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At least 91 records · Page 5Linked to original sources
PubMed2002

Distal nerve blocks at the wrist for outpatient carpal tunnel surgery offer intraoperative cardiovascular stability and reduce discharge time.

UNLABELLED: Carpal tunnel release is often performed as an outpatient procedure. We designed this retrospective study to assess the effect of different anesthesia techniques on intraoperative cardiovascular stability and discharge time. According to the anesthesia technique received, 62 consecutive patients were categorized in Group BIER (IV regional anesthesia), Group BLOCK (distal nerve blocks), and Group GENERAL (general anesthesia). Incidences of intraoperative periods of tachycardia or bradycardia and hyper- or hypotension were studied, as were tourniquet, surgical, operating room, and discharge times. Cardiovascular stability was better achieved in Group BLOCK, as indicated by a significantly smaller incidence of periods of hypertension compared with Group BIER (5% vs 25%) and a significantly less frequent incidence of periods of hypotension compared with Group GENERAL (14% vs 42%). Patients in Group BLOCK spent significantly less time in the hospital after surgery than patients in Group BIER (65 vs 88 min) or patients in Group GENERAL (65 vs 133 min). We conclude that distal nerve blocks for outpatient carpal tunnel surgery are associated with greater intraoperative cardiovascular stability than general anesthesia. After surgery, patients in Group BLOCK could be discharged earlier than patients who received IV regional anesthesia or general anesthesia; this could be related to the superior postoperative analgesia provided by this technique. IMPLICATIONS: This retrospective analysis of three different anesthetic techniques for ambulatory carpal tunnel surgery shows that nerve blocks performed at the wrist provided excellent intraoperative cardiovascular stability and allowed for earlier discharge.

Adult↗
PubMed2000

Lower extremity nerve blocks.

Lower extremity nerve blocks have not become as popular as upper extremity blocks for anesthesia; however, the use of lower extremity nerve blocks will become more widespread, as teaching programs are now providing more regional anesthesia experiences for their trainees so that the anesthesia provider will have the familiarity to use these blocks. To increase the enthusiasm among our surgical colleagues, we must begin to use these blocks for surgery, and if the block must be supplemented with local anesthetic or a light general anesthetic, we must educate them that the block is not a failure but a success, as it will provide analgesia after surgery in a method of multimodal pain control. Lower extremity nerve blocks will become more popular when it is realized that they are an effective way of increasing operating room efficiency. Because the block may be placed in an induction room, there is no induction or emergence in the operating room. Patients may be discharged without the need for pain medications, thus lowering the incidence of nausea postoperatively and decreasing PACU and discharge times.

Humans↗
PubMed1985

Nerve blocks and chronic pain states--an update. 2. Clinical indications.

With the unfortunate exception of the differential spinal block, diagnostic nerve blocking has become somewhat obsolete with the development of newer, more sophisticated diagnostic technology. Therapeutic nerve blocks remain useful in treating patients with various terminal cancers, some forms of back pain, tic douloreux, causalgia, reflex sympathetic dystrophy, and many trigger point syndromes. For dysfunctional and pain-disabled patients (rated as class 1 or 3 on Emory Pain Estimate Model), block therapy must be structured in comprehensive pain rehabilitation programs.

Adult↗
PubMed2005

Signs of inflammation after sciatic nerve block in pigs.

Nerve stimulators are widely used to assist with peripheral nerve blocks but do not eliminate the risk of nerve injury. We evaluated the histologic findings 6 h after sciatic nerve block with bupivacaine in pigs. When a motor response was still obtained with a current <0.2 mA (n = 10), the postmortem microscopic evaluation revealed lymphocytes and granulocytes sub-, peri-, and intraneurally in 5 (50%) of 10 pigs. No signs of inflammation were observed when the muscle contraction was achieved with a current between 0.3 and 0.5 mA (P = 0.03). In conclusion, the current required to elicit a motor response, the position of the needle tip, and the subsequent likelihood of nerve damage merit further evaluation.

Animals↗
PubMed2006

Preservation of the marginal mandibular branch of the facial nerve using a plexus block nerve stimulator.

Preserving the marginal mandibular branch of the facial nerve is essential in submandibular neck dissection to avert disfiguring complications. Despite the high incidence of postoperative palsy, old-fashioned techniques of nerve identification remain widespread. The use of disposable plexus block nerve stimulators as a safe and accurate method to localize the nerve intraoperatively is suggested herein. Such devices are significantly more affordable and user-friendly than larger facial nerve monitoring devices, which are rather favored for those procedures more extensively jeopardizing the branches of the facial nerve. In this report, disposable stimulators led to successful identification of the nerve in 100% of 25 patients between 2003 and 2005, with no postoperative paralysis. In addition, stimulation devices are constantly gaining in reliability and safety, and the number of surgical fields supporting their use is expanding. Therefore, their routine use for surgery on the submandibular area is recommended by the authors.

Disposable Equipment↗
PubMed1995

Lower limb nerve blocks in children using unsheathed needles and a nerve stimulator.

The use of unsheathed non-insulated needles and a nerve stimulator as an aid to peripheral nerve blockade in children has received little attention in the literature. In order to assess the value of such a technique, a study was performed in children presenting for lower limb surgery with no contraindication to femoral and/or sciatic nerve block. Four hundred and eleven children, mean age 4.25 (SD 3.8) years and mean weight 16.8 (SD 9.4) kg, received a total of 883 peripheral nerve blocks: 419 femoral nerve blocks and 464 sciatic nerve blocks. One hundred and twenty six children were below one year of age. The current required to stimulate the more superficial femoral nerve ranged from 0.5-1.0 mA whilst for the deeper sciatic nerve ranged from 1.2-2.0 mA. Staff in training, with little or no experience of the technique, successfully performed 223 nerve blocks in 114 patients under the author's guidance. The overall success rate was 98%, the failures occurring early in the series.

Bupivacaine↗
PubMed1975

Supersensitivity to ACh in muscles after prolonged nerve block.

Sciatic nerves of rats and tibial nerves of rabbits were kept anaesthetized in situ for periods of 3-11 days by applying silastic cuffs containing lidocaine base or marcaine hydrochloride. To insure a more uniform release of the rapidly diffusing lidocaine base, the drug was contained in compartments at some distance from the nerve and the cuffs were covered with polystyrene. The completeness of anaesthesia and the functional state of the nerve were tested by stimulating the exposed nerves proximal and distal to the cuff and by observing the behaviour of the muscle prior to killing the animals. The ACh sensitivity was tested by electrophoretic application of ACh from micropipettes and by recording the results changes of the resting membrane potential in individual muscle fibres. The ACh sensitivity was found to be present in the extrajunctional area of all muscle fibres including those displaying miniature end-plate potentials. These was no difference between the behaviour of muscles from rats and rabbits and between the action of lidocaine base and marcaine hydrochloride. Previous reports on the absence of extrajunctional ACh sensitivity in muscles of rabbits whose nerves had been treated by lidocaine base were explained by a relatively rapid loss of the drug from the usual type of nerve cuffs (more than 70% of the drug lost in one day), permitting a premature recovery of the nerves from anaesthesia.

Acetylcholine↗
PubMed2005

Neurologic deficit after peripheral nerve block: what to do?

Regional nerve injury is a recognized complication of plexus anesthesia. Nerve damage after regional anesthesia is the most frightening complication for the patient, the anesthetist and the surgeon too. In order to limit possible medico-legal issues, the anesthetist has to follow an algorithm. The indication and information obtained from the ultrasonography, the sudomotor test, the electromyogram, the elctroneuromyogram and the evoked potentials are discussed. The principles to avoid anesthetic-related nerve damage during regional anesthesia are given. Finally treatment and surveillance, after nerve damage has occurred, are explained.

Humans↗
PubMed1979

Therapeutic nerve blocks for chronic pain.

Nerve blocks are an effective treatment in patients with many types of acute pain. However, they are much less effective in patients with chronic pain. Candidates for therapeutic nerve blocks should be carefully screened by: assessment of organic disease; evaluation of psychologic and behavioral disorders, and differential nerve blocks. The best candidates for therapeutic nerve blocks have known or inferred organic disease, minimal psychologic or behavioral disorders, and evidence of sympathetic or somatic pain mechanisms.

Diagnosis↗
PubMed2003

Greater occipital nerve block.

The occipital nerve block is used to diagnose and treat occipital neuralgia. The clinical presentation of occipital neuralgia, the anatomy of the greater occipital nerve, and the technique of the occipital nerve block is described.

Cranial Nerves↗
PubMedDate not supplied

Peripheral nerve block with use of nerve stimulator.

The authors describe use of the nerve stimulator in conjunction with a percutaneous exploring needle to achieve peripheral blocks accurately and without injuring the nerve. The nerve stimulator allows accurate nerve blocks without causing paresthesiae and the need for additional anesthetic. This technique decreases the possibility of nerve injury.

Electric Stimulation↗
PubMedDate not supplied

Sodium bicarbonate reduces pain associated with ophthalmic nerve blocks.

Administration of local nerve blocks for ophthalmic surgical procedures causes pain resulting in an unpleasant and stressful experience for the patient. A prospective, randomized, double-masked study compared injection pain of anesthetic solutions used for facial and retrobulbar nerve blocks. Anesthetic solutions to which sodium bicarbonate had been added were compared with anesthetic solutions without added sodium bicarbonate. Pain on injection of both facial and retrobulbar nerve blocks was significantly less (P = .0009 and P less than .0001 respectively), without diminution of effectiveness of either type of nerve block, in the group using anesthetic solutions to which sodium bicarbonate had been added.

Anesthetics, Local↗
PubMed1998

[Indications and limits of nerve block techniques].

Repetitive nerve blocks as a monotherapeutic treatment are loosing importance in the therapy of chronic pain. Such invasive methods for pain reduction are just one strategy in the interdisciplinary and multimodal planning of pain therapy. They are mostly used in special indications, e.g. reflex sympathetic dystrophy neurolysis in S3-S5 localized cancer pain. Premises for an invasive pain therapy are the patient's knowledge and agreement concerning this method. Furthermore, it is necessary for the physician to know the typical complications of the invasive treatment and to be able to manage them. It is recommended to document the pain course.

Analgesia, Epidural↗
PubMed1980

Nerve blocking of the sciatic and femoral nerves. Continual block with vein catheter on 44 patients.

The accessibility of the sciatic nerve from three directions (anterior, lateral and posterior) has prevented many patients from being moved, especially those who would be endangered by a change of position. A vein catheter is introduced in accordance with the approved technique up to the selected point. The stylus is withdrawn, the catheter is fixed on the skin by a suture or adhesive plaster, and by the use of a precisely fitting syringe the chosen local anesthetic solution is perfused. By this technique we can reblock the patient.

Anesthetics, Local↗