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Biomedical subjects

M R Wassef

Publications and source records attributed to M R Wassef.

11 recordsLinked to original sources
PubMed1998

Concepts of preemptive analgesia for postoperative pain.

BACKGROUND: The predictable relationship between surgical injury responses and the ensuring postoperative pain has led to the development of the concept of preemptive analgesia, with its potential to improve the quality of the postoperative period. METHODS: A review of publications concerning the studies of the physiology of pain and the development of clinical strategies toward the prevention of postoperative pain was undertaken. RESULTS: Clinical studies using various methodologies indicate that preemptive analgesia may, in some circumstances, attenuate postoperative pain. Unfortunately, these studies were not always reproducible. Preemptive analgesia in these studies failed to prevent or attenuate postoperative pain. CONCLUSION: Techniques directed toward reducing and/or eliminating postoperative pain are still being developed, and their clinical utility is yet to be fully evaluated.

Analgesia↗
PubMed1992

Suprascapular nerve block. A new approach for the management of frozen shoulder.

A new approach for the management of frozen shoulder associated with reflex sympathetic dystrophy is presented. A suprascapular nerve block was performed by needle insertion behind the lateral end of the clavicle at its junction with the insertion of the trapezius muscle; the needle was directed downwards and backwards. The suprascapular nerve was identified by its response to nerve stimulation. Three ml of 0.25% bupivacaine with 1:200,000 adrenaline was injected. The block was repeated twice weekly for a total of 2-4 treatments. Evaluation of the efficacy of the block was achieved by comparing subjective pain scores and passive range of movement before the first block and after the final one. Highly significant improvements were obtained. The choice of blockade of the suprascapular nerve is a new concept for the management of the frozen shoulder of reflex sympathetic dystrophy. This is based on the fact that the nerve contains a high proportion of sympathetic fibres supplying the shoulder joint. The new approach proved to be simple, highly successful, and reproducible.

Adult↗
PubMed1991

Posterior tibial nerve block. A new approach using the bony landmark of the sustentaculum tali.

A local analgesic block of the posterior tibial nerve, using a new subcalcaneal approach, is described. The point of insertion of the needle is defined in relation to a bony prominence below the medial malleolus, the sustentaculum tali, to which the posterior tibial nerve bears a constant relationship. Twenty patients given a posterior tibial block using the subcalcaneal approach were compared with 20 patients in whom a traditional retrotibial approach was used. In this technique the major landmark for needle insertion is the posterior tibial artery. In all patients the techniques formed part of an ankle block for foot surgery. Eighty-five to 90% of patients had peripheral vascular disease and in 60-65% the posterior tibial artery was not palpable. In the group of patients without palpable pulses, the subcalcaneal approach had a success rate of 100%, whereas all those having the retrotibial approach required additional local analgesic supplements (p less than 0.001). The subcalcaneal approach is simple and is particularly recommended for patients with peripheral vascular disease.

Adult↗
PubMed1974

The cardiovascular effects of ergometrine in the experimental animal in vivo and in vitro.

The cardiovascular effects of ergometrine have been examined using animal models in vivo and in vitro. In rats in vivo the pressor effects of a standard dose of ergometrine were found to be dependent upon the anaesthetic used for the procedure. The pressor action of ergometrine was greater when urethane, an anaesthetic which produces both sympathetic and parasympathetic acitivity, was used. The in-vitro experiments, using isolated rabbit aorta and portal vein, failed to explain the phenomenon; they suggested that ergometrine has a direct action on the alpha-adrenoceptor in rabbits. No evidence was found to suggest that ergometrine inhibits noradrenaline uptake or its release from the nerve terminals.

Anesthetics↗
PubMedDate not supplied

Phantom pain with probable reflex sympathetic dystrophy: efficacy of fentanyl infiltration of the stellate ganglion.

BACKGROUND AND OBJECTIVES: The stellate ganglion can alleviate phantom pain of the upper extremity, possibly because of the presence in it of enkephalin receptors, as has been suggested by experimental and clinical reports. A case is reported in which fentanyl, instead of local anesthetic, was used for stellate ganglion block. METHODS: A 49-year-old man, with a left below-elbow amputation, presented with probable symptoms of reflex sympathetic dystrophy, pain and temperature changes at the stump, and phantom hand symptoms the English-language literature revealed no reports of the use of fentanyl infiltration of the stellate ganglion was performed for management of this condition. RESULTS: Significant alleviation of pain and sensation of warmth at the stump and in the phantom hand was achieved. CONCLUSIONS: Fentanyl infiltration of the stellate ganglion proved to be successful in the management of the pain and temperature sensation changes in the stump and phantom upper extremity.

Analgesics, Opioid↗
PubMedDate not supplied

The paravertebral nerve root block for inguinal herniorrhaphy--a comparison with the field block approach.

BACKGROUND AND OBJECTIVES: Our objective was to evaluate the efficacy of the paravertebral block for inguinal herniorrhaphy by comparison with the well-established field block. METHODS: Thirty patients undergoing inguinal herniorrhaphy were randomly divided into two groups. Group A (n = 15) received paravertebral block of the ipsilateral nerve roots of T12, L1, and L2. Group B (n = 15) received field block. Each block was evaluated in terms of the degree of patient discomfort associated with surgical manipulations, requirement for supplemental anesthetic, the degree of patient discomfort associated with block performance, and the overall degree of patient satisfaction. RESULTS: Both approaches were successful in blocking somatic sensory fibers. The paravertebral approach showed a significantly higher success rate than the field block (P < .01), regarding frequency of pain relative to surgical manipulation of the spermatic cord, hernial sac, and also in terms of need to supplement the surgery with local anesthetic (P < .01). The paravertebral block required significantly less local anesthetic and less needle insertions than the field block. CONCLUSIONS: The paravertebral nerve root block proved to be superior to the field block, to be devoid of side effects, and was acceptable to the patients.

Adult↗
PubMedDate not supplied

Interadductor approach to obturator nerve blockade for spastic conditions of adductor thigh muscles.

BACKGROUND AND OBJECTIVES: The authors describe a new approach for the management of adductor muscle spasm associated with multiple sclerosis and paraplegia. METHODS: An obturator nerve block was performed by needle insertion behind the upper end of the adductor longus muscle; the needle was directed laterally, with slight upward and posterior inclination, toward the obturator canal. The obturator nerve was identified by its response to nerve stimulation. An initial diagnostic block using 5 mL of 2.0% lidocaine followed by two or three prognostic blocks using 5 mL of 0.5% bupivacaine and 1:200,000 epinephrine were performed. In the final block, 5 mL of 6.0% phenol in glycerin was injected. RESULTS: Evaluation of the efficacy of the block was achieved in terms of its success rate, the degree of alleviation of muscle spasm, the improvement of gait in the patients with multiple sclerosis, and the facilitation of nursing hygienic care in bedridden patients. In comparison with the traditional approach, the success rate and improvements were highly significant. CONCLUSIONS: The interadductor approach is a new approach based on the anatomy of the obturator nerve trunk, which, though in the obturator canal, is shielded by its osseous part from the anteroposterior perspective of the traditional approach. The interadductor approach allows needle positioning inside the obturator canal through a mediolateral perspective, thus facilitating the blockade of the obturator nerve trunk before it branches immediately outside the canal. The new approach proved to be successful, reproducible and without complications.

Adult↗