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PubMed2003

Suprascapular nerve block (using bupivacaine and methylprednisolone acetate) in chronic shoulder pain.

BACKGROUND: Shoulder pain from inflammatory arthritis and/or degenerative disease is a common cause of morbidity in the community. It is difficult to treat and there are limited data on the efficacy of most interventions. Suprascapular nerve block has shown promise in limited trials in reducing shoulder pain. There have been no large randomised placebo controlled trials examining the efficacy of suprascapular nerve block for shoulder pain in arthritis and/or degenerative disease using pain and disability end points. OBJECTIVE: To perform a randomised, double blind, placebo controlled trial of the efficacy of suprascapular nerve block for shoulder pain in rheumatoid arthritis (RA) and/or degenerative disease of the shoulder. METHODS: 83 people with chronic shoulder pain from degenerative disease or RA took part in the trial. If a person had two painful shoulders, these were randomised separately. A total of 108 shoulders were randomised. Patients in the group receiving active treatment had a single suprascapular nerve block following the protocol described by Dangoisse et al, while those in the other group received a placebo injection of normal saline administered subcutaneously. The patients were followed up for 12 weeks by an observer who was unaware of the randomisation and reviewed at weeks 1, 4, and 12 after the injection. Pain, disability, and range of movement data were gathered. RESULTS: Clinically and statistically significant improvements in all pain scores, all disability scores, and some range of movement scores in the shoulders receiving suprascapular nerve block compared with those receiving placebo were seen at weeks 1, 4, and 12. There were no significant adverse effects in either group. CONCLUSION: Suprascapular nerve block is a safe and efficacious treatment for the treatment of shoulder pain in degenerative disease and/or arthritis. It improves pain, disability, and range of movement at the shoulder compared with placebo. It is a useful adjunct treatment for the practising clinician to assist in the management of a difficult and common clinical problem.

Adult↗
PubMed1999

The effect of differential and complete nerve block on experimental muscle pain in humans.

We have attempted to examine the nerve fiber population mediating experimentally induced muscle pain in humans. Two established methods induced muscle pain: continuous, intramuscular, electrical stimulation and intramuscular infusion of hypertonic saline. A progressive nerve block was achieved by a combination of compression nerve block and intravenous regional anesthesia. Regular tests of muscle pain intensity were performed during the blocking period of 60 min. At the same time, the blocking of thick and thin afferents was monitored by assessment of proprioception and cutaneous touch, pin-prick, pressure pain, and heat-detection thresholds. Electrically induced muscle pain was inhibited (P < 0.0001) in parallel with proprioception, touch, and pin-prick, which were mediated by thick and thin myelinated nerve fibers. Saline-induced muscle pain was inhibited (P < 0.002) synchronously with heat detection and pressure pain, which are mediated by unmyelinated nerve fibers. Based on the present psychophysical experiments, it is suggested that: (1) myelinated afferents mediated mainly electrically induced muscle pain, and (2) unmyelinated afferents mediated mainly saline-induced muscle pain.

Adult↗
PubMed1994

Clinical and force plate evaluation of the effect of a high plantar nerve block in lameness caused by induced mid-metatarsal tendinitis.

To answer the question whether it is possible to differentiate, by means of a high plantar nerve block in the hind limb, flexor tendon lameness from a suspensory ligament lameness, mid-plantar tendinitis or desmitis was induced with collagenase in five Standardbred horses in two trials. Before the induction of lameness, and on the fourth (D4) and fourteenth day (D14) after the induction of lameness the horses were evaluated subjectively (clinical lameness score), objectively (ground reaction force (GRF) measurements), and ultrasonographically. Clinical evaluation and GRF measurements were also done on D4 and D14 after a high plantar nerve block. From the GRF measurements variables were selected and analysed and related to the clinical lameness score. The horses were significantly lame on D4; this lameness had decreased on D14. The clinical findings were supported by the GRF data. In the flexor tendon group, a high plantar nerve block resulted in soundness or lameness in the other hind limb, whereas in the suspensory ligament group the effect was less conclusive. The correlation between the subjective clinical lameness score and several objectively measured GRF variables proved to be moderate to high. The collagenase model proved to be useful to study the effect of a high plantar nerve block on lameness resulting from induced tendon/ligament lesion. However, a high plantar nerve block cannot be used to differentiate between flexor tendon and suspensory ligament lesions.

Animals↗
PubMed2003

Comparison of the retrobulbar and Peterson nerve block techniques via magnetic resonance imaging in bovine cadavers.

OBJECTIVE: To use magnetic resonance (MR) imaging to describe and compare the anatomic distribution of a lipid contrast medium injected via the retrobulbar and Peterson nerve block techniques in heads of bovine cadavers. DESIGN: Original study. SAMPLE: 5 grossly normal heads obtained from cattle at necropsy. PROCEDURE: Standardized techniques for the modified retrobulbar and Peterson nerve blocks were established. Each cadaver had 1 treatment performed on a randomly selected side of the head; the second treatment was performed on the alternate side of the head. Injections were performed with canola oil, which is an MR-positive contrast medium. Images of heads in the transverse and dorsal planes were obtained with a 3.0 Tesla short-bore MR system. RESULTS: The retrobulbar technique was characterized by widespread distribution of the contrast medium around the periorbital structures; further distribution of the medium was detected along the optic nerve and in the ethmoid turbinates and nasopharynx. After the Peterson nerve block technique, contrast medium was repeatedly located in the pterygopalatine fossa, but distribution to surrounding structures was minimal. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicate that the retrobulbar injection technique results in a greater distribution of contrast medium to the target nerves and surrounding structures, compared with that achieved via the Peterson nerve block technique. This may explain the previously reported clinical impression that the retrobulbar block is more reliable than the Peterson nerve block but is associated with a greater risk of complications.

Animals↗
PubMed2002

Suprascapular nerve block for pain relief in adhesive capsulitis: comparison of 2 different techniques.

OBJECTIVE: To evaluate the clinical effectiveness of 2 suprascapular nerve block techniques in adhesive capsulitis. DESIGN: A single-blinded, randomized, comparative clinical trial. SETTING: Physical medicine and rehabilitation department of a university hospital in Turkey. PARTICIPANTS: Forty-one patients with adhesive capsulitis. INTERVENTIONS: Suprascapular nerve block with patients randomly divided into 2 groups: group A, needle tip guided by superficial bony landmarks, or group B, near-nerve electromyographically guided technique. MAIN OUTCOME MEASURES: Visual analog scale (VAS) score for pain severity and range of motion (ROM) were assessed before the injection and at 10 and 60 minutes after it. RESULTS: Active and passive ROM changes and VAS score changes from baseline were statistically significant for each group (P<.05). Passive ROM changes within time after the injection were statistically significant between the 2 groups in all planes except glenohumeral abduction. Achieved VAS score changes in the groups within time were significantly different from each other (P=.001). The VAS score difference after the suprascapular nerve block was more prominent in the near-nerve electromyography group. CONCLUSION: The near-nerve electromyography technique for suprascapular nerve block was more successful in providing and maintaining pain relief for up to 60 minutes.

Adult↗
PubMed1996

Regional anesthesia in knee arthroscopy: a new technique involving femoral and sciatic nerve blocks in knee arthroscopy.

We describe a new anesthetic technique of femoral and sciatic nerve blocks in knee arthroscopy. The sciatic nerve block is administered through a posterior approach, and the block of the femoral and lateral femoral cutaneous nerves in a single anterior approach. This type of regional anesthesia is safe and effective, providing excellent intraoperative and postoperative analgesia as well as minimizing postoperative complications.

Adult↗
PubMed2002

[Peri-prostatic nerve block at the level of the apex versus intrarectal lidocaine gel].

INTRODUCTION: After a review of the contradictory results of studies concerning periprostatic nerve block, the authors decided to prospectively evaluate the efficacy of periprostatic nerve block in the apex compared to the use of endorectal lidocaine gel. METHODS: From January 2001 to January 2002, 110 patients underwent prostatic biopsies. Patients were randomized to receive 10 cc of 2% lidocaine gel in the endorectal (group 1), or 10 cc of 1% lidocaine solution injected into the apex to induce bilateral periprostatic nerve block (group 2). Pain was evaluated by a 10-point linear visual analogue pain scale (VAS), and a 5-point digital visual scale (DVS). RESULTS: 96 patients were included in the study: 43 in group 1 and 53 in group 2. The mean pain score on the VAS was 2.76 +/- 1.69 and 1.73 +/- 1.26 for groups 1 and 2, respectively (p = 0.001). The DVS score was 2.26 +/- 0.82 and 1.62 +/- 0.56 for groups 1 and 2, respectively (p < 0.001). No significant difference was observed for mean age (p = 0.348), prostatic volume (p = 0.899), PSA level (p = 0.932) and complications between the two groups. The number of biopsies per patient was significantly higher in group 2 (p = 0.006), with significantly lower pain scores on each of the 2 scales. CONCLUSIONS: Apical periprostatic nerve block ensured better pain control during transrectal prostate biopsy, compared to the use of endorectal lidocaine gel, with no increase in the complication rate.

Administration, Rectal↗
PubMed1999

Transient extraocular muscle palsy resulting from inferior alveolar nerve block in children.

Transient extraocular muscle palsy after inferior alveolar nerve block was described in adults. Two children who had dental treatment under inferior alveolar nerve block developed this complication. One child suffered from lateral rectus muscle palsy, and the other child from levator palpebral muscle palsy. Both cases recovered spontaneously after a short time.

Anesthesia, Dental↗
PubMedDate not supplied

Continuous parasacral sciatic nerve block: two case reports.

OBJECTIVE: This study investigated the use of a continuous parasacral sciatic nerve block for anesthesia and postoperative analgesia for lower extremity surgery. METHODS: A continuous parasacral sciatic nerve block was performed in two patients (triple ankle arthrodesis and below-knee amputation). The sacral plexus was identified using an insulated Tuohy needle and a nerve stimulator. A catheter was placed near the elements of the sacral plexus via the Tuohy needle. RESULTS: In both patients, surgical anesthesia was successfully established through the parasacral catheter with lidocaine 1% (1/200,000 epinephrine), and postoperative analgesia was successfully established with a bolus of bupivacaine 0.375% (1/200,000 epinephrine) and maintained with a continuous infusion of bupivacaine 0.1% (8 mL/h) for 48 hours. CONCLUSION: We conclude that continuous parasacral sciatic nerve block can provide anesthesia and long-term analgesia for operative procedures of the foot and leg.

Amputation, Surgical↗
PubMed2004

Maxillary nerve block--a new approach using a computer-controlled anesthetic delivery system for maxillary sinus elevation procedure. A prospective study.

OBJECTIVE: The maxillary (or second division) nerve block is an effective method of achieving profound anesthesia of a hemimaxilla. This block can be used for procedures involving the maxillary sinus, including the maxillary sinus elevation procedure. The purpose of this study was to evaluate a computer-controlled anesthetic delivery system (Wand) for maxillary nerve block injection to attain maxillary sinus anesthesia for sinus floor elevation procedure. METHOD AND MATERIALS: The study population consisted of 61 healthy adult patients, ranging in age from 40 to 72 years (mean 45 years), who received 76 maxillary nerve blocks (17 having both right and left maxillary blocks) by means of the Wand system via the greater palatine nerve approach, for sinus floor elevation procedure. Two patients (3%) were excluded from the study due to the inability to negotiate the greater palatine foramen. For each block, two cartridges of 2% lidocaine hydrochloride with adrenaline (1:100,000) were administered, using a 27-gauge--long needle. After ensuring the anesthetized areas (waiting time 2.5 minutes), the sinus elevation procedure was performed. Parameters recorded were the success or failure of anesthesia, positive (blood) aspiration, bony obstructions in the greater palatine canal, and complications. RESULTS: The use of this technique increased the ability to more easily locate the greater palatine foramen. A local infiltration (at the incisor region) was needed in 13 (17%) of the blocks, and seven (9.2%) sites required an extra infraorbital block injection in addition to the maxillary nerve block. One block had a positive aspiration. There were no bony obstructions demonstrated in the canal interfering with the injection, and no complications were recorded. CONCLUSION: The Wand appears to offer a number of advantages over the hand-held syringe when the greater palatine block technique for the maxillary nerve block is used. It is suggested that, when indicated, and with the required knowledge and respect for the associated anatomy, this technique should be considered with greater ease and more confidence.

Adult↗
PubMed1997

Suprascapular nerve block for postoperative pain relief in arthroscopic shoulder surgery: a new modality?

Arthroscopic shoulder surgery has a 45% incidence of severe postoperative pain. Opiates and interscalene nerve blocks have a high incidence of side effects, and intraarticular local anesthetic has been shown to be ineffective when used for postoperative pain relief. The suprascapular nerve supplies 70% of the sensory nerve supply to the shoulder joint, and local anesthetic block of this nerve is effective in certain shoulder pain disorders. To determine the efficacy of a suprascapular nerve block, subcutaneous saline was compared with a suprascapular nerve block using 10mL of 0.5% bupivacaine with 1:200,000 epinephrine before general anesthesia was induced. In the immediate postoperative period, a 51% reduction in demand and a 31% reduction in consumption of morphine delivered by a patient-controlled analgesic system was demonstrated. There was more than fivefold reduction in the incidence of nausea, as well as reduced visual analog and verbal pain scores for patients who received a suprascapular nerve block. The duration of hospital stay was reduced by 24% in the suprascapular nerve block group. A 24-h phone call interview revealed a 40% reduction in analgesic consumption and a reduction in verbal pain scores at rest and on abduction. There were no complications from the suprascapular nerve block. This study demonstrates that a suprascapular nerve block for pain relief in arthroscopic shoulder surgery is an effective and safe modality of postoperative pain relief.

Adult↗
PubMed1996

Plasma concentrations of different local anesthetics after facial nerve block.

BACKGROUND AND OBJECTIVE: The authors studied the plasma concentrations of several anesthetics to determine the relative safety of facial blocks as reflected by each anesthetic's kinetics. PATIENTS AND METHODS: Seventy-five patients undergoing cataract extraction received a proximal block of a facial nerve using prilocaine, lidocaine, mepivacaine, bupivacaine, or etidocaine. RESULTS: Mean plasma concentrations were significantly lower after the administration of prilocaine than they were after the administration of lidocaine and mepivacaine (P < .0008; multivariate analysis of variance, Roy's max root). Plasma concentrations of lidocaine and mepivacaine or bupivacaine and etidocaine did not differ from each other. Mean plasma concentrations of prilocaine, lidocaine, and mepivacaine increased continuously for 15 to 22 minutes, whereas mean plasma concentrations of bupivacaine and etidocaine peaked after 10 and 9 minutes, respectively. Peak plasma concentrations of anesthetics were well below toxic levels in all patients. CONCLUSIONS: Although systemic toxicity resulting from the rapid absorption of local anesthetics after facial nerve block seems unlikely, prilocaine may be the anesthetic most preferred for such a block because of its high level of safety.

Absorption↗
PubMed2003

Variability in determination of point of needle insertion in peripheral nerve blocks: a comparison of experienced and inexperienced anaesthetists.

Accurate identification of surface landmarks is essential for the successful performance of peripheral nerve blocks. The variability between experienced and inexperienced practitioners in identifying anatomical landmarks has not been studied previously. Anaesthetists were asked to identify the point of needle insertion for posterior lumbar plexus and sciatic nerve blocks on a volunteer using a standard textbook description. The chosen point for needle insertion was described in terms of X and Y co-ordinates, measured in millimetres, from a zero reference point marked on a volunteer's back. Fifteen experienced and 22 inexperienced anaesthetists took part in the study. The lumbar plexus block mean [range] values for the X, Y co-ordinates were 80 [62-108], 66 [46-86] and 92 [49-150], 62 [0-131] in the experienced and inexperienced groups, respectively. The sciatic nerve block X, Y co-ordinates were 77 [62-99], 70 [49-89] and 68 [29-116], 62 [26-93] in the experienced and inexperienced groups, respectively. The variance for the point of needle insertion was significantly greater in the inexperienced group (p <0.01) for both the lumbar plexus and sciatic nerve blocks. We conclude that with increasing experience, there is decreased variability in determining the point of needle insertion using anatomical landmarks.

Anesthesiology↗
PubMed1999

Nerve block and intra-articular anaesthesia of the forelimb in the sound horse.

Nerve blocks and intra-articular anaesthesia are used extensively as routine methods in lameness evaluation. The method is based on the assumption that the technique itself does not change the movement pattern. The aim of this study was to carry out a quantitative kinematic study to confirm or reject the hypothesis that high palmar digital nerve block (HPDN) and intra-articular fetlock joint anaesthesia (IAF) influence significantly the movement pattern of the horse. Seven Standardbred horses trotting at 4.5 m/s were recorded at 240 Hz on a treadmill before and after anaesthesia by use of a ProReflex video system. Time variables, segment and joint angles were calculated. The high palmar digital nerve block (HPDN) resulted in a longer stance time and caused a greater fetlock joint angle range and greater maximal pastern joint angle. No systematic differences in time and angle variables were observed after intra-articular fetlock joint anaesthesia (IAF). In conclusion, HPDN but not IAF affects locomotor pattern in sound horses. Distal limb proprioception is important in normal movement, while fetlock intra-articular proprioception is apparently not. Interpretation of the effect of HPDN in lame individuals should incorporate more variables than maximal overextension of the fetlock joint.

Anesthesia↗
PubMed2005

Sciatic nerve block causing heel ulcer after total knee replacement in 36 patients.

Femoral and sciatic nerve blocks are often used for postoperative analgesia following total knee replacement surgery. In this report, we focus on cases of heel ulcers which occurred following the implementation of peripheral nerve block in concert with knee replacement surgery. In some instances, heel ulcers have resulted in delayed rehabilitation and prolonged hospital stays in this group of patients, which makes this phenomenon a potential burden on the healthcare system. Pressure points in the foot should be protected after the implementation of nerve blocks to prevent pressure sores. An awareness of this unusual complication related to knee replacement surgery is necessary to prevent its occurrence and avoid delays in patient rehabilitation and recovery.

Arthroplasty, Replacement, Knee↗
PubMed1998

Lack of type 1 and type 2A myosin heavy chain isoforms in rat slow muscle regenerating during chronic nerve block.

The degeneration-regeneration process was induced by bupivacaine injection in innervated, denervated, and nerve-blocked rat soleus muscles. Nerve block was obtained by superfusion of the sciatic nerve with tetrodotoxin (TTX). Two weeks after bupivacaine injection, immunohistochemical and electrophoretical analyses showed the presence of type 1 myosin heavy chain (MHC) only in innervated regenerated muscles, type 2A in innervated and denervated, but not in TTX-paralyzed muscles, and type 2X under all experimental conditions. The presence of type 1 MHC in the innervated, and its absence in both denervated and TTX-paralyzed muscles were also verified immunohistochemically 1 week after bupivacaine injection. It is concluded that the nerve impulses play a determinant role in the expression of 1 and 2A MHC isoforms in the innervated regenerating muscle. The possible causes of the absence of the type 2A MHC isoform in the TTX-paralyzed muscles are discussed.

Animals↗
PubMed1984

Continuous sciatic nerve block.

A technique of continuous sciatic nerve block is described. The method was used to relieve pain from ischaemic gangrene of the foot for 2 days before below-knee amputation and, combined with a continuous inguinal paravascular block, to provide regional anaesthesia both for the surgery and for the first 2 postoperative days.

Aged↗