PubMed · 11028742
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Z Koscielniak-Nielsen. 2000. Axillary block studies--quality problems.. https://doi.org/10.1034/j.1399-6576.2000.440923.x
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Magnetic field exposure was consistently found to affect pain inhibition (i.e. analgesia). Recently, we showed that an extreme reduction of the ambient magnetic and electric environment, by mu-metal shielding, also affected stress-induced analgesia (SIA) in C57 mice. Using CD1 mice, we report here the same findings from replication studies performed independently in Pisa, Italy and London, ON, Canada. Also, neither selective vector nulling of the static component of the ambient magnetic field with Helmholtz coils, nor copper shielding of only the ambient electric field, affected SIA in mice. We further show that a pre-stress exposure to the mu-metal box is necessary for the anti-analgesic effects to occur. The differential effects of the two near-zero magnetic conditions may depend on the elimination (obtained only by mu-metal shielding) of the extremely weak time-varying component of the magnetic environment. This would provide the first direct and repeatable evidence for a behavioural and physiological effect of very weak time-varying magnetic fields, suggesting the existence of a very sensitive magnetic discrimination in the endogenous mechanisms that underlie SIA. This has important implications for other reported effects of exposures to very weak magnetic fields and for the theoretical work that considers the mechanisms underlying the biological detection of weak magnetic fields.
Peripheral nerve blocks are used as part of a preemptive and multimodal analgesic technique to provide safe and effective postoperative pain management with minimal side effects. They are used for a variety of surgical procedures in both inpatient and outpatient settings. Peripheral nerve blocks have resulted in shorter recovery times, decreased anesthesia-related complications, and better postoperative pain management. Peripheral nerve blocks, as part of a multimodal analgesic regimen, have decreased recovery times by lessening side effects (e.g., nausea, vomiting, drowsiness). Nerve blocks have allowed procedures previously performed only in hospitals to be performed on an outpatient basis by providing extended surgical area analgesia. The use of peripheral nerve blocks, however, requires skilled and knowledgeable clinicians. This article discusses the mechanism of action and the role of peripheral nerve blocks in multimodal analgesia, as well as perioperative nursing implications and management for upper and lower extremity peripheral nerve blocks.
BACKGROUND/PURPOSE: A prospective, randomised, double-blind, controlled trial to evaluate efficacy of double-caudal versus single-caudal injection for postoperative analgesia in hypospadias repair was performed. METHODS: Between October 1998 and September 2000, 160 boys underwent distal hypospadias repair. The first 80 boys were analyzed prospectively for postoperative analgesia after double-caudal bupivacaine, which involves the administration of a second bupivacaine injection into the caudal extradural space at the end of surgery. Pain was assessed using the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS). The study groups were: group 1, unstented Thiersch-Duplay urethroplasty (50); and group 2, stented Mathieu type repair (30). Results of this cohort formed the basis for a prospective, randomised, double-blind control trial comparing double-caudal against a single injection before operation. The further 80 patients were allocated randomly: group 3, single caudal injection of 1 mL kg(-1) of 0.25% plain bupivacaine at the start of surgery with unstented Thiersh-Duplay repair (25); group 4, similar single caudal injection but stented Mattieu type operation (15); group 5, second caudal and at end of operation (0.5 mL kg(-1) on each occasion) with unstented Thiersh-Duplay repair (25); and group 6, similar to group 5 but with stented Mattieu type repair (15). RESULTS: Patient demographics (age and weight) and mean duration of operative time were similar for all groups. There was no significant difference in early pain scores at 0 to 2 hours with a good correlation coefficient (r = 0.88). At 4, 6, and 8 hours there was a significant difference in pain scores between double and single caudals (P <.05). There was a significant difference in mean duration of caudal analgesia and need for oral analgesia between single caudal 3.45 versus 7.85 hours for double caudal (P <.001). Mean duration of caudal analgesia and requirement for oral analgesia after single caudal in group 3 (unstented) was 3.5 versus 3.4 hours in group 4 (stented). In double caudals this lengthened to 9.4 hours in group 5 (unstented) versus 6.3 hours in group 6 (stented; P <.05). This also was significant when operation time was excluded. CONCLUSIONS: A prospective study of double caudal analgesia showed good postoperative pain control after hypospadias surgery. This was followed by a prospective, randomised, double-blind controlled trial that has confirmed that double caudal injection of bupivacaine prolonged the duration of pain relief after hypospadias repair. The second or top-up caudal did not increase the total dose but supplemented and prolonged postoperative analgesia.