Sub-sartorial saphenous nerve block with the aid of nerve stimulator.
Explore the source record for details and available documents.
Electric Stimulation↗
SEARCH · PubMed Health
Results for “Nerve Block”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
A comparison of two approaches to sciatic nerve block.
This study compared the posterior and popliteal fossa approaches for sciatic nerve block. Patients scheduled to undergo foot surgery were allocated randomly into one of two groups: group A (n = 20) received sciatic nerve block via the posterior approach and group B (n = 20) received a block using the popliteal fossa approach. All blocks were performed with the aid of a peripheral nerve stimulator and alkalinised 0.5% bupivacaine with 1 in 200,000 adrenaline was injected in a dose of 2 mg.kg-1. Nineteen of 20 blocks in group A were successful compared with nine of 20 in group B (p less than 0.01). There was no significant difference between the groups in respect of time to onset or duration of block. Patients in group B reported less discomfort during performance of the sciatic nerve block but required supplementary nerve blocks more frequently. We recommend the use of the posterior approach for sciatic nerve block.
Adult↗
Evaluation of the local analgesic effect of ketamine in the palmar digital nerve block at the base of the proximal sesamoid (abaxial sesamoid block) in horses.
OBJECTIVE: To evaluate the local analgesic effect of ketamine in a palmar digital nerve block at the base of the proximal sesamoid (abaxial sesamoid block) in horses. ANIMALS: 36 mature healthy Andalusian horses. PROCEDURE: Horses were randomly assigned to 4 groups of 9 horses each and received an abaxial sesamoid block in a randomly chosen forelimb with 1 of the following: saline (0.9% NaCl) solution, 1% ketamine solution, 2% ketamine solution, or 3% ketamine solution. To determine analgesia, the radiant heat lamp-hoof withdrawal model was used as a noxious thermal stimulus. Before each nerve block, baseline hoof withdrawal reflex latency (HWRL, time between lamp illumination and withdrawal of the hoof) was determined; after the nerve block, local analgesic effects were determined by measuring HWRL at 2 and 5 minutes after injection and then every 5 minutes for a total period of 1 hour. RESULTS: Significant differences in HWRL were found between baseline values and values at 2 to 15 minutes following a nerve block with ketamine. Significant differences were found between HWRL values at every time point from 2 to 10 minutes following a nerve block with saline solution, compared with 1 or 2% ketamine solution. Similarly, significant differences were found between HWRL values at every time point from 2 to 15 minutes following a nerve block with saline solution, compared with 3% ketamine solution. CONCLUSIONS AND CLINICAL RELEVANCE: Abaxial sesamoid block with ketamine ensures adequate analgesia in horses with an onset of action of 2 minutes and a maximal duration of action of 15 minutes.
Anesthesia, Local↗
Use of EMLA cream or alfentanil for analgesia during ophthalmic nerve blocks.
This prospective double-blind study compared the effectiveness of EMLA with alfentanil and placebo in reducing the overall pain during ophthalmic nerve blocks. Seventy-five patients scheduled for cataract surgery were divided into three groups. Patients in the EMLA group had EMLA cream applied over skin areas corresponding to injection sites for retrobulbar and facial nerve blocks one hour before the nerve blocks, and placebo intravenous normal-saline injection 2 minutes before the first nerve block. The alfentanil group had placebo cream applied and intravenous alfentanil 10 micrograms.kg-1 while patients in the placebo group received placebo cream and intravenous normal-saline at similar time intervals prior to the nerve blocks. Patients then received facial nerve blocks and retrobulbar block by the same surgeon. Pain scores by patients and independent observers were significantly lower in the EMLA and alfentanil groups compared to placebo (P < 0.005) with no significant difference between the EMLA and alfentanil groups.
Aged↗
High-concentration tetracaine for the management of trigeminal neuralgia: quantitative assessment of sensory function after peripheral nerve block.
OBJECTIVE: This study examined the effects of peripheral nerve block with high-concentration tetracaine for the management of trigeminal neuralgia, and evaluated sensory function by measuring the postblock current perception threshold. METHODS: Five infraorbital nerve blocks were performed in five elderly patients using 4% tetracaine dissolved in saline or 0.5% bupivacaine. The authors used a neurometer to compare postblock current perception threshold between the block side and the contralateral healthy side, and used cold tests to assess the sensory level. RESULTS: The analgesic effect of tetracaine blocks continued for a median period of 2 months (range, 1.5-months). Hypesthesia was observed in all patients after the block but resolved within a mean period of 2.2 weeks. Although differences in current perception threshold values between sides were not significant in any patient, block-side values in two patients were clinically higher than contralateral-side values (250 vs. 5 Hz) for some time before returning to normal levels. CONCLUSION: Peripheral nerve block with high-concentration tetracaine is a relatively safe and useful technique in the management of trigeminal neuralgia, particularly among older patients and those with systemic problems.
Aged↗
New technique of sciatic nerve block in the popliteal fossa.
A new technique of sciatic nerve block in the popliteal fossa was evaluated in 120 patients using an 18 s.w.g. cannula. Precise placement of the cannula was facilitated with the aid of a nerve stimulator. In addition to an initial dose of 1% prilocaine with adrenaline 1: 200,000 (5 mg kg-1), 5 mL 0.5% bupivacaine was used for blockade of the saphenous nerve distal to the medial tibial condyle. One-third or one-quarter of the initial dose was administered when required for augmentation of anaesthesia or post-operative pain relief. Satisfactory anaesthesia was achieved in 117 patients (97.5%); two patients required general anaesthesia, since repositioning of the cannula after initial application of local anaesthetic was strictly avoided. No post-operative complications relating to the nerve block were observed. This technique of sciatic nerve block in the popliteal fossa provides effective and safe anaesthesia of the lower leg.
Adolescent↗
The use of peripheral nerve blocks at the elbow for carpal tunnel release.
This case report illustrates that median, radial, and ulnar nerve blocks at the elbow provides anesthesia for ambulatory carpal tunnel release surgery. This report discusses 3 patients with medical conditions, including vascular access problems and morbid obesity, which made nerve blocks at the elbow advantageous compared with other anesthetic techniques. Peripheral nerve blocks at the elbow were done before surgery in a block room, so the patients spent less time in the operating room. Nerve blocks at the elbow are effective anesthesia for hand procedures with no patient requiring further local anesthetic injection and opioids for pain or expressing any discomfort during surgery. The blocks are easy to perform and set up quickly, and using long-acting local anesthetics, elbow blocks provide postoperative pain control for approximately 10 hours. The nerve blocks at the elbow facilitate the perioperative process by being done out of the operating room and providing prolonged pain control without the need for opioids, so nausea may be avoided.
Aged↗
Local anesthetic efficacy of ropivacaine (LEA 103) in ulnar nerve block.
Ropivacaine (LEA 103) is a new long-acting local anesthetic that in animal experiments has proved to be equally potent but less toxic than bupivacaine. In this controlled double-blind study in man, the dose-response relation of ropivacaine was examined in peripheral nerve block and its potency was compared to that of bupivacaine. Nerve functions during bilateral ulnar nerve block were monitored in 70 normal subjects by a computer-controlled method. Results indicate that plain ropivacaine is optimally effective at concentrations between 0.5% and 0.75%, where it reliably blocks nerve functions for about 8 hours. Its profile of action is uniform for the different fiber groups and resembles that of bupivacaine. Addition of epinephrine does not improve latency or duration of ropivacaine nerve block. Adverse effects attributable to ropivacaine have not been observed.
Adult↗
Continuous peripheral nerve blocks in children.
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.
Anesthetics, Local↗
[Peripheral nerve block during ambulatory surgery of varicose veins].
This retrospective study of the 46 operations, carried out over a one year period for lower limb varicose veins using peripheral nerve blocks, included 45 patients (35 women and 10 men, mean age 49.3 years), all ASA 1 or 2, except for 4 elderly patients with a varicose ulcer (ASA 2 or 3). In 40 procedures, a sciatic nerve block combined with a "3 in 1" lumbar plexus block at the level of the groin (as described by Winnie) were used. In the remaining six, either a sciatic nerve block (short saphenous vein crossectomy; n = 3), or a "3 in 1" lumbar plexus block alone (short stripping of the long saphenous vein; n = 3) were required. A peripheral nerve stimulator to locate accurately each nerve was used. For each nerve block, the anaesthetic mixture consisted of 20 ml lidocaine 1.5% with 1:200,000 adrenaline, and 10 ml of bupivacaine 0.375% with 1:200,000 adrenaline. Surgery was only performed on one limb at a time, as the required dose of local anaesthetic was too high to safely carry out bilateral nerve blocks. In 71.7% of patients surgery was made on an day-case basis. Of those patients who had to remain in hospital overnight or longer, the peripheral nerve block was never responsible for this. During the same period, nine similar procedures were carried out under general anaesthesia, and two under epidural anaesthesia. They included seven bilateral varicose veins, three patient refusals for peripheral nerve blocks, and one allergy to lidocaine. Already used for some procedures in orthopaedic and casualty surgery, peripheral nerve blocks seem to be well suited for surgery of unilateral varicose veins.
Adult↗
Nerve blocks with 5% butamben suspension for the treatment of chronic pain syndromes.
BACKGROUND AND OBJECTIVES: Butamben is a non-water-soluble local anesthetic that can be prepared as an aqueous suspension for nerve blocks. This report describes the use of 5% butamben suspension for the treatment of chronic pain of cancer and noncancer origin. METHODS: The clinical courses of 75 consecutive patients were analyzed following 5% butamben nerve blocks (35 epidural blocks only, 33 peripheral nerve blocks only, and 7 had both epidural and peripheral nerve blocks). Epidural blocks were performed as a series of four with additional blocks offered if needed. Peripheral nerve blocks were done as a single block with repeat injections if needed. Injection volumes varied between 15 and 25 mL for epidural injections and 5 and 20 mL for peripheral nerve blocks. Successful therapy was defined as a -75% reduction in subjective pain assessments for -4 weeks or until death. Daily opioid requirements were also recorded. RESULTS: Fifty-four of the 75 patients (72%) were successfully treated. This included 48 of 67 cancer patients (71.6%) and 6 of 8 noncancer patients (75%). Median duration of pain relief was 12 weeks (range, 1-96) in the cancer patients and 10 weeks (range, 6-166) in the noncancer patients. Mean reduction in opioid requirements in successfully treated cancer patients was 74+/-5%. Pain on epidural injection occurred in half of the patients and was the most prevalent complication of treatment. Five patients had signs of intravascular injection. There were no serious long-term sequelae. CONCLUSIONS: When used as described in this report, 5% butamben suspension appears to be effective for treatment of chronic pain of both cancer and noncancer origin and has a low incidence of adverse sequelae.
Anesthetics, Local↗
The effects of the single or multiple injection technique on the onset time of femoral nerve blocks with 0.75% ropivacaine.
UNLABELLED: We evaluated the effect of the injection technique on the onset time and efficacy of femoral nerve block performed with 0.75% ropivacaine. A total of 30 patients undergoing arthroscopic knee surgery were randomly allocated to receive femoral nerve blockade with 0.75% ropivacaine by using either a single injection (Single group, n = 15) or multiple injection (Multiple group, n = 15). Nerve blocks were placed by using a short-beveled, Teflon-coated, stimulating needle. The stimulation frequency was set at 2 Hz, and the intensity of stimulating current, initially set at 1 mA, was gradually decreased to <0.5 mA after each muscular twitch was observed. In the Single group, 12 mL of 0.75% ropivacaine was slowly injected, as soon as the first muscular twitch was observed. In the Multiple group, the stimulating needle was inserted and redirected, eliciting each of the following muscular twitches: contraction of vastus medialis, vastus intermedius, and vastus lateralis. At each muscular twitch, 4 mL of the study solution was injected. Placing the block required 4.2 +/- 1.7 min (median, 5 min; range, 2-8 min) in the Multiple group and 3.4 +/- 2.2 min (median, 3 min; range, 1-5 min) in the Single group (P = 0.02). Onset of nerve block (complete loss of pinprick sensation in the femoral nerve distribution with concomitant inability to elevate the leg from the operating table with the hip flexed) required 10 +/- 3.7 min in the Multiple group (median, 10 min; range, 5-20 min) and 30 +/- 11 min in the Single group (median, 30 min; range, 10-50 min) (P < 0.0005). Propofol sedation was never required to complete surgery; although 0.1 mg fentanyl at trocar insertion was required in two patients of the Multiple group (13%) and nine patients of the Single group (60%) (P = 0.02). We conclude that searching for multiple muscular twitches shortened the onset time and improved the quality of femoral nerve block performed with small volumes of 0.75% ropivacaine. IMPLICATIONS: This prospective, randomized, blinded study was conducted to evaluate the effect of searching for multiple muscular twitches when performing femoral nerve block with small volumes of 0. 75% ropivacaine. Our results demonstrated that multiple injections markedly shortened the onset time and improved the quality of nerve blockade. This technique-related effect must be carefully considered when different clinical studies evaluating the use of new local anesthetic solutions for peripheral nerve blocks are compared.
Adolescent↗
[Comparison of 4 techniques for internal saphenous nerve block].
OBJECTIVE: To assess the efficacy of 4 techniques for internal saphenous nerve block with 10 mL of 1.5% mepivacaine. METHODS: Eighty ASA I-II patients scheduled for foot (hallux valgus) surgery with combined sciatic and saphenous nerve blocks were randomized to receive the saphenous nerve block by one of the following techniques: a paravenous approach (n = 20), a transsartorial approach (n = 20), a femoral nerve approach in the inguinal region using a nerve stimulator (n = 20), and by subcutaneous infiltration between the tibial tuberosity and the internal gastrocnemius muscle (n = 20). A pressure cuff was placed 10 cm below the knee of all patients. Success was assessed by pin prick inside the ankle 30 minutes after initiation of the block. Tolerance of the pressure cuff and discomfort during performance of the technique were also assessed. RESULTS: The 4 groups were similar as to distribution of males and females and mean weight, age, and height. Blocking the saphenous nerve by way of the femoral nerve in the inguinal region was the most effective approach (success in 95% of patients), significantly better than the other 3 techniques (P < 0.05). The paravenous approach was successful in 60% of cases, the transsartorial approach in 50%, and the subcutaneous infiltration technique in 45%. The pressure cuff was well tolerated by all patients (100%) in whom the femoral nerve approach was used. The cuff was tolerated by 70% in the paravenous approach group, by 65% in the transsartorial approach group, and by 60% in the subcutaneous infiltration group. Patients reported more discomfort during initiation of the blockade in the paravenous approach and subcutaneous infiltration groups than in the femoral nerve or transsartorial approach groups (P < 0.05). CONCLUSION: The femoral nerve approach in the inguinal region, with nerve stimulator, to block the internal saphenous nerve led to a larger number of successful blocks than did the paravenous or transsartorial approaches, or the technique of subcutaneous infiltration between the tibial tuberosity and internal gastrocnemius muscle.
Aged↗
Permanent nerve involvement resulting from inferior alveolar nerve blocks.
BACKGROUND: This is a prospective study of patients referred to a tertiary care center with permanent alteration in sensation of the inferior alveolar nerves, lingual nerves or both that could have resulted only from an inferior alveolar nerve block. METHODS: Working with a subject pool of 83 patients, the researchers outlined and photographed the area of altered sensation on each patient, tested it with von Frey's hairs and two-point discrimination and tested temperature sensation and direction sense. RESULTS: Among a study population of 55 women and 28 men with a mean age of 41.2 years, the lingual nerve was affected in 79 percent of patients and the inferior alveolar nerve in 21 percent of patients. In 47 patients, the causative inferior alveolar nerve block was painful when administered, but to the other 36 patients [corrected], it felt like a normal injection. Of the local anesthetic agents used, prilocaine was found to be more frequently linked to cases of nerve involvement in this study. DISCUSSION: Occasionally, an inferior alveolar nerve block can result in permanent involvement of the inferior alveolar nerve, lingual nerve or both. The incidence and exact mechanism of involvement still are unknown. By extrapolation from this study, an incidence of anywhere between 1:26,762 and 1:160,571 inferior alveolar nerve blocks can be surmised to result in this complication. A difference in referral rates for male and female patients is difficult to explain. The 34 percent [corrected] incidence of dysesthesia in the patients in this study is of concern. CONCLUSION: Permanent nerve involvement after receiving an inferior alveolar nerve block is a documented but very rare complication of the inferior alveolar nerve block, and the exact mechanism involved is still unknown. CLINICAL IMPLICATIONS: Permanent nerve damage can very occasionally occur as a result of an inferior alveolar nerve block. The exact mechanism is unknown, and there is no means of prevention. Knowledge of the risks and complications of local anesthesia is essential.
Adult↗
[Are peripheral nerve blocks of the leg (femoralis in combination with anterior sciatic blockade) as sole anaesthetic technique an alternative to epidural anaesthesia].
OBJECTIVE: We compared peripheral nerve blocks (PNB, femoral nerve block together with anterior sciatic nerve block) as sole anaesthetic with epidural anaesthesia (EA) in a randomised study in patients undergoing elective arthroscopic knee surgery with respect to patient satisfaction and time required to perform each procedure. METHODS: 99 ASA class I-III patients were randomised to either PNB (20 ml bupivacaine 0.5 % + 60 ml prilocaine 1 %) or EA (12 - 20 ml bupivacaine 0.5 %). ENDPOINTS: patient satisfaction with the anaesthetic evaluated by a questionnaire 3 months after the operation, anaesthesia and surgical times, need for additional analgesics and the modified Aldrete-score (global assessment of postanaesthetic condition) at admission in the postanaesthesia care unit. RESULTS: Significantly more patients in the PNB compared to the EA group needed intravenous opioid supplementation (10 vs. 3, p = 0.040). While the patients in the PNB group had a significantly higher modified Aldrete score (9.3 +/- 0.7 vs. 8.8 +/- 0.9, p = 0.0009), assessment (0 = worst, 10 = best) of the induction of PNB or EA respectively, was significantly better rated in the EA compared to PNB group (8.7 +/- 2.1 vs. 6.7 +/- 2.6, p = 0.0024). Assuming that the willingness to undergo the same anaesthetic again reflect overall satisfaction with the procedure satisfaction in both groups was high: 25/26 (PNB) and 27/28 (EA) would have preferred their regional blockade (p = 0.95). CONCLUSION: Patients in the PNB and EA group both were satisfied with their anaesthetic procedure. While there are obviously differences in favour of the EA, PNB is an alternative in the case of contraindication or patient rejection to EA.
Aged↗
A new anterior approach to the sciatic nerve block.
BACKGROUND: Although several anterior approaches to sciatic nerve block have been described, they are used infrequently. The authors describe a new anterior approach that allows access to the sciatic nerve with the patient in the supine position. METHOD: Sciatic nerve blocks were performed in 22 patients. A line was drawn between the inferior border of the anterosuperior iliac spine and the superior angle of the pubic symphysis tubercle. Next, a perpendicular line bisecting the initial line was drawn and extended 8 cm caudad. The needle was inserted perpendicularly to the skin, and the sciatic nerve was identified at a depth of 10.5 cm (9.5-13.5 cm; median and range) using a nerve stimulator and a 15-cm b-beveled insulated needle. After appropriate localization, either 30 ml mepivacaine, 1.5% (group 1 = knee arthroscopy; n = 16), or 15 ml mepivacaine, 1.5%, plus 15 ml ropivacaine, 0.75%, (group 2 = other procedures; n = 6) was injected. RESULTS: Appropriate landmarks were determined within 1.3 min (0.5-2.0 min). The sciatic nerve was identified in all patients within 2.5 min (1.2-5 min), starting from the beginning of the appropriate landmark determination to the stimulation of its common peroneal nerve component in 13 cases and its tibial nerve component in 9 cases. A complete sensory block in the distribution of both the common peroneal nerve component and the tibial nerve component was obtained within 15 min (5-30 min). A shorter onset was observed in patients who received mepivacaine alone compared with those who received a mixture of mepivacaine plus ropivacaine (10 min [5-25 min] vs. 20 min [10-30 min]; P < 0.05). Recovery time was 4.6 h (2.5-5.5 h) after mepivacaine administration. The addition of ropivacaine produced a block of a much longer duration 13.8 h (5.2-23.6 h); P < 0.05. No complications were observed. CONCLUSIONS: This approach represents an easy and reliable anterior technique for performing sciatic nerve blocks.
Adult↗
[Obturator nerve block for transurethral surgery. comparing ropivacaine 0.75 % vs. prilocaine 1 %].
OBJECTIVE: Obturator nerve block is used for transurethral resection of lateral bladder wall tumors to prevent adductor muscle spasm and associated complications. Therefore, the local anesthetic applied should provide an adequate motor blockade. Ropivacaine 0.75 % was compared to prilocaine 1 % and motor blockade assessment performed by the Medical Research Council (MRC)-scale. METHODS: 40 patients (20 per group) scheduled for transurethral resection were randomized to either receiving 10 ml ropivacaine 0.75 % or prilocaine 1 % for direct obturator nerve block in a controlled user-blinded study. Motor block was assessed with the MRC-scale 5 and 10 minutes after local anesthetic injection followed by an assessment 120 and 180 minutes after surgery. Surgery was performed in equally distributed spinal or general anesthesia, intraoperative adductor spasm intensity was evaluated by surgeon's ranking. RESULTS: Motor blockade intensity was significantly higher with ropivacaine 0.75 % at all time points of assessment. Intraoperatively, severe spasm only occurred in the prilocaine 1 %-group. CONCLUSION: Ropivacaine 0.75 % is a more appropriate agent for direct obturator nerve block than prilocaine 1 %, providing a faster onset and a more intense and longer-lasting motor blockade. This may reduce surgical complications and facilitate early surgical re-intervention. In this study, MRC-scale was appropriate for motor blockade assessment in a peripheral nerve block.
Aged↗
[Significance of phrenic nerve block in the anesthetic management of laparoscopic cholecystectomy].
The significance of phrenic nerve block was studied in the anesthetic management of laparoscopic cholecystectomy. Right phrenic nerve block with 1% mepivacaine 10 ml was performed after the patients were epidurally catheterized and anesthetized with isoflurane and nitrous oxide in oxygen. Intraoperative anesthetic requirement and postoperative shoulder pain incidence in patients with this block were compared with those in patients without block. Addition of the phrenic nerve block to general and epidural anesthesia did not reduce the intraoperative dosage of isoflurane, but it significantly prevented occurrence of postoperative right shoulder pain. It is known that phrenic nerve contains sensory element and that laparoscopic procedures of gall bladder elicit noxious stimuli which cannot be blocked by ordinary epidural anesthesia for abdominal surgery. Also, shoulder pain is said to be phrenic nerve-mediated referred pain. Our study suggests that blockade of these stimuli is effective in preventing postoperative event rather than intraoperative.
Adult↗