others 10 (11%). 69 patients had 1%, 18 patients had 2% and 29 patient were given 5% Lidocaine. All Lidocaine injections were given with 20 mg Depo-medrol and the same injection technique and location were used for all the procedures. Eight patients (9%)had adverse effects to the Lidocaine and Depo-medrol injections, of which 5 received 5% and 3 received 1% Lidocaine. Majority of patients who had adverse effects were female 7(87%), and had received bilateral blocks (75%). ONB is a safe procedure with 1% Lidocaine; however, caution should be exerted with 5% in elderly patients, 70 or older, especially when administering bilateral injections.

Sahai-Srivastava S; Subhani D

2010-12-01

200

Effects Of Oral Carbamazepine With 2% Lidocaine On Maxillary And Mandibular Nerve Blocks In Trigeminal Neuralgia  

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Full Text Available Purpose: We evaluated the therapeutic efficacy of associating the oral administration ofcarbamazepine with 2% lidocaine for maxillary and mandibular nerve blocks in acute and long-term pain relief of trigeminal neuralgia in this retrospective study.Methods: A total of 13 patients (9 men and 4 women), with trigeminal neuralgia aged between34 and 91 years (Mean age 53±13.39), and who applied to our hospitals Pain Unit between July2007-July 2009 were included in this study. The records of 13 patients suffering pain due totrigeminal neuralgia were examined; pain free periods, treatment success, side effects, andrecurrence were recorded.Results: At the end of a 5-week treatment period, pain relapses ceased in all patients. Themajority of patients benefited remarkably from the treatment after week three. Pain recurred inone patient after one month and in two patients after six months. No relapse was observed inthe other 10 patients during the 12-month follow-up period. Conclusion: Pain episodes in trigeminal neuralgia cases may be controlled by maxillary andmandibular blocks applied with oral carbamazepine and 2% lidocaine. Favorable results areobtained in both the short and long–term, and notable increases are observed in the comfort andquality of life of patients.

Mehmet BAYKAL, Metin KAPLAN

2010-01-01

 
 
 
 
201

Vagus nerve stimulation blocks vascular permeability following burn in both local and distal sites.  

UK PubMed Central (United Kingdom)

Recent studies have shown that vagus nerve stimulation (VNS) can block the burn-induced systemic inflammatory response (SIRS). In this study we examined the potential for VNS to modulate vascular permeability (VP) in local sites (i.e. skin) and in secondary sites (i.e. lung) following burn. In a 30% total body surface area burn model, VP was measured using intravascular fluorescent dextran for quantification of the VP response in skin and lung. A peak in VP of the skin was observed 24h post-burn injury, that was blocked by VNS. Moreover, in the lung, VNS led to a reduction in burn-induced VP compared to sham-treated animals subjected to burn alone. The protective effects of VNS in this model were independent of the spleen, suggesting that the spleen was not a direct mediator of VNS. These studies identify a role for VNS in the regulation of VP in burns, with the translational potential of attenuating lung complications following burn.

Ortiz-Pomales YT; Krzyzaniak M; Coimbra R; Baird A; Eliceiri BP

2013-02-01

202

Anesthetic efficacy of a repeated intraosseous injection given 30 min following an inferior alveolar nerve block/intraosseous injection.  

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To determine whether a repeated intraosseous (IO) injection would increase or prolong pulpal anesthesia, we measured the degree of anesthesia obtained by a repeated IO injection given 30 min following a combination inferior alveolar nerve block/intraosseous injection (IAN/IO) in mandibular second pr...

Reitz, J.; Reader, A.; Nist, R.; Beck, M.; Meyers, W. J.

203

Low Cost Continuous Femoral Nerve Block for Relief of Acute Severe Cancer Related Pain Due to Pathological Fracture Femur  

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Pathological fractures in cancer patient cause severe pain that is difficult to control pharmacologically. Even with good pain relief at rest, breakthrough and incident pain can be unmanageable. Continuous regional nerve blocks have a definite role in controlling such intractable pain. We describe t...

Koshy, Rachel Cherian; Padmakumar, G; Rajasree, O

204

Low cost continuous femoral nerve block for relief of acute severe cancer related pain due to pathological fracture femur  

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Pathological fractures in cancer patient cause severe pain that is difficult to control pharmacologically. Even with good pain relief at rest, breakthrough and incident pain can be unmanageable. Continuous regional nerve blocks have a definite role in controlling such intractable pain. We describe t...

Koshy Rachel; Padmakumar G; Rajasree O

205

Effects of hypoglossal nerve block and electrical stimulation of the thyrohyoideus muscles on position of the larynx and hyoid apparatus in healthy horses.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To determine the effects of hypoglossal nerve block and electrical stimulation of the thyrohyoideus muscles on position of the larynx and hyoid apparatus in resting horses. ANIMALS: 16 healthy horses that underwent hypoglossal nerve block and 5 healthy horses that underwent electrical stimulation of the thyrohyoideus muscles. PROCEDURES: Horses underwent bilateral hypoglossal nerve block or electrical stimulation of the thyrohyoideus muscles. Positions of the basihyoid bone, ossified part of the thyroid cartilage, and articulations of the thyrohyoid bones and thyroid cartilage were determined in radiographic images obtained before and after performance of hypoglossal nerve blocks or during thyrohyoideus muscle stimulation. Radiographic images were obtained with the heads of horses in neutral (thyrohyoideus muscle stimulation) or neutral and extended (hypoglossal nerve block) positions. Radiographic images of horses obtained after performance of hypoglossal nerve blocks were also evaluated to detect dorsal displacement of the soft palate. RESULTS: Hypoglossal nerve blocks did not induce significant changes in the positions of evaluated anatomic sites in radiographic images obtained in neutral or extended head positions. Hypoglossal nerve block did not induce dorsal displacement of the soft palate in horses at rest. Bilateral thyrohyoideus muscle stimulation induced significant dorsal movement (mean ± SD change in position, 18.7 ± 6.8 mm) of the ossified part of the thyroid cartilage; rostral movement of evaluated anatomic structures was small and not significant after thyrohyoideus muscle stimulation. CONCLUSIONS AND CLINICAL RELEVANCE: Bilateral electrical stimulation of the thyrohyoideus muscles in horses in this study induced dorsal laryngeal movement.

Zantingh AJ; Ducharme NG; Mitchell LM; Cheetham J

2013-05-01

206

A randomized comparison of infraclavicular and supraclavicular continuous peripheral nerve blocks for postoperative analgesia.  

UK PubMed Central (United Kingdom)

BACKGROUND: Although the efficacy of single-injection supraclavicular nerve blocks is well established, no controlled study of continuous supraclavicular blocks is available, and their relative risks and benefits remain unknown. In contrast, the analgesia provided by continuous infraclavicular nerve blocks has been validated in randomized controlled trials. We therefore compared supraclavicular with infraclavicular perineural local anesthetic infusion following distal upper-extremity surgery. METHODS: Preoperatively, subjects were randomly assigned to receive a brachial plexus perineural catheter in either the infraclavicular or supraclavicular location using an ultrasound-guided nonstimulating catheter technique. Postoperatively, subjects were discharged home with a portable pump (400-mL reservoir) infusing 0.2% ropivacaine (basal rate of 8 mL/hr; 4-mL bolus dose; 30-min lockout interval). Subjects were followed up by telephone on an outpatient basis. The primary outcome was the average pain score on the day after surgery. RESULTS: Sixty subjects were enrolled, with 31 and 29 randomized to receive an infraclavicular and supraclavicular catheter, respectively. All perineural catheters were successfully placed per protocol. Because of protocol violations and missing data, an intention-to-treat analysis was not used; rather, only subjects with catheters in situ and whom we were able to contact were included in the analyses. The day after surgery, subjects in the infraclavicular group reported average pain as median of 2.0 (10th-90th percentiles, 0.5-6.0) compared with 4.0 (10th-90th percentiles, 0.6-7.7) in the supraclavicular group (P = 0.025). Similarly, least pain scores (numeric rating scale) on postoperative day 1 were lower in the infraclavicular group compared with the supraclavicular group (0.5 [10th-90th percentiles, 0.0-3.5] vs 2.0 [10th-90th percentiles, 0.0-4.7], respectively; P = 0.040). Subjects in the infraclavicular group required less rescue oral analgesic (oxycodone, in milligrams) for breakthrough pain in the 18 to 24 hrs after surgery compared with the supraclavicular group (0.0 [10th-90th percentiles, 0.0-5.0] vs 5.0 [10th-90th percentiles, 0.0-15.0], respectively; P = 0.048). There were no statistically significant differences in other secondary outcomes. CONCLUSIONS: A local anesthetic infusion via an infraclavicular perineural catheter provides superior analgesia compared with a supraclavicular perineural catheter.

Mariano ER; Sandhu NS; Loland VJ; Bishop ML; Madison SJ; Abrams RA; Meunier MJ; Ferguson EJ; Ilfeld BM

2011-01-01

207

Ultrasound guidance for brachial plexus block decreases the incidence of complete hemi-diaphragmatic paresis or vascular punctures and improves success rate of brachial plexus nerve block compared with peripheral nerve stimulator in adults.  

UK PubMed Central (United Kingdom)

BACKGROUND: The use of traditional techniques (such as landmark techniques, paresthesia and peripheral nerve stimulator) for upper-limb anesthesia has often been restricted to the expert or enthusiast, which was blind. Recently, ultrasound (US) has been applied to differ blood vessel, pleura and nerve, thus may reduce the risk of complications while have a high rate of success. The aim of this study was to determine if the use of ultrasound guidance (vs. peripheral nerve stimulator, (PNS)) decreases risk of vascular puncture, risk of hemi-diaphragmatic paresis and risk of Horner syndrome and improves the success rate of nerve block. METHODS: A search strategy was developed to identify randomized control trials (RCTs) reporting on complications of US and PNS guidance for upper-extremity peripheral nerve blocks (brachial plexus) in adults available through PubMed databases, the Cochrane Central Register of Controlled Trials, Embase databases, SinoMed databases and Wanfang data (date up to 2011-12-20). Two independent reviewers appraised eligible studies and extracted data. Risk ratios (OR) were calculated for each outcome and presented with 95% confidence intervals (CI) with the software of Review Manager 5.1.0 System (Cochrane Library). RESULTS: Sixteen trials involving 1321 adults met our criteria were included for analysis. Blocks performed using US guidance were more likely to be successful (risk ratio (RR) for block success 0.36, 95%CI 0.23 - 0.56, P < 0.00001), decreased incidence of vascular puncture during block performance (RR 0.13, 95%CI 0.06 - 0.27, P < 0.00001), decreased the risk of complete hemi-diaphragmatic paresis (RR 0.09, 95%CI 0.03 - 0.52, P = 0.0001). CONCLUSIONS: US decreases risks of complete hemi-diaphragmatic paresis or vascular puncture and improves success rate of brachial plexus 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 risk of neurologic complications.

Yuan JM; Yang XH; Fu SK; Yuan CQ; Chen K; Li JY; Li Q

2012-05-01

208

Efficacy of Ultrasound-Guided Axillary Brachial Plexus Block: A Comparative Study with Nerve Stimulator-Guided Method  

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Full Text Available Background: The aim of this study was to compare the efficacy of axillary brachial plexusblock using an ultrasound-guided method with the nerve stimulator-guidedmethod. We also compared the efficacy of ultrasound-guided single-injectionwith those of double-injection for the quality of the block.Methods: Ninety patients scheduled for surgery of the forearm or hand were randomlyallocated into three groups (n = 30 per group), i.e., nerve stimulator-guidedand double-injection (ND) group, ultrasound-guided and double-injection(UD) group, and ultrasound-guided and single-injection (US) group. Eachpatient received 0.5 ml kg-1 of 1.5% lidocaine with 5 ?g kg-1 epinephrine.Patients in the ND group received half the volume of lidocaine injected nearthe median and radial nerves after identification using a nerve stimulator.Patients in the UD group received half the volume of lidocaine injectedaround the lateral and medial aspects of the axillary artery, while those in theUS group were given the entire volume near the lateral aspect of the axillaryartery. The extent of the sensory blockade of the seven nerves and motorblockades of the four nerves were assessed 40 min after the performance ofaxillary brachial plexus block.Results: Seventy percent of the patients in the ND and US groups as well as 73% ofthe patients in the UD group obtained satisfactory sensory and motor blockades.The success rate of performing the block was 90% in patients in theND and UD groups and 70% in the US group. The incidence of adverseevents was significantly higher in the ND group (20%) compared with that inthe US group and the UD group (0%; p = 0.03).Conclusions: Ultrasound-guided axillary brachial plexus block, using either single- or double-injection technique, provided excellent sensory and motor blockadeswith fewer adverse events.

Fu-Chao Liu; Jiin-Tarng Liou; Yung-Fong Tsai; Allen H. Li; Yuan-Yi Day; Yu-Ling Hui; Ping-Wing Lui

2005-01-01

209

Continuous peripheral nerve blocks at home for treatment of recurrent complex regional pain syndrome I in children.  

UK PubMed Central (United Kingdom)

BACKGROUND: Recurrent complex regional pain syndrome I is not rare in the pediatric population. The authors conducted this study to evaluate the efficacy of continuous peripheral nerve blocks with elastomeric disposable pumps associated with initial Bier blocks for the treatment of recurrent complex regional pain syndrome I in children. METHODS: After parental informed consent, 13 children who did not respond to conventional complex regional pain syndrome treatment were included (mean age, 13 yr; range, 9-16 yr). After general anesthesia, peripheral nerve block was performed using 0.5 ml/kg lidocaine, 1%, with epinephrine and 0.5% ropivacaine injected in the peripheral nerve block catheter. Then, a 20-min Bier block was performed using a tourniquet and 0.2 ml/kg lidocaine, 1%; 3 ml/kg hydroxyethyl starch 130/06; and 5 mg/kg buflomedil injected intravenously. A solution of 0.1 ml . kg . h continuous ropivacaine, 0.2%, was infused through the catheter using an elastomeric pump for 96 h. Need for rescue analgesia, occurrence of side effects, and status of motor and sensory block were recorded at hours 1, 6, 12, 24, 48, 72, and 96. Children and parents completed a satisfaction assessment. All of the children had follow-up visits after 2 months. RESULTS: Postoperative analgesia was excellent. The median pain score was 0 for each period studied. Motor blockade was minimal before 12 h (median, 1) and absent thereafter. One child needed rescue analgesia. All children were able to walk easily after the initial 24-h period (walking score, > 4). Children and parents were all satisfied. Children returned home under parental surveillance beginning in the 24th hour. Neither peripheral nerve block nor Bier block caused side effects. After 2 months, none of the children exhibited any clinical symptom of recurrent complex regional pain syndrome. CONCLUSION: Ambulatory continuous peripheral nerve block associated with an initial Bier block seems to be a significant and novel contribution to treat recurrent pediatric complex regional pain syndrome I. It allows complete pain relief, early mobilization, and rapid return home, representing a psychological advantage for these children.

Dadure C; Motais F; Ricard C; Raux O; Troncin R; Capdevila X

2005-02-01

210

Comparative Study of Greater Palatine Nerve Block and Intravenous Pethidine for Postoperative Analgesia in Children Undergoing Palatoplasty  

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Summary Greater palatine nerve block anaesthetizes posterior portions of the hard palate and its overlying soft tissues. This study compared the efficacy, safety, and ease of the nerve block for cleft palate surgeries in children with i.v. pethidine for postoperative pain management. A prospective, double blind, randomized trial, enrolled 50 children aged below 10 years scheduled for palatoplasty and were alternatively allocated to two groups. Group A received intravenous pethidine 1mg.kg?1, whereas Group B, bilateral greater palatine nerve block with bupivacaine 0.25%, 1ml on each side, before the surgical stimulation. Modified Aldrete Scoring System, Children's Hospital Eastern Ontario Pain Scale (CHEOPS) and Brussels Sedation Score were employed to assess recovery, quality of analgesia and sedation respectively, by the nursing staff. Whenever pain score was >8, 0.5mg.kg?1 of pethidine was given intravenously for rescue analgesia in both groups. Recovery scores were better in Group B (p=0.007). In the immediate postoperative period, pain score was more in Group A (number of patients with pain score >8, 44% v/s 12%, p= .0117). Requirement for rescue analgesia was more in Group A (60 times v/s 7). The average sedation scores were similar. There was a higher incidence of agitation in Group A (66 vs. 30). The incidence of deep sedation was nearly half in Group B (34 Vs 63). Greater palatine nerve block was considered successful in 88% of cases. Greater palatine nerve block produces more effective, consistent and prolonged analgesia than pethidine.

Kamath, Manjunath R; Mehandale, Sripada G; US, Raveendra

2009-01-01

211

Effect of lingual nerve block on burning mouth syndrome (stomatodynia): a randomized crossover trial.  

UK PubMed Central (United Kingdom)

Burning mouth syndrome (stomatodynia) is associated with changes of a neuropathic nature the main location of which, peripheral or central, remains unknown. A randomised, double-blind crossover design was used to investigate the effects of lingual nerve block on spontaneous burning pain and a possible correlation with the effects of topical clonazepam, the patient's response to a psychological questionnaire, and the taste and heat thresholds. The spontaneous burning was measured with a visual analogue scale (VAS) just before and 15 min after injection. The decreases in VAS score after lidocaine or saline injection were not significantly different (2.7+/-3.9 and 2.0+/-2.6, respectively; n=20). However, two groups of patients could be identified: in a "peripheral group" (n=10) the VAS decrease due to lingual nerve injection was 4.3+/-3.1cm after lidocaine and 0.9+/-0.3 cm after saline (p=0.02). In a "central group" (n=7), there were an increase in pain intensity score (-0.8+/-2.6 cm) after lidocaine and a decrease (1.5+/-3.0 cm) after saline (p=0.15). An increase in the hospital anxiety and depression (HAD) score and a decreased taste sensitivity and heat pain threshold of painful oral area were seen in patients compared with age-and-sex-matched controls (p<0.05). Topical clonazepam treatment tended to be more effective (p=0.07) and HAD score lower (p<0.03) in the peripheral than in the central group. These results suggest that the neuropathic disorder associated with stomatodynia may be predominantly peripheral, central or mixed depending on the individual. Topical application of clonazepam and HAD may serve as indicators of which mechanism is dominating.

Grémeau-Richard C; Dubray C; Aublet-Cuvelier B; Ughetto S; Woda A

2010-04-01

212

Effect of lingual nerve block on burning mouth syndrome (stomatodynia): a randomized crossover trial.  

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Burning mouth syndrome (stomatodynia) is associated with changes of a neuropathic nature the main location of which, peripheral or central, remains unknown. A randomised, double-blind crossover design was used to investigate the effects of lingual nerve block on spontaneous burning pain and a possible correlation with the effects of topical clonazepam, the patient's response to a psychological questionnaire, and the taste and heat thresholds. The spontaneous burning was measured with a visual analogue scale (VAS) just before and 15 min after injection. The decreases in VAS score after lidocaine or saline injection were not significantly different (2.7+/-3.9 and 2.0+/-2.6, respectively; n=20). However, two groups of patients could be identified: in a "peripheral group" (n=10) the VAS decrease due to lingual nerve injection was 4.3+/-3.1cm after lidocaine and 0.9+/-0.3 cm after saline (p=0.02). In a "central group" (n=7), there were an increase in pain intensity score (-0.8+/-2.6 cm) after lidocaine and a decrease (1.5+/-3.0 cm) after saline (p=0.15). An increase in the hospital anxiety and depression (HAD) score and a decreased taste sensitivity and heat pain threshold of painful oral area were seen in patients compared with age-and-sex-matched controls (p<0.05). Topical clonazepam treatment tended to be more effective (p=0.07) and HAD score lower (p<0.03) in the peripheral than in the central group. These results suggest that the neuropathic disorder associated with stomatodynia may be predominantly peripheral, central or mixed depending on the individual. Topical application of clonazepam and HAD may serve as indicators of which mechanism is dominating. PMID:20083352

Grémeau-Richard, Christelle; Dubray, Claude; Aublet-Cuvelier, Bruno; Ughetto, Sylvie; Woda, Alain

2010-01-18

213

The long term myotoxic effects of bupivacaine and ropivacaine after continuous peripheral nerve blocks.  

UK PubMed Central (United Kingdom)

UNLABELLED: Compared with bupivacaine, acute myotoxicity of ropivacaine is less severe. Thus, in this study we compared the long term myotoxic effects of both drugs in a clinically relevant setting. Femoral nerve catheters were inserted in anesthetized pigs, and either 20 mL of bupivacaine (5 mg/mL) or ropivacaine (7.5 mg/mL) was injected. Subsequently, bupivacaine (2.5 mg/mL) and ropivacaine (3.75 mg/mL) were continuously infused (8 mL/h) over 6 h. Control animals were treated with corresponding volumes of normal saline. After 7 and 28 days, respectively, muscle samples were dissected at the former injection sites, and histological patterns of muscle damage were blindly scored (0 = no damage to 3 = marked lesions/myonecrosis) and compared. No morphological tissue changes were detected in control animals. In the observed period, both local anesthetics induced morphologically identical patterns of calcific myonecrosis, formation of scar tissue, and a marked rate of fiber regeneration. However, bupivacaine's effects were constantly more pronounced than those of ropivacaine. These data show that both drugs induce irreversible skeletal muscle damage in a clinically relevant model, and confirm the exceeding rate of myotoxicity of bupivacaine. However, the clinical impact of these long term myotoxic effects still has to be assessed. IMPLICATIONS: In a period of 4 wk after peripheral nerve block, both long-acting local anesthetics, bupivacaine and ropivacaine, produced calcific myonecrosis suggestive of irreversible skeletal muscle damage. In comparison with ropivacaine, however, the extent of bupivacaine-induced muscle lesions was significantly larger.

Zink W; Bohl JR; Hacke N; Sinner B; Martin E; Graf BM

2005-08-01

214

Popliteal sciatic nerve block versus spinal anesthesia in hallux valgus surgery.  

UK PubMed Central (United Kingdom)

BACKGROUND: We compared clinical properties and patient satisfaction between spinal anesthesia and popliteal sciatic nerve block (PSNB) for hallux valgus surgery. METHODS: Forty patients undergoing hallux valgus surgery were divided into spinal group (spinal anesthesia with 2.5 ml of 0.5% bupivacaine [n = 20]) and PSNB group (PSNB with 30 ml of 0.75% ropivacaine mixed with 10 ml of normal saline solution using a nerve stimulator [n = 20]). The PSNB group used a patient-controlled-analgesia (PCA) pump for postoperative pain control. The quality and side effects were compared between the two groups. A questionnaire was used to evaluate patient satisfaction with the use of anesthetic techniques and postoperative pain control in the PSNB group. This study was assessed 3 days postoperatively by a blinded observer. RESULTS: Procedure time and time from anesthesia until start of sugery were significantly shorter in the spinal group than those in the PSNB group (P < 0.01). Anesthesia-related complications such as hypotension, bradycardia, shivering, nausea/vomitting, post-dural puncture headache (PDPH) and urinary retension were observed in 15%, 10%, 5%, 5%, 10%, and 20% of patients in the spinal group, respectively. PSNB was not associated with these complications. Patient satisfaction was slightly higher for PSNB than for spinal anesthesia. In the PSNB group, patient satisfaction with postoperative pain-control was 95% above ordinary satisfaction. CONCLUSIONS: Despite the long duration of the procedure, PSNB is relatively safe, provides an adequate level of anesthesia, effectively controls postoperative pain and reduces side effects. Therefore, PSNB could be a potential anesthetic technique for hallux valgus surgery.

Jeon HJ; Park YC; Lee JN; Bae JS

2013-04-01

215

Management of low back pain with facet joint injections and nerve root blocks under computed tomography guidance. A prospective study  

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The aim of this work was to assess the performance of facet joint and nerve root infiltrations under computed tomography guidance for the management of low back pain and to investigate the complications and patient tolerance. The study was board-certified and informed consent was obtained from all patients. In 1 year, 86 consecutive patients (47 male, 39 female, age range 47-87 years, mean age 63) with low back pain for more than 2 years were included. All patients were clinically examined and had cross-sectional imaging performed before the procedure. Fifty-five facet joint infiltrations and 31 nerve blocks were performed under computed tomography guidance. All patients completed two valid pain questionnaires before and 3 months after the procedures. At the same time, they were clinically examined by the referring Orthopaedic Surgeon. The pain response was assessed by comparing the scores of the questionnaires. The improvement in clinical examination findings was assessed as well. In patients who underwent facet joint infiltrations, long-term pain improvement was achieved in 79% and in those with nerve blocks in 85%. Immediate pain relief was demonstrated in 83% of patients with nerve infiltrations. No complications were observed. All procedures were very well tolerated by patients. Facet joint and nerve infiltrations under computed tomography guidance constitute an accurate and safe method that could be used to relieve low back pain and minimize the risk of disability. (orig.)

2012-01-01

216

A comparison between acute pressure block of the sciatic nerve and acupressure: methodology, analgesia, and mechanism involved  

Directory of Open Access Journals (Sweden)

Full Text Available Danping Luo,1,2 Xiaolin Wang,1 Jiman He1,31Pain Medicine Program, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China; 2The First Affiliated Hospital of Guangdong College of Pharmacy, Guangzhou, People's Republic of China; 3Department of Medicine, Brown University, Providence, RI, USAAbstract: Acupressure is an alternative medicine methodology that originated in ancient China. Treatment effects are achieved by stimulating acupuncture points using acute pressure. Acute pressure block of the sciatic nerve is a newly reported analgesic method based on a current neuroscience concept: stimulation of the peripheral nerves increases the pain threshold. Both methods use pressure as an intervention method. Herein, we compare the methodology and mechanism of these two methods, which exhibit several similarities and differences. Acupressure entails variation in the duration of manipulation, and the analgesic effect achieved can be short- or long-term. The acute effect attained with acupressure presents a scope that is very different from that of the chronic effect attained after long-term treatment. This acute effect appears to have some similarities to that achieved with acute pressure block of the sciatic nerve, both in methodology and mechanism. More evidence is needed to determine whether there is a relationship between the two methods.Keywords: acupressure, acute pressure block, sciatic nerve, pain

Luo D; Wang X; He J

2013-01-01

217

A critique of current practice of transvaginal pudendal nerve blocks: a prospective audit of understanding and clinical practice.  

UK PubMed Central (United Kingdom)

Pudendal nerve blocks are a pre-requisite to forceps delivery without regional anaesthesia. Their efficacy is dependent on introducing local anaesthetic in close proximity to the pudendal nerve and allowing sufficient time for its onset of action. An audit of 57 obstetricians evaluated their clinical technique against standards using both a questionnaire and adapted model pelvis. The majority of participants were unable to describe correctly the point of infiltration and were unaware of the lag time required to effect adequate analgesia. We identify a deficiency in training and describe a method by which training can be facilitated and assessed.

Ford JM; Owen DJ; Coughlin LB; Byrd LM

2013-07-01

218

Ultrasound-guided continuous suprascapular nerve block for adhesive capsulitis: one case and a short topical review  

DEFF Research Database (Denmark)

We present a case with an ultrasound-guided (USG) placement of a perineural catheter beneath the transverse scapular ligament in the scapular notch to provide a continuous block of the suprascapular nerve (SSN). The patient suffered from a severe and very painful adhesive capsulitis of the left shoulder secondary to an operation in the same shoulder conducted 20 weeks previously for impingement syndrome and a superior labral anterior-posterior tear. Following a new operation with capsular release, the placement of a continuous nerve block catheter subsequently allowed for nearly pain-free low impact passive and guided active mobilization by the performing physiotherapist for three consecutive weeks. This case and a short topical review on the use of SSN block in painful shoulder conditions highlight the possibility of a USG continuous nerve block of the SSN as sufficient pain management in the immediate post-operative period following capsular release of the shoulder. Findings in other painful shoulder conditions and suggestions for future studies are discussed in the text.

Neimann, Jens Dupont BØrglum; Bartholdy, Anne

2011-01-01

219

Effect of acute versus continuous glycemic control on duration of local anesthetic sciatic nerve block in diabetic rats.  

UK PubMed Central (United Kingdom)

BACKGROUND AND OBJECTIVES: The duration of nerve block is longer in streptozotocin (STZ)-induced diabetic rats for all local anesthetics (with and without adjuvants) compared with normal rats. Perioperative glycemic control is currently practiced to reduce adverse events in many at-risk patients, especially in diabetic patients, to prevent neuropathy, poor wound healing, and greater incidence of infection. The aim of this study was to investigate in diabetic rats the importance of glycemic control before peripheral nerve block. METHODS: To induce diabetes, rats were intravenously injected with a single dose of 50 mg/kg STZ to destroy pancreatic beta cells. Tactile allodynia in response to von Frey filament stimulation of the plantar hind paws was used as the criterion for diabetic neuropathy. Diabetic rats were randomly divided into experimental treatment groups. The continuous glycemic control experiment compared: 3 U/d insulin implant for 14 days, 1.5 U/d insulin implant for 14 days, and placebo treatment. The acute glycemic control experiment compared a single 6U Human Insulin Isophane Suspension (NPH) injection and placebo treatment. Nondiabetic rats received placebo implants or injections. Following treatment, 0.1 mL of 1% lidocaine hydrochloride with 5 ?g/mL epinephrine hydrochloride was injected into the left sciatic notch. Animals were then reevaluated at 10-minute intervals for the absence or presence of sensory and motor response. RESULTS: All STZ-injected rats had blood glucose levels greater than 350 mg/dL and tactile allodynia. After insulin implants or injections, diabetic rats had much lower blood glucose levels than diabetic rats with placebo treatment. With both 3 and 1.5 U/d continuous glycemic control, the local anesthetic solution produced a shorter duration of sensory and motor nerve block in insulin-treated diabetic rats compared with placebo-treated diabetic rats, and shorter duration was similar to nondiabetic rats. With 6 U acute glycemic control in diabetic rats, there was no reduction in nerve block duration compared with placebo-treated diabetic rats. CONCLUSIONS: With continuous glycemic control in diabetic rats, the duration of sensory and motor nerve block was about 40 minutes shorter than that in the untreated diabetic rats and similar to that of normal rats. However, acute glycemic control did not affect nerve block duration, suggesting that this neuropathy cannot be rapidly reversed.

Kroin JS; Buvanendran A; Tuman KJ; Kerns JM

2012-11-01

220

Nerve growth factor inhibits metalloproteinase-disintegrins and blocks ectodomain shedding of platelet glycoprotein VI.  

UK PubMed Central (United Kingdom)

Nerve growth factor (NGF) plays an important role in regulating mammalian neuronal/embryonic development, angiogenesis, and other physiological processes and has recently been investigated as a potential treatment for the neurodegenerative disorder, Alzheimer disease. In this study, we provide evidence that human NGF may also function as a metalloproteinase inhibitor, based on studies of NGF from snake venom. Originally, our aim was to isolate snake venom metalloproteinases targeting platelet receptors and/or ligands relevant to hemostasis and thrombosis, using Ni(2+)-agarose as a purification step based on the conserved metal ion-coordination motif in venom metalloproteinases. However, subsequent analysis of cobra (Naja kaouthia) venom led to the unexpected discovery that cobra venom NGF bound to Ni(2+)-agarose, eluting at approximately 15 mm imidazole, enabling a one-step purification. The identity of the purified protein was confirmed by mass spectrometry and N-terminal sequence analysis. Partial co-purification of NGF within metalloproteinase-enriched venom fractions led us to test whether NGF affected metalloproteinase activity. Venom NGF potently inhibited metalloproteinases isolated from the same or different venom and specifically bound to purified Nk metalloproteinase immobilized on agarose beads. Human NGF also interacted with human metalloproteinases because it blocked metalloproteinase-mediated shedding of the platelet collagen receptor, glycoprotein (GP)VI, and associated with recombinant ADAM10 by surface plasmon resonance. Together, these results suggest that NGF can function as a metalloproteinase inhibitor.

Wijeyewickrema LC; Gardiner EE; Gladigau EL; Berndt MC; Andrews RK

2010-04-01

 
 
 
 
221

Nerve growth factor inhibits metalloproteinase-disintegrins and blocks ectodomain shedding of platelet glycoprotein VI.  

Science.gov (United States)

Nerve growth factor (NGF) plays an important role in regulating mammalian neuronal/embryonic development, angiogenesis, and other physiological processes and has recently been investigated as a potential treatment for the neurodegenerative disorder, Alzheimer disease. In this study, we provide evidence that human NGF may also function as a metalloproteinase inhibitor, based on studies of NGF from snake venom. Originally, our aim was to isolate snake venom metalloproteinases targeting platelet receptors and/or ligands relevant to hemostasis and thrombosis, using Ni(2+)-agarose as a purification step based on the conserved metal ion-coordination motif in venom metalloproteinases. However, subsequent analysis of cobra (Naja kaouthia) venom led to the unexpected discovery that cobra venom NGF bound to Ni(2+)-agarose, eluting at approximately 15 mm imidazole, enabling a one-step purification. The identity of the purified protein was confirmed by mass spectrometry and N-terminal sequence analysis. Partial co-purification of NGF within metalloproteinase-enriched venom fractions led us to test whether NGF affected metalloproteinase activity. Venom NGF potently inhibited metalloproteinases isolated from the same or different venom and specifically bound to purified Nk metalloproteinase immobilized on agarose beads. Human NGF also interacted with human metalloproteinases because it blocked metalloproteinase-mediated shedding of the platelet collagen receptor, glycoprotein (GP)VI, and associated with recombinant ADAM10 by surface plasmon resonance. Together, these results suggest that NGF can function as a metalloproteinase inhibitor. PMID:20164177

Wijeyewickrema, Lakshmi C; Gardiner, Elizabeth E; Gladigau, Elsa L; Berndt, Michael C; Andrews, Robert K

2010-02-17

222

Nerve Growth Factor Inhibits Metalloproteinase-Disintegrins and Blocks Ectodomain Shedding of Platelet Glycoprotein VI*  

Science.gov (United States)

Nerve growth factor (NGF) plays an important role in regulating mammalian neuronal/embryonic development, angiogenesis, and other physiological processes and has recently been investigated as a potential treatment for the neurodegenerative disorder, Alzheimer disease. In this study, we provide evidence that human NGF may also function as a metalloproteinase inhibitor, based on studies of NGF from snake venom. Originally, our aim was to isolate snake venom metalloproteinases targeting platelet receptors and/or ligands relevant to hemostasis and thrombosis, using Ni2+-agarose as a purification step based on the conserved metal ion-coordination motif in venom metalloproteinases. However, subsequent analysis of cobra (Naja kaouthia) venom led to the unexpected discovery that cobra venom NGF bound to Ni2+-agarose, eluting at ?15 mm imidazole, enabling a one-step purification. The identity of the purified protein was confirmed by mass spectrometry and N-terminal sequence analysis. Partial co-purification of NGF within metalloproteinase-enriched venom fractions led us to test whether NGF affected metalloproteinase activity. Venom NGF potently inhibited metalloproteinases isolated from the same or different venom and specifically bound to purified Nk metalloproteinase immobilized on agarose beads. Human NGF also interacted with human metalloproteinases because it blocked metalloproteinase-mediated shedding of the platelet collagen receptor, glycoprotein (GP)VI, and associated with recombinant ADAM10 by surface plasmon resonance. Together, these results suggest that NGF can function as a metalloproteinase inhibitor.

Wijeyewickrema, Lakshmi C.; Gardiner, Elizabeth E.; Gladigau, Elsa L.; Berndt, Michael C.; Andrews, Robert K.

2010-01-01

223

Excitability of intracortical inhibitory and facilitatory circuits during ischemic nerve block.  

UK PubMed Central (United Kingdom)

PURPOSE: The primary motor cortex is capable of rapid, reversible plastic changes and longer-term, more permanent reorganization. Ischemic nerve block (INB) is a model of deafferentation-induced short-term plasticity. We used transcranial magnetic stimulation to examine whether changes in the excitability of short- and/or long-interval intracortical inhibitory (SICI, LICI) or short-interval intracortical facilitatory (SICF) circuits underlie the corticospinal excitability increases observed during INB. METHODS: SICI and LICI recruitment curves, obtained by varying conditioning stimulus intensity, and SICF were measured at multiple inter-stimulus intervals (ISIs). RESULTS: Forearm flexor MEP amplitude increased during INB at the wrist; this was not accompanied by changes in SICI at ISIs of 1 or 2 ms, in SICF at ISIs of 1.2, 2.7, or 4.4 ms, or in LICI at an ISI of 80 ms, but was accompanied by an increase in LICI at an ISI of 150 ms. CONCLUSIONS: The results suggest that (1) the increased excitability of forearm flexors is not due to reduced SICI or LICI or increased SICF, and (2) LICI measured at ISIs of 80 and 150 ms are distinct processes. We discuss the importance of identifying distinct processes of LICI and speculate regarding other mechanisms that could potentially underlie INB-induced plasticity.

Vallence AM; Reilly K; Hammond G

2012-01-01

224

Extended Use of Vettath’s Anastomotic Obturator (VAO)  

Directory of Open Access Journals (Sweden)

Full Text Available Stroke rate in redo coronary artery bypass surgery has remained a stumbling block, where the aorta is used as origin for the top end of the vein graft. Avoiding the side-clamp on these redo aortas by using the Vettath’s Anastomotic Obturator (VAO) technique of anatomosing the vein graft could bring this down. We have also been able to use this technique in combined aortic valve replacement and CABG. These two situations where the VAO is used are elucidated here.

Vettath Prabhakaran Murali; Ismail E. Thazhkuni; Kannan A. Vellachamy

2011-01-01

225

METHOD FOR DIAGNOSTICS OF OBTURATIVE CALCULOUS CHOLECYSTITIS  

UK PubMed Central (United Kingdom)

FIELD: medicine. ^ SUBSTANCE: invention is referred to the field of medicine and can be used for diagnostics of obturative calculous cholecystitis. The patient has the magnetic resonance imaging of bile ducts performed and then the criteria of persistent gall bladder obturation are estimated: increased gall bladder size - 10.0 cm and more in length and/or 4.0 cm and more in width thickening of gall bladder walls - 4.0 mm and more presence of concretion in the area of cervical ductal segment decreased intensity of signal from liquid content of gall bladder compared to the signal from bile in ducts. If two or more criteria are present, the obturative calculous cholecystitis is diagnosed. ^ EFFECT: method allows precise diagnostics of persisted gall bladder obturation at acute and chronic calculous cholecystitis for timely decision on indications for surgical intervention. ^ 1 dwg, 2 ex, 4 dwg

ZHURIKHIN ALEKSANDR VIKTOROVICH; KUTUKOV VLADIMIR EVGEN EVICH; KUZ MICHEV VLADIMIR JUR EVICH

226

[Continuous block of the brachial plexus with nerve stimulation. Intra and postoperative control in orthopedic surgery of the arm  

UK PubMed Central (United Kingdom)

A perivascular axillary plexus block was performed to 87 patients scheduled for orthopedic surgery of hand or arm using an electric nerve stimulator. A catheter was inserted for the postoperative pain control. The success rate was of 90.8% (79 cases); 65 patients (74.7%) presented a complete motor block. Complications were: arterial puncture (3), difficulty in inserting catheter (3), injection out of the sheath (1), pain at the electric stimulation (3). No allergic reactions nor neurologic complications were founded during a year of posterior control.

de Andrés JA; Bolinches R; Vila M; Serrano MT

1989-07-01

227

Comparison between ultrasound-guided sciatic-femoral nerve block and unilateral spinal anaesthesia for outpatient knee arthroscopy.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To compare unilateral spinal anaesthesia (USA) and ultrasound-guided combined sciatic-femoral nerve block (USFB) in ambulatory arthroscopic knee surgeries in terms of haemodynamic stability, nerve block quality, bladder function, adverse events and time-to-readiness for discharge (TRD). METHODS: Patients undergoing ambulatory arthroscopic knee surgery were randomly assigned to one of two groups. The USA group received 2?ml (10?mg) of 0.5% levobupivacaine and the USFB group received a 25?ml mixture consisting of 10?ml of 2.0% lidocaine, 10?ml of 0.5% levobupivacaine and 5?ml of saline (15?ml for the femoral and 10?ml for the sciatic nerve block). Preparation time (PT), surgical anaesthesia time (SAT), operation time, total anaesthesia time, time-to-first spontaneous urination, time-to-first analgesia, TRD, adverse events and patient satisfaction were recorded. RESULTS: A total of 40 patients were enrolled in the study (n?=?20 per group). PT, SAT, total anaesthesia time and time-to-first analgesia were significantly shorter in the USA group than the USFB group; time-to-first spontaneous urination and TRD were significantly longer in the USA group than the USFB group. CONCLUSIONS: USFB provided sufficient duration of sensory blockade and it reduced the TRD and the rate of adverse events.

Davarci I; Tuzcu K; Karcioglu M; Hakimoglu S; Ozden R; Yengil E; Akkurt CÖ; Inanoglu K

2013-10-01

228

Expert consensus recommendations for the performance of peripheral nerve blocks for headaches--a narrative review.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To describe a standardized methodology for the performance of peripheral nerve blocks (PNBs) in the treatment of headache disorders. BACKGROUND: PNBs have long been employed in the management of headache disorders, but a wide variety of techniques are utilized in literature reports and clinical practice. METHODS: The American Headache Society Special Interest Section for PNBs and other Interventional Procedures convened meetings during 2010-2011 featuring formal discussions and agreements about the procedural details for occipital and trigeminal PNBs. A subcommittee then generated a narrative review detailing the methodology. RESULTS: PNB indications may include select primary headache disorders, secondary headache disorders, and cranial neuralgias. Special procedural considerations may be necessary in certain patient populations, including pregnancy, the elderly, anesthetic allergy, prior vasovagal attacks, an open skull defect, antiplatelet/anticoagulant use, and cosmetic concerns. PNBs described include greater occipital, lesser occipital, supratrochlear, supraorbital, and auriculotemporal injections. Technical success of the PNB should result in cutaneous anesthesia. Targeted clinical outcomes depend on the indication, and include relief of an acute headache attack, terminating a headache cycle, and transitioning out of a medication-overuse pattern. Reinjection frequency is variable, depending on the indications and agents used, and the addition of corticosteroids may be most appropriate when treating cluster headache. CONCLUSIONS: These recommendations from the American Headache Society Special Interest Section for PNBs and other Interventional Procedures members for PNB methodology in headache disorder treatment are derived from the available literature and expert consensus. With the exception of cluster headache, there is a paucity of evidence, and further research may result in the revision of these recommendations to improve the outcome and safety of these interventions.

Blumenfeld A; Ashkenazi A; Napchan U; Bender SD; Klein BC; Berliner R; Ailani J; Schim J; Friedman DI; Charleston L 4th; Young WB; Robertson CE; Dodick DW; Silberstein SD; Robbins MS

2013-03-01

229

Treating intractable phantom limb pain with ambulatory continuous peripheral nerve blocks: a pilot study.  

UK PubMed Central (United Kingdom)

BACKGROUND: There is currently no reliable treatment for phantom limb pain (PLP). Chronic PLP and associated cortical abnormalities may be maintained from abnormal peripheral input, raising the possibility that a continuous peripheral nerve block (CPNB) of extended duration may permanently reorganize cortical pain mapping, thus providing lasting relief. METHODS: Three men with below-the-knee (2) or -elbow (1) amputations and intractable PLP received femoral/sciatic or infraclavicular perineural catheter(s), respectively. Subjects were randomized in a double-masked fashion to receive perineural ropivacaine (0.5%) or normal saline for over 6 days as outpatients using portable electronic infusion pumps. Four months later, subjects returned for repeated perineural catheter insertion and received an ambulatory infusion with the alternate solution ("crossover"). Subjects were followed for up to 1 year. RESULTS: By chance, all three subjects received saline during their initial infusion and reported little change in their PLP. One subject did not receive crossover treatment, but the remaining two subjects reported complete resolution of their PLP during and immediately following treatment with ropivacaine. One subject experienced no PLP recurrence through the 52-week follow-up period and the other reported mild PLP occurring once each week of just a small fraction of his original pain (pretreatment: continuous PLP rated 10/10; posttreatment: no PLP at baseline with average of one PLP episode each week rated 2/10) for 12 weeks (lost to follow-up thereafter). CONCLUSIONS: A prolonged ambulatory CPNB may be a reliable treatment for intractable PLP. The results of this pilot study suggest that a large, randomized clinical trial is warranted.

Ilfeld BM; Moeller-Bertram T; Hanling SR; Tokarz K; Mariano ER; Loland VJ; Madison SJ; Ferguson EJ; Morgan AC; Wallace MS

2013-06-01

230

Ultrasound anatomy of the brachial plexus nerves in the neurovascular bundle at the axilla in patients undergoing upper-extremity block anesthesia.  

UK PubMed Central (United Kingdom)

PURPOSE: Familiarity with the localization of the nerves in the neurovascular bundle that constitutes the axillary segment of the brachial plexus (BP) is important when applying ultrasound (US)-guided block anesthesia. Therefore in this study we aimed to delineate the anatomy of the median, radial, and ulnar nerves of the BP at the axilla with US and electrical stimulation. MATERIALS AND METHODS: The study included 60 patients who were scheduled to undergo upper-arm surgery with axillary block anesthesia. Prior to anesthesia, ulnar, radial, and median nerves were localized with US using a 12-h quadrant identification system that placed the axillary artery (AA) in the middle. The nerves were then functionally tested using a neurostimulator. RESULTS: The radial nerve was mainly located in the 4-6 o'clock arc (posterior and posteromedial to AA) in 50 (83 %) of patients. Ulnar nerve was mainly at the 12-3 o'clock arc (anteromedial to AA) in 51 (85 %) of patients. Ulnar nerve showed a second peak at 9-10 o'clock quadrant (anterolateral to AA) in 11 % (7) of patients. Median nerve location was most common in the 12 and 9 o'clock arc (anterior and anterolateral to AA) in 53 (88 %) of the patients. CONCLUSIONS: Ultrasound is a useful tool for depicting BP anatomy in the axillary fossa prior to block anesthesia. Median, ulnar, and radial nerves form a highly consistent triangular pattern around the axillary artery that is easily recognizable with US.

Ustuner E; Y?lmaz A; Özgencil E; Okten F; Turhan SC

2013-05-01

231

Clinical comparisons of 0.5% and 0.375% levobupivacaine for ultrasound-guided axillary brachial plexus block with nerve stimulation.  

UK PubMed Central (United Kingdom)

BACKGROUND: In an axillary brachial plexus block (ABPB), where relatively large doses of local anesthetics are administered, levobupivacaine is preferred due to a greater margin of safety. However, the efficacy of levobupivacaine in ABPB has not been studied much. We performed a prospective, double-blinded study to compare the clinical effect of 0.375% levobupivacaine with 0.5% levobupivacaine for ultrasound (US)-guided ABPB with nerve stimulation. METHODS: FORTY PATIENTS UNDERGOING ELECTIVE UPPER LIMB SURGERY WERE RANDOMIZED INTO TWO GROUPS: Group I (0.375% levobupivacaine) and Group II (0.5% levobupivacaine). All four main terminal nerves of the brachial plexus were blocked separately with 7 ml of levobupivacaine using US guidance with nerve stimulation according to study group. A blinded observer recorded the onset time for sensory and motor block, elapsed time to be ready for surgery, recovery time for sensory and motor block, quality of anesthesia, patient satisfaction and complications. RESULTS: There were no significant differences in the time to find nerve locations, time to perform block and number of skin punctures between groups. Insufficient block was reported in one patient of Group I, but no failed block was reported in either group. There were no differences in the onset time for sensory and motor block, elapsed time to be ready for surgery, patient satisfaction and complications. CONCLUSIONS: 0.375% levobupivacaine produced adequate anesthesia for ABPB using US guidance with nerve stimulation, without any clinically significant differences compared to 0.5% levobupivacaine.

Kim W; Kim YJ; Kim JH; Kim DY; Chung RK; Kim CH; Heo S

2012-01-01

232

Clinical comparisons of 0.5% and 0.375% levobupivacaine for ultrasound-guided axillary brachial plexus block with nerve stimulation  

Science.gov (United States)

Background In an axillary brachial plexus block (ABPB), where relatively large doses of local anesthetics are administered, levobupivacaine is preferred due to a greater margin of safety. However, the efficacy of levobupivacaine in ABPB has not been studied much. We performed a prospective, double-blinded study to compare the clinical effect of 0.375% levobupivacaine with 0.5% levobupivacaine for ultrasound (US)-guided ABPB with nerve stimulation. Methods Forty patients undergoing elective upper limb surgery were randomized into two groups: Group I (0.375% levobupivacaine) and Group II (0.5% levobupivacaine). All four main terminal nerves of the brachial plexus were blocked separately with 7 ml of levobupivacaine using US guidance with nerve stimulation according to study group. A blinded observer recorded the onset time for sensory and motor block, elapsed time to be ready for surgery, recovery time for sensory and motor block, quality of anesthesia, patient satisfaction and complications. Results There were no significant differences in the time to find nerve locations, time to perform block and number of skin punctures between groups. Insufficient block was reported in one patient of Group I, but no failed block was reported in either group. There were no differences in the onset time for sensory and motor block, elapsed time to be ready for surgery, patient satisfaction and complications. Conclusions 0.375% levobupivacaine produced adequate anesthesia for ABPB using US guidance with nerve stimulation, without any clinically significant differences compared to 0.5% levobupivacaine.

Kim, Wonkyo; Kim, Jong-Hak; Kim, Dong Yeon; Chung, Rack Kyung; Kim, Chi Hyo; Heo, Seok

2012-01-01

233

Case report: Three-dimensional high-resolution ultrasound-guided nerve blocks: a new panoramic vision of local anesthetic spread and perineural catheter tip location.  

UK PubMed Central (United Kingdom)

We report in 3 patients that high-frequency ultrasound 3-dimensional imaging enabled us to analyze anatomic variations, evaluate local anesthetic spread, and optimize a perineural catheter location by withdrawing it until its tip was appropriately positioned. This innovative technology may provide answers to different problems facing the operator performing ultrasound-guided nerve blocks. It may enhance predictability and safety aspects of peripheral nerve blocks.

Choquet O; Capdevila X

2013-05-01

234

Obturator hernia: laparoscopic diagnosis and repair.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Review of international literature reveals eight reported cases of laparoscopic obturator hernia repair. Non-specific signs and symptoms make the diagnosis of an obturator hernia difficult. Laparoscopic intervention provides a minimally invasive method to simultaneously diagnose and repair these hernias. METHODS AND PROCEDURES: A 35 year old woman presented with lower abdominal pain, vaginal bleeding, and dyspareunia. During gynecological diagnostic laparoscopy, a pelvic floor hernia was suspected, and a general surgical evaluation was sought. At a subsequent laparoscopy, the diagnosis of a left direct inguinal and a right obturator hernia was made. Both were repaired laparoscopically with polypropylene mesh. RESULTS: At follow-up at one and six weeks postoperatively, the patient's complaints of pain had completely resolved. CONCLUSION: The diagnosis of obturator hernia is problematic. The usual presenting signs and symptoms are non-specific. Without conclusive historical or physical findings, laparoscopy is an excellent method for diagnosing obturator hernia. This entity, once diagnosed laparoscopically, can be repaired simultaneously via laparoscopic mesh technique.

Haith LR Jr; Simeone MR; Reilly KJ; Patton ML; Moss BE; Shotwell BA

1998-04-01

235

Diagnosis and treatment of obturator hernia  

International Nuclear Information System (INIS)

Obturator hernia is a rare type of hernia, but it is a significant cause of intestinal obstruction due to the associated anatomy. Correct diagnosis and treatment of obturator hernia is important, because delay can lead to high mortality. Twelve patients with obturator hernia were managed during a 11-year period, including 11 women and 1 man with a mean age of 82 years. We compared our experience with the previously published data to establish standards for the diagnosis and treatment of this hernia. All 12 patients presented with intestinal obstruction. The median interval from admission to operation was 2 days. The Howship-Romberg sign was positive in 5 patients. A correct diagnosis was made in all 8 patients who underwent pelvic CT scanning. Surgery was performed via an abdominal approach (n=7) or an inguinal approach (n=5). The hernial orifice was closed using the uterine fundus (n=6), a patch (n=5), and direct suture (n=1). Mean follow-up time was 33 months, and no recurrence has been detected. The poor physical condition of patients might have led to a delay in diagnosis and treatment. In troubled patients with nonspecific intestinal obstruction, CT scanning is useful for the early diagnosis of obturator hernia. Correct CT diagnosis of obturator hernia allows us to select the inguinal approach combined with patch repair, which is minimally invasive surgery. (author)

2002-01-01

236

Diagnosis and treatment of obturator hernia  

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Obturator hernia is a rare type of hernia, but it is a significant cause of intestinal obstruction due to the associated anatomy. Correct diagnosis and treatment of obturator hernia is important, because delay can lead to high mortality. Twelve patients with obturator hernia were managed during a 11-year period, including 11 women and 1 man with a mean age of 82 years. We compared our experience with the previously published data to establish standards for the diagnosis and treatment of this hernia. All 12 patients presented with intestinal obstruction. The median interval from admission to operation was 2 days. The Howship-Romberg sign was positive in 5 patients. A correct diagnosis was made in all 8 patients who underwent pelvic CT scanning. Surgery was performed via an abdominal approach (n=7) or an inguinal approach (n=5). The hernial orifice was closed using the uterine fundus (n=6), a patch (n=5), and direct suture (n=1). Mean follow-up time was 33 months, and no recurrence has been detected. The poor physical condition of patients might have led to a delay in diagnosis and treatment. In troubled patients with nonspecific intestinal obstruction, CT scanning is useful for the early diagnosis of obturator hernia. Correct CT diagnosis of obturator hernia allows us to select the inguinal approach combined with patch repair, which is minimally invasive surgery. (author)

Nakayama, Takamori; Kobayashi, Seiji; Shiraishi, Kou; Nishiumi, Takao; Mori, Syunji; Isobe, Kiyoshi; Furuta, Yoshiaki [Shizuoka Red Cross Hospital (Japan)

2002-09-01

237

The perioperative effect of increased body mass index on peripheral nerve blockade: an analysis of 528 ultrasound guided interscalene blocks.  

UK PubMed Central (United Kingdom)

BACKGROUND AND OBJECTIVES: Obese patients can pose a unique perioperative anesthetic challenge, making regional anesthetic techniques an intriguing means of providing analgesia for this population. Ultrasound guidance has been touted recently as being beneficial for this population in which surface landmarks can become obscured. In this study, the effect of increased Body Mass Index (BMI) on ultrasound guided interscalene peripheral nerve blockade is investigated. MATERIAL AND METHODS: This study is a retrospective review of 528 consecutive patients who received preoperative ultrasound-guided interscalene nerve blocks at the University of Wisconsin Hospital and Clinics. We examined the association between BMI and the following parameters: time required for block placement; presence of Postoperative Nausea and Vomiting (PONV); postoperative Post Anesthesia Care Unit (PACU) pain scores; volume of local anesthetic injected; acute complications; and opioid administration preoperatively, intraoperatively, and postoperatively. Univariate and multivariate least squares and logistic regression models were used. RESULTS: An elevated BMI was associated with an increased: time required for block placement (p-value=0.025), intraoperative fentanyl administration (p-value<0.001), peak PACU pain scores (p-value<0.001), PACU opioid administration (p-value<0.001), PACU oral opioid administration (p-value<0.001), total PACU opioid administration (p-value<0.001) and incidence of PACU nausea (p-value=0.025) CONCLUSIONS: Ultrasound guided interscalene nerve blocks for perioperative analgesia can be safely and effectively performed in the obese patient but they may be more difficult to perform and analgesia may not be as complete.

Schroeder K; Andrei AC; Furlong MJ; Donnelly MJ; Han S; Becker AM

2012-01-01

238

Onset and Duration Period of Pulpal Anesthesia of Articaine and Lidocaine in Inferior Alveolar Nerve Block  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese A proposta deste estudo prospectivo, randomizado e duplo cego foi comparar o período de latência e duração da anestesia pulpar utilizando lidocaina 2% com epinefrina 1:100.000, articaina 4% com epinefrina 1:100.000 e articaina 4% com epinefrina 1:200.000 no bloqueio do nervo alveolar inferior (BNAI). Trinta pacientes receberam 1,8 mL de cada uma das soluções anestésicas no BNAI. Os períodos de latência e duração da an (more) estesia pulpar foram determinados usando estimulação pulpar elétrica. O tempo médio da latência da anestesia pulpar foi 8,7, 7,4 e 7,7 min e da duração média da anestesia pulpar foi 61,8, 106,6 e 88,0 min para lidocaina 2% com epinefrina 1:100.000, articaina 4% com epinefrina 1:100.000 e articaina 4% com epinefrina 1:200.000, respectivamente. Para latência houve somente diferença significante entre lidocaina 2% com epinefrina 1:100.000 e articaina 4% com epinefrina 1:100.000 (p=0,037). Para a duração houve diferença significante para todas as soluções anestésicas locais (p?0,05). Em conclusão, articaina 4% com epinefrina 1:100.000 exibiu mais rápida latência e também obteve mais longa duração da anestesia pulpar no BNAI. Abstract in english The purpose of this prospective, randomized, double blind study was to compare the onset and duration periods of pulpal anesthesia using 2% lidocaine with 1:100,000 epinephrine, 4% articaine with 1:100,000 epinephrine and 4% articaine with 1:200,000 epinephrine in inferior alveolar nerve block (IANB). Thirty subjects received 1.8 mL of each of the three local anesthetic solutions in IANB. Onset and duration periods of pulpal anesthesia were determined using electric pulp (more) stimulation. The mean time of onset of pulpal anesthesia was 8.7, 7.4 and 7.7 min and the mean duration of pulpal anesthesia was 61.8, 106.6 and 88.0 min for 2% lidocaine with 1:100,000 epinephrine, 4% articaine with 1:100,000 epinephrine and 4% articaine with 1:200,000 epinephrine, respectively. For onset, there was only a significant difference between 2% lidocaine with 1:100,000 epinephrine and 4% articaine with 1:100,000 epinephrine (p=0.037). For duration, there was significant difference for all the local anesthetic solutions (p?0.05). In conclusion, 4% articaine with 1:100,000 epinephrine exhibited faster onset and also had longest duration of pulpal anesthesia in IANB.

Tortamano, Isabel Peixoto; Siviero, Marcelo; Lee, Sara; Sampaio, Roberta Moura; Simone, Jose Leonardo; Rocha, Rodney Garcia

2013-07-01

239

Effect of massage on the efficacy of the mental and incisive nerve block.  

UK PubMed Central (United Kingdom)

The purpose of this trial was to assess the effect of soft tissue massage on the efficacy of the mental and incisive nerve block (MINB). Thirty-eight volunteers received MINB of 2.2 mL of 2% lidocaine with 1?:?80,000 epinephrine on 2 occasions. At one visit the soft tissue overlying the injection site was massaged for 60 seconds (active treatment). At the other visit the crowns of the mandibular premolar teeth were massaged (control treatment). Order of treatments was randomized. An electronic pulp tester was used to measure pulpal anesthesia in the ipsilateral mandibular first molar, a premolar, and lateral incisor teeth up to 45 minutes following the injection. The efficacy of pulp anesthesia was determined by 2 methods: (a) by quantifying the number of episodes with no response to maximal electronic pulp stimulation after each treatment, and (b) by quantifying the number of volunteers with no response to maximal pulp stimulation (80 reading) on 2 or more consecutive tests, termed anesthetic success. Data were analyzed by McNemar, Mann-Whitney, and paired-samples t tests. Anesthetic success was 52.6% for active and 42.1% for control treatment for lateral incisors, 89.5 and 86.8% respectively for premolars, and 50.0 and 42.1% respectively for first molars (P = .344, 1.0, and .508 respectively). There were no significant differences in the number of episodes of negative response to maximum pulp tester stimulation between active and control massage. A total of 131 episodes were recorded after both active and control massage in lateral incisors (McNemar test, P = 1.0), 329 (active) versus 316 (control) episodes in the premolars (McNemar test, P = .344), and 119 (active) versus 109 (control) episodes respectively for first molars (McNemar test, P = .444). Speed of anesthetic onset and discomfort did not differ between treatments. We concluded that soft tissue massage after MINB does not influence anesthetic efficacy.

Jaber A; Whitworth JM; Corbett IP; Al-Baqshi B; Jauhar S; Meechan JG

2013-01-01

240

The association between lower extremity continuous peripheral nerve blocks and patient falls after knee and hip arthroplasty.  

UK PubMed Central (United Kingdom)

BACKGROUND: Continuous peripheral nerve blocks (CPNB) may induce muscle weakness, and multiple recently published series emphasize patient falls after postarthroplasty CPNB. However, none have included an adequate control group, and therefore the relationship between CPNB and falls remains speculative. METHODS: We pooled data from 3 previously published, randomized, triple-masked, placebo-controlled studies of CPNB involving the femoral nerve after knee and hip arthroplasty. RESULTS: No patients receiving perineural saline (n = 86) fell (0%; 95% confidence interval [CI] = 0%-5%), but there were 7 falls in 6 patients receiving perineural ropivacaine (n = 85; 7%; 95% CI = 3%-15%; Fisher's exact test P = 0.013). CONCLUSIONS: Our analysis suggests that there is a causal relationship between CPNB and the risk of falling after knee and hip arthroplasty.

Ilfeld BM; Duke KB; Donohue MC

2010-12-01

 
 
 
 
241

An unusual cause of sciatic pain as a result of the dynamic motion of the obturator internus muscle.  

UK PubMed Central (United Kingdom)

BACKGROUND CONTEXT: It has been reported that compression of the sciatic nerve because of any cause, including endometriosis, piriformis syndrome, abscess, tumor, adjoining uterus provoke sciatic pain. Some of these pathophysiologies have been diagnosed clinically and sometimes by exclusion. PURPOSE: To discuss the clinical features of sciatic neuropathy under the belief that dynamic motion of the obturator internus muscle and tendon should be included in the differential diagnosis of sciatic neuropathy. STUDY DESIGN: Sciatic neuropathy, which was because of compression of the sciatic nerve caused by dynamic motion of the tendon and muscle of the obturator internus, was reported. METHODS: We performed surgery to confirm the outlet of the pelvis. RESULTS: Although no compression was provoked by the piriformis muscle, obvious compression was observed on the sciatic nerve by the stretched obturator internus muscle. CONCLUSIONS: Although it may not be common, compression of the sacral plexus caused by dynamic motion of the obturator internus muscle should be included as a possible diagnosis for sciatic pain.

Murata Y; Ogata S; Ikeda Y; Yamagata M

2009-06-01

242

Wound/intra-articular infiltration or peripheral nerve blocks for orthopedic joint surgery: efficacy and safety issues.  

UK PubMed Central (United Kingdom)

PURPOSE OF REVIEW: Pain following arthroplasty is managed utilizing continuous peripheral nerve blocks (PNB) or local infiltration analgesia (LIA). The current economic climate in many countries requires discharge from the hospital within a couple of days following arthroplasty. Earlier studies had documented the efficacy of LIA for lower limb arthroplasty with preserved motor function and early rehabilitation, but some recent studies fail to confirm such a benefit. The motor block associated with PNB can be challenging with well tolerated rehabilitation. This review will discuss the efficacy and safety of these two analgesic techniques. RECENT FINDINGS: LIA facilitates early rehabilitation with total knee joint arthroplasty but such a benefit may not be obvious with total hip arthroplasty in the presence of multimodal analgesia. LIA data are very diverse depending on drugs injected, site of catheters, drug dosing and use of adjuvants. Chondrolysis documented with shoulder surgery with LIA is not a concern as there is no cartilage left with arthroplasty except in uniknees. Unpredictable motor weakness poses challenge with lower limb nerve blocks. SUMMARY: More rigorously conducted large-scale comparative studies are required to document the relative safety and efficacy of these two analgesic techniques. Standardization of infiltration techniques, catheter location, drugs and dosing are much needed. LIA with extended duration long-acting local anesthetic is in its infancy and may be an alternative to PNBs.

Ganapathy S

2012-10-01

243

The efficacy of automated intermittent boluses for continuous femoral nerve block: a prospective, randomized comparison to continuous infusions.  

UK PubMed Central (United Kingdom)

STUDY OBJECTIVE: To determine whether an automated intermittent bolus technique provides enhanced analgesia compared with a continuous infusion for femoral nerve block. DESIGN: Prospective, single-blinded, randomized controlled trial (ClinicalTrials.gov Identifier: NCT01226927). SETTING: Perioperative areas and orthopedic surgical ward of a university hospital. PATIENTS: 45 ASA physical status 1, 2, and 3 patients undergoing unilateral primary total knee arthroplasty. INTERVENTIONS: All patients received single-injection sciatic and femoral nerve blocks plus femoral nerve catheter placement for postoperative analgesia. Patients were randomly assigned to an automated intermittent bolus (5 mL every 30 min with 0.1 mL/hr basal rate) or a continuous infusion (10.1 mL/hr) delivery method of 0.2% ropivacaine. MEASUREMENTS: Consumption of intravenous patient-controlled analgesia (IV-PCA) and visual analog scale (VAS) pain scores were assessed postoperatively at set intervals until the morning of postoperative day (POD) 2. MAIN RESULTS: The mean (SEM) cumulative IV-PCA dose (mg of hydromorphone) for the 36-hour postoperative interval measured was 12.9 ± 2.32 in the continuous infusion rate group (n = 20) and 7.8 ± 1.02 in the intermittent bolus group [n = 21, t(39) = 2.04, P = 0.048; a 39 ± 14% difference in total usage]. Pain scores were statistically significantly lower in the intermittent bolus group in the afternoon of POD 1 (t(39) = 2.47, P = 0.018), but were otherwise similar. CONCLUSIONS: An automated intermittent bolus infusion technique for femoral nerve catheters is associated with clinically and statistically significantly less IV-PCA use (ie, an opioid-sparing effect) than a continuous infusion technique.

Hillegass MG; Field LC; Stewart SR; Borckardt JJ; Dong L; Kotlowski PE; Demos HA; Del Schutte H; Reeves ST

2013-06-01

244

Feasibility of ultrasound-guided peripheral nerve block catheters for pain control on pediatric medical missions in developing countries.  

UK PubMed Central (United Kingdom)

Continuous peripheral nerve blocks (CPNB) are effective for postoperative pain management in children in the hospital and at home. CPNB techniques are particularly advantageous when compared with systemic or oral opioids on medical missions to unfamiliar environments with minimal monitoring capacity. In addition, ultrasound-guidance facilitates the placement of perineural catheters in anesthetized children even in the absence of commercially packaged regional anesthesia equipment. We present a series of successful cases employing ultrasound-guided CPNB for postoperative analgesia on medical missions and discuss the impact of this technology on present and future patients in underserved countries.

Mariano ER; Ilfeld BM; Cheng GS; Nicodemus HF; Suresh S

2008-07-01

245

Analgesic efficacy and safety of medical therapy alone vs combined medical therapy and extraoral glossopharyngeal nerve block in glossopharyngeal neuralgia.  

UK PubMed Central (United Kingdom)

OBJECTIVE: The aim of this study is to compare medical therapy alone and medical therapy with add on extraoral glossopharyngeal nerve block in terms of analgesic efficacy and hemodynamic safety in patients with glossopharyngeal neuralgia (GPN). As GPN is a rare disease, our secondary targets were to review the demographic profile of the disease, clinical profile, and any associations with the disease. DESIGN: This was a randomized, prospective, active-controlled, parallel group study conducted from 2007 to 2009 to determine the safety and efficacy of extraoral glossopharyngeal nerve block in GPN and compare it with pharmacological intervention. After institutional ethics committee approval and patient's consent, GPN patients were randomly allocated into two groups. Group A (N?=?15) received standard medical therapy (gabapentin 300?mg, tramadol 50?mg TDS, methylcobalamin 500??gm PO) and group B (N?=?15) patients received extraoral glossopharyngeal nerve block together with standard medical therapy. Patients were analyzed for analgesic outcome using numerical pain scale (NPS) and brief pain inventory (BPI) assessing both analgesic effect and degree of interference in quality of life (QOL) during 3-month follow-up. They were also evaluated for any significant hemodynamic alterations. RESULTS: Over the follow-up of 90 days, the mean NPS in group A decreased from 6?±?2 to 3?±?2 and in group B from 5?±?1 to 2?±?2. From the mean NPS scores, it can be interpreted that both the modalities were effective clinically in treating GPN. However, NPS scores were statistically similar by the end of 90 days. Improvement from baseline in BPI measurement of QOL (mood, interpersonal relationship, and emotion) was earlier in group B (1, 2, and 1 months, respectively) compared with group A (2, 3, and 2 months, respectively). However, there were no significant hemodynamic adverse outcomes after administration of the block. CONCLUSION: This study found that patients in both the groups had significantly lower pain intensities, improved pain relief, and reduced pain interference with QOL, which was especially evident on fourth visit (2 months) after the initiation of treatment regimen. Both were safe and well tolerated. The study advocates rational polypharmacy approach (oral and block) in difficult to treat painful conditions. Further controlled trials are warranted to further define the impact of such a combination therapy.

Singh PM; Dehran M; Mohan VK; Trikha A; Kaur M

2013-01-01

246

Evidence-based guideline for neuropathic pain interventional treatments: spinal cord stimulation, intravenous infusions, epidural injections and nerve blocks.  

UK PubMed Central (United Kingdom)

BACKGROUND: The Special Interest Group of the Canadian Pain Society has produced consensus-based guidelines for the pharmacological management of neuropathic pain. The society aimed to generate an additional guideline for other forms of neuropathic pain treatments. OBJECTIVE: To develop evidence-based recommendations for neuropathic pain interventional treatments. METHODS: A task force was created and engaged the Institute of Health Economics in Edmonton, Alberta, to survey the literature pertaining to multiple treatments. Sufficient literature existed on four interventions only: spinal cord stimulation; epidural injections; intravenous infusions; and nerve blocks. A comprehensive search was conducted for systematic reviews, randomized controlled trials and evidence-based clinical practice guidelines; a critical review was generated on each topic. A modified United States Preventive Services Task Force tool was used for quality rating and grading of recommendations. RESULTS: Investigators reviewed four studies of spinal cord stimulation, 19 studies of intravenous infusions, 14 studies of epidural injections and 16 studies of nerve blocks that met the inclusion criteria. The task force chairs rated the quality of evidence and graded the recommendations. Feedback was solicited from the members of the task force. CONCLUSION: There is sufficient evidence to support recommendations for some of these interventions for selected neuropathic pain conditions. This evidence is, at best, moderate and is often limited or conflicting. Pain practitioners are encouraged to explore evidence-based treatment options before considering unproven treatments. Full disclosure of risks and benefits of the available options is necessary for shared decision making and informed consent.

Mailis A; Taenzer P

2012-05-01

247

Risk of catheter-associated infection in young hematology/oncology patients receiving long-term peripheral nerve blocks.  

UK PubMed Central (United Kingdom)

Background:? Continuous peripheral nerve blocks (CPNBs) are increasingly used to control postoperative and chronic pain. At our pediatric oncology institution, the duration of CPNBs is often prolonged. The risk of catheter-associated infection with prolonged CPNBs has not been previously investigated. Aim:? We analyzed the incidence of CPNB-related infection and its relation to catheter duration, catheter site, intensive care stay, and antibiotic coverage. Methods:? All CPNBs placed at our institution between August 1, 2005 and October 31, 2010 were studied. Primary diagnosis and the site, indication, duration, and infectious adverse effects of CPNBs were obtained from our Pain Service QI database. Patients' age and sex, antibiotic administration, and number of days in intensive care were collected from patients' medical records. Results:? The use of 179 catheters in 116 patients was evaluated. Mean age at CPNB placement was 15.1?years (median, 14.7; range, 0.4-26.9). The most frequent indication for CPNB was surgery (89.4%), most commonly orthopedic (78.8%). Mean CPNB duration was 7.2?days (median, 5.0; range, 1-81?days). Two cases (1.12%) of CPNBs developed signs of infection, both associated with femoral catheters. The infections were mild and necessitated catheter removal at days 10 and 13, respectively. Conclusion:? Nerve block catheter-associated infections are infrequent at our institution despite prolonged CPNB use. Both patients with infection had femoral catheters and prolonged catheter (?10?days) use.

Anghelescu DL; Harris BL; Faughnan LG; Oakes LL; Windsor KB; Wright BB; McCullers JA

2012-05-01

248

Does suprascapular nerve block reduce shoulder pain following stroke: a double-blind randomised controlled trial with masked outcome assessment.  

UK PubMed Central (United Kingdom)

BACKGROUND: Shoulder pain is a common complication of a stroke which can impede participation in rehabilitation programs and has been associated with poorer outcomes. The evidence base for current medical and therapeutic management options of hemiplegic shoulder pain is limited. This study will evaluate the use of suprascapular nerve block injection as part of an interdisciplinary approach to the treatment of shoulder pain following stroke. The technique has previously been proven safe and effective in the treatment of shoulder pain associated with rheumatoid arthritis and degenerative shoulder conditions but its usefulness in a stroke population is unclear. METHODS/DESIGN: A double blind randomised placebo controlled trial will assess the effect of a suprascapular nerve block compared with placebo in a population of 66 stroke patients. The trial will measure effect of injection on the primary outcome of pain, and secondary outcomes of function and quality of life. Measurements will take place at baseline, and 1, 4 and 12 weeks post intervention. Both groups will continue to receive routine physiotherapy and standard ward care. DISCUSSION: The results of this study could reduce pain symptoms in persons with mechanical shoulder pain post stroke and provide improvement in upper limb function. TRIAL REGISTRATION: This trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) - ACTRN12609000621213.

Allen ZA; Shanahan EM; Crotty M

2010-01-01

249

[Attenuation of phrenic nerve palsy associated with brachial plexus block by modified supra costal approach under fluoroscopic guidance].  

UK PubMed Central (United Kingdom)

BACKGROUND: Brachial plexus block (BPB) frequently accompanies phrenic nerve palsy (PNP). METHODS: Thirty six patients scheduled for upper-limb surgery were allocated to 2 groups; 14 patients undergoing BPB with the supra costal approach (i. e. placing the needle-tip at the middle of the 1st lib), and 22 patients undergoing BPB with the modified supra costal approach (i. e. placing the needle-tip in the visceral or dorsal area of the 1st lib). We evaluated analgesic effects of the block and changes in forced vital capacity (FVC). RESULTS: BPB with both approaches provided sufficient analgesia. After BPB with both approaches, a significant reductions in FVC was observed; however, the reduction after BPB with the modified supra costal approach was significantly lower than that with the supra costal approach. CONCLUSIONS: These results suggest that BPB with the modified supra costal approach provides sufficient analgesia with a significantly lower degree of PNP. We suppose that distribution of local anesthetics is altered by changing the location of the needle-tip on the 1st lib. Amounts of local anesthetics distributing around the phrenic nerve can be reduced by the modified supra costal approach, leading to the significantly less reduction in FVC after BPB.

Saito Y; Kitamura T; Otsuji M; Yamada Y

2010-06-01

250

Multilevel nerve stimulator-guided paravertebral block as a sole anesthetic technique for breast cancer surgery in morbidly obese patients.  

Science.gov (United States)

In this case series, we present the effectiveness of multilevel nerve stimulator-guided paravertebral block (PVB) technique in obese women of body mass index ?30 kg/m(2) undergoing breast cancer surgery with or without axillary dissection. Twenty-six obese women were included in this case series. Block classification, hemodynamics and complication rate, postoperative nausea and vomiting, postoperative analgesic consumption, post-anesthesia care unit (PACU) stay, and hospital stay were recorded. All patients were hemodynamically stable during the operation, and no complications were noted. Patients stayed 69 min on average in the PACU and were discharged within 2 days. Confirmation of the landmark was established from the initial attempt in 61.5%. Surgical PVB was achieved in 76.9% of the patients; the failure rate of the technique was 11.5%. This case series suggested that the multilevel nerve stimulator-guided PVB may be an effective technique for obese patients undergoing breast cancer surgery, although further studies are needed to compare PVB and general anesthesia. PMID:21748373

Naja, Zoher M; Naccache, Nicole; Ziade, Fouad; El-Rajab, Mariam; Itani, Taha; Baraka, Anis

2011-07-12

251

Addition of femoral nerve block to epidural infusion for pain control post total knee arthroplasty: Does it make a difference?  

Directory of Open Access Journals (Sweden)

Full Text Available Introduction: Effective post-operative analgesia is a major factor in functional outcome after total knee arthroplasty (TKA). To reduce post-operative pain and expedite recovery, peripheral nerve blocks, such as the femoral nerve block (FNB) have been used as an adjunct to the analgesic regime. We assessed whether the addition of a FNB to continuous epidural analgesia (CEA) would improve pain control after TKA. Materials and Methods: A prospective, randomised, controlled study was conducted on 58 patients undergoing TKA and randomised into two groups. The CEA+FNB Group received a single-shot FNB of 30 ml 0.5% bupivacaine using a nerve stimulator technique. The CEA Group acted as a control group and did not receive FNB. Patients in both groups then received combined spinal-epidural anaesthesia for the surgery. Post-operative epidural infusion with 0.1% bupivacaine and 2 µg/ml of fentanyl, at 6 ml/hr was continued up to 48 hours post-operatively. Visual analogue scale (VAS) scores, motor blockade, requirement of rescue analgesia and patient satisfaction were recorded. Results: VAS scores were not significantly different between the CEA+FNB and CEA groups during rest (3 vs. 2) and flexion (5 vs. 6) on postoperative day-1 and during rest (1 vs. 2) and flexion (4 vs. 4) on postoperative day-2. There was no significant difference in rescue analgesia required, the volume of epidural infusion, motor blockade or patient satisfaction between both groups. Conclusion: We concluded that the addition of FNB to epidural infusion did not improve analgesia after TKA.

Melvin KANDASAMY; Muhammad MAAYA; Raha ABDUL RAHMAN; Nadia MD NOR; Nurlia YAHYA

2012-01-01

252

Ultrasound-Guided Trigeminal Nerve Block via the Pterygopalatine Fossa: An Effective Treatment for Trigeminal Neuralgia and Atypical Facial Pain.  

UK PubMed Central (United Kingdom)

BACKGROUND: Patients presenting with facial pain often have ineffective pain relief with medical therapy. Cases refractory to medical management are frequently treated with surgical or minimally invasive procedures with variable success rates. We report on the use of ultrasound-guided trigeminal nerve block via the pterygopalatine fossa in patients following refractory medical and surgical treatment. OBJECTIVE: To present the immediate and long-term efficacy of ultrasound-guided injections of local anesthetic and steroids in the pterygopalatine fossa in patients with unilateral facial pain that failed pharmacological and surgical interventions. SETTING: Academic pain management center. STUDY DESIGN: Prospective case series. METHODS: Fifteen patients were treated with ultrasound-guided trigeminal nerve block with local anesthetic and steroids placed into the pterygopalatine fossa. RESULTS: All patients achieved complete sensory analgesia to pin prick in the distribution of the V2 branch of the trigeminal nerve and 80% (12 out of 15) achieved complete sensory analgesia in V1, V2, V3 distribution within 15 minutes of the injection. All patients reported pain relief within 5 minutes of the injection. The majority of patients maintained pain relief throughout the 15 month study period. No patients experienced symptoms of local anesthetic toxicity or onset of new neurological sequelae. LIMITATIONS: Prospective case series. CONCLUSION: We conclude that the use of ultrasound guidance for injectate delivery in the pterygopalatine fossa is a simple, free of radiation or magnetization, safe, and effective percutaneous procedure that provides sustained pain relief in trigeminal neuralgia or atypical facial pain patients who have failed previous medical interventions.

Nader A; Kendall MC; Deoliveria GS; Chen JQ; Vanderby B; Rosenow JM; Bendok BR

2013-09-01

253

Supraclavicular approach to brachial plexus block using fluoroscopic anatomic landmarks and nerve stimulation.  

Science.gov (United States)

Irritation of neural structures, specifically the brachial plexus outside of the cervical spine is capable of producing pain in the upper extremity. These pain patterns may be similar to pain originating from the cervical spine, presenting a diagnostic challenge. Brachial plexus block is performed at multiple levels, including interscalene, supraclavicular, infraclavicular, and axillary. Interscalene block is frequently utilized by interventional pain management physicians for diagnostic and therapeutic purposes to isolate and manage the brachial plexus as a pain generator. The traditional methods employed in performing interscalene or supraclavicular brachial plexus blocks are associated with multiple disadvantages. A new technique is described to meet five essential requirements encompassing safety, specificity, consistency, reproducibility and a high success rate. Relevant anatomy and proposed technique of brachial plexus block is described. The procedure is performed under fluoroscopy with contrast injection. It is concluded that the proposed technique of brachial plexus block is useful for brachial plexus blockade providing precision and specificity with minimal complications. PMID:16883379

Vilims, Bradley D; Wright, Robert E

2003-04-01

254

Combined axillary block with "selective" injection of nerves and the axillary catheter: comparison of bupivacaine 0.25% or levobupivacaine 0.25%.  

UK PubMed Central (United Kingdom)

PURPOSE: The aim of this study is to apply combination of axillary plexus block with "selective" injection of nerves and continuous catheter technique, and to compare the anesthetic and postoperative analgesic effects of bupivacaine and levobupivacaine. METHODS: In 30 scheduled patients for unilateral hand or forearm surgery, an axillary brachial plexus block with "selective" injection of nerves and continuous catheter technique was performed with 40 ml of 2.5 mg/ml of bupivacaine, or levobupivacaine. After catheter placement, motor and sensory block were scored, and the patient was interviwed in the postoperative first 24 hours. The postoperative first analgesic need, total analgesic needs, pain scale and side-effects were registered. RESULTS: At the 30th min, complete sensory block was more frequent in the inervation area of the median nerve in the Bupivacaine group than Levobopivacaine group, and in the Bupivacaine group, complete sensory block was more frequent in the inervation area of the median nerve than the other nerves (P < 0.05). Simultaneously, partial motor block of radial nevre was more frequent in the levobupivacaine group (P < 0.05). Tourniquet was well tolerated in all patients with successful block in both groups. Mean duration of analgesia was similar to the bupivacaine and levobupivacaine groups at 14.2 h, and 18.4 h, respectively (NS). CONCLUSION: In this tecnique, for median and radial nevre, bupivacained 0.25% produced slightly beter sensory and motor block intensity than levobupivacaine 0.25% in onset of the block. General success in relation to surgery and in the duration of the analgesia was identical in the two groups.

Al E; Pirbudak L; Tahtaci N; Kul S

2012-06-01

255

JTS-653 blocks afferent nerve firing and attenuates bladder overactivity without affecting normal voiding function.  

UK PubMed Central (United Kingdom)

PURPOSE: We evaluated the role of TRPV1 in bladder overactivity based on afferent nerve firing and urodynamic parameters using the selective TRPV1 antagonist JTS-653. MATERIALS AND METHODS: We evaluated the effects of JTS-653 on the increased pelvic nerve discharge and intravesical pressure induced by intravesical infusion of 100 ?M capsaicin in anesthetized rats. The effects of JTS-653 on the urodynamic parameters of bladder overactivity induced by intravesical infusion of 30 nM resiniferatoxin or 0.2% acetic acid, or on normal bladder activity were evaluated by cystometry in conscious rats. The effects of JTS-653 on carbachol induced contraction were investigated using bladder muscle strips. RESULTS: JTS-653 significantly suppressed the capsaicin induced increase in nerve discharge and intravesical pressure. Intravesical infusion of resiniferatoxin or acetic acid decreased the intercontraction interval and voided volume. JTS-653 significantly increased the intercontraction interval and voided volume in rats with resiniferatoxin or acetic acid induced bladder overactivity without affecting maximal voiding pressure. The antimuscarinic agent propiverine significantly decreased maximal voiding pressure but did not affect the intercontraction interval or voided volume in rats with acetic acid induced bladder overactivity. In normal rats JTS-653 showed no significant effects on the intercontraction interval, voided volume or maximal voiding pressure. JTS-653 did not affect carbachol induced contraction of the bladder muscle. CONCLUSIONS: Our findings suggest that TRPV1 is involved in bladder overactivity via afferent nerve activation but it is not associated with normal voiding function. A TRPV1 antagonist would be a useful drug for bladder overactivity with a different pharmacological profile than antimuscarinic agents.

Kitagawa Y; Wada M; Kanehisa T; Miyai A; Usui K; Maekawa M; Sakata M; Matsuo A; Hayashi M; Matsushita M

2013-03-01

256

A comparison of bilateral infraorbital nerve block with intravenous fentanyl for analgesia following cleft lip repair in children.  

UK PubMed Central (United Kingdom)

BACKGROUND: The efficacy of analgesia with bilateral infraorbital nerve block and intravenous (i.v.) fentanyl were compared for cleft lip surgery in children. METHODS: Eighty-two children aged 3 months to 10 years undergoing cleft lip repair were prospectively randomized to one of two groups: bilateral infraorbital nerve block (Group B), or i.v. fentanyl (Group F). Group B (n = 41) received bilateral infraorbital injection of 1 ml 0.25% bupivacaine and 2 ml i.v. saline as control. Group F (n = 41) received 2 microg x kg(-1) i.v. fentanyl, and bilateral infraorbital injection of 1 ml saline as control. Pain was evaluated by the incidence of tachycardia, hypertension, and/or modified pain score > or =4. The time to awakening, time to first cry and time to feeding were noted. RESULTS: Thirty four children (82.9%) in Group B had adequate analgesia compared with 15 (36.6%) in Group F (P < 0.0001, RR of failure 0.27 for Group B). Group B had a mean time to awakening of 5.65 +/- 2.52 min (Group F: 9.37 +/- 4.50 min; P < 0.0001), time to first cry 32.14 +/- 18.22 min (Group F: 28.00 +/- 16.27 min; P = 0.3), time to feed 62.05 +/- 20.06 min (Group F: 72.44 +/- 17.72; P = 0.015), and pain score 2.81 +/- 1.38 (Group F: 4.71 +/- 1.89; P < 0.0001). There were no major complications. CONCLUSIONS: Bilateral infraorbital block is superior to fentanyl in terms of analgesia, and time to awakening and feeding.

Rajamani A; Kamat V; Rajavel VP; Murthy J; Hussain SA

2007-02-01

257

Effect of mepivacaine in an infraorbital nerve block on minimum alveolar concentration of isoflurane in clinically normal anesthetized dogs undergoing a modified form of dental dolorimetry.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To evaluate the effects of a routinely used infraorbital nerve block, performed for dental procedures, on the anesthetic requirement for isoflurane in dogs. DESIGN: Prospective controlled study. ANIMALS: 8 healthy adult Beagles. PROCEDURES: Dogs were anesthetized with isoflurane, and the minimum alveolar concentration (MAC) of isoflurane was established. A modification of a well-established method of stimulating the dental pulp, dental dolorimetry, was used to deliver a noxious stimulus (electrical stimulation) for isoflurane MAC determination. Once the isoflurane MAC was established, an infraorbital nerve block was performed with mepivacaine. The isoflurane MAC was then determined with the addition of the nerve block. Measurements of heart rate and mean arterial blood pressure were obtained at specified time points (baseline and prevention and elicitation of purposeful movement) during the determination of MAC and in response to the noxious stimulus. RESULTS: The mean ± SD isoflurane MAC without an infraorbital nerve block was 1.12 ± 0.13%. Isoflurane MAC with the regional mepivacaine anesthesia was 0.86 ± 0.11%. A significant reduction in isoflurane MAC (23%) was seen after the infraorbital nerve block, compared with results before the nerve block. With the exception of baseline measurements, no significant differences were found between treatments (isoflurane alone vs isoflurane with regional mepivacaine anesthesia) in heart rate or mean arterial blood pressure before or after the noxious stimulus. CONCLUSIONS AND CLINICAL RELEVANCE: The significant reduction in MAC of isoflurane supported the practice of the addition of regional anesthesia for painful dental procedures to reduce the dose-dependent cardiorespiratory effects of general anesthesia.

Snyder CJ; Snyder LB

2013-01-01

258

Therapeutic effectiveness of epicranial nerve blocks on post-traumatic syndrome from head injury  

Directory of Open Access Journals (Sweden)

Full Text Available The autor describes the case of a 53-year-old woman suffering from headache and dizziness, sometimes nausea, tinnitus in the right ear, and diffuse scalp allodynia following an occupational accident involving a head injury. Hyposensitizing treatment by anesthetic blockade at the emergence points of the epicranial nerves, which were hyperalgesic to fi nger pressure, rapidly controlled the allodynia and eventually the headache. Unexpectedly, the patient also reported reduced dizziness and resolution of the tinnitus. The unforeseen outcome highlights the unpredictable therapeutic potential of a simple and modestly invasive procedure. The neuropathophysiological interpretation is consequently very interesting.

C. A. Caputi

2011-01-01

259

Bloqueios nervosos guiados por ultra-som Bloqueos nerviosos guiados por ultrasonido Ultrasound-guided nerve blocks  

Directory of Open Access Journals (Sweden)

Full Text Available JUSTIFICATIVA E OBJETIVOS: As técnicas de bloqueios nervosos guiados por ultra-som são baseadas na visualização direta das estruturas nervosas, da agulha de bloqueio e das estruturas anatômicas adjacentes. Desta maneira, é possível depositar a solução de anestésico local precisamente em torno dos nervos e acompanhar a sua dispersão em tempo real, obtendo-se, assim, um bloqueio mais eficaz, de menor latência, menor dependência de referências anatômicas, menor volume de solução anestésica e maior segurança. CONTEÚDO: O artigo revisa os aspectos relativos aos mecanismos físicos para formação de imagens, a anatomia ultra-sonográfica do neuroeixo e dos plexos braquial e lombossacral, os equipamentos e materiais empregados nos bloqueios, os ajustes do aparelho de ultra-som para melhorar as imagens, os planos de visualização das agulhas de bloqueio e as técnicas e o treinamento em bloqueios guiados por ultra-som. CONCLUSÕES: Os passos para se obter sucesso em anestesia regional incluem a identificação exata da posição dos nervos, a localização precisa da agulha, sem lesões nas estruturas adjacentes e, finalmente, a injeção cuidadosa de anestésico local junto aos nervos. Embora a neuroestimulação forneça grande auxílio na identificação dos nervos, esta não consegue, isoladamente, preencher todas essas exigências. Por isso, acredita-se que os bloqueios guiados por ultra-som serão a técnica de eleição para anestesia regional num futuro não muito distante.JUSTIFICATIVA Y OBJETIVOS: Las técnicas de bloqueos nerviosos guiados por ultrasonido se basan en la visualización directa de las estructuras nerviosas, de la aguja de bloqueo y de las estructuras anatómicas adyacentes. De esa manera, se puede depositar la solución de anestésico local precisamente en torno de los nervios y acompañar su dispersión en tiempo real, obteniéndose así, un bloqueo más eficaz, de menor latencia, menor dependencia de referencias anatómicas, menor volumenn de solución anestésica y una mayor seguridad. CONCLUSION: El artículo revisa los aspectos relativos a los mecanismos físicos para la formación de imágenes, la anatomía ultra sonográfica del neuro eje y de los plexos braquial y lumbo sacral, los equipos y materiales empleados en los bloqueos, los ajustes del aparato de ultrasonido para mejorar las imágenes, los planos de visualización de las agujas de bloqueo y las técnicas y el entrenamiento en bloqueos guiados por ultrasonido. CONCLUSIONES: Los pasos para obtener el éxito en anestesia regional incluyen la identificación exacta de la posición de los nervios, la localización precisa de la aguja, sin lesiones en las estructuras adyacentes y, finalmente, la inyección cuidadosa de anestésico local junto a los nervios. Aunque la neuro estimulación sea de gran ayuda en la identificación de los nervios, ella no logra, aisladamente, rellenar todas esas exigencias. A causa de eso, se cree que los bloqueos guiados por ultrasonido serán la técnica de elección para la anestesia regional en un futuro no muy distante.BACKGROUND AND OBJECTIVES: Ultrasound-guided nerve blocks are based on the direct visualization of nerve structures, needle, and adjacent anatomic structures. Thus, it is possible to place the local anesthetic precisely around the nerves and follow its dispersion in real time, obtaining, therefore, more effective blockades, reduced dependency on anatomic references, decreased anesthetic volume, and increased safety. CONTENTS: The aim of this paper was to review the physical mechanisms of image formation, ultrasound anatomy of the neuro axis and of the brachial and lumbosacral plexuses, equipment and materials used in the blockades, settings of the ultrasound equipment to improve the image, planes of visualization of the needles, the techniques, and training in ultrasound-guided nerve blocks. CONCLUSIONS: The steps for a successful regional block include the identification of the exact position of the nerves, the precise localization of the needle, withou

Pablo Escovedo Helayel; Diogo Brüggemann da Conceição; Getúlio Rodrigues de Oliveira Filho

2007-01-01

260

Obturator internus pyomyositis: iatrogenic haematogenous spread.  

UK PubMed Central (United Kingdom)

Obturator internus pyomyositis is a rare disorder that should be on the differential diagnosis in a child who presents with a fever, limp, abdominal or groin pain. We present a case of a 5-year-old girl successfully treated with open drainage following failed medical management. We postulate the source of infection to be secondary to an infected elastic stable intramedullary nail in the forearm that was protruding through the skin.

Kosuge DD; Davis BJ

2013-01-01

 
 
 
 
261

Obturator internus pyomyositis: iatrogenic haematogenous spread.  

Science.gov (United States)

Obturator internus pyomyositis is a rare disorder that should be on the differential diagnosis in a child who presents with a fever, limp, abdominal or groin pain. We present a case of a 5-year-old girl successfully treated with open drainage following failed medical management. We postulate the source of infection to be secondary to an infected elastic stable intramedullary nail in the forearm that was protruding through the skin. PMID:22495614

Kosuge, Dennis Daisaku; Davis, Benjamin J

2013-01-01

262

Antihypertensive role of glossopharyngeal nerve stimulation by nifedipine using as calcium channel blocking agent in hypertension: an experimental study.  

Science.gov (United States)

Nifedipine is a therapeutic drug in acute attacks of hypertension because of its rapid absorption from oral mucosa. Taste receptors are innervated by glossopharyngeal nerves (GPN) as well as by facial and vagal nerves. Sensory neurons of the GPNs are localised in the petrous ganglion (PG). Transection of the taste sensitive GPN fibres causes taste bud and PG degeneration and spontaneous hypertension. In this study, the role of chemical stimulation of the taste buds of the GPN by nifedipine and its role in treatment of hypertension were investigated in rabbits. Nifedipine was dropped sublingually (20 mg) for 4 days in the study group, followed by measuring blood pressures again. Then, the lingual branches of GPNs were cut. One month later, blood pressures were measured for 4 days. All animals were sacrificed humanely at the end of the experiment, and normal and degenerated neuron densities in the petrosal ganglions were enumerated stereologically. The antihypertensive effect of nifedipine decreased after GPNs denervation, in accordance with the increase of degenerated neurons in the PG. The chemical stimulation of taste buds of the GPNs by nifedipine may be an important effect of nifedipine application in addition to its calcium channel blocking effect. The rapid decrease in blood pressure following sublingual use of nifedipine may also result from the direct stimulation of taste buds innervated by the GPNs. PMID:20091275

Aydin, Mehmet Dumlu; Bayram, Ednan; Halici, Zekai; Aydin, Nazan; Atalay, Canan; Ulvi, Hizir; Kotan, Dilcan; Gundogdu, Cemal

2009-11-01

263

Antihypertensive role of glossopharyngeal nerve stimulation by nifedipine using as calcium channel blocking agent in hypertension: an experimental study.  

UK PubMed Central (United Kingdom)

Nifedipine is a therapeutic drug in acute attacks of hypertension because of its rapid absorption from oral mucosa. Taste receptors are innervated by glossopharyngeal nerves (GPN) as well as by facial and vagal nerves. Sensory neurons of the GPNs are localised in the petrous ganglion (PG). Transection of the taste sensitive GPN fibres causes taste bud and PG degeneration and spontaneous hypertension. In this study, the role of chemical stimulation of the taste buds of the GPN by nifedipine and its role in treatment of hypertension were investigated in rabbits. Nifedipine was dropped sublingually (20 mg) for 4 days in the study group, followed by measuring blood pressures again. Then, the lingual branches of GPNs were cut. One month later, blood pressures were measured for 4 days. All animals were sacrificed humanely at the end of the experiment, and normal and degenerated neuron densities in the petrosal ganglions were enumerated stereologically. The antihypertensive effect of nifedipine decreased after GPNs denervation, in accordance with the increase of degenerated neurons in the PG. The chemical stimulation of taste buds of the GPNs by nifedipine may be an important effect of nifedipine application in addition to its calcium channel blocking effect. The rapid decrease in blood pressure following sublingual use of nifedipine may also result from the direct stimulation of taste buds innervated by the GPNs.

Aydin MD; Bayram E; Halici Z; Aydin N; Atalay C; Ulvi H; Kotan D; Gundogdu C

2009-11-01

264

Ketamine as an adjuvant in sympathetic blocks for management of central sensitization following peripheral nerve injury  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Proliferation of NMDA receptors and role of glutamate in producing central sensitization and 'wind up' phenomena in CRPS [complex regional pain syndrome] forms a strong basis for the use of Ketamine to block the cellular mechanisms that initiate and maintain these changes. In this case series, we de...

Sunder, Rani A; Toshniwal, Gokul; Dureja, GP

265

Blood reinfusion combined with femoral nerve block in total knee replacement for patients with increased risk of bleeding  

DEFF Research Database (Denmark)

PURPOSE. To compare patients with increased risk of bleeding who received combined blood reinfusion and femoral nerve block in total knee replacement (TKR) to regular patients treated routinely with respect to pain relief, blood loss, and knee function. METHODS. In a consecutive series of 67 patients who underwent unilateral TKR, 12 patients with increased risk of bleeding owing to cardiac disease or previous thromboembolic events received continuous femoral nerve block and blood reinfusion, without tranexamic acid (TA) injection. The remaining 55 patients were controls who received standard postoperative treatment (TA injection, local injection of analgesics, and suction drainage without reinfusion). The volume of blood loss (drained or reinfused), pain score (using a visual analogue scale) and knee function (using the Knee Society Score [KSS]) in the 2 groups were compared. RESULTS. In the study group, patients were 5 years older and tended to have a lower preoperative KSS function score (35 vs. 45, p=0.08)and a higher function-related pain score (6.5 vs. 6, p=0.10). The mean volume of drained blood wasted in the study group did not differ significantly from the mean total volume of drained blood in the control group (235 vs. 300 ml, p=0.14). Similarly, the mean decrease in postoperative haemoglobin concentration did not differ significantly between the respective groups (2.1 vs. 2.1 mmol/l, p=0.97). A significantly greater proportion of patients received allogenic blood transfusion in the study group than in controls (3/12 vs. 2/55, p

Simonsen, O H; Gorst-Rasmussen, Anders

2011-01-01

266

Ketamine as an adjuvant in sympathetic blocks for management of central sensitization following peripheral nerve injury  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Proliferation of NMDA receptors and role of glutamate in producing central sensitization and 'wind up' phenomena in CRPS [complex regional pain syndrome] forms a strong basis for the use of Ketamine to block the cellular mechanisms that initiate and maintain these changes. In this case series, we describe 3 patients of CRPS Type II with debilitating central sensitization, heat/mechano allodynia and cognitive symptoms that we termed 'vicarious pain'. Each of these patients had dramatic relief with addition of Ketamine as an adjuvant to the sympathetic blocks after conventional therapy failed. Case Reports All 3 patients suffered gunshot wounds and developed characteristic features of CRPS Type II. Within 2–3 weeks they developed extraterritorial symptoms typical of central sensitization. The generalized mechanical allodynia and debilitating heat allodynia described to be rare in human subjects had life altering affect on their daily life. Case 2 and 3 also described an unusual cognitive phenomenon i.e. visual stimuli of friction would evoke severe pain in the affected limb that we have termed as 'vicarious pain'. They responded positively to sympathetic blocks but the sympatholysis did not bring relief to the heat and mechanical allodynia. Addition of Ketamine 0.5 mg/kg to the sympathetic blocks elicited resulted in marked relief in the allodynia. Conclusion Ketamine has a special role in patients with debilitating heat allodynia and positive cognitive symptoms via its action on central pain pathway. As an adjuvant in sympatholytic blocks it has a targeted action without significant neuropsychiatric side effects.

Sunder Rani A; Toshniwal Gokul; Dureja GP

2008-01-01

267

Effect of retrobulbar nerve block on heart rate variability during enucleation in horses under general anesthesia.  

Science.gov (United States)

OBJECTIVE: Analysis of any effect of retrobulbar block during ocular surgery on heart rate variability and oculocardiac reflex. STUDY DESIGN: Prospective study. ANIMAL STUDIED: Horses (n = 16) undergoing eye enucleation due to chronic ophthalmologic diseases. PROCEDURE: Eye enucleation was performed under general anesthesia. The horses were randomly assigned to the first (inhalation anesthesia only, n = 10) or second group (inhalation and local retrobulbar anesthesia, n = 6). The retrobulbar block was performed using 12 mL of mepivacaine hydrochloride 2%. ECG data were taken by a Telemetric ECG before, during, and after surgery. Heart rate variability was analyzed in the time domain as mean heart rate, mean beat-to-beat interval duration, and standard deviation of continuous beat-to-beat intervals. The frequency domain analysis included the low- and high-frequency components of heart rate variability and the sympathovagal balance (low/high frequency). The low frequency represents mainly sympathetic influences on the heart, whereas high frequency is mediated by the parasympathetic tone. RESULTS: All horses without a retrobulbar block showed a significant decrease in the heart rate during traction on the globe and pressure on the orbital fat pad for homoestasis (P = 0.04). Simultaneously, high-frequency power, as an indicator of vagal stimulation, increased significantly. High-frequency and low-frequency power in the retrobulbar block group increased in five horses, and heart rate decreased in only one horse. Both were not significant within the group, but there was a significant difference between both groups relating to the incidence of heart rate decrease occurring at globe traction. CONCLUSIONS AND CLINICAL RELEVANCE: Heart rate variability is a sensitive, non-invasive parameter to obtain sympathovagal stimulations during general anesthesia. The retrobulbar block can prevent heart rate decrease associated with initiation of the oculocardiac reflex. PMID:23738675

Oel, Carolin; Gerhards, Hartmut; Gehlen, Heidrun

2013-06-01

268

Effect of retrobulbar nerve block on heart rate variability during enucleation in horses under general anesthesia.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Analysis of any effect of retrobulbar block during ocular surgery on heart rate variability and oculocardiac reflex. STUDY DESIGN: Prospective study. ANIMAL STUDIED: Horses (n = 16) undergoing eye enucleation due to chronic ophthalmologic diseases. PROCEDURE: Eye enucleation was performed under general anesthesia. The horses were randomly assigned to the first (inhalation anesthesia only, n = 10) or second group (inhalation and local retrobulbar anesthesia, n = 6). The retrobulbar block was performed using 12 mL of mepivacaine hydrochloride 2%. ECG data were taken by a Telemetric ECG before, during, and after surgery. Heart rate variability was analyzed in the time domain as mean heart rate, mean beat-to-beat interval duration, and standard deviation of continuous beat-to-beat intervals. The frequency domain analysis included the low- and high-frequency components of heart rate variability and the sympathovagal balance (low/high frequency). The low frequency represents mainly sympathetic influences on the heart, whereas high frequency is mediated by the parasympathetic tone. RESULTS: All horses without a retrobulbar block showed a significant decrease in the heart rate during traction on the globe and pressure on the orbital fat pad for homoestasis (P = 0.04). Simultaneously, high-frequency power, as an indicator of vagal stimulation, increased significantly. High-frequency and low-frequency power in the retrobulbar block group increased in five horses, and heart rate decreased in only one horse. Both were not significant within the group, but there was a significant difference between both groups relating to the incidence of heart rate decrease occurring at globe traction. CONCLUSIONS AND CLINICAL RELEVANCE: Heart rate variability is a sensitive, non-invasive parameter to obtain sympathovagal stimulations during general anesthesia. The retrobulbar block can prevent heart rate decrease associated with initiation of the oculocardiac reflex.

Oel C; Gerhards H; Gehlen H

2013-06-01

269

A new approach for peri-operative analgesia of cleft palate repair in infants: the bilateral suprazygomatic maxillary nerve block.  

UK PubMed Central (United Kingdom)

BACKGROUND: Congenital cleft palate (CP) is a common and painful surgical procedure in infants. CP repair is associated with the risk of postoperative airway obstruction, which may be increased with administration of opioids, often needed for analgesia. No described regional anesthesia technique can provide adequate pain control following CP repair in infants. The primary aim of this prospective and descriptive study was to observe the effectiveness of bilateral maxillary nerve blocks (BMB) using a suprazygomatic approach on pain relief and consumption of rescue analgesics following CP repair in infants. Analgesic consumption was compared to retrospective data. Complications related to this new technique in infants were also reviewed. METHODS: The landmarks and measurements recently defined in a three-dimensional study using computed tomography in infants were used. After general anesthesia, a BMB was performed bilaterally with 0.15 ml x kg(-1) 0.2% ropivacaine in infants scheduled for CP repair. Postoperative analgesia, administration of rescue analgesics, adverse effects, and time to feed were recorded in the 48-h period following surgery and compared to retrospective data. RESULTS: Thirty-three children, mean age 5 +/- 1.8 months and weight 8.3 +/- 1.2 kg, were studied. Eighteen patients out of 33 (55%) did not require additional opioids intra-operatively, vs two out of 20 (10%) without block. None needed morphine postoperatively, and intravenous nalbuphine was required in only six children (18%), vs 16 (80%) without block. Median time to feed was 8 h (range 2-24 h), vs 13 h (4-25) without block. No technical failure or complication related to the BMB was reported. CONCLUSION: BMB using a suprazygomatic approach seems to improve pain relief, to decrease peri-operative consumption of opioids, and to favor early feeding resumption after CP repair in infants.

Mesnil M; Dadure C; Captier G; Raux O; Rochette A; Canaud N; Sauter M; Capdevila X

2010-04-01

270

The attitude of anesthesiologists and anesthesiology residents of the CET/SBA regarding upper and lower limb nerve blocks.  

UK PubMed Central (United Kingdom)

BACKGROUND AND OBJECTIVES: The use of regional blocks especially peripheral nerve blocks (PNB) has been increasing in anesthesiology due to the reduced need to manage the airways, lower cost, and excellent postoperative analgesia. However, its use has restrictions due to the lack of training, that it takes longer to be done, fear of neurological complications, and systemic toxicity. The objective of this study was to measure the attitude of anesthesiologists and anesthesiology residents at Teaching and Training Centers (CET/SBA) regarding PNBs. METHODS: A 25-item questionnaire was developed and it was available, via the Internet and by mail, to those responsible for the 80 CETs, their instructors and residents. RESULTS: Forty-two CETs (52.5%) returned 188 questionnaires, 62 (32%) from anesthesiology residents and 126 (68%) from anesthesiologists. The Cronbach's alpha coefficient of the questionnaire was 0.79. Factor analysis revealed six factors that explain 53% of scores variance: factor 1 - positive attitude, responsible for 18.34% of the variance; factor 2 - training/use, responsible for 11.73% of the variance; factor 3 - negative aspects, responsible for 7.11% of the variance; factor 4 - limiting factors, responsible for 6.39% of the variance; and factor 5 - regional block as a competence differential, responsible for 5.79% of the variance; and factor 6 - respect for the patient, responsible for 5.4% of the variance. CONCLUSIONS: The questionnaire proved to be a reliable tool to measure the attitude regarding regional blocks. Anesthesiologists demonstrated greater interest for patient-related aspects, while the main focus of residents was the acquisition of technical abilities.

Helayel PE; da Conceição DB; da Conceição MJ; Boos GL; de Toledo GB; de Oliveira Filho GR

2009-05-01

271

The nance obturator, a new fixed obturator for patients with cleft palate and fistula.  

UK PubMed Central (United Kingdom)

In patients with fistulas that impair function (e.g., feeding, resonance, intelligibility), obturators are used to improve feeding and reduce nasal air emission by occluding the abnormal opening between the oral and nasal cavities. This report describes a novel method for occluding an anterior palatal fistula in patients with cleft palates. The new design for a fixed obturator is based on the Nance appliance, which was originally used as a space maintainer, but has been redesigned for closing an anterior palatal fistula in a patient with cleft lip and palate. The Nance obturator may be used when the surgical closure of the fistula is not feasible and a removable device is not successful. As it is a fixed device, it does not require remaking with maxillary growth. The new design may also function as a fixed space maintainer to preserve molar anchorage and maxillary transverse width.

Borzabadi-Farahani A; Groper JN; Tanner AM; Urata MM; Panossian A; Yen SL

2012-07-01

272

Continuous epidural block versus continuous popliteal nerve block for postoperative pain relief after major podiatric surgery in children: a prospective, comparative randomized study.  

UK PubMed Central (United Kingdom)

Foot and ankle surgery in children is very painful postoperatively. Adverse effects from opioids and continuous epidural block (CEB) limit their use in children. Continuous popliteal nerve blocks (CPNB) have not been studied for this indication in children. In this prospective, randomized study we evaluated the effectiveness and adverse events of CPNB or CEB in children after podiatric surgery. Fifty-two children scheduled for foot surgery were separated into four groups by age and analgesia technique. After general anesthesia, 0.5 to 1 mL/kg of an equal-volume mixture of 0.25% bupivacaine and 1% lidocaine with 1:200000 epinephrine was injected via epidural or popliteal catheters. In the postoperative period, 0.1 mL x kg(-1) x h(-1) (group CPNB) or 0.2 mL x kg(-1) x h(-1) (group CEB) of 0.2% ropivacaine was administered for 48 h. Niflumic acid was routinely used. Adverse events were noted in each treatment group. Postoperative pain during motion was evaluated at 1, 6, 12, 18, 24, 36, and 48 h. Requirement for rescue analgesia (first-line propacetamol 30 mg/kg 4 times daily or second-line 0.2 mg/kg IV nalbuphine), and motor blockade were recorded. Parental satisfaction was noted at 48 h. Twenty-seven patients were included in the CEB groups and 25 in CPNB groups. There were 32 children 1 to 6 yr of age (CPNB = 15; CEB = 17) and 20 children 7 to 12 yr of age (CPNB = 10; CEB = 10). The demographic data were comparable among groups. Postoperative analgesia was excellent for the two continuous block techniques and in the two age groups. Motor block intensity was equal between techniques. Adverse events (postoperative nausea or vomiting, urinary retention, and premature discontinuation of local anesthetic infusion in the 1- to 6-yr-old group) were significantly more frequent in the CEB group (P < 0.05). Eighty-six percent of the parents in the CEB groups and 100% in the CPNB groups were satisfied. We conclude that although both CEB and CPNB resulted in excellent postoperative analgesia in this study, CPNB was associated with less urinary retention and nausea and vomiting. Therefore, we recommend CPNB as the ideal form of postoperative analgesia after major podiatric surgery in 1- to 12-yr-old children.

Dadure C; Bringuier S; Nicolas F; Bromilow L; Raux O; Rochette A; Capdevila X

2006-03-01

273

Ultrasound-Guided Ilioinguinal/Iliohypogastric Nerve Blocks for Persistent Inguinal Postherniorrhaphy Pain : A Randomized, Double-Blind, Placebo-Controlled, Crossover Trial  

DEFF Research Database (Denmark)

Background:Ilioinguinal and iliohypogastric nerve blocks are used in the clinical management of persistent inguinal postherniorrhaphy pain, but no controlled studies have been published on the subject. In this controlled study, we investigated the analgesic and sensory effects of ultrasound-guided blocks of the ilioinguinal and iliohypogastric nerves with lidocaine.Methods:A randomized, double-blind, placebo-controlled, crossover trial in 12 patients with severe persistent inguinal postherniorrhaphy pain, including a control group of 12 healthy controls, was performed. Assessments included pain ratings under standardized conditions with numerical rating scale (0-10), sensory mapping to a cool roller, and quantitative sensory testing (QST), in the groin regions, before and after each ultrasound-guided block. A needle approach of 1 to 2 cm superior and medial to the anterior superior iliac spine was used. Outcomes were changes in pain ratings, sensory mapping, and QST compared with preblock values. Lidocaine responders were a priori defined by a pain reduction of =80% after lidocaine block and =25% after placebo block, nonresponders by pain reduction of 25% after placebo block.Results:One of 12 pain patients was a lidocaine responder, 6 patients were nonresponders, and 5 patients were placebo responders. No consistent QST changes were observed in patients after the lidocaine block. In 10 of 12 healthy controls, a cool hypoesthesia area developed in the groin after the lidocaine block. Furthermore, QST assessments demonstrated significantly decreased suprathreshold heat pain perception in the groin after lidocaine versus placebo blocks (95% confidence interval = -3.5 to -0.5, P = 0.008).Conclusion:Ultrasound-guided lidocaine blocks of the ilioinguinal and iliohypogastric nerves, at the level of the anterior superior iliac spine, are not useful in diagnosis and management of persistent inguinal postherniorrhaphy pain.

Mutahi Bischoff, Joakim; Koscielniak-Nielsen, Zbigniew J

2012-01-01

274

Dimethylsulfoxide potentiates the nerve conduction-blocking effect of lidocaine without augmentation of the intracellular lidocaine concentration in the giant axon of crayfish in vitro.  

UK PubMed Central (United Kingdom)

The purpose of this study was to investigate how dimethylsulfoxide (DMSO) potentiates the blocking action of lidocaine. A giant axon removed from a crayfish was used to investigate nerve conduction and intracellular lidocaine concentration. The maximum values of the differential waveform (dV/dt max) calculated from evoked action potentials were used for evaluating an inhibition of nerve conduction. The inhibition of the dV/dt max in low-frequency stimulation (tonic block) and high-frequency stimulation (phasic block) after perfusion of 1?mm lidocaine with or without 0.2 vol % DMSO, in which the concentration of DMSO alone had no anesthetic effect, was measured to evaluate the potentiating action of DMSO. The intracellular lidocaine concentration was measured via a lidocaine-sensitive glass microelectrode during 30?min of perfusion of 1?mm lidocaine alone or in combination with DMSO. When applied without lidocaine, DMSO caused a dose-dependent nerve conduction block when used at concentrations >1 vol %. The dV/dt max in the tonic block was significantly decreased when 0.2 vol % DMSO was added to the lidocaine solution (P?=?0.004). In the phasic block, there was no significant potentiating action of DMSO. There were no significant differences in the intracellular lidocaine concentrations with or without DMSO. The potentiating effects of DMSO were observed only in the condition of low-frequency stimulation and were not related to the intracellular lidocaine concentration in the giant axon of crayfish in vitro.

Yano T; Ibusuki S; Takasaki M; Tsuneyoshi I

2013-08-01

275

Bloqueios nervosos guiados por ultra-som/ Ultrasound-guided nerve blocks/ Bloqueos nerviosos guiados por ultrasonido  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese JUSTIFICATIVA E OBJETIVOS: As técnicas de bloqueios nervosos guiados por ultra-som são baseadas na visualização direta das estruturas nervosas, da agulha de bloqueio e das estruturas anatômicas adjacentes. Desta maneira, é possível depositar a solução de anestésico local precisamente em torno dos nervos e acompanhar a sua dispersão em tempo real, obtendo-se, assim, um bloqueio mais eficaz, de menor latência, menor dependência de referências anatômicas, meno (more) r volume de solução anestésica e maior segurança. CONTEÚDO: O artigo revisa os aspectos relativos aos mecanismos físicos para formação de imagens, a anatomia ultra-sonográfica do neuroeixo e dos plexos braquial e lombossacral, os equipamentos e materiais empregados nos bloqueios, os ajustes do aparelho de ultra-som para melhorar as imagens, os planos de visualização das agulhas de bloqueio e as técnicas e o treinamento em bloqueios guiados por ultra-som. CONCLUSÕES: Os passos para se obter sucesso em anestesia regional incluem a identificação exata da posição dos nervos, a localização precisa da agulha, sem lesões nas estruturas adjacentes e, finalmente, a injeção cuidadosa de anestésico local junto aos nervos. Embora a neuroestimulação forneça grande auxílio na identificação dos nervos, esta não consegue, isoladamente, preencher todas essas exigências. Por isso, acredita-se que os bloqueios guiados por ultra-som serão a técnica de eleição para anestesia regional num futuro não muito distante. Abstract in spanish JUSTIFICATIVA Y OBJETIVOS: Las técnicas de bloqueos nerviosos guiados por ultrasonido se basan en la visualización directa de las estructuras nerviosas, de la aguja de bloqueo y de las estructuras anatómicas adyacentes. De esa manera, se puede depositar la solución de anestésico local precisamente en torno de los nervios y acompañar su dispersión en tiempo real, obteniéndose así, un bloqueo más eficaz, de menor latencia, menor dependencia de referencias anatómi (more) cas, menor volumenn de solución anestésica y una mayor seguridad. CONCLUSION: El artículo revisa los aspectos relativos a los mecanismos físicos para la formación de imágenes, la anatomía ultra sonográfica del neuro eje y de los plexos braquial y lumbo sacral, los equipos y materiales empleados en los bloqueos, los ajustes del aparato de ultrasonido para mejorar las imágenes, los planos de visualización de las agujas de bloqueo y las técnicas y el entrenamiento en bloqueos guiados por ultrasonido. CONCLUSIONES: Los pasos para obtener el éxito en anestesia regional incluyen la identificación exacta de la posición de los nervios, la localización precisa de la aguja, sin lesiones en las estructuras adyacentes y, finalmente, la inyección cuidadosa de anestésico local junto a los nervios. Aunque la neuro estimulación sea de gran ayuda en la identificación de los nervios, ella no logra, aisladamente, rellenar todas esas exigencias. A causa de eso, se cree que los bloqueos guiados por ultrasonido serán la técnica de elección para la anestesia regional en un futuro no muy distante. Abstract in english BACKGROUND AND OBJECTIVES: Ultrasound-guided nerve blocks are based on the direct visualization of nerve structures, needle, and adjacent anatomic structures. Thus, it is possible to place the local anesthetic precisely around the nerves and follow its dispersion in real time, obtaining, therefore, more effective blockades, reduced dependency on anatomic references, decreased anesthetic volume, and increased safety. CONTENTS: The aim of this paper was to review the physic (more) al mechanisms of image formation, ultrasound anatomy of the neuro axis and of the brachial and lumbosacral plexuses, equipment and materials used in the blockades, settings of the ultrasound equipment to improve the image, planes of visualization of the needles, the techniques, and training in ultrasound-guided nerve blocks. CONCLUSIONS: The steps for a successful regional block include the identific

Helayel, Pablo Escovedo; Conceição, Diogo Brüggemann da; Oliveira Filho, Getúlio Rodrigues de

2007-02-01

276

Transient quadriplegia after fluoroscopic-guided selective cervical nerve root block in a patient who received cervical interbody fusion -A case report-.  

UK PubMed Central (United Kingdom)

Selective cervical nerve root block is executed for patients who have symptoms of cervical radiculopathy for diagnostic and therapeutic purposes. However several catastrophic complications caused by this procedure have been reported including neurological complications. A 43-year-old male received a C5 selective cervical nerve root block procedure due to continuous radiating pain even after cervical discectomy and interbody fusion was performed. At the time of the procedure, the contrast outline revealed reflux of the nerve root and epidural space. But after the procedure was performed, the patient experienced decreased sensation in the upper and low extremities as well as motor paralysis of both extremities. Our sspecting diagnosis was anterior spinal artery syndrome but both sensory and motor functions were subsequently recovered within a few hours after the procedure was completed. Due to the difficult nature of this case, we reported these complications and reviewed current literature related to this study.

Lee MH; Cha YD; Song JH; An YM; Han JU; Lee du I

2010-12-01

277

Transient quadriplegia after fluoroscopic-guided selective cervical nerve root block in a patient who received cervical interbody fusion -A case report-.  

Science.gov (United States)

Selective cervical nerve root block is executed for patients who have symptoms of cervical radiculopathy for diagnostic and therapeutic purposes. However several catastrophic complications caused by this procedure have been reported including neurological complications. A 43-year-old male received a C5 selective cervical nerve root block procedure due to continuous radiating pain even after cervical discectomy and interbody fusion was performed. At the time of the procedure, the contrast outline revealed reflux of the nerve root and epidural space. But after the procedure was performed, the patient experienced decreased sensation in the upper and low extremities as well as motor paralysis of both extremities. Our sspecting diagnosis was anterior spinal artery syndrome but both sensory and motor functions were subsequently recovered within a few hours after the procedure was completed. Due to the difficult nature of this case, we reported these complications and reviewed current literature related to this study. PMID:21286472

Lee, Mi Hyeon; Cha, Young Deog; Song, Jang Ho; An, Young Mi; Han, Jeong Uk; Lee, Du Ik

2010-12-31

278

Time course of the soleus m response and h reflex after lidocaine tibial nerve block in the rat.  

UK PubMed Central (United Kingdom)

Aims. In spastic subjects, lidocaine is often used to induce a block predictive of the result provided by subsequent surgery. Lidocaine has been demonstrated to inhibit the Hoffmann (H) reflex to a greater extent than the direct motor (M) response induced by electrical stimulation, but the timecourse of these responses has not been investigated. Methods. An animal (rat) model of the effects of lidocaine on M and H responses was therefore developed to assess this time course. M and H responses were recorded in 18 adult rats before and after application of lidocaine to the sciatic nerve. Results. Two to five minutes after lidocaine injection, M responses were markedly reduced (mean reduction of 44%) and H reflexes were completely abolished. Changes were observed more rapidly for the H reflex. The effects of lidocaine then persisted for 100 minutes. The effect of lidocaine was therefore more prolonged on the H reflex than on the M response. Conclusion. This study confirms that lidocaine blocks not only alpha motoneurons but also Ia afferent fibres responsible for the H reflex. The authors describe, for the first time, the detailed time course of the effect of lidocaine on direct or reflex activation of motoneurons in the rat.

Buffenoir K; Decq P; Pérot C

2013-01-01

279

Time course of the soleus m response and h reflex after lidocaine tibial nerve block in the rat.  

Science.gov (United States)

Aims. In spastic subjects, lidocaine is often used to induce a block predictive of the result provided by subsequent surgery. Lidocaine has been demonstrated to inhibit the Hoffmann (H) reflex to a greater extent than the direct motor (M) response induced by electrical stimulation, but the timecourse of these responses has not been investigated. Methods. An animal (rat) model of the effects of lidocaine on M and H responses was therefore developed to assess this time course. M and H responses were recorded in 18 adult rats before and after application of lidocaine to the sciatic nerve. Results. Two to five minutes after lidocaine injection, M responses were markedly reduced (mean reduction of 44%) and H reflexes were completely abolished. Changes were observed more rapidly for the H reflex. The effects of lidocaine then persisted for 100 minutes. The effect of lidocaine was therefore more prolonged on the H reflex than on the M response. Conclusion. This study confirms that lidocaine blocks not only alpha motoneurons but also Ia afferent fibres responsible for the H reflex. The authors describe, for the first time, the detailed time course of the effect of lidocaine on direct or reflex activation of motoneurons in the rat. PMID:23997682

Buffenoir, Kévin; Decq, Philippe; Pérot, Chantal

2013-08-07

280

CT-guided percutaneous ethanol nerve block therapy of celiac plexus embedded in metastatic lymph nodes for the treatment of intractable carcinomatous abdominal pain  

International Nuclear Information System (INIS)

Objective: To evaluate CT-guided percutaneous ethanol nerve block therapy of celiac plexus embedded in metastatic lymph nodes in treating intractable carcinomatous abdominal pain. Methods: A total of 104 patients with late stage cancers were enrolled in this study. All patients suffered from serious carcinomatous pain at upper abdomen and their retroperitoneal lymph nodes were extensively enlarged and fused, together with the involved celiac plexus, into a hard crumb. As the patients failed to respond to narcotic analgesics CT-guided ethanol nerve block therapy of celiac plexus was carried out by pushing the puncture needle through the fused lymphatic mass to celiac plexus site. The analgesic effects and complications were observed and the therapeutic results were evaluated. Results: The analgesic effective rate of ethanol nerve block therapy immediately after the procedure was 100%, and at 2 weeks, 1, 2, 3 and 4 months after the treatment it was 100%, 100%, 98.0%, 96.9% and 92.6%, respectively. No serious complications occurred during perioperative period. The living quality was markedly improved in all patients. Conclusion: For the treatment of intractable carcinomatous abdominal pain in patients with their celiac plexus being embedded in mass-like metastatic retroperitoneal lymph nodes CT-guided percutaneous ethanol nerve block therapy by pushing the puncture needle through the fused lymphatic mass to celiac plexus site is of great clinical value in relieving carcinomatous abdominal pain. (authors)

2010-01-01

 
 
 
 
281

Transient quadriplegia after fluoroscopic-guided selective cervical nerve root block in a patient who received cervical interbody fusion -A case report-  

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Selective cervical nerve root block is executed for patients who have symptoms of cervical radiculopathy for diagnostic and therapeutic purposes. However several catastrophic complications caused by this procedure have been reported including neurological complications. A 43-year-old male received a...

Lee, Mi Hyeon; Cha, Young Deog; Song, Jang Ho; An, Young Mi; Han, Jeong Uk; Lee, Du Ik

282

A Prospective, Randomized, Double-Blind Study of the Anesthetic Efficacy of Sodium Bicarbonate Buffered 2% Lidocaine With 1?:?100,000 Epinephrine in Inferior Alveolar Nerve Blocks  

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The authors, using a crossover design, randomly administered, in a double-blind manner, inferior alveolar nerve (IAN) blocks using a buffered 2% lidocaine with 1?:?100,000 epinephrine/sodium bicarbonate formulation and an unbuffered 2% lidocaine with 1?:?100,000 epinephrine formulation at 2 separate...

Whitcomb, Michael; Drum, Melissa; Reader, Al; Nusstein, John; Beck, Mike

283

Effect of Addition of Magnesium Sulphate and Fentanyl to Ropivacaine Continuous Femoral Nerve Block in Patients Undergoing Elective Total Knee Replacement  

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This prospective double blinded study was designed to compare the effect of magnesium or fentanyl addition to ropivacaine in continuous femoral nerve block in patients undergoing elective total knee replacement under general anesthesia. Sixty patients undergoing elective TKR under general anesth...

Md. Ashraf Abd Elmawgoud; Ahmed Badawy; Samaa Abu Elkassem; Doaa Rashwan

284

Comparison of two needle models in terms of bevel deformation during truncal block of the inferior alveolar nerve  

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish Objetivos: Evaluar las posibles diferencias existentes en cuanto a la deformación del bisel de dos tipos de aguja de igual longitud y calibre externo, pero de distinto diámetro interno, durante el bloqueo troncal del nervio dentario inferior. Diseño del estudio: Cuatro operadores de similar formación quirúrgica realizaron el bloqueo troncal del nervio dentario inferior y la anestesia infiltrativa del nervio bucal para proceder a la extracción quirúrgica o convencio (more) nal del tercer molar inferior en 266 pacientes. Para efectuar el bloqueo troncal se utilizó en todos los casos un sistema de jeringa no auto-aspirante (Uniject K®; Hoechst AG, Frankfurt, Alemania) y dos tipos de aguja: una aguja Monoprotect® de 27G x 35 mm con un calibre interno de 0.215 mm (Sofic SA, Mazamet, Francia) o una aguja XL Monoprotect® de 27G x 35 mm con un calibre interno de 0.265 mm (Sofic SA, Mazamet, Francia). Para hacer la anestesia infiltrativa del nervio bucal se utilizó el mismo tipo de jeringa y otros dos tipos de aguja: la Monoprotect®o la XL Monoprotect®, ambas con un calibre de 30G y 25 mm de longitud, diferenciándose en su calibre interno (0.215 y 0.265 mm, respectivamente) (Sofic SA, Mazamet, Francia). En cada paciente fue recopilada de forma sistemática la siguiente información: el tipo de aguja, la técnica anestésica utilizada (troncular directa o indirecta) y el número de veces que se había contactado con el hueso durante ésta, el lado de trabajo del operador, el lado del diente a extraer, el operador que hizo la intervención quirúrgica, así como la presencia o ausencia de deformación del bisel tras la técnica anestésica. Resultados: Para la técnica troncular, sólo se observó una asociación estadísticamente significativa entre la deformación de los biseles de las agujas y el operador que efectuó la técnica anestésica, mientras que para la técnica infiltrativa, se encontró una asociación estadísticamente significativa (p Abstract in english Objectives: To evaluate the differences in terms of bevel deformation between two types of needle of the same length and external caliber, but with different internal diameters, during truncal block of the inferior alveolar nerve. Study design: Four operators performed truncal block of the inferior alveolar nerve and infiltrating anesthesia of the buccal nerve for the extraction of a lower third molar in 266 patients. The truncal block was carried out using a standard 27G (more) x 35 mm needle with an internal caliber of 0.215 mm, or a 27G x 35 mm XL Monoprotect® needle with an internal caliber of 0.265 mm. The infiltrating anesthesia was made with a Monoprotect® or XL Monoprotect® needle, both with a caliber of 30G and a length of 25 mm, but with different internal calibers (0.215 and 0.265 mm, respectively). The type of needle used, the anesthetic technique and the number of bone contacts was established during the procedure, the operator working side, the side of the tooth to be removed, the operator in charge of the intervention and the presence of bevel deformation after the anesthetic technique were collected for each patient. Results: A statistically significant association was observed between bevel deformation and the operator performing the truncal block, while a statistically significant association (p

Almendros Marqués, Nieves; Delgado Molina, Esther; Tamarit Borrás, Meritxell; Berini Aytés, Leonardo; Gay Escoda, Cosme

2007-08-01

285

Effect of two obturation techniques on the filling of lateral canals and the main canal.  

UK PubMed Central (United Kingdom)

The three-dimensional obturation of the root canal system is widely accepted as a key factor for successful endodontic therapy. The purpose of this study was to evaluate the obturation of lateral canals and the main canal using cold lateral condensation versus the gutta-percha coated rigid carrier. Thirty epoxy blocks with five lateral canals placed at varying angles from the main canal were used. Each experimental group was obturated by a board certified endodontist with clinical experience in the respective obturation technique. The length of gutta-percha and sealer in the lateral canals was measured under a microscope (x30, Unitron) to the nearest 0.5 mm. The blocks were sectioned with an Isomet Plus precision saw (Buehler, Lake Bluff, IL) and copious water irrigation perpendicular to the main canal at the apex, the height of contour, and at 0.8, 1.6 and 2.4 mm from the canal apex. A microscope (x100, Leitz, Switzerland) was used to determine voids. There was significantly (p < .001) more gutta-percha in the lateral canals with the gutta-percha coated rigid carrier technique. In contrast, the cold lateral condensation technique had significantly (p < .001) more sealer in the lateral canals. However, there was no significant (p < .05) difference, in gutta-percha-plus-sealer filling of the lateral canals, between the two techniques. In the apical 1 mm of the main canal there were significantly (p < .011) fewer voids with the gutta-percha coated rigid carrier technique compared to the cold lateral condensation. In the model chosen, the gutta-percha coated rigid carrier technique and the cold lateral condensation technique were equally effective in filling lateral canals. In filling the main canal, however, the coated rigid carrier technique was more effective.

Wolcott J; Himel VT; Powell W; Penney J

1997-10-01

286

Slow sodium inactivation in nerve after exposure to sulhydryl blocking reagents.  

UK PubMed Central (United Kingdom)

Exposure to N-ethylmaleimide (NEM), a reagent that binds covalently to protein sulfhydryl groups, results in a specific reduction in sodium conductance in crayfish axons. Resting potential, the delayed rise in potassium conductance, and the selectivity of the sodium channel are unaffected. Sodium currents are only slightly increased by hyperpolarizing prepulses of up to 50 ms duration, but can be restored to about 70% of their value before treatment if this duration is increased to 300-800 ms. The time to peak sodium current and the time constant of decay of sodium tail currents are unaffected by NEM, suggesting that the sodium activation system remains unaltered. Kinetic studies suggest that NEM reacts with a "slow" sodium inactivation system that is present in normal axons and that may be seen after depolarization produced by lowered the holding potential or increasing the external potassium concentration. NEM also perturbs the fast h inactivation system, and in a potential-dependent manner. At small depolarizations tauh is decreased, while at strong depolarizations it is increased over control values. Experiments with structural analogs of NEM suggest that sulfhydryl block is involved, but do not rule out an action similar to that of local anesthetics, p-Chloromercuriphenylsulfonic acid (PCMBS), another reagent with high specificity for SH groups, also blocks sodium currents, but restoration with prolonged hyperpolarizations is not possible.

Shrager P

1977-02-01

287

Obturator hernia: a rare case of acute mechanical intestinal obstruction.  

UK PubMed Central (United Kingdom)

Obturator hernia is a rare type of pelvic hernia which generally occurs in elderly patients with accompanying diseases. Because it is difficult to diagnose before surgery, the morbidity and mortality rates for obturator hernia are high. The most common symptom is strangulation combined with mechanical intestinal obstruction.

Aydin I; Yucel AF; Pergel A; Sahin DA

2013-01-01

288

Obturator Hernia: A Rare Case of Acute Mechanical Intestinal Obstruction  

Science.gov (United States)

Obturator hernia is a rare type of pelvic hernia which generally occurs in elderly patients with accompanying diseases. Because it is difficult to diagnose before surgery, the morbidity and mortality rates for obturator hernia are high. The most common symptom is strangulation combined with mechanical intestinal obstruction.

Yucel, Ahmet Fikret; Pergel, Ahmet; Sahin, Dursun Ali

2013-01-01

289

Identification of Materials from 60-mm Mortar Obturators.  

Science.gov (United States)

Two plastic obturators for the 60-mm mortar were submitted for physical and chemical analysis. One of the obturators was from current U.S. Army stock while the other was from a contractor which had failed by misfire during field tests. The analysis reveal...

A. F. Tatyrek

1988-01-01

290

Analgesic efficacy of continuous femoral nerve block commenced prior to operative fixation of fractured neck of femur  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Peripheral nerve blocks are effective in treating acute pain, thereby minimizing the requirement for opiate analgesics. Fractured neck of femur (FNF) is a common, painful injury. The provision of effective analgesia to this cohort is challenging but an important determinant of their functional outcome. We investigated the analgesic efficacy of continuous femoral nerve block (CFNB) in patients with FNF. Methods Following institutional ethical approval and with informed consent, patients awaiting FNF surgery were randomly allocated to receive either standard opiate-based analgesia (Group 1) or a femoral perineural catheter (Group 2). Patients in Group 1 received parenteral morphine as required. Those in Group 2 received a CFNB comprising a bolus of local anaesthetic followed by a continuous infusion of 0.25% bupivacaine. For both Groups, rescue analgesia consisted of intramuscular morphine as required and all patients received paracetamol regularly. Pain was assessed using a visual analogue scale at rest and during passive movement (dynamic pain score) at 30?min following first analgesic intervention and six hourly thereafter for 72 hours. Patient satisfaction with the analgesic regimen received was recorded using verbal rating scores (0-10). The primary outcome measured was dynamic pain score from initial analgesic intervention to 72 hours later. Results Of 27 recruited, 24 patients successfully completed the study protocol and underwent per protocol analysis. The intervals from recruitment to the study until surgery were similar in both groups [31.4(17.7) vs 27.5(14.2) h, P?=?0.57]. The groups were similar in terms of baseline clinical characteristics. For patients in Group 2, pain scores at rest were less than those reported by patients in Group 1 [9.5(9.4) vs 31(28), P?=?0.031]. Dynamic pain scores reported by patients in Group 2 were less at each time point from 30?min up to 54 hours [e.g at 6?h 30.7(23.4) vs 67.0(32.0), P?=?0.004]. Cumulative morphine consumption over 72?h was less in Group 2. Patient satisfaction scores were greater in Group 2 [9.4(1.1) vs 7.6(1.8), P?=?0.014]. Conclusions CFNB provides more effective perioperative analgesia than a standard opiate-based regimen for patients undergoing fixation of FNF. It is associated with lesser opiate use and greater patient satisfaction.

Szucs Szilard; Iohom Gabriella; O’Donnell Brian; Sajgalik Pavol; Ahmad Ishtiaq; Salah Nazar; Shorten George

2012-01-01

291

Structural evidence that botulinum toxin blocks neuromuscular transmission by impairing the calcium influx that normally accompanies nerve depolarization  

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Taking advantage of the fact that nerve terminal mitochondria swell and sequester calcium during repetitive nerve stimulation, we here confirm that this change is caused by calcium influx into the nerve and use this fact to show that botulinum toxin abolishes such calcium influx. The optimal paradig...

292

Reduction in sodium content of local anesthetics for peripheral nerve blocks: a comparative evaluation of saline with 5% dextrose--a randomized controlled double-blind study.  

UK PubMed Central (United Kingdom)

BACKGROUND: Commercially available local anesthetic drugs when diluted with normal saline have high sodium content. High perineural sodium concentration has been implicated in antagonizing the analgesic effects of local anesthetics by preventing and/or delaying neural blockade. Five percent dextrose is not known to cause any short- or long-term injury when injected around neural tissue. In this study, we prospectively compared and evaluated block characteristics when local anesthetic drug was diluted with these 2 different agents. METHODS: Patients scheduled for upper limb surgery were randomly assigned to receive axillary brachial plexus block with 0.5% ropivacaine (1% diluted with either 5% dextrose or normal saline). Motor and sensory block were tested every 5 minutes for 30 minutes. Postoperatively, a telephone interview was conducted after 24 hours and 7 days along with surgical follow-up at days 3, 10, and/or 14 to 28 days to document side effects, patient satisfaction, and time for block resolution. Any nerve deficits were followed until resolution. The primary outcome was time to onset of sensory nerve block. RESULTS: Five hundred fifty patients were recruited for this study. The mean time to complete sensory block was 18.3 ± 6.1 minutes in the dextrose group and 22.5 ± 6.4 minutes in the saline group (P < 0.001, 95% confidence interval for mean difference 3.0-5.4 minutes). There were 5 patients with clinical nerve deficits (no statistical difference between groups). CONCLUSIONS: Dilution with 5% dextrose provides earlier onset of axillary brachial plexus block with ropivacaine.

Dhir S; Tureanu L; Bouzari A; Masood A; Francispragasam M; Ganapathy S

2012-06-01

293

Suprascapular Nerve Block and Glenohumeral Injection in Hemiplegic Shoulder Pain: To Compare the Effectiveness on Pain and Disability  

Directory of Open Access Journals (Sweden)

Full Text Available Objective: The aim of this study was to compare the effectiveness of glenohumeral (GH) joint injection and suprascapular nerve block (SNB) in patients with hemiplegic shoulder pain.Materials and Methods: Thirty-six patients with shoulder pain lasting for at least 3 months were randomized into two groups in which SNB was applied in the first and GH joint steroid injection in the second group. All patients were evaluated before treatment, after 30 minutes, second week and third month after the treatment. Pain at rest, with motion and nocturnal pain were determined by the visual analogue scale. Shoulder joint range of motion was recorded for all patients. Disability status was assessed using the Functional Independence Measure (FIM). Results: There was a significant decrease in VAS scores for pain at rest, night and activity immediately after, at the second week and at the third month after the treatment in both groups. Change scores were similar in both groups. Conclusion: Although, both GH joint injection and SNB reduced pain and improved functional status at upto 3 months, there was no superiority of the one over the other. Turk J Phys Med Re­hab 2012;58:299-306.

Ay?egu?l TUBAY; Serpil BAL; Korhan Bar?? BAYRAM; Hikmet KOÇYI?IT; Alev GÜRGAN

2012-01-01

294

Radiofrequency treatment of peripheral nerves.  

UK PubMed Central (United Kingdom)

Treatment of chronic refractory pain in which peripheral nerves are involved has proven to be difficult. Neurolysis by surgical, chemical, cryogenic, or thermal means may be considered as an option on seldom occasions, because of the risk of neuritis and deafferentation pain, motor deficit, and potential unintentional damage to nontargeted tissue. To our knowledge, there is only 1 report concerning selective radiofrequency (RF) treatment of the obturator and femoral nerves that was published. The introduction of the non-neurodestructive pulsed radiofrequency technique has provided new possibilities for the treatment of peripheral nerves. Today there is some experience with the management of chronic shoulder pain and additional case reports on other indications.

Rohof OJ

2002-09-01

295

Variability in the origin of the obturator artery  

Scientific Electronic Library Online (English)

Full Text Available Abstract in english INTRODUCTION: General surgeons dealing with laparoscopic herniorrhaphy should be aware of the aberrant obturator artery that crosses the superior pubic ramus and is susceptible to injuries during dissection of the Bogros space and mesh stapling onto Cooper's ligament. The obturator artery is usually described as a branch of the anterior division of the internal iliac artery, although variations have been reported. MATERIALS AND METHODS: The present study was conducted on (more) 98 pelvic halves of embalmed cadavers, and the origin and course of the obturator artery were traced and noted. RESULTS: In 79% of the specimens, the obturator artery was a branch of the internal iliac artery. It branched off at different levels either from the anterior division or posterior division, individually or with other named branches. In 19% of the cases, the obturator artery branched off from the external iliac artery as a separate branch or with the inferior epigastric artery. However, in the remaining 2% of the specimens, both the internal and the external iliac arteries branched to form an anastomotic structure within the pelvic cavity. CONCLUSION: The data obtained in this study show that it is more common to find an abnormal obturator artery than was reported previously, and this observation has implications for pelvic surgeons and is of academic interest to anatomists. Surgeons dealing with direct, indirect, femoral, or obturator hernias need to be aware of these variations and their close proximity to the femoral ring.

Pai, Mangala M.; Krishnamurthy, Ashwin; Prabhu, Latha V; Pai, Manohar V.; Kumar, Senthil A.; Hadimani, Gavishiddappa A.

2009-01-01

296

Obturator foramen dissection for excision of symptomatic transobturator mesh.  

UK PubMed Central (United Kingdom)

PURPOSE: Groin pain after transobturator synthetic mesh placement can be recalcitrant to conservative therapy and ultimately requires surgical excision. We describe our experiences with and technique of obturator foramen dissection for mesh excision. MATERIALS AND METHODS: The records of 8 patients treated from 2005 to 2010, were reviewed. Obturator dissection was performed via a lateral groin incision over the inferior pubic ramus at the level of the obturator foramen, typically in conjunction with orthopedic surgery. RESULTS: Five patients had transobturator mid urethral sling surgery for stress urinary incontinence, 2 had mid urethral sling and trocar based anterior vaginal wall mesh kits with transobturator passage of mesh arms for stress urinary incontinence and pelvic organ prolapse, and 1 had an anterior vaginal wall mesh kit for pelvic organ prolapse. Patients had 0 to 2 prior transvaginal mesh excisions before obturator surgery. All patients presented with intractable pain in the area of the obturator foramen and/or medial groin for which conservative treatment measures had failed. Six patients underwent concurrent vaginal and obturator dissection and 2 underwent obturator dissection alone. In all cases residual mesh (3 to 11 cm) was identified and excised from the obturator foramen. Mesh was closely associated to or traversing the adductor longus muscle and tendon with significant fibrous reaction in all cases. Postoperatively 5 patients were cured of pain and/or infection, and 3 reported no or some improvement at a mean followup of 6 months (range 1 to 12). CONCLUSIONS: Our experience suggests that surgical excision of residual mesh can alleviate many of the symptoms in many patients. In all cases mesh remnants were identified and removed, and typically involved neuromuscular structures adjacent to the obturator foramen.

Reynolds WS; Kit LC; Kaufman MR; Karram M; Bales GT; Dmochowski RR

2012-05-01

297

Preoperative oral use of Ibuprofen or dexamethasone may improve the anesthetic efficacy of an inferior alveolar nerve block in patients diagnosed with irreversible pulpitis.  

UK PubMed Central (United Kingdom)

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Effect of premedication with ibuprofen and dexamethasone on success rate of inferior alveolar nerve block for teeth with asymptomatic irreversible pulpitis: a randomized clinical trial. Shahi S, Moktari H, Rahimi S, Yavari HR, Narimani S, Abdolrahmi M, Nezafati S. J Endod 2013;39(2):160-2. REVIEWER: John M. Nusstein, DDS, MS PURPOSE/QUESTION: To determine whether preoperative oral administration of ibuprofen (400 mg), dexamethasone (0.5 mg), or placebo (lactose) would improve the anesthetic success rate of an inferior alveolar nerve block in patients with molars diagnosed with asymptomatic irreversible pulpitis SOURCE OF FUNDING: University: Dental and Periodontal Research Center of Tabriz, Tabriz University of Medical Sciences, Tabriz, Iran TYPE OF STUDY/DESIGN: Randomized controlled trial LEVEL OF EVIDENCE: Level 2: Limited-quality, patient-oriented evidence STRENGTH OF RECOMMENDATION GRADE: Not applicable.

Nusstein JM

2013-09-01

298

Selective expression of Jun proteins following axotomy and axonal transport block in peripheral nerves in the rat: evidence for a role in the regeneration process.  

UK PubMed Central (United Kingdom)

Expression of the protein products of the immediate-early genes (IEGs), members of the fos, jun and krox families (Jun, Fos, and Krox, resp.) was investigated in the spinal cord and sensory ganglia (DRG) of normal rats; and following transection of, block of axonal transport in, or electrical stimulation of their peripheral axons. The nuclei of many moto- and DRG neurons showed a faint basal immunoreactivity (IR) for Jun proteins, but not for Fos or Krox proteins. There was a strong and selective induction of Jun-IR in moto- and DRG neurons after peripheral nerve transection or crush, or colchicine- or vinblastine-induced block of axonal transport. The Jun-IR induced by nerve transection disappeared after nerve regeneration. In contrast, Jun, Fos and Krox proteins were all induced transynaptically in spinal dorsal horn neurons following electrical stimulation of the C-fibers in the afferent nerves. Thus in differentiated neurons in vivo these IEG proteins can be expressed either independently or concomitantly depending on the type of stimulus.

Leah JD; Herdegen T; Bravo R

1991-12-01

299

Obturator internus muscle abscess in a child: a case report.  

UK PubMed Central (United Kingdom)

The authors report a case of abscess in the obturator internus muscle, which is a rare occurrence. It was managed with antibiotics and surgical intervention was not necessary. Pyomyositis involving the muscles around the hip needs to be differentiated from septic arthritis and transient synovitis of the hip because these pathologies more commonly afflict this joint. However, when present, abscesses usually affect the psoas or the glutei. Only rarely is the obturator internus involved by the abscess. Magnetic resonance imaging is the imaging modality of choice to image the obturator internus and to ascertain the diagnosis. Lack of awareness of the existence of this condition leads to a delay in the correct diagnosis.

Bansal M; Bhaliak V; Bruce CE

2008-09-01

300

Bloqueos nerviosos periféricos de la extremidad inferior para analgesia postoperatoria y tratamiento del dolor crónico/ Lower limb continuous peripheral nerve blocks for postoperative analgesia and chronic pain  

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish Existe un interés creciente por la realización de los bloqueos de nervio periférico (BNP) debido a sus potenciales beneficios como los concernientes a las interacciones de los fármacos anticoagulantes y los bloqueos neuroaxiales. Los BNP de la extremidad inferior, y sobre todo, los bloqueos periféricos del nervio ciático son el pariente pobre de las técnicas de anestesia regional y, en general, son poco conocidos y por tanto poco utilizados. En este artículo se re (more) aliza una revisión de los bloqueos del plexo lumbosacro, realizando especial énfasis en los bloqueos continuos mediante catéteres para analgesia postoperatoria y para el tratamiento del dolor crónico. La utilización de anestésicos locales de larga duración de acción, asociada a un escaso bloqueo motor, como es el caso de la ropivacaína, nos permite combinar técnicas de punción única para conseguir una adecuada analgesia intraoperatoria, con las técnicas de perfusión continua para analgesia postoperatoria. Es necesario un conocimiento anatómico preciso, así como de los territorios cutáneos de inervación de las ramas del plexo lumbosacro, para la realización de estas técnicas de bloqueo. La introducción de diferentes técnicas de imagen, fundamentalmente la ultrasonografía, para la localización de las estructuras nerviosas, facilita la realización de estos bloqueos y disminuye el riesgo de lesiones de los órganos adyacentes. La realización de los bloqueos continuos de nervio periférico ofrece el beneficio de una analgesia postoperatoria prolongada, con menores efectos adversos, mayor grado de satisfacción del paciente, y una recuperación funcional más rápida después de la cirugía. Abstract in english There is increasing interest in peripheral nerve blocks (PNB) because of potential benefits relative to interactions of anticoagulants and central neuraxial techniques. Among all the regional anesthesia procedures, PNB of the lower limb, and specially sciatic nerve block, are the less known and rarely used. In this paper, we summarize the recent advances in lumbosacral plexus block, with special remark on continuous catheter blocks for postoperative analgesia and chronic (more) pain treatment. The use of long action local anes-thetics combined with a weak motor block, like ropivacaine, permits the combination of a single skin injection technique to achieve an adequate intraoperative analgesia with continuous infusion ones for postoperative analgesia. A detailed knowledge of anatomy as well as cutaneous nerve distribution is needed for the performance of these techniques. The introduction of several image-based techniques, principally ultrasound imaging, may improve the accuracy of nerve localization and needle placement. It also can help to prevent accidental puncture to vessels and other neighbouring structures. Continuous plexus and peripheral nerve blocks offer the potential benefits of prolonged analgesia with fewer side effects, greater patient satisfaction, and faster functional recovery after surgery.

Domingo, V.; Aguilar, J. L.; Pelaez, R.

2004-05-01

 
 
 
 
301

Bloqueos nerviosos periféricos de la extremidad inferior para analgesia postoperatoria y tratamiento del dolor crónico Lower limb continuous peripheral nerve blocks for postoperative analgesia and chronic pain  

Directory of Open Access Journals (Sweden)

Full Text Available Existe un interés creciente por la realización de los bloqueos de nervio periférico (BNP) debido a sus potenciales beneficios como los concernientes a las interacciones de los fármacos anticoagulantes y los bloqueos neuroaxiales. Los BNP de la extremidad inferior, y sobre todo, los bloqueos periféricos del nervio ciático son el pariente pobre de las técnicas de anestesia regional y, en general, son poco conocidos y por tanto poco utilizados. En este artículo se realiza una revisión de los bloqueos del plexo lumbosacro, realizando especial énfasis en los bloqueos continuos mediante catéteres para analgesia postoperatoria y para el tratamiento del dolor crónico. La utilización de anestésicos locales de larga duración de acción, asociada a un escaso bloqueo motor, como es el caso de la ropivacaína, nos permite combinar técnicas de punción única para conseguir una adecuada analgesia intraoperatoria, con las técnicas de perfusión continua para analgesia postoperatoria. Es necesario un conocimiento anatómico preciso, así como de los territorios cutáneos de inervación de las ramas del plexo lumbosacro, para la realización de estas técnicas de bloqueo. La introducción de diferentes técnicas de imagen, fundamentalmente la ultrasonografía, para la localización de las estructuras nerviosas, facilita la realización de estos bloqueos y disminuye el riesgo de lesiones de los órganos adyacentes. La realización de los bloqueos continuos de nervio periférico ofrece el beneficio de una analgesia postoperatoria prolongada, con menores efectos adversos, mayor grado de satisfacción del paciente, y una recuperación funcional más rápida después de la cirugía.There is increasing interest in peripheral nerve blocks (PNB) because of potential benefits relative to interactions of anticoagulants and central neuraxial techniques. Among all the regional anesthesia procedures, PNB of the lower limb, and specially sciatic nerve block, are the less known and rarely used. In this paper, we summarize the recent advances in lumbosacral plexus block, with special remark on continuous catheter blocks for postoperative analgesia and chronic pain treatment. The use of long action local anes-thetics combined with a weak motor block, like ropivacaine, permits the combination of a single skin injection technique to achieve an adequate intraoperative analgesia with continuous infusion ones for postoperative analgesia. A detailed knowledge of anatomy as well as cutaneous nerve distribution is needed for the performance of these techniques. The introduction of several image-based techniques, principally ultrasound imaging, may improve the accuracy of nerve localization and needle placement. It also can help to prevent accidental puncture to vessels and other neighbouring structures. Continuous plexus and peripheral nerve blocks offer the potential benefits of prolonged analgesia with fewer side effects, greater patient satisfaction, and faster functional recovery after surgery.

V. Domingo; J. L. Aguilar; R. Pelaez

2004-01-01

302

Long-term pain and functional disability after total knee arthroplasty with and without single-injection or continuous sciatic nerve block in addition to continuous femoral nerve block: a prospective, 1-year follow-up of a randomized controlled trial.  

UK PubMed Central (United Kingdom)

BACKGROUND AND OBJECTIVES: This is a follow-up to determine long-term outcomes after total knee arthroplasty (TKA) in patients enrolled in a previous randomized trial that found reduced postoperative pain after addition of sciatic nerve block to continuous femoral nerve block for TKA. METHODS: Physical function after TKA was evaluated at 3 and 12 months in patients (n = 89) receiving continuous femoral nerve block alone (group F), combined with a single-injection (group Fs) or continuous sciatic nerve block (group FCS) after TKA, until the second postoperative day. Physical function, stiffness, and pain were measured by using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Oxford Knee Score 12-item knee questionnaires, and visual analog scale at rest and during mobilization before TKA and 3 and 12 months afterward. Post hoc, a median split on poor functioning (WOMAC) was analyzed. RESULTS: Western Ontario and McMaster Universities Osteoarthritis Index, Oxford Knee Score 12-item knee, and visual analog scale scores improved significantly in all patients, without any differences among groups. Median (range) WOMAC at 3 months were in group F, 83 (20-97); group Fs, 72 (25-99); and group, FCS 76 (28-100) and at 12 months 87 (35-98), 77 (43-100), and 89 (35-100), respectively. CONCLUSIONS: No differences were detected in the secondary outcomes we examined. Thus, improved postoperative outcome did not translate into improved functional outcome or long-term pain.

Wegener JT; van Ooij B; van Dijk CN; Karayeva SA; Hollmann MW; Preckel B; Stevens MF

2013-01-01

303

Continuous peripheral nerve blocks for postoperative analgesia in children: feasibility and side effects in a cohort study of 339 catheters.  

UK PubMed Central (United Kingdom)

INTRODUCTION: Perioperative continuous peripheral nerve blocks (CPNB) are increasingly being used in children. Only one previous study has reported adverse events of CPNB in a high number of pediatric cases. We evaluated the indications, block efficacy, and adverse events related to CPNB in children. METHODS: All CPNBs that were performed in children for postoperative analgesia over a 5-year period at the Montpellier University Hospital in France were included in this study. The first bolus dose and the continuous doses of local anesthetic were not standardized. In the postoperative period, demographic data, quality of analgesia, amount of rescue analgesic medication, child/parent satisfaction, and adverse events were recorded in our Departmental Regional Anesthesia registry. RESULTS: A total of 339 catheters were evaluated in 292 children ASA physical status I to III. The median age was 8 yr (0.6-17 yr) and the median weight was 28 kg (7-116 kg). The main surgical indications were hip, femoral, or tibial osteotomies (44.5%) and club foot repair (27.4%). The local anesthetics used were either bupivacaine or ropivacaine. The mean volume of the local anesthetic bolus dose was 0.49 +/- 0.16 mL . kg(-1), and the mean regimen of local anesthetic continuous infusion was 0.11 +/- 0.04 mL . kg(-1) . hr(-1). The median duration of CPNB was 61.6 hr (range 0-264 hr). Pain relief, which was evaluated with the children at rest, was considered optimal in the majority of patients throughout the study period. The Children and Infants Postoperative Pain Scale (CHIPPS) was used in children age 0-6 yr and the Visual Analog Pain Scale (VAS) was used in children 7 yr and older. There were no major adverse events. There were 211 minor adverse events recorded in 153 CPNBs (45.1%). The most frequently reported complication (20.1%) involved mechanical problems with the catheter, followed by nausea and vomiting (14.7%). CONCLUSION: CPNBs are indicated after orthopedic surgery in children. Our results demonstrate that CPNBs are feasible in the pediatric setting, and in skilled hands, they promote prolonged analgesia in the majority of patients without major adverse events. The most common minor adverse events are catheter-related mechanical problems and postoperative nausea and vomiting.

Dadure C; Bringuier S; Raux O; Rochette A; Troncin R; Canaud N; Lubrano-Lavadera JF; Capdevila X

2009-11-01

304

Seal integrity of hollow-bulb obturators.  

UK PubMed Central (United Kingdom)

Five techniques using various materials were evaluated for their ability to produce a watertight seal between obturator and lid. Leakage was determined by an increase in sample weight above that attributed to sorption and by visualization of water inside the clear acrylic resin samples. A watertight seal was obtained for some samples in each of the test groups. Only the two-flask technique sealed with heat-processed acrylic resin produced a watertight seal in all samples. It was determined that pressure up to 30 psi for 1 hour does not rupture a sealed hollow bulb and immersion under pressure is required to detect leakage of a bulb in a short period of time.

Paprocki GJ; Jacob RF; Kramer DC

1990-09-01

305

Seal integrity of hollow-bulb obturators.  

Science.gov (United States)

Five techniques using various materials were evaluated for their ability to produce a watertight seal between obturator and lid. Leakage was determined by an increase in sample weight above that attributed to sorption and by visualization of water inside the clear acrylic resin samples. A watertight seal was obtained for some samples in each of the test groups. Only the two-flask technique sealed with heat-processed acrylic resin produced a watertight seal in all samples. It was determined that pressure up to 30 psi for 1 hour does not rupture a sealed hollow bulb and immersion under pressure is required to detect leakage of a bulb in a short period of time. PMID:2088383

Paprocki, G J; Jacob, R F; Kramer, D C

306

Evaluation of Lumbar Facet Joint Nerve Blocks in Managing Chronic Low Back Pain: A Randomized, Double-Blind, Controlled Trial with a 2-Year Follow-Up  

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Full Text Available Study Design: A randomized, double-blind, controlled trial. Objective: To determine the clinical effectiveness of therapeutic lumbar facet joint nerve blocks with or without steroids in managing chronic low back pain of facet joint origin. Summary of Background Data: Lumbar facet joints have been shown as the source of chronic pain in 21% to 41% of low back patients with an average prevalence of 31% utilizing controlled comparative local anesthetic blocks. Intraarticular injections, medial branch blocks, and radiofrequency neurotomy of lumbar facet joint nerves have been described in the alleviation of chronic low back pain of facet joint origin. Methods: The study included 120 patients with 60 patients in each group with local anesthetic alone or local anesthetic and steroids. The inclusion criteria was based upon a positive response to diagnostic controlled, comparative local anesthetic lumbar facet joint blocks. Outcome measures included the numeric rating scale (NRS), Oswestry Disability Index (ODI), opioid intake, and work status, at baseline, 3, 6, 12, 18, and 24 months. Results: Significant improvement with significant pain relief of ? 50% and functional improvement of ? 40% were observed in 85% in Group 1, and 90% in Group II, at 2-year follow-up. The patients in the study experienced significant pain relief for 82 to 84 weeks of 104 weeks, requiring approximately 5 to 6 treatments with an average relief of 19 weeks per episode of treatment. Conclusions: Therapeutic lumbar facet joint nerve blocks, with or without steroids, may provide a management option for chronic function-limiting low back pain of facet joint origin.

Laxmaiah Manchikanti, Vijay Singh, Frank J.E. Falco, Kimberly A. Cash, Vidyasagar Pampati

2010-01-01

307

[Hepatic dysfunction correction in patients with obturation jaundice].  

Science.gov (United States)

Comparative analysis of results of examination and treatment of 54 patients, suffering obturation jaundice syndrome, is presented. The presence and severity of hepatic dysfunction was determined in accordance to indices of cytolysis and cholestasis syndromes, and its severity--in accordance to V. P. Zinevich criteria (1986). There was established, that timely elimination of obturation jaundice, using miniinvasive interventions and subsequent conduction of complex hepatotropic therapy, using L-ornitin L-aspartate, permits to correct hepatic dysfunction effectively. PMID:23888709

Datsenko, B M; Tamm, T I; Borisenko, V B; Kramarenko, K A

2013-04-01

308

[Hepatic dysfunction correction in patients with obturation jaundice].  

UK PubMed Central (United Kingdom)

Comparative analysis of results of examination and treatment of 54 patients, suffering obturation jaundice syndrome, is presented. The presence and severity of hepatic dysfunction was determined in accordance to indices of cytolysis and cholestasis syndromes, and its severity--in accordance to V. P. Zinevich criteria (1986). There was established, that timely elimination of obturation jaundice, using miniinvasive interventions and subsequent conduction of complex hepatotropic therapy, using L-ornitin L-aspartate, permits to correct hepatic dysfunction effectively.

Datsenko BM; Tamm TI; Borisenko VB; Kramarenko KA

2013-04-01

309

Application of a peripheral nerve block technique in laser treatment of the entire facial skin and evaluation of its analgesic effect.  

UK PubMed Central (United Kingdom)

Background: The aim was to develop a technique for peripheral nerve block anesthesia (PNB) for the skin of the entire face and neck, considering the nerves anesthetized, injection sites, use of an injection method assisted by computer-controlled local anesthetic delivery (CCLAD), and to evaluate the analgesic effects of the PNB technique. Methods: 50 patients who suffered from large nevus of Ota lesions or port-wine stains on their facial and neck skin and who required laser treatment were included. This study was designed as a non-randomized self-control trial. All the patients received the laser treatment under topical anesthesia in the first phase and three to six months later, they received the same treatment under the PNB using CCLAD. The differences in scores from the visual analogue scale of pain for the two phases were analyzed by the t-test. P values <0.05 were considered to be statistically significant. Results: The peripheral nerve block technique was simple to execute and easy to learn, the anesthetic injection site was generally located at a subcutaneous depth of 0.5-1.0 cm. The analgesic effect of PNB was significant, the mean pain score (2.8 ± 2.2) was significantly lower than that with topical anesthesia (P<0.0001). Patients during the PNB phase did not experience injection pain following CCLAD. Conclusion: The peripheral nerve block technique can greatly ease the pain that occurs during laser treatment, especially for patients with larger lesions. CCLAD will allow PNB to be broadly applied in laser treatments.

Wan K; Jing Q; Sun QN; Wang HW; Zhao JZ; Ma L; Kong LJ

2013-06-01

310

Continuous saphenous nerve block as supplement to single-dose local infiltration analgesia for postoperative pain management after total knee arthroplasty.  

UK PubMed Central (United Kingdom)

BACKGROUND AND OBJECTIVES: Local infiltration analgesia (LIA) reduces pain after total knee arthroplasty without the motor blockade associated with epidural analgesia or femoral nerve block. However, the duration and efficacy of LIA are not sufficient. A saphenous nerve block, in addition to single-dose LIA, may improve analgesia without interfering with early mobilization. METHODS: Forty patients were included in this double-blind randomized controlled trial. All patients received spinal anesthesia for surgery and single-dose LIA during the operation. An ultrasound-guided saphenous nerve catheter was placed postoperatively in the adductor canal at midthigh level. Patients were randomized into 2 groups to receive 15-mL boluses of either ropivacaine 7.5 mg/mL or saline twice daily for 2 postoperative days. RESULTS: Worst pain scores during movement on the day of surgery were significantly lower in the ropivacaine group (median [range] visual analog scale, 3 [0-7] vs 5.5 [0-10]; P < 0.050), as well as pain at rest (visual analog scale, 2 [0-8] vs 4 [0-8]; P = 0.032). Breakthrough pain occurred later in the ropivacaine group (10.5 [range, 0.5-48] hours vs 3.4 [range, 0.5-24] hours; P = 0.011). All patients in the ropivacaine group were able to ambulate on the day of surgery versus 13 patients in the control group (P = 0.004). Fewer patients had sleep disturbance on the first postoperative night in the ropivacaine group (P = 0.038). We found no differences in morphine consumption. CONCLUSIONS: The combination of a saphenous nerve block with single-dose LIA offered better pain relief on the day of surgery than LIA alone.

Andersen HL; Gyrn J; Møller L; Christensen B; Zaric D

2013-03-01

311

Lack of correlation between obturation limits and apical leakage.  

UK PubMed Central (United Kingdom)

The aim of this paper was to evaluate a possible correlation between obturation limits and leakage. Thirty-six extracted human mandibular incisors were used, characterized by straight and single canals, non-anatomical complexities, absence of previous endodontic treatment, complete root formation and patent foramen. For standardization of the specimens for the leakage analysis, foraminal instrumentation was performed up to a Flexofile #25 (Dentsply-Maillefer, Ballaigues, Switzerland). All specimens were instrumented and filled following the same protocol, and the obturation limits were measured using Axiovision 4.5 Software (Carl Zeiss Vision, Hallbergmoos, Germany). The specimens were then separated into three groups (n=12) according to the following variables: Group I--obturation limits ranging from 0 mm to 0.76 mm of the main apical foramen. Group II--obturation limits ranging from 0.77 mm to 0.98 mm of the main apical foramen. Group III--obturation limits ranging from 0.99 mm to 1.68 mm of the main apical foramen. Apical leakage was quantified by fluid filtration. The analyses were confronted using Pearson's test (p>0.05). Groups I, II and III showed Pearson correlation values (r2) of -0.152, -0.186 and 0.058, respectively. No correlation was found between the obturation limits and apical leakage.

Machado R; da Silva Neto UX; Ignácio SA; Cunha RS

2013-07-01

312

Continuous peripheral nerve blocks: is local anesthetic dose the only factor, or do concentration and volume influence infusion effects as well?  

UK PubMed Central (United Kingdom)

BACKGROUND: The main determinant of continuous peripheral nerve block effects--local anesthetic concentration and volume or simply total drug dose--remains unknown. METHODS: We compared two different concentrations and basal rates of ropivacaine--but at equivalent total doses--for continuous posterior lumbar plexus blocks after hip arthroplasty. Preoperatively, a psoas compartment perineural catheter was inserted. Postoperatively, patients were randomly assigned to receive perineural ropivacaine of either 0.1% (basal 12 ml/h, bolus 4 ml) or 0.4% (basal 3 ml/h, bolus 1 ml) for at least 48 h. Therefore, both groups received 12 mg of ropivacaine each hour with a possible addition of 4 mg every 30 min via a patient-controlled bolus dose. The primary endpoint was the difference in maximum voluntary isometric contraction (MVIC) of the ipsilateral quadriceps the morning after surgery, compared with the preoperative MVIC, expressed as a percentage of the preoperative MVIC. Secondary endpoints included hip adductor and hip flexor MVIC, sensory levels in the femoral nerve distribution, hip range-of-motion, ambulatory ability, pain scores, and ropivacaine consumption. RESULTS: Quadriceps MVIC for patients receiving 0.1% ropivacaine (n = 26) declined by a mean (SE) of 64.1% (6.4) versus 68.0% (5.4) for patients receiving 0.4% ropivacaine (n = 24) between the preoperative period and the day after surgery (95% CI for group difference: -8.0-14.4%; P = 0.70). Similarly, the groups were found to be equivalent with respect to secondary endpoints. CONCLUSIONS: For continuous posterior lumbar plexus blocks, local anesthetic concentration and volume do not influence nerve block characteristics, suggesting that local anesthetic dose (mass) is the primary determinant of perineural infusion effects.

Ilfeld BM; Moeller LK; Mariano ER; Loland VJ; Stevens-Lapsley JE; Fleisher AS; Girard PJ; Donohue MC; Ferguson EJ; Ball ST

2010-02-01

313

Optimal effective concentration of ropivacaine for postoperative analgesia by single-shot femoral-sciatic nerve block in outpatient knee arthroscopy.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To compare analgesic and mobility effects of different ropivacaine concentrations in femoral-sciatic nerve block, for postoperative analgesia in knee arthroscopy. METHODS: Outpatients (American Society of Anesthesiologists physical classification status of I or II), scheduled for elective knee arthroscopy, were randomly allocated to one of seven groups, prospectively investigating different concentrations of ropivacaine (0.12%; 0.14%; 0.16%; 0.18%; 0.20%; 0.22% or 0.50%), for ultrasound-guided femoral-sciatic nerve block procedures for postoperative analgesia. Visual analogue scale (VAS) pain scores and motor block evaluation scales were observed at 4, 8, 16 and 24 h postsurgery. RESULTS: In total, 105 patients were enrolled; results were analysed for 103. VAS scores for the 0.12%, 0.14% and 0.16% groups were significantly different from the 0.50% group. There were no significant differences between the 0.18%, 0.20%, 0.22% and 0.50% groups: half maximal effective concentrations and 95% maximal effective concentrations of ropivacaine were 0.158 (95% confidence intervals [CI] 0.149, 0.167) and 0.198 (95% CI 0.186, 0.221), respectively. Rates of motor blockade (Bromage score or hip motor function scale > 0) were significantly different between the 0.50% group and all other ropivacaine doses. CONCLUSION: The 0.20% ropivacaine dose for femoral-sciatic nerve block in knee arthroscopy provided satisfactory postoperative analgesia, while preserving ability of motion.

Yao J; Zeng Z; Jiao ZH; Wang AZ; Wang J; Yu A

2013-04-01

314

Bilateral intra-oral, infra-orbital nerve block for postoperative analgesia following cleft lip repair in paediatric patients: comparison of bupivacaine vs bupivacaine-pethidine combination.  

UK PubMed Central (United Kingdom)

This prospective, randomised, double blind study compared the efficacy of pethidine as an adjuvant to bupivacaine with the efficacy of bupivacaine alone for infra-orbital nerve block in alleviating postoperative pain in children undergoing cleft lip repair. Forty paediatric patients aged between 5 and 60 months undergoing cleft lip repair were randomly allocated to two groups of 20. After tracheal intubation, group B received bilateral intra-oral, infra-orbital nerve block with 1 ml of 0.25% bupivacaine on each side and group P received 1 ml of 0.25% bupivacaine along with 0.25 mg.kg(-1) body weight pethidine. Sedation after recovery from anaesthesia was assessed using the University of Michigan Sedation Scale (UMSS) and pain was assessed postoperatively up to 36 h using the FLACC scale (Face, Legs, Activity, Cry, Consolability). The median (IQR) duration of analgesia from the time of administration of block in group B was 18 h (14.2-20) compared to 29.1 h (24-36) in group P (p = 0.001). Addition of pethidine as an adjunct to local anaesthetic significantly prolonged the duration of postoperative analgesia without any adverse effects.

Jonnavithula N; Durga P; Kulkarni DK; Ramachandran G

2007-06-01

315

Bilateral intra-oral, infra-orbital nerve block for postoperative analgesia following cleft lip repair in paediatric patients: comparison of bupivacaine vs bupivacaine-pethidine combination.  

Science.gov (United States)

This prospective, randomised, double blind study compared the efficacy of pethidine as an adjuvant to bupivacaine with the efficacy of bupivacaine alone for infra-orbital nerve block in alleviating postoperative pain in children undergoing cleft lip repair. Forty paediatric patients aged between 5 and 60 months undergoing cleft lip repair were randomly allocated to two groups of 20. After tracheal intubation, group B received bilateral intra-oral, infra-orbital nerve block with 1 ml of 0.25% bupivacaine on each side and group P received 1 ml of 0.25% bupivacaine along with 0.25 mg.kg(-1) body weight pethidine. Sedation after recovery from anaesthesia was assessed using the University of Michigan Sedation Scale (UMSS) and pain was assessed postoperatively up to 36 h using the FLACC scale (Face, Legs, Activity, Cry, Consolability). The median (IQR) duration of analgesia from the time of administration of block in group B was 18 h (14.2-20) compared to 29.1 h (24-36) in group P (p = 0.001). Addition of pethidine as an adjunct to local anaesthetic significantly prolonged the duration of postoperative analgesia without any adverse effects. PMID:17506736

Jonnavithula, N; Durga, P; Kulkarni, D K; Ramachandran, G

2007-06-01

316

Obturator internus muscle abscess in children.  

UK PubMed Central (United Kingdom)

The authors describe four cases of obturator internus muscle (OIM) abscess in children, including their clinical presentations and treatment. This was a retrospective chart review. Children and adolescents younger than 18 years discharged between July 1, 1985, and September 30, 1998, from Brenner Children's Hospital with the diagnosis of muscle abscess or pelvic abscess were identified. A total of 56 patients were identified with the diagnosis of muscle abscess or pelvic abscess. OIM abscess was defined by radiologic findings of an inflammatory process with fluid collection in the OIM, along with the clinical findings suggestive of an OIM abscess. Four of the patients met the definition of OIM muscle abscess. The common presenting features were fever, limp, and hip pain. Computed tomography or magnetic resonance imaging was diagnostic in all four patients, and Staphylococcus aureus was the causative agent in each. All the patients recovered, one after surgical drainage and the other three after antimicrobial therapy alone or with needle aspiration. The presentation of OIM pyomyositis is similar to that of psoas muscle pyomyositis and other infectious processes of the pelvis and hip. The S. aureus is the most common etiologic agent but not the only one reported. Most patients can be managed without open surgical drainage, but needle aspirations may be helpful both therapeutically and diagnostically.

Orlicek SL; Abramson JS; Woods CR; Givner LB

2001-11-01

317

Obturator internus muscle abscess in children.  

Science.gov (United States)

The authors describe four cases of obturator internus muscle (OIM) abscess in children, including their clinical presentations and treatment. This was a retrospective chart review. Children and adolescents younger than 18 years discharged between July 1, 1985, and September 30, 1998, from Brenner Children's Hospital with the diagnosis of muscle abscess or pelvic abscess were identified. A total of 56 patients were identified with the diagnosis of muscle abscess or pelvic abscess. OIM abscess was defined by radiologic findings of an inflammatory process with fluid collection in the OIM, along with the clinical findings suggestive of an OIM abscess. Four of the patients met the definition of OIM muscle abscess. The common presenting features were fever, limp, and hip pain. Computed tomography or magnetic resonance imaging was diagnostic in all four patients, and Staphylococcus aureus was the causative agent in each. All the patients recovered, one after surgical drainage and the other three after antimicrobial therapy alone or with needle aspiration. The presentation of OIM pyomyositis is similar to that of psoas muscle pyomyositis and other infectious processes of the pelvis and hip. The S. aureus is the most common etiologic agent but not the only one reported. Most patients can be managed without open surgical drainage, but needle aspirations may be helpful both therapeutically and diagnostically. PMID:11675547

Orlicek, S L; Abramson, J S; Woods, C R; Givner, L B

318

Pain control after primary total knee replacement. A prospective randomised controlled trial of local infiltration versus single shot femoral nerve block.  

UK PubMed Central (United Kingdom)

BACKGROUND: We report a prospective blinded randomised trial of local infiltration versus femoral nerve block in patients undergoing primary total knee replacement (TKR), in accordance with the CONSORT statement 2010. METHODS: Fifty patients in a teaching hospital were consented for the study. The study arms were intraoperative local anaesthesia (150ml 0.2% ropivacaine/1ml 1:1000 adrenaline/30mg ketolorac) and femoral nerve block (30ml 0.2% ropivacaine) with a primary outcome of pain score at 4h post operatively. Secondary outcomes were pain at 2h, pain scores before and after physiotherapy on day one, total opiate administered, time to physiotherapy goals and length of stay. Randomisation was by sealed envelope. The assessor was blinded and the patients partially blinded to the intervention. RESULTS: Ten patients were excluded, eight before randomisation. The trial is complete. Forty patients were analysed for the primary outcome measure. The local infiltration group had significantly lower pain scores at 4h post-operatively; mean [SD] score 2.1 [2.6] versus 6.8 [3.2], p<0.00001 and on post-operative day one prior to physiotherapy; mean score 2.4 [2.3] versus 4.4 [2.3], p<0.05. Total opiate use was also significantly lower in the local infiltration group; mean total 115 [50.3]mg versus 176.5 [103.5]mg, p<0.01. There was no difference in any other outcome. There were no harms as a result of either intervention. CONCLUSION: Intraoperative local infiltration gives superior pain relief compared to single shot femoral nerve block over the first 24h following primary TKR and minimises post-operative opiate use.

Ashraf A; Raut VV; Canty SJ; McLauchlan GJ

2013-10-01

319

CT-guided plexus and splanchnic nerve neurolytic block. Experience in 150 cases and techniques optimization; Il blocco neurolitico del plesso celiaco e dei nervi splancnici con tomografia computerizzata  

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The paper reports the personal experience in computerized tomography guided celiac plexus and splanchnic nerve neurolytic block blocks. [Italian] Scopo del lavoro e' illustrare l'esperienza personale nell'uso della tomografia computerizzata nel trattamento del dolore da neoplasie addominali superiori, rivoluzionando le tecniche di esecuzione, aumentandone la precisione e riducendone notevolmente il rischio di complicanze.

Marra, V.; Frigerio, A.; Menna, S.; Di Virgilio, M.R. [Ospedale San Giovanni, Turin (Italy). Serv. di Radiologia; Debernardi, F.; Musso, L. [Ospedale San Giovanni, Turin (Italy). Serv. di Anestesia, Rianimazione e Terapia Antalgica

1999-09-01

320

CT imaging features of obturator prostheses in patients following palatectomy or maxillectomy.  

UK PubMed Central (United Kingdom)

Palatal tumors are often treated with palatectomy or maxillectomy. The resulting surgical defect produces an oroantral communication. An obturator is a removable prosthesis used to close the palatal or maxillectomy defect. Fifteen patients who had undergone palatectomy or maxillectomy for carcinoma and subsequent obturator prosthesis placement were retrospectively studied. Obturators were characterized by Hounsfield units and were subdivided into 3 CT imaging groups: either hyperattenuated, hollow (air-containing), or heterogeneous (isoattenuated to hyperattenuated with internal foci of air). Eight patients had hyperattenuated obturators either representing acrylic resin or Trusoft. Four patients had hollow obturators also composed of acrylic resin or Trusoft. Three patients had heterogeneous obturators, which were composed of only Trusoft. The postoperative imaging of patients treated for palatal or maxillary tumors can be complicated by the presence of obturator prostheses. The intent of this article was to familiarize the reader with the CT imaging features of obturator prostheses.

Kumar VA; Hofstede TM; Ginsberg LE

2011-11-01

 
 
 
 
321

CT imaging features of obturator prostheses in patients following palatectomy or maxillectomy.  

Science.gov (United States)

Palatal tumors are often treated with palatectomy or maxillectomy. The resulting surgical defect produces an oroantral communication. An obturator is a removable prosthesis used to close the palatal or maxillectomy defect. Fifteen patients who had undergone palatectomy or maxillectomy for carcinoma and subsequent obturator prosthesis placement were retrospectively studied. Obturators were characterized by Hounsfield units and were subdivided into 3 CT imaging groups: either hyperattenuated, hollow (air-containing), or heterogeneous (isoattenuated to hyperattenuated with internal foci of air). Eight patients had hyperattenuated obturators either representing acrylic resin or Trusoft. Four patients had hollow obturators also composed of acrylic resin or Trusoft. Three patients had heterogeneous obturators, which were composed of only Trusoft. The postoperative imaging of patients treated for palatal or maxillary tumors can be complicated by the presence of obturator prostheses. The intent of this article was to familiarize the reader with the CT imaging features of obturator prostheses. PMID:21799037

Kumar, V A; Hofstede, T M; Ginsberg, L E

2011-07-28

322

A review of 12 cases of obturator hernia  

International Nuclear Information System (INIS)

We report on our evaluation in twelve cases of obturator hernia in our hospital. The subjects were twelve patients who underwent an operation for obturator hernia in our hospital between April 2001 and August 2009. We divided these patients into two groups, namely the intestinal resection group and the non-intestinal resection group, and evaluated both groups for duration from onset, radiographic findings and so on. The average age of the patients was 83.5 years (73-93 yr), and all patients were women. The average body mass index (BMI) was 17.6 kg/m2. The majority of the chief complaints was vomiting (7 cases 58.3%). The Howship-Romberg sign was observed in only three patients (25%). Preoperative CT scan revealed obturator hernia in nine patients. Preoperative duration from onset was 5-528 hr (average 120 hr). Emergency surgery was performed in all cases, and we tried the open method for eleven cases and the laparoscopic method for one case. The hernia hilus in four cases was closed with simple closure, and with mesh in eight cases. Recently, early diagnosis and treatment of obturator hernia has become feasible. Therefore, minimally invasive surgery such as laparoscopic surgery might be desirable as the first choice of surgical treatment for obturator hernia in the future. (author)

2010-01-01

323

Psoas compartment block for lower extremity surgery: a meta-analysis.  

Science.gov (United States)

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. The main outcome measure for anaesthesia was anaesthetic efficacy. For postoperative analgesia, the severity of postoperative pain was compared. The data were subjected to meta-analysis using relative risks with 95% confidence intervals (95% CI) for dichotomous variables and weighted mean differences with 95% CI for continuous variables. Thirty publications were included. PCB is an effective intervention for analgesia after hip and knee surgery. It appears superior to opioids for pain relief after hip surgery. This analgesic benefit may be extended beyond 8 h by the use of a catheter technique. Compared with Winnie's 3-in-1 block, PCB is associated with more consistent block of the obturator nerve. PCB may be an alternative to postoperative neuraxial block. 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. PMID:18945717

Touray, S T; de Leeuw, M A; Zuurmond, W W A; Perez, R S G M

2008-10-22

324

Obturator internus muscle abscess in a child: a case report.  

Science.gov (United States)

The authors report a case of abscess in the obturator internus muscle, which is a rare occurrence. It was managed with antibiotics and surgical intervention was not necessary. Pyomyositis involving the muscles around the hip needs to be differentiated from septic arthritis and transient synovitis of the hip because these pathologies more commonly afflict this joint. However, when present, abscesses usually affect the psoas or the glutei. Only rarely is the obturator internus involved by the abscess. Magnetic resonance imaging is the imaging modality of choice to image the obturator internus and to ascertain the diagnosis. Lack of awareness of the existence of this condition leads to a delay in the correct diagnosis. PMID:19471173

Bansal, Manish; Bhaliak, Vijay; Bruce, Colin E

2008-09-01

325

[Effective anesthetic volumes in sciatic nerve block: comparison between the parasacral and infragluteal-parabiceps approaches with 0.5% bupivacaine with adrenaline and 0.5% ropivacaine].  

UK PubMed Central (United Kingdom)

BACKGROUND AND OBJECTIVES: The volume and mass of local anesthetics (LA) affect the success rate of peripheral nerve blocks. Thus, the main objective of this study was to determine the volumes of local anesthetics in parasacral and infragluteal-parabiceps sciatic nerve block (SNB). METHODS: One hundred and one patients undergoing infragluteal-parabiceps or parasacral SNB with 0.5% ropivacaine or 0.5% bupivacaine with 5 microg.mL-1 of adrenaline were randomly divided into 4 groups. Success was defined as complete sensitive and motor blockades of the sciatic nerve 30 minutes after the administration of the LA. Volumes were calculated by the up-and-down method. RESULTS: In the parasacral approach, the mean effective volume of ropivacaine was 17.6 mL (95% CI: 14.9-20.8) and of bupivacaine it was 16.4 mL (95% CI: 12.3-21.9). In the infragluteal-parabiceps approach, the mean effective volume of ropivacaine was 21.8 mL (95% CI: 18.7-25.5), and that of bupivacaine was 20.4 mL (95% CI: 18.6-22.5). Volumes were significantly lower (p < 0.01) in the parasacral than in the infragluteal-parabiceps approach. In Probit regression, the estimated effective volume in 95% of the patients in the parasacral approach was 21.8 mL for ropivacaine, and 20.5 mL for bupivacaine; in the infragluteal-parabiceps approach the volumes were 27.2 mL for ropivacaine and 25.5 mL for bupivacaine. The effective volume in 99% of the patients in parasacral SNB was 24 mL for ropivacaine, and 24 mL for bupivacaine; and in the infragluteal-parabiceps approach, 29.9 mL for ropivacaine, and 28.0 mL for bupivacaine. CONCLUSIONS: In sciatic nerve block, significantly smaller volumes were necessary in the parasacral than in the infragluteal-parabiceps approach, but volumes did not differ between both LAs.

Helayel PE; Conceição DB; Knaesel JA; Ceccon MS; Mago AJ; Oliveira Filho GR

2009-09-01

326

[Chronic postoperative pain after general anesthesia with or without a single-dose preincisional paravertebral nerve block in radical breast cancer surgery].  

UK PubMed Central (United Kingdom)

BACKGROUND AND OBJECTIVE: Over 50% of patients still experience pain a year after mastectomy with or without lymphadenectomy. We aimed to determine the association between anesthetic technique, acute postoperative pain intensity, and the development of chronic postoperative pain. Patients and METHODS: Forty patients were randomly assigned to receive general anesthesia with or without a paravertebral nerve block for modified radical mastectomy. Postoperative pain was assessed on a visual analog scale at 60 minutes and 24 hours; the patients were also asked to respond to a telephone questionnaire on chronic pain 4 to 5 months later. RESULTS: No significant differences in acute pain were observed. Twenty-nine responded to the telephone questionnaire. Only 1 patient in the paravertebral block group reported chronic neuropathic pain and none had phantom breast pain. Only 1 patient (6.7%) in the paravertebral block group reported chronic neuropathic pain and none had phantom breast pain. In the group that received general anesthesia alone, 1 patient reported phantom breast pain and 6 patients had neuropathic pain, associated with phantom breast pain in 2 cases (incidence of chronic pain 50%; P = .01, Fischer exact test; relative risk, 7.5, 95% confidence interval, 1.0-53.5). The incidences of myofascial pain (neck muscle tightness) were similar in the 2 groups. CONCLUSIONS: Four to 5 months after mastectomy, fewer cases of chronic pain developed in the group operated under general anesthesia with a preincisional paravertebral block than in the group that received only general anesthesia, with postoperative morphine chloride for analgesia.

Ibarra MM; S-Carralero GC; Vicente GU; Cuartero del Pozo A; López Rincón R; Fajardo del Castillo MJ

2011-05-01

327

A Brief Educational Intervention Is Effective in Teaching the Femoral Nerve Block Procedure to First-Year Emergency Medicine Residents.  

UK PubMed Central (United Kingdom)

BACKGROUND: Hip fractures are a painful condition commonly encountered in the emergency department (ED). Older adults in pain often receive suboptimal doses of analgesics, particularly in crowded EDs. Nerve blocks have been utilized by anesthesiologists to help control pain from hip fractures postoperatively. The use of nerve stimulator with ultrasonographic guidance has increased the safety of this procedure. OBJECTIVES: We instituted a pilot study to assess the ability of Emergency Medicine (EM) resident physicians to effectively perform this procedure after a didactic and demonstration session. METHODS: First-year EM residents from three urban training programs underwent a 1-h didactic and hands-on training session on the femoral nerve block (FNB) procedure. A written pretest was used to assess baseline knowledge; it was administered again (with test items randomized) at 1 and 3 months post training session. A critical actions checklist (direct observation of procedure steps via simulated patient encounter) was used to assess the residents after the training session and again at 3 months. RESULTS: A total of 38 EM residents were initially evaluated. Thirty-three successfully completed 1-month and 3-month written test evaluations; 30 completed all written and direct observation evaluations. The mean written pretest scores were 66% (SD 9); post-test 92% (SD 5), 1-month 74% (SD 8), and 3-month 75% (SD 9). After initial training, 37 of 38 (97%) residents demonstrated competency (completing ? 15 of 19 critical actions) in the FNB procedure determined via direct observation. At 3 months, 25 of 30 residents (83%) continued to retain 85% of their initial critical action skills, and 3 of 30 (10%) saw an improvement in their proficiency. CONCLUSION: A 1-h training and demonstration module yielded high competency rates in residents performing critical actions related to the FNB; these skills were well maintained at 3 months. An ongoing study will attempt to correlate this competency with procedures performed on patients.

Akhtar S; Hwang U; Dickman E; Nelson BP; Morrison RS; Todd KH

2013-08-01

328

Internal obturator muscle abscess caused by Klebsiella pneumoniae.  

Science.gov (United States)

Obturator internus muscle abscess is an infrequent form of pyomyositis. To date, this disease has been described almost exclusively in children and young adults, and in most cases the causative agents are Gram-positive bacteria. We present the first report of obturator internus muscle abscess caused by a highly antibiotic resistant Klebsiella pneumoniae, in an elderly diabetic patient. Once considered very rare, Gram-negative pyomyositis is increasingly reported, and is an important concern in diabetic patients. Since pyomyositis can easily be missed if not considered, physicians should become familiar with this condition, and consider it in the differential diagnosis of septic diabetic patients. PMID:17055584

Yahalom, G; Guranda, L; Meltzer, E

2006-10-20

329

Internal obturator muscle abscess caused by Klebsiella pneumoniae.  

UK PubMed Central (United Kingdom)

Obturator internus muscle abscess is an infrequent form of pyomyositis. To date, this disease has been described almost exclusively in children and young adults, and in most cases the causative agents are Gram-positive bacteria. We present the first report of obturator internus muscle abscess caused by a highly antibiotic resistant Klebsiella pneumoniae, in an elderly diabetic patient. Once considered very rare, Gram-negative pyomyositis is increasingly reported, and is an important concern in diabetic patients. Since pyomyositis can easily be missed if not considered, physicians should become familiar with this condition, and consider it in the differential diagnosis of septic diabetic patients.

Yahalom G; Guranda L; Meltzer E

2007-03-01

330

Continuous peripheral nerve blocks in hospital wards after orthopedic surgery: a multicenter prospective analysis of the quality of postoperative analgesia and complications in 1,416 patients.  

UK PubMed Central (United Kingdom)

BACKGROUND: Continuous peripheral nerve block (CPNB) is the technique of choice for postoperative analgesia after painful orthopedic surgery. However, the incidence of neurologic and infectious adverse events in the postoperative period are not well established. This issue was the aim of the study. METHODS: Patients scheduled to undergo orthopedic surgery performed with a CPNB were prospectively included during 1 yr in a multicenter study. Efficacy of postoperative analgesia, bacteriologic cultures of the catheter, and acute neurologic and infectious adverse events were evaluated after surgery in 1,416 patients at arrival in the postanesthesia care unit, at hour 1, and every 24 h up to day 5. Risk factors for adverse events were determined using logistic regression. RESULTS: The median duration of CPNB was 56 h. Both general anesthesia and CPNB were performed in 73.6% of the patients. Postoperative analgesia was effective in 96.3%, but an increase in pain scores was noted at hour 24 (P = 0.01). Hypoesthesia or numbness occurred in 3% and 2.2%, respectively, and paresthesia occurred in 1.5%. Three neural lesions (0.21%) were noted after continuous femoral nerve block. Two of these patients were anesthetized during block procedure. Nerve damage completely resolved 36 h to 10 weeks later. Cultures from 28.7% of the catheters were positive. Three percent of patients had local inflammatory signs. The bacterial species most frequently found were coagulase-negative staphylococcus (61%) and gram-negative bacillus (21.6%). A Staphylococcus aureus psoas abscess (0.07%) was reported in one diabetic woman. Independent risk factors for paresthesia/dysesthesia were postoperative monitoring in intensive care, age less than 40 yr, and use of bupivacaine. Risk factors for local inflammation/infection were postoperative monitoring in intensive care, catheter duration greater than 48 h, male sex, and absence of antibiotic prophylaxis. CONCLUSION: CPNB is an effective technique for postoperative analgesia. Minor incidents and bacterial colonization of catheters are frequent, with no adverse clinical consequences in the large majority of cases. Major neurologic and infectious adverse events are rare.

Capdevila X; Pirat P; Bringuier S; Gaertner E; Singelyn F; Bernard N; Choquet O; Bouaziz H; Bonnet F

2005-11-01

331

The diagnostic validity and therapeutic value of lumbar facet joint nerve blocks with or without adjuvant agents.  

UK PubMed Central (United Kingdom)

Facet joints have been described as an important source of low back pain. The value of medial branch blocks in the diagnosis of facet joint mediated pain is considered important. However, the therapeutic value of medial branch blocks has not been determined. This study was designed to evaluate the duration of relief obtained and therapeutic value following controlled medial branch blocks with or without adjuvant agents Sarapin (High Chemical Company, Levittown, PA) and Depo-medrol (Pharmacia and Upjohn Company, Kalamazoo, MI). The study population consisted of 180 consecutive patients seen in a single pain management practice, divided into three groups with 60 patients in each group. Group I was treated with local anesthetic only, Group II with the addition of Sarapin, and Group III with the addition of Depo-medrol along with Sarapin. The prevalence of facet joint pain in chronic low back pain was determined as 36%, with a false-positive rate of 25%. Comparison of duration of relief in days with each block in the three groups showed that the relief was significantly superior in Group III compared with Group I and Group II, whereas Group II was superior to Group I.

Manchikanti L; Pampati V; Fellows B; Bakhit CE

2000-01-01

332

Prospective randomized trial of iliohypogastric-ilioinguinal nerve block on post-operative morphine use after inpatient surgery of the female reproductive tract  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Objective To determine the impact of pre-operative and intra-operative ilioinguinal and iliohypogastric nerve block on post-operative analgesic utilization and length of stay (LOS). Methods We conducted a prospective randomized double-blind placebo controlled trial to assess effectiveness of ilioinguinal-iliohypogastric nerve block (IINB) on post-operative morphine consumption in female study patients (n = 60). Patients undergoing laparotomy via Pfannenstiel incision received injection of either 0.5% bupivacaine + 5 mcg/ml epinephrine for IINB (Group I, n = 28) or saline of equivalent volume given to the same site (Group II, n = 32). All injections were placed before the skin incision and after closure of rectus fascia via direct infiltration. Measured outcomes were post-operative morphine consumption (and associated side-effects), visual analogue pain scores, and hospital length of stay (LOS). Results No difference in morphine use was observed between the two groups (47.3 mg in Group I vs. 45.9 mg in Group II; p = 0.85). There was a trend toward lower pain scores after surgery in Group I, but this was not statistically significant. The mean time to initiate oral narcotics was also similar, 23.3 h in Group I and 22.8 h in Group II (p = 0.7). LOS was somewhat shorter in Group I compared to Group II, but this difference was not statistically significant (p = 0.8). Side-effects occurred with similar frequency in both study groups. Conclusion In this population of patients undergoing inpatient surgery of the female reproductive tract, utilization of post-operative narcotics was not significantly influenced by IINB. Pain scores and LOS were also apparently unaffected by IINB, indicating a need for additional properly controlled prospective studies to identify alternative methods to optimize post-surgical pain management and reduce LOS.

Wehbe Salim A; Ghulmiyyah Labib M; Dominique El-Khawand H; Hosford Sarah L; Ehleben Carole M; Saltzman Steven L; Sills Eric

2008-01-01

333

Bloqueio do nervo supraescapular: procedimento importante na prática clínica. Parte II/ Suprascapular nerve block: important procedure in clinical practice. Part II  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese O bloqueio do nervo supraescapular é um método de tratamento reprodutível, confiável e extremamente efetivo no controle da dor no ombro. Esse método tem sido amplamente utilizado por profissionais na prática clínica, como reumatologistas, ortopedistas, neurologistas e especialistas em dor, na terapêutica de enfermidades crônicas, como lesão irreparável do manguito rotador, artrite reumatoide, sequelas de AVC e capsulite adesiva, o que justifica a presente revis (more) ão (Parte II). O objetivo deste estudo foi descrever as técnicas do procedimento e suas complicações descritas na literatura, já que a primeira parte reportou as indicações clínicas, drogas e volumes utilizados em aplicação única ou múltipla. Apresentamse, detalhadamente, os acessos para a realização do procedimento tanto direto como indireto, anterior e posterior, lateral e medial, e superior e inferior. Diversas são as opções para se realizar o bloqueio do nervo supraescapular. Apesar de raras, as complicações podem ocorrer. Quando bem indicado, este método deve ser considerado. Abstract in english The suprascapular nerve block is a reproducible, reliable, and extremely effective treatment method in shoulder pain control. This method has been widely used by professionals in clinical practice such as rheumatologists, orthopedists, neurologists, and pain specialists in the treatment of chronic diseases such as irreparable rotator cuff injury, rheumatoid arthritis, stroke sequelae, and adhesive capsulitis, which justifies the present review (Part II). The objective of (more) this study was to describe the techniques and complications of the procedure described in the literature, as the first part reported the clinical indications, drugs, and volumes used in single or multiple procedures. We present in details the accesses used in the procedure: direct and indirect, anterior and posterior, lateral and medial, upper and lower. There are several options to perform suprascapular nerve block. Although rare, complications can occur. When properly indicated, this method should be considered.

Fernandes, Marcos Rassi; Barbosa, Maria Alves; Sousa, Ana Luiza Lima; Ramos, Gilson Cassem

2012-08-01

334

Effect of Addition of Magnesium Sulphate and Fentanyl to Ropivacaine Continuous Femoral Nerve Block in Patients Undergoing Elective Total Knee Replacement  

Directory of Open Access Journals (Sweden)

Full Text Available This prospective double blinded study was designed to compare the effect of magnesium or fentanyl addition to ropivacaine in continuous femoral nerve block in patients undergoing elective total knee replacement under general anesthesia. Sixty patients undergoing elective TKR under general anesthesia, were randomly allocated into three equal groups, Group (R): given 30 mL Ropivacaine 0.2%. Group (R+F): given 30 mL Ropivacaine 0.2% and 4 ?g mL-1 fentanyl. Group (R+M): given 30 mL Ropivacaine 0.2% and 50 mg mL-1 of magnesium sulphate, through femoral catheter. The following parameters were evaluated: (1) demographic data of the patients and duration of the surgery, (2) intraoperative and postoperative hemodynamics, (3) intraoperative fentanyl requirements, (4) the severity of postoperative pain for 24 h, (5) time to first request of analgesia and (6) amount of postoperative morphine consumed in 0-6, 6-12, 12-18, 18-24 and 0-24 h, postoperatively. There were no difference among the three groups as regards the demographic data, the duration of the surgery, the pre and postoperative hemodynamics, the total intraoperative fentanyl consumption and the VAS during the 1st postoperative hour. The postoperative pain showed significant lower values in groups (R+F) and (R+M) compared to group (R) when measured at 6, 12, 18 and 24 postoperative hours. The time for the first postoperative request for analgesia was statistically longer in the (R+M) group and (R+F) group compared with group (R). The postoperative morphine consumption was statistically lower in groups (R+F) and (R+M) compared to group (R) but insignificant between groups (R+F) and (R+M). The admixture of magnesium sulphate or fentanyl to ropivacaine for continuous femoral nerve block provided a significant prolongation of postoperative analgesia than ropivacaine alone.

Md. Ashraf Abd Elmawgoud; Ahmed Badawy; Samaa Abu Elkassem; Doaa Rashwan

2008-01-01

335

A case of bilateral high division of the sciatic nerves, together with a unilateral unusual course of the tibial nerve  

Directory of Open Access Journals (Sweden)

Full Text Available In a 62-year-old male cadaver, high division of the sciatic nerve was observed bilaterally. Additionally, on the right side of the same cadaver, the common peroneal nerve passed just inferior to the piriformis muscle and the tibial nerve emerged inferior to the gemellus superior, between the gemellus superior and obturator internus muscles. Then, both of the nerves coursed posterior to the obturator internus, gemellus inferior and quadratus femoris muscles. The gemellus superior muscle, lying just posterior to the tibial nerve may cause to the symptoms of sciatica, because of the compression of the tibial nerve between the gemellus superior and obturator internus muscles. This pathology may lead to a new syndrome; the gemellus superior syndrome, just like the piriformis syndrome. As a conclusion, in the etiology and pathogenesis of sciatica, in addition to the priformis muscle, the abnormalities of the other gluteal external rotator muscles of the hip joint must also be taken into consideration by the clinicians. MR imaging of this region will be very helpful for the accurate diagnosis of this type of pathologies.

Mas N; Ozeksi P; Ozdemir B; Kapakin S; Sargon MF; Celik HH; Yener N

2003-01-01

336

Bloqueio do nervo supraescapular: procedimento importante na prática clínica Bloqueo del nervio supraescapular: procedimiento importante en la práctica clínica Suprascapular nerve block: important procedure in clinical practice  

Directory of Open Access Journals (Sweden)

Full Text Available JUSTIFICATIVA E OBJETIVOS: A dor no ombro é uma queixa frequente que ocasiona grande incapacidade funcional no membro acometido, assim como redução na qualidade de vida dos pacientes. O bloqueio do nervo supraescapular é um método terapêutico eficaz e vem sendo cada vez mais utilizado pelos anestesiologistas tanto para anestesia regional quanto para analgesia pós-operatória de cirurgias realizadas nesta articulação, o que justifica a presente revisão, cujo objetivo principal é descrever a técnica aplicada e as indicações clínicas. CONTEÚDO: Apresenta-se a anatomia do nervo supraescapular, desde a sua origem do plexo braquial até os seus ramos terminais, assim como as características gerais e a técnica empregada na execução do bloqueio deste nervo, as principais drogas utilizadas e o volume e as situações em que se faz jus a sua aplicação. CONCLUSÕES: O bloqueio do nervo supraescapular é um procedimento seguro e extremamente eficaz na terapia da dor no ombro. Também de fácil reprodutibilidade, está sendo muito utilizado por profissionais de várias especialidades médicas. Quando bem indicado, este método deve ser consideradoJUSTIFICATIVA Y OBJETIVOS: El dolor en el hombro es un quejido frecuente que ocasiona una gran incapacidad funcional en el miembro perjudicado, como también la reducción en la calidad de vida de los pacientes. El bloqueo del nervio supraescapular es un método terapéutico eficaz y ha venido siendo cada vez más utilizado por los anestesiólogos tanto para la anestesia regional como para la analgesia postoperatoria de cirugías realizadas en esa articulación, lo que justifica la presente revisión cuyo objetivo principal es describir la técnica aplicada y las indicaciones clínicas. CONTENIDO: Presentamos la anatomía del nervio supraescapular, desde su origen, y desde el plexo braquial hasta sus ramas terminales, como también las características generales y la técnica usada en la ejecución del bloqueo de ese nervio, los principales fármacos utilizados y el volumen y las situaciones en que se justifica su aplicación. CONCLUSIONES: El bloqueo del nervio supraescapular es un procedimiento seguro y extremadamente eficaz en la terapia del dolor en el hombro. También es fácilmente reproducible y está siendo muy utilizado por profesionales de varias especialidades médicas. Cuando está bien indicado, el método debe ser tenido en cuentaBACKGROUND AND OBJECTIVES: Shoulder pain is a frequent complaint that results in great functional disability in the affected shoulder as well as the decrease in patients' quality of life. Suprascapular nerve block is an effective therapeutic method and has been increasingly used by anesthesiologists both for regional anesthesia and postoperative analgesia of surgeries carried out in this articulation, which justifies this review, whose main purpose was to describe the applied technique and clinical indications. CONTENT: It is presented the anatomy of suprascapular nerve, since its brachial plexus origin until its terminal branches, as well as general characteristics and technique employed to carry out the block of this nerve, main drugs used, volume and situations that give rise to its applications. CONCLUSIONS: Suprascapular nerve block is a safe and extremely effective procedure in shoulder pain therapy. It also has an easy reproducibility and has been very used by professionals of many medical specialties. When it is well-indicated, this method must be taken into consideration

Marcos Rassi Fernandes; Maria Alves Barbosa; Ana Luiza Lima Sousa; Gilson Cassem Ramos

2012-01-01

337

Bloqueio do nervo supraescapular: procedimento importante na prática clínica/ Suprascapular nerve block: important procedure in clinical practice/ Bloqueo del nervio supraescapular: procedimiento importante en la práctica clínica  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese JUSTIFICATIVA E OBJETIVOS: A dor no ombro é uma queixa frequente que ocasiona grande incapacidade funcional no membro acometido, assim como redução na qualidade de vida dos pacientes. O bloqueio do nervo supraescapular é um método terapêutico eficaz e vem sendo cada vez mais utilizado pelos anestesiologistas tanto para anestesia regional quanto para analgesia pós-operatória de cirurgias realizadas nesta articulação, o que justifica a presente revisão, cujo obje (more) tivo principal é descrever a técnica aplicada e as indicações clínicas. CONTEÚDO: Apresenta-se a anatomia do nervo supraescapular, desde a sua origem do plexo braquial até os seus ramos terminais, assim como as características gerais e a técnica empregada na execução do bloqueio deste nervo, as principais drogas utilizadas e o volume e as situações em que se faz jus a sua aplicação. CONCLUSÕES: O bloqueio do nervo supraescapular é um procedimento seguro e extremamente eficaz na terapia da dor no ombro. Também de fácil reprodutibilidade, está sendo muito utilizado por profissionais de várias especialidades médicas. Quando bem indicado, este método deve ser considerado Abstract in spanish JUSTIFICATIVA Y OBJETIVOS: El dolor en el hombro es un quejido frecuente que ocasiona una gran incapacidad funcional en el miembro perjudicado, como también la reducción en la calidad de vida de los pacientes. El bloqueo del nervio supraescapular es un método terapéutico eficaz y ha venido siendo cada vez más utilizado por los anestesiólogos tanto para la anestesia regional como para la analgesia postoperatoria de cirugías realizadas en esa articulación, lo que ju (more) stifica la presente revisión cuyo objetivo principal es describir la técnica aplicada y las indicaciones clínicas. CONTENIDO: Presentamos la anatomía del nervio supraescapular, desde su origen, y desde el plexo braquial hasta sus ramas terminales, como también las características generales y la técnica usada en la ejecución del bloqueo de ese nervio, los principales fármacos utilizados y el volumen y las situaciones en que se justifica su aplicación. CONCLUSIONES: El bloqueo del nervio supraescapular es un procedimiento seguro y extremadamente eficaz en la terapia del dolor en el hombro. También es fácilmente reproducible y está siendo muy utilizado por profesionales de varias especialidades médicas. Cuando está bien indicado, el método debe ser tenido en cuenta Abstract in english BACKGROUND AND OBJECTIVES: Shoulder pain is a frequent complaint that results in great functional disability in the affected shoulder as well as the decrease in patients' quality of life. Suprascapular nerve block is an effective therapeutic method and has been increasingly used by anesthesiologists both for regional anesthesia and postoperative analgesia of surgeries carried out in this articulation, which justifies this review, whose main purpose was to describe the app (more) lied technique and clinical indications. CONTENT: It is presented the anatomy of suprascapular nerve, since its brachial plexus origin until its terminal branches, as well as general characteristics and technique employed to carry out the block of this nerve, main drugs used, volume and situations that give rise to its applications. CONCLUSIONS: Suprascapular nerve block is a safe and extremely effective procedure in shoulder pain therapy. It also has an easy reproducibility and has been very used by professionals of many medical specialties. When it is well-indicated, this method must be taken into consideration

Fernandes, Marcos Rassi; Barbosa, Maria Alves; Sousa, Ana Luiza Lima; Ramos, Gilson Cassem

2012-02-01

338

Radiofrequency treatment of peripheral nerves.  

Science.gov (United States)

Treatment of chronic refractory pain in which peripheral nerves are involved has proven to be difficult. Neurolysis by surgical, chemical, cryogenic, or thermal means may be considered as an option on seldom occasions, because of the risk of neuritis and deafferentation pain, motor deficit, and potential unintentional damage to nontargeted tissue. To our knowledge, there is only 1 report concerning selective radiofrequency (RF) treatment of the obturator and femoral nerves that was published. The introduction of the non-neurodestructive pulsed radiofrequency technique has provided new possibilities for the treatment of peripheral nerves. Today there is some experience with the management of chronic shoulder pain and additional case reports on other indications. PMID:17147740

Rohof, O J J M

2002-09-01

339

An Evaluation of 4% Prilocaine with 1:200,000 Epinephrine and 2% Mepivacaine with 1:20,000 Levonordefrin Compared with 2% Lidocaine with 1:100,000 Epinephrine for Inferior Alveolar Nerve Block  

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The purpose of this study was to measure the degree of anesthesia obtained with 4% prilocaine with 1:200,000 epinephrine and 2% mepivacaine with 1:20,000 levonordefrin compared with 2% lidocaine with 1:100,000 epinephrine for inferior alveolar nerve block. Using a repeated measures design, 30 subjec...

Hinkley, Stewart A.; Reader, Al; Beck, Mike; Meyers, William J.

340

Pharmacokinetics of 450?mg ropivacaine with and without epinephrine for combined femoral and sciatic nerve block in lower extremity surgery. A pilot study.  

UK PubMed Central (United Kingdom)

AIMS: No pharmacokinetic data exist on doses of ropivacaine larger than 300?mg for peripheral nerve block in man, although in clinical practice higher doses are frequently used. The purpose of the present study was to describe the pharmacokinetic profile in serum of 450?mg ropivacaine with and without epinephrine in patients undergoing anterior cruciate ligament reconstruction. METHODS: Twelve patients were randomly allocated to receive a single shot combined sciatic/femoral nerve block with 60?ml of either ropivacaine 0.75% alone (group R, n = 6) or ropivacaine 0.75% plus epinephrine 5??g?ml(-1) (group RE, n = 6). Venous blood samples for total and free ropivacaine serum concentrations were obtained during 48?h following block placement. Pharmacokinetic parameters were calculated using a non-compartmental approach. RESULTS: Results are given as mean (SD) for group R?vs. group RE (95% CI of the difference). Total Cmax was 2.81 (0.94) ?g?ml(-1) vs. 2.16 (0.21) ?g?ml(-1) (95% CI -0.23, 1.53). tmax was 1.17 (0.30) h vs. 1.67 (0.94) h (95% CI -1.40, 0.40). The highest free ropivacaine concentration per patient was 0.16 (0.08) ?g?ml(-1) vs. 0.12 (0.04) ?g?ml(-1) (95% CI -0.04, 0.12). t(1/2) was 6.82 (2.26) h vs. 5.48 (1.69) h (95% CI -1.23, 3.91). AUC was 28.35 (5.92) ?g?ml(-1) ?h vs. 29.12 (7.34) ?g?ml(-1) ?h (95% CI -9.35, 7.81). CONCLUSIONS: Free serum concentrations of ropivacaine with and without epinephrine remained well below the assumed threshold of 0.56??g?ml(-1) for systemic toxicity. Changes in pharmacokinetics with epinephrine co-administration did not reach statistical significance.

Schoenmakers KP; Vree TB; Jack NT; van den Bemt B; van Limbeek J; Stienstra R

2013-05-01

 
 
 
 
341

Rehabilitation of maxillary cleft with hybrid obturator prosthesis.  

Science.gov (United States)

The hybrid obturator prosthesis aims to provide a sense of well-being to the patient, offering improvements in speech, chewing, and swallowing. Thus, the retention and stabilization of the prosthesis become decisive factors for the success of the rehabilitation treatment. The objective of this study was to describe the treatment of a 70-year-old man with a congenital maxillary cleft performed through aesthetic and functional prosthetic rehabilitation with hybrid obturator prosthesis. In this study, the fabricated prosthesis achieved its purpose by providing adequate functional and aesthetic conditions to the patient, promoting the reduction of airspace through the sealing of the oronasal communication, with consequent improvement in the quality of life. PMID:24036832

Goiato, Marcelo Coelho; Dos Santos, Daniela Micheline; Magri, Felipe Melhado; Rahal, Vanessa; Andreotti, Agda Marobo; Moreno, Amália; Filho, Aljomar José Vechiato

2013-09-01

342

Primary obturator-muscle pyomyositis in immunocompetent children.  

UK PubMed Central (United Kingdom)

PURPOSE: Primary pyomyositis in immunocompetent children in non-tropical regions (countries with temperate climates) is very uncommon. It is rarely found in the intrapelvic muscles, and even more rarely in the obturator muscles. We try to draw attention to the potential occurrence in these conditions. METHODS: Five new cases of primary obturator-muscle pyomyositis in immunocompetent children aged between 6 and 11 years in a temperate climate are presented. They present with symptoms as follows: fever, pain (thigh, abdominal, inguinal, and/or hip pain), and limp. Three of them had no hip movement limitation. All of them had tenderness in the perineum zone. RESULTS: Laboratory tests may reveal high erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) counts, but depend on the length of diagnostic delay. The evolution time oscillated from 1 to 5 days. Fever and limp disappearance depends on the evolution time previous to the onset of the antibiotics administration. In 4 out of 5 patients, Staphylococcus aureus was present in the blood cultures. In all cases of obturator-muscle pyomyositis, diagnosis was confirmed using computed tomography (CT) scan (one) and/or magnetic resonance imaging (MRI) (four). CONCLUSIONS: Obturator-muscle pyomyositis is aimed at emphasizing the diagnostic difficulties associated with the condition, due to its deep location and to the fact that the disease presents with multiple manifestations that may initially cause confusion, since they mimic other conditions occurring in the abdomen, hip (septic arthritis, osteomyelitis), spine, etc. The diagnosis is only confirmed using CT scan and/or MRI. In the five patients with antibiotics treatment, the condition resolves without sequelae, even at long-term follow-up.

García-Mata S; Hidalgo-Ovejero A; Esparza-Estaun J

2012-07-01

343

Laser-Guided Cervical Selective Nerve Root Block with the Dyna-CT: Initial Experience of Three-Dimensional Puncture Planning with an Ex-Vivo Model  

Science.gov (United States)

Background Cervical selective nerve root block (CSNRB) is a well-established, minimally invasive procedure to treat radicular cervical pain. However, the procedure is technically challenging and might lead to major complications. The objective of this study was to evaluate the feasibility of a three-dimensional puncture planning and two-dimensional laser-guidance system for CSNRB in an ex-vivo model. Methods Dyna-CT of the cervical spine of an ex-vivo lamb model was performed with the Artis Zee® Ceiling (Siemens Medical Solutions, Erlangen, Germany) to acquire multiplanar reconstruction images. 15 cervical nerve root punctures were planned and conducted with the syngo iGuide® laser-guidance system. Needle tip location and contrast dye distribution were analyzed by two independent investigators. Procedural, planning, and fluoroscopic time, tract length, and dose area product (DAP) were acquired for each puncture. Results All 15 punctures were rated as successful with 12 punctures on the first attempt. Total procedural time was approximately 5 minutes. Mean planning time for the puncture was 2.03 (±0.39) min. Mean puncture time was 2.16 (±0.32) min, while mean fluoroscopy time was 0.17 (±0.06) min. Mean tract length was 2.68 (±0.23) cm. Mean total DAP was 397.45 (±15.63) µGy m2. Conclusion CSNRB performed with Dyna-CT and the tested laser guidance system is feasible. 3D pre-puncture planning is easy and fast and the laser-guiding system ensures very accurate and intuitive puncture control.

Al-Zghloul, Mansour; Groden, Christoph; Kerl, Hans U.

2013-01-01

344

The effect of magnesium added to levobupivacaine for femoral nerve block on postoperative analgesia in patients undergoing ACL reconstruction.  

UK PubMed Central (United Kingdom)

PURPOSE: The aim of this prospective randomised double-blind study is to investigate the effect of magnesium added to local anaesthetics on postoperative VAS scores, total opioid consumption, time to first mobilisation, patient satisfaction and rescue analgesic requirements in arthroscopic ACL reconstruction surgery. METHODS: A total of 107 American Society of Anaesthesiologists physical status grade I and II patients between 18 and 65 years of age who were scheduled to undergo elective anterior crucial ligament (ACL) reconstruction with hamstring autografts were enrolled in the study. The patients were randomly allocated to Groups L (n = 51) and LM (n = 56) using the closed-envelope method. Group LM was administered 19 ml of 0.25% levobupivacaine and 1 ml of 15% magnesium sulphate, while Group L was administered 20 ml of 0.25% levobupivacaine for femoral blockade. General anaesthesia was administered using laryngeal airway masks following neural blockade in both groups. The patients were evaluated for heart rate and mean arterial pressure, oxygen saturation, visual analogue score (VAS), verbal rating scale (VRS), rescue analgesic requirements, total opioid consumption, side effects and time to first mobilisation at the 1st, 2nd, 4th, 6th, 12th and 24th hours postoperatively. RESULTS: There was no statistically significant difference in terms of demographic data, mean arterial pressure, heart rate or oxygen saturation between groups. The area under the curve VAS and VRS scores were lower at 4, 6, 12 and 24 h in Group LM (p = 0.001, p = 0.016, respectively). The rescue analgesic requirement and the total opioid consumption were significantly lower in Group LM (p = 0.015, p = 0.019, respectively). The time to first mobilisation and the Likert score (completely comfortable; quite comfortable; slight discomfort; painful; very painful) were higher, and the block onset time was lower in Group LM (p = 0.014 and p = 0.012, respectively). There was no difference in terms of side effects. CONCLUSIONS: The addition of magnesium to levobupivacaine prolongs the sensory and motor block duration without increasing side effects, enhances the quality of postoperative analgesia and increases patient satisfaction; however, the addition of magnesium delays the time to first mobilisation and decreases rescue analgesic requirements.

Ekmekci P; Bengisun ZK; Akan B; Kazbek BK; Ozkan KS; Suer AH

2013-05-01

345

Relationship between Mandibular Nerve Block Anesthesia and Body Mass Index in Children/ Relación entre la Anestesia del Nervio Mandibular y el Índice de Masa Corporal en Niños  

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish El objetivo de este trabajo fue observar la relación entre el bloqueo anestésico efectivo (BAE) del nervio mandibular, inyectando 1,8 ml de lidocaína al 2% con epinefrina 1:100.000, en niños y su índice de masa corporal (IMC). Fue diseñado un estudio de cohorte prospectivo. Se seleccionó una muestra de 93 niños que se atienden en el Módulo Dental de JUNAEB de Frutillar entre abril y julio de 2011. Se registró edad, sexo, motivo de la exodoncia y tipo de diente ( (more) permanente o deciduo). Se calculó el IMC para cada niño, que fue categorizado en 2 cohortes de acuerdo al criterio de la OMS: “bajo peso - normal” (BPN) para aquellos con un IMC Abstract in english The aim of this study was to observe the relationship between the anesthetic block sucess (ABS) of mandibular nerve, by injecting 1.8 ml of lidocaine 2% with epinephrine 1:100,000, in children and their body mass index (BMI). A prospective cohort study was designed. A sample of 93 6-13 years children attended in JUNAEB Dental Module of Frutillar between April and July 2011. We recorded age, gender, reason for tooth extraction and tooth type (permanent or deciduous). BMI w (more) as calculated for each child and categorized into two cohorts of study according to WHO criteria: those with a BMI

Castillo, Viviana; Cerón, Andrea; Cartes-Velásquez, Ricardo; Aravena, Pedro

2012-04-01

346

Success rate of 10th semester dental students of Tehran University of Medical students in infra alveolar nerve block injection technique  

Directory of Open Access Journals (Sweden)

Full Text Available "nBackground and Aim: Inducing anesthesia is one of the important tasks in dentistry. Among various techniques for injection, the Inferior Alveolar Nerve Block (IANB) technique is one of the most practical and prevalent methods. However, according to some proofs in reference books, the success rate for this technique is some how low. Therefore the success rate of IANB performed by 10th-semester undergraduare students from Faculty of Dentistry of Tehran University of Medical Sciences was assessed in this study. "nMaterials and Methods: In this cross-sectional study from patients referring to oral and maxillofacial surgery ward, 20 patients with predefined conditions were selected. For each of them, two IANB injections were done in two separated days; one by a student and the other by an attend (or resident) of maxillofacial surgery ward. Success or failure of each injection was examined by Pin Prick test. In this study, the non-parametric Willcoxon test was used. "nResults: In this study, the success rate of IANB was 70% and 90%, respectively for students and attends (or resident). "nConclusion: Significant statistically difference was seen between the two groups, we hope that through further practical education, this differences rsduce in following similar studies.

Hoseinitodashki H.; Rahmati AH.

2009-01-01

347

Efficacy of preoperative ibuprofen on the success of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis: a randomized clinical trial.  

UK PubMed Central (United Kingdom)

AIM: To evaluate the effect of preoperative oral ibuprofen (IBU) on the success of inferior alveolar nerve blocks (IANBs) with mepivacaine containing 1 : 100 000 epinephrine for patients with symptomatic irreversible pulpitis (SIP). METHODOLOGY: The present study was a double-blind, randomized, placebo-controlled clinical trial. The study included two study groups each consisting of 25 patients who exhibited symptomatic irreversible pulpitis of a mandibular posterior tooth. The patients presented prolonged moderate or severe pain (>10 s) after cold testing and indicated their pain scores on a Heft-Parker visual analogue scale. The patients received identically appearing capsules containing either 600 mg IBU (IBUg) or gelatin (placebo, PLAg) 1 h before administration of IANB with 2% mepivacaine containing 1 : 100 000 epinephrine. After 15 min, the anaesthetic blockade was assessed by a three-step examination (lip numbness, positive/negative response to cold testing and clinical discomfort during endodontic access). IANB success was defined as the absence of pain during any of these evaluations. The data were analysed using the chi-squared test. RESULTS: All of the patients reported moderate or severe pain before the preoperative procedure. Statistically significant differences were observed between the IBUg and PLAg (P < 0.05); the success rates for the IANB were 72% (IBUg) and 36% (PLAg). CONCLUSIONS: Preoperative oral administration of IBU significantly improved the efficacy of IANB in patients with symptomatic irreversible pulpitis.

Noguera-Gonzalez D; Cerda-Cristerna BI; Chavarria-Bolaños D; Flores-Reyes H; Pozos-Guillen A

2013-03-01

348

Anaesthetic efficacy of supplemental lingual infiltration of mandibular molars after inferior alveolar nerve block plus buccal infiltration in patients with irreversible pulpitis.  

UK PubMed Central (United Kingdom)

AIM: To investigate the effect of supplemental lingual infiltration (LI) of mandibular molars following an inferior alveolar nerve block (IANB) plus buccal infiltration (BI) in patients with irreversible pulpitis. METHODOLOGY: Eighty adult patients diagnosed with irreversible pulpitis participated in this prospective study. All patients received standard IANB via injection of 4 mL of 2% lidocaine with 1 : 100,000 epinephrine. Ten minutes after the IANB, patients with numbness of the lower lip were randomly divided into two groups. In the BI group, 40 patients received supplemental BI of 0.9 mL of 4% articaine with 1 : 100,000 epinephrine. In the buccal plus lingual infiltration (BLI) group, 40 patients received supplemental BI of 0.9 mL of 4% articaine with 1 : 100,000 epinephrine and, subsequently, LIs with the same anaesthetic solution and dose. Endodontic access cavity preparation began 15 min after the IANB. Pain during treatment was recorded using a Heft-Parker visual analogue scale. Success was defined when pain was 'none' or 'mild' on endodontic access and initial instrumentation. The pain was estimated and statistically analysed by the chi-squared test (? = 0.05). RESULTS: The success rates for the BI and BLI groups were 70% and 62.5%, respectively. No statistical difference was found between the two groups (P = 0.478). CONCLUSIONS: Supplemental LIs are not recommended for administration in mandibular molars with irreversible pulpitis, because they do not improve the anaesthetic success after IANB plus BI.

Dou L; Luo J; Yang D

2013-07-01

349

Bloqueo ciático continuo con catéter estimulador guiado mediante ecografía para tratamiento del miembro fantasma doloroso Ultrasound-guided continuous sciatic nerve block with stimulating catheter for the treatment of phantom limb pain  

Directory of Open Access Journals (Sweden)

Full Text Available Los bloqueos nerviosos periféricos pueden ser una alternativa a la analgesia intravenosa y epidural en el tratamiento del miembro fantasma doloroso. La dificultad en la localización del nervio ciático mediante neuroestimulación en pacientes con arteriopatía periférica y neuropatía puede verse aumentada por el hecho de presentar una amputación del miembro inferior, que imposibilita la observación de una respuesta motora en el pie coincidiendo con la localización del nervio. En estos casos, la ecografía puede convertirse en una técnica de localización nerviosa determinante del éxito de la analgesia ya que permite la identificación del nervio, así como la visualización en tiempo real de la posición relativa de la aguja y catéter respecto al nervio y la difusión del anestésico local administrado. Se presenta el caso de un paciente con miembro fantasma doloroso resistente al tratamiento convencional que se controló con un bloqueo ciático continuo con catéter estimulador guiado con ecografía.Peripheral nerve blocks can be an alternative to intravenous and epidural analgesia in the treatment of phantom limb pain. The difficulty of localizing the sciatic nerve through neurostimulation in patients with peripheral arteriopathy and neuropathy can be increased by lower limb amputation, making it impossible to observe a motor response in the foot coinciding with localization of the nerve. In these cases, ultrasonography can become a t