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Nerve Block (nerve + block)
Kinds of Nerve Block Selected AbstractsUltrasound-guided Ulnar Nerve Block in the Management of Digital Abscess and Hand CellulitisACADEMIC EMERGENCY MEDICINE, Issue 1 2010Michael B. Stone MD No abstract is available for this article. [source] Suboccipital Nerve Blocks for Suppression of Chronic Migraine: Safety, Efficacy, and Predictors of OutcomeHEADACHE, Issue 6 2010Silvia Weibelt RN (Headache 2010;50:1041-1044) Background., Approximately 1 in 50 Americans is afflicted by chronic migraine (CM). Many patients with CM describe cervicogenic headache. Options for treating CM effectively are at present quite limited. Objective., To determine the safety and efficacy of occipital nerve blocks (ONBs) used to treat cervicogenic chronic migraine (CCM) and to identify variables predictive of a positive treatment response. Methods., Using a uniform dose and injection paradigm, we performed ONBs consecutively on a series of patients presenting with CCM. Patients were stratified according to specific findings found to be present or absent on physical examination. A positive treatment outcome was defined as a 50% or greater reduction in headache days per month over the 30 days following treatment relative to the 30-day pre-treatment baseline. We used a 5-point Likert scale as one of the secondary outcome variables. Results., We treated 150 consecutive patients with unilateral (37) or bilateral (113) ONBs. At the 1-month follow-up visit 78 (52%) exhibited evidence of a positive treatment response according to the primary outcome variable, and 90 (60%) reported their headache disorder to be "better" (44; 29%) or "much better" (46; 30%). A total of 8 (5%) patients reported adverse events within the ensuing 72 hours, and 3 (2%) experienced adverse events that reversed spontaneously but required emergent evaluation and management. Conclusion., For suppression of CCM, ONBs may offer an attractive alternative to orally administered prophylactic therapy. [source] Occipital Nerve Blocks: Effect of Symptomatic MedicationHEADACHE, Issue 10 2009Headache Type on Failure Rate, Overuse Objective., To explore the effect of symptomatic medication overuse (SMO) and headache type on occipital nerve block (ONB) efficacy. Methods., We conducted a chart review of all of the ONBs performed in our clinic over a 2-year period. Results., Of 108 ONBs with follow-up data, ONB failed in 22% of injections overall. Of the other 78%, the mean decrease in head pain was 83%, and the benefit lasted a mean of 6.6 weeks. Failure rate without SMO was 16% overall, and with SMO was 44% overall (P < .000). In those who did respond, overall magnitude and duration of response did not differ between those with and those without SMO. Without SMO, ONB failure rate was 0% for postconcussive syndrome, 14% for occipital neuralgia, 11% for non-intractable migraine, and 39% for intractable migraine. With SMO, failure rate increased by 24% (P = .14) in occipital neuralgia, by 36% (P = .08) for all migraine, and by 52% (P = .04) for non-intractable migraine. Conclusions., SMO tripled the risk of ONB failure, possibly because medication overuse headache does not respond to ONB. SMO increased ONB failure rate more in migraineurs than in those with occipital neuralgia, possibly because migraineurs are particularly susceptible to medication overuse headache. This effect was much more pronounced in non-intractable migraineurs than in intractable migraineurs. [source] Peripheral Nerve Blocks of the HandACADEMIC EMERGENCY MEDICINE, Issue 1 2007Douglas Dillon No abstract is available for this article. [source] Stimulating or conventional perineural catheters after hallux valgus repair: a double-blind, pharmaco-economic evaluationACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 10 2006A. Casati Background:, We prospectively evaluated direct analgesia-related costs of continuous sciatic nerve block using either a stimulating or conventional catheter after hallux valgus repair. Methods:, The perineural catheter was inserted through a stimulating introducer either blindly (group Conventional, n= 38) or while stimulating via the catheter (group Stimulating, n= 38). Nerve block was induced with 25 ml of mepivacaine 15 mg/ml, and was followed 3 h later by a patient-controlled infusion of ropivacaine 2 mg/ml (basal infusion: 3 ml/h; incremental dose: 5 ml; lock-out time: 30 min). Rescue tramadol [100 mg intravenous (i.v.)] was given if required. Local anesthetic consumption, need for rescue tramadol and post-operative nausea and vomiting (PONV) treatment, and patient's satisfaction were recorded during first 24-h infusion. Cost calculations were based on the acquisition cost of drugs and devices. Results:, Both techniques were similarly effective, but local anesthetic consumption and need for rescue analgesics were lower in the Stimulating group [respectively, 120 vs. 153 ml (P= 0.004) and 21% vs. 60% (P= 0.001)]. The analgesia-related costs for 24 h were similar when 100-ml bags of ropivacaine 2 mg/ml were used (66 , vs. 67 ,; P= 0.26). When 200-ml bags of ropivacaine were used, the analgesia-related costs were higher in the Stimulating group than the Conventional group (75 , vs. 55 ,; P= 0.0005). Conclusions:, Direct costs of continuous sciatic nerve block ranged from 55 to 75 ,. Stimulating catheters reduced local anesthetic consumption and need for rescue analgesics. This was only cost effective when 100-ml bags of 2 mg/ml ropivacaine were used, while the cheapest combination was the use of conventional catheters and 200-ml bags of ropivacaine. [source] Ice Minimizes Discomfort Associated with Injection of Botulinum Toxin Type A for the Treatment of Palmar and Plantar HyperhidrosisDERMATOLOGIC SURGERY, Issue 2007KEVIN C. SMITH MD BACKGROUND The value of botulinum toxin type A (BTX-A) for treatment of palmar and plantar hyperhidrosis (HH) has been limited by injection pain, which in the past has generally required administration of a nerve block. We describe the successful use of ice applied to the intended injection point followed immediately by application of either ice or vibration to skin adjacent to the injection point to reduce discomfort associated with injection of BTX-A for the treatment of palmar and plantar HH. RESULTS During needle insertion and injection of BTX-A, both the application of ice to the intended injection point followed by application of ice adjacent to the injection point (ice+ice) and the application of ice to the intended injection point followed by application of vibration adjacent to the injection point have been preferred by our patients to nerve block. These two techniques allow efficient treatment of both hands and/or both feet in a single session. CONCLUSION By eliminating the need for nerve blocks, the techniques described here will enlarge the pool of physicians who can administer BTX-A for palmar and plantar HH, and will enlarge the pool of patients who are willing to have this treatment. [source] Recurrent Ingrown Big Toenails Are Efficiently Treated by CO2 LaserDERMATOLOGIC SURGERY, Issue 6 2002Francis Serour MD background. Surgery for onychocryptosis has a high rate of recurrence. objective. To evaluate CO2 laser partial matricectomy for recurrent onychocryptosis. methods. One hundred ninety-six consecutive patients (predominantly teenagers) previously unsuccessfully treated by surgery underwent CO2 laser for recurrent onychocryptosis. After a digital nerve block and a simple partial nail plate avulsion, the laser was used (5 W, defocused 2 mm beam in continuous mode) to vaporize the matrix, the lateral horn, and the lateral nail groove, including local granulation tissue if present. Follow-up was at least 12 months. results. Three hundred forty-four matricectomies were performed. Disease was mostly at stage II and III, with severe local infection in 24 cases (12.2%). All wounds healed in 21.9 ± 3.2 days, with no postoperative local infection or prolonged exudative drainage. Onychocryptosis reoccurred in 5 of 344 treated margins (1.45%, average 15 months), all after primary bilateral matricectomy. Spicules in the lateral nail groove occurred in 14 of 344 treated margins (4%, average 5.9 months), mostly after primary bilateral matricectomy (7 cases) and in infected margins (8 cases). One patient developed a neuroma in the lateral nail groove. conclusion. CO2 laser is effective for the treatment of recurrent onychocryptosis. Bilateral matricectomy and local infection seem to be the predisposing factors for recurrence and postoperative spicule growth. [source] Scintigraphic examination of the cartilages of the footEQUINE VETERINARY JOURNAL, Issue 3 2007A. NAGY Summary Reasons for performing study: Radiographic examination of the cartilages of the foot is well documented; however, there is limited information about their scintigraphic assessment. Objectives: To evaluate the scintigraphic appearance of the cartilages of the foot using subjective and quantitative image analysis and to correlate radiographic and scintigraphic findings. Hypotheses: An ossified cartilage would have similar radiopharmaceutical uptake (RU) to the ipsilateral aspect of the distal phalanx; RU would extend throughout the length of the ossified cartilage; a separate centre of ossification (SCO) would be identified on a scintigraphic image; and fracture or trauma to an ossified cartilage would manifest as increased RU (IRU). Methods: Front feet (n = 223) of horses (n = 186) that had dorsopalmar radiographic views and dorsal scintigraphic images were included in the study. The cartilages of the foot were graded radiographically and scintigraphically. Quantitative evaluation of the scintigraphic images was carried out using region of interest (ROI) analysis. For statistical analysis RU ratios were used. Correlations between a radiographically detected SCO and focal RU and between IRU and radiographic abnormalities were assessed. Results: There was a good correlation and an excellent agreement between radiographic and scintigraphic grades. ROI analysis showed a proximal to distal increase in RU ratios within each cartilage of the foot. A radiographically identified SCO could be detected scintigraphically in 12/17 feet (70.6%). Thirty-eight feet had IRU in the region of a cartilage, 25 of which (65.8%) had corresponding radiographic abnormalities. Fracture of an ossified cartilage was associated with IRU in all horses. Conclusions and potential relevance: Scintigraphy may give information about the potential clinical significance of ossification of the cartilages of the foot and associated lesions, therefore prompting further investigation by use of a uniaxial ipsilateral palmar nerve block and imaging, using either magnetic resonance imaging and/or computed tomography. [source] The effect of bilateral glossopharyngeal nerve anaesthesia on swallowing in horsesEQUINE VETERINARY JOURNAL, Issue 1 2005E. A. KLEBE Summary Reasons for performing study: Dysfunction of the glossopharyngeal nerve has been implicated as a cause of dysphagia in horses. However, recent studies have indicated that this is not the case. Objectives: To determine whether bilateral glossopharyngeal nerve anaesthesia would cause dysphagia in horses or result in measurable alterations in the timing, function, or sequence of swallowing. Methods: Swallowing was evaluated in 6 normal horses with and without bilateral glossopharyngeal nerve anaesthesia. Swallowing dynamics were assessed subjectively and objectively based on time from prehension of food until swallowing, number of tongue movements until initiation of swallowing, depth of bolus at the base of the tongue prior to initiation of swallow and evidence of tracheal aspiration using fluoroscopy and endoscopy. Results: There was no evidence of aspiration or dysphagia in horses before or after bilateral glossopharyngeal nerve block. No observed or measured differences in swallowing sequence or function could be detected in blocked compared to unblocked horses. However, there was a trend in blocked horses for the number of tongue pushes and the time to swallowing to be increased. Conclusions: Glossopharyngeal nerve function may not be essential for normal swallowing function in otherwise healthy horses. Potential relevance: Clinically, normal swallowing is not an appropriate test of glossopharyngeal nerve function and dysphagic horses should not be assumed to have glossopharyngeal nerve dysfunction. [source] Mepivacaine local anaesthetic duration in equine palmar digital nerve blocksEQUINE VETERINARY JOURNAL, Issue 8 2004L. A. BIDWELL Summary Reasons for performing study: Perineural analgesics are used for lameness diagnosis but the duration of effect, knowledge of which would provide valuable information when performing subsequent blocks, is unknown. Objective: To evaluate the duration of a palmar digital nerve block using force plate measurements. Methods: Ten horses diagnosed with unilateral navicular syndrome were trotted at range of 3 ± 0.15 m/sec over a force plate to record ground reaction forces for 5 trials of each forelimb. Data were recorded before nerve block, and then at 15 mins, 1, 2 and 24 h post nerve block. Results: Before nerve block, peak vertical force (mean ± s.e.) was significantly higher in the contralateral forelimb (CL = 5345 ± 188 N) than in the lame forelimb (L = 4256 ± 204 N; P<0.05). At 15 mins post nerve block there was no significant difference between the 2 forelimbs (CL = 5140 ± 184 N; L = 5126 ± 129 N), and this remained the case for 1 h. By 2 h, the mean score for the lame leg had decreased (L = 4642 ± 182 N) but was still greater than preblock. By 24 h, vertical forces had returned to preblock values. Conclusions: The palmar digital nerve block was fully effective between 15 mins and 1 h. The analgesic effect began to subside between 1 and 2 h but sufficient analgesia persisted to affect gait characteristics beyond 2 h. Potential relevance: When using a palmar digital nerve block, it is important to perform lameness evaluations between 15 mins and 1 h to be sure of effective nerve blockade. [source] Effects of stylopharyngeus muscle dysfunction on the nasopharynx in exercising horsesEQUINE VETERINARY JOURNAL, Issue 4 2004C. TESSIER Summary Reasons for performing study: Nasopharyngeal collapse has been observed in horses as a potential cause of exercise intolerance and upper respiratory noise. No treatment is currently available and affected horses are often retired from performance. Objective: To determine the effect of bilateral glossopharyngeal nerve block and stylopharyngeus muscle dysfunction on nasopharyngeal function and airway pressures in exercising horses. Methods: Endoscopic examinations were performed on horses at rest and while running on a treadmill at speeds corresponding to HRmax50, HRmax75 and HRmax, with upper airway pressures measured with and without bilateral glossopharyngeal nerve block. Results: Bilateral glossopharyngeal nerve block caused stylopharyngeus muscle dysfunction and dorsal nasopharyngeal collapse in all horses. Peak inspiratory upper airway pressure was significantly (P = 0.0069) more negative at all speeds and respiratory frequency was lower (P = 0.017) in horses with bilateral glossopharyngeal nerve block and stylopharyngeus muscle dysfunction compared to control values. Conclusions: Bilateral glossopharyngeal nerve anaesthesia produced stylopharyngeus muscle dysfunction, dorsal pharyngeal collapse and airway obstruction in all horses. Potential relevance: The stylopharyngeus muscle is probably an important nasopharyngeal dilating muscle in horses and dysfunction of this muscle may be implicated in clinical cases of dorsal nasopharyngeal collapse. Before this information can be clinically useful, further research on the possible aetiology of stylopharyngeus dysfunction and dysfunction of other muscles that dilate the dorsal and lateral walls of the nasopharynx in horses is needed. [source] Rapid functional plasticity in the primary somatomotor cortex and perceptual changes after nerve blockEUROPEAN JOURNAL OF NEUROSCIENCE, Issue 12 2004Thomas Weiss Abstract The mature human primary somatosensory cortex displays a striking plastic capacity to reorganize itself in response to changes in sensory input. Following the elimination of afferent return, produced by either amputation, deafferentation by dorsal rhizotomy, or nerve block, there is a well-known but little-understood ,invasion' of the deafferented region of the brain by the cortical representation zones of still-intact portions of the brain adjacent to it. We report here that within an hour of abolishing sensation from the radial and medial three-quarters of the hand by pharmacological blockade of the radial and median nerves, magnetic source imaging showed that the cortical representation of the little finger and the skin beneath the lower lip, whose intact cortical representation zones are adjacent to the deafferented region, had moved closer together, presumably because of their expansion across the deafferented area. A paired-pulse transcranial magnetic stimulation procedure revealed a motor cortex disinhibition for two muscles supplied by the unaffected ulnar nerve. In addition, two notable perceptual changes were observed: increased two-point discrimination ability near the lip and mislocalization of touch of the intact ulnar portion of the fourth finger to the neighbouring third finger whose nerve supply was blocked. We suggest that disinhibition within the somatosensory system as a functional correlate for the known enlargement of cortical representation zones might account for not only the ,invasion' phenomenon, but also for the observed behavioural correlates of the nerve block. [source] Occipital Nerve Blocks: Effect of Symptomatic MedicationHEADACHE, Issue 10 2009Headache Type on Failure Rate, Overuse Objective., To explore the effect of symptomatic medication overuse (SMO) and headache type on occipital nerve block (ONB) efficacy. Methods., We conducted a chart review of all of the ONBs performed in our clinic over a 2-year period. Results., Of 108 ONBs with follow-up data, ONB failed in 22% of injections overall. Of the other 78%, the mean decrease in head pain was 83%, and the benefit lasted a mean of 6.6 weeks. Failure rate without SMO was 16% overall, and with SMO was 44% overall (P < .000). In those who did respond, overall magnitude and duration of response did not differ between those with and those without SMO. Without SMO, ONB failure rate was 0% for postconcussive syndrome, 14% for occipital neuralgia, 11% for non-intractable migraine, and 39% for intractable migraine. With SMO, failure rate increased by 24% (P = .14) in occipital neuralgia, by 36% (P = .08) for all migraine, and by 52% (P = .04) for non-intractable migraine. Conclusions., SMO tripled the risk of ONB failure, possibly because medication overuse headache does not respond to ONB. SMO increased ONB failure rate more in migraineurs than in those with occipital neuralgia, possibly because migraineurs are particularly susceptible to medication overuse headache. This effect was much more pronounced in non-intractable migraineurs than in intractable migraineurs. [source] Femoral nerve block with ropivacaine or bupivacaine in day case anterior crucial ligament reconstructionACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2010H. WULF Background/Objective: Our aim was to evaluate analgesia, motor block and pharmacokinetics of ropivacaine 0.2% and 0.75% in a femoral nerve block (FNB) in day case patients for anterior crucial ligament (ACL)-reconstruction compared with bupivacaine 0.25% and placebo. Methods: Following ethics committee approval and informed consent, 280 patients were randomly allocated to four groups for single-shot FNB [30 ml ropivacaine 0.2% (group RO2.0), 0.75% (RO7.5), bupivacaine 0.25% (BU2.5) and NaCl 0.9% (NaCl)]. Analgesia (pain scores, primary outcome) and motor block were assessed at 4 h (dismissal) and up to 24 h. Plasma concentration was determined up to 240 min thereafter. Results: Pain scores at 4 h were significantly higher for NaCl 4 (0,8) (median, range) (vs.) BU2.5 2 (0,8), RO2.0 3 (0,9) and RO7.5 2 (0,8) (NS within the LA groups). Patients of the NaCl group needed analgesics significantly more often (93%) within 4 h after surgery vs. 16% of group RO2.0, 19% of group RO7.5 and 19% of group BU2.5. Motor block was significantly increased with all local anesthetics without a significant difference within the LA groups 3 (0,5) in RO2.0, 3 (0,5) in RO7.5 and 3 (0,4) in BU2.5 vs. 0 (0,3) in group NaCl (median (range); scale from 0=full strength to 5=complete paralysis). Peak plasma concentrations differed significantly: RO7.5: 1.4 ± 0.4 (0.73,2.6) [,g/ml, mean ± SD (range)] after 33 ± 14 (10,40) min, RO2.0: 0.6 ± 0.3 (0.13,1.0) after 22+17 (10,60) and BU2.5: 0.3 ± 0.16 (0.05,0.62) at 31 ± 17 (10,60), respectively. Conclusion: FNB for ACL reconstruction with ropivacaine or bupivacaine provided better post-operative analgesia than placebo without reaching toxic plasma concentrations. Significant motor block was observed after 4 h in all groups including the lowest concentration of ropivacaine but occurred even with placebo. [source] Continuous femoral nerve block after total knee arthroplasty?ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2009L. KADIC Background: A continuous femoral nerve block is frequently used as an adjunct therapy after total knee arthroplasty (TKA). However, there is still debate on its benefits. Methods: In this prospective, randomized study, patients received a basic analgesic regimen of paracetamol and dicloflenac for the first 48 h postoperatively. In addition, the study group received a continuous femoral nerve block. A morphine patient-controlled analgesia pump was also available as a rescue analgesic to all the patients. Patients' numeric rating scores for pain, the amount of morphine consumed and its side effects during the first 48 h were recorded. Knee flexion angles achieved during the first week were registered. Three months postoperatively, patients completed Western Ontario and McMaster Universities Osteoarthritis Index and Knee Society Score. Results: The study group (n=27) had less pain (P=0.0016) during the first 48 h, was more satisfied with the analgesia (P<0.001) and used less morphine (P=0.007) compared with the control group (n=26). Fewer patients were nauseated, vomited or were drowsy in the study group (P=0.001). Also, the study group achieved better knee flexion in the first 6 days after surgery (P=0.001), with more patients reaching 90° flexion than the control group. However, after 3 months, there were no significant functional differences between the groups. Conclusion: A continuous femoral nerve block leads to better analgesia, less morphine consumption and less morphine-related side effects after TKA. Early functional recovery is improved, resulting in more patients reaching 90° knee flexion after 6 days. However, after 3 months, no significant functional benefits were found. [source] Major complications after 400 continuous popliteal sciatic nerve blocks for post-operative analgesiaACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2009V. COMPÈRE Background: A continuous popliteal sciatic nerve block (CPSNB) has been performed with increasing frequency for post-operative analgesia after foot surgery. Major complications associated with the placement of a perineural catheter remain rarely studied. The aim of this study was to prospectively determine the incidence of major complications (neurological and infectious) in post-operative adult patients with a continuous popliteal catheter inserted by the anatomical posterior approach for analgesia after foot surgery. Methods: All popliteal catheters were placed pre-operatively under sterile conditions with the aid of a nerve stimulator technique. The primary outcome measure was the incidence of major complications including infection and neuropathy. As a secondary outcome, adverse effects as well as other complications were also evaluated. Data were expressed as median [25th,75th percentiles]. Results: A total of 400 patients were included in the study during a 2-year period. The median time the catheter remained indwelling was 47 h [23, 54]. Major complications included three events (0.75%) with one infection (0.25%) and two neuropathies (0.50%). Three blocks were unsuccessful and the catheter insertion was difficult in 12 patients (3%). During the CPSNB procedure, one patient reported slight paraesthesia during stimulation. Patient satisfaction was scored at 4 for 89%, 3 for 6% and 2 for 5% on the analogue scale. Conclusions: Major complications after the use of CPSN are not in fact rare. The incidence of severe neuropathy or infection complications is, respectively, 0.50% and 0.25%. However, the insertion of CPSN could be considered effective and is associated with only a few minor complications. [source] Facial and glossal distribution of anaesthesia after inferior alveolar nerve blockJOURNAL OF ORAL REHABILITATION, Issue 2 2003H.-K. Kim summary, The aim of this study was to subjectively determine the distribution of anaesthesia by mapping areas of sensory loss following inferior alveolar nerve block. Fifty healthy dental students were the subjects of this study (men 32, women 18). They were asked to draw the anaesthetized area on a diagram of the face and tongue 20 min after inferior alveolar nerve block. They evaluated the degree of anaesthesia by touching their faces and moving their tongues. All of the 50 subjects reported anaesthesia in the facial area. Of these, 21 (42%) reported the cutaneous distribution of anaesthesia on mental nerve territory only. Seventeen subjects (34%) reported anaesthesia on mental and buccal nerve territory. Nine subjects (18%) reported anaesthesia on mental, buccal, and auriculotemporal nerve territory. Two subjects (4%) reported anaesthesia on mental and auriculotemporal nerve territory and one subject (2%) on mental, buccal and infra-orbital nerve territory. Forty-seven of the 50 subjects (94%) reported anaesthesia of the tongue with the various degree of anaesthesia according to the area. Of these, 17 subjects (34%) reported strong anaesthesia on the anterior area and weak anaesthesia on the middle part of the tongue. Nineteen subjects (38%) reported strong anaesthesia of the lateral area and weak anaesthesia on the medial area, and 11 subjects (22%) reported anaesthesia on only the lateral side of the tongue. Three subjects (6%) reported no anaesthesia of the tongue. The distribution of anaesthesia of the facial and glossal regions determined subjectively after inferior alveolar nerve block, varies significantly between individuals. [source] Ultra-sound guided sciatic nerve block combined with lumbar plexus block for infra-inguinal artery bypass graft surgeryACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2008Y. Asakura No abstract is available for this article. [source] Stimulating or conventional perineural catheters after hallux valgus repair: a double-blind, pharmaco-economic evaluationACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 10 2006A. Casati Background:, We prospectively evaluated direct analgesia-related costs of continuous sciatic nerve block using either a stimulating or conventional catheter after hallux valgus repair. Methods:, The perineural catheter was inserted through a stimulating introducer either blindly (group Conventional, n= 38) or while stimulating via the catheter (group Stimulating, n= 38). Nerve block was induced with 25 ml of mepivacaine 15 mg/ml, and was followed 3 h later by a patient-controlled infusion of ropivacaine 2 mg/ml (basal infusion: 3 ml/h; incremental dose: 5 ml; lock-out time: 30 min). Rescue tramadol [100 mg intravenous (i.v.)] was given if required. Local anesthetic consumption, need for rescue tramadol and post-operative nausea and vomiting (PONV) treatment, and patient's satisfaction were recorded during first 24-h infusion. Cost calculations were based on the acquisition cost of drugs and devices. Results:, Both techniques were similarly effective, but local anesthetic consumption and need for rescue analgesics were lower in the Stimulating group [respectively, 120 vs. 153 ml (P= 0.004) and 21% vs. 60% (P= 0.001)]. The analgesia-related costs for 24 h were similar when 100-ml bags of ropivacaine 2 mg/ml were used (66 , vs. 67 ,; P= 0.26). When 200-ml bags of ropivacaine were used, the analgesia-related costs were higher in the Stimulating group than the Conventional group (75 , vs. 55 ,; P= 0.0005). Conclusions:, Direct costs of continuous sciatic nerve block ranged from 55 to 75 ,. Stimulating catheters reduced local anesthetic consumption and need for rescue analgesics. This was only cost effective when 100-ml bags of 2 mg/ml ropivacaine were used, while the cheapest combination was the use of conventional catheters and 200-ml bags of ropivacaine. [source] Botulinum toxin A for palmar hyperhidrosisJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 6 2001U Wollina Abstract Objective We evaluated the efficacy and safety of intracutaneous injections of botulinum toxin A on severe palmar hyperhidrosis. Methods Ten patients with recalcitrant palmar hyperhidrosis were treated with intercutaneous injections of botulinum toxin A (Botox; 200 U for each hand). Patients were followed up to 23 months (mean ± SD: 12.1 ± 6.2 months). Results Botulinum toxin significantly reduced abnormal sweating within 1 week in 100% of the patients. In six patients with a follow-up of 12 months or more the antisudorific effect lasted 12.3 ± 5.5 months. The longest response duration was 22 months. Repeated treatment was performed in five patients with unchanged clinical efficacy. The only side-effect was tolerable pain from the intracutaneous injections in patients where a nerve block was not performed. Conclusions Botulinum toxin A (200 U Botox per palm) was able to induce long-term remission in palmar hyperhidrosis without significant acute and long-term side-effects. Strictly intracutaneous injection of small volumes is recommended. So far, response to repeated treatments did not show evidence of neutralizing antibody induction. [source] Continuous peripheral nerve block catheter tip adhesion in a rat modelACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 6 2006C. C. Buckenmaier III Background:, Continuous peripheral nerve block (CPNB) has been used effectively in combat casualties from Iraq and Afghanistan to provide surgical anesthesia and extended duration analgesia during evacuation and convalescence. Little information is available concerning catheter tip tissue reaction with prolonged use. Methods:, Forty-eight male Sprague-Dawley rats were assigned (12 per group) to one of four catheter tip designs provided by Arrow International: group A, 20-gauge catheter with three side-holes and a bullet-shaped tip; group B, 19-gauge StimuCathÔ catheter with coiled omni-port end with hemispherical distal tip; group C, 19-gauge catheter with single end-hole in conducting tip; group D, 19-gauge catheter with closed conducting tip with four side-holes. Following laparotomy, a randomly assigned catheter tip was sutured to the parietal peritoneal wall with the tip extending between experimental injuries created on the abdominal wall and cecum. After 7 days in situ, the catheter tips were removed from the adhesion mass using a force gauge, and the grams of force needed for removal were recorded. Results:, The mean force ± standard deviation values were 1.09 ± 1.21 g for group A, 21.20 ± 30.15 g for group B, 0.88 ± 1.47 g for group C and 1.60 ± 2.50 g for group D. The variation of each catheter group mean force compared with that of group B was significant (P < 0.05). There was no significant difference in adhesion force between groups A, C and D. Conclusions:, These results suggest that the manufactured design of a CPNB catheter tip can contribute to the adhesion of the tip in an intense inflammatory environment. This finding may have important clinical implications for CPNB catheters left in place for extended periods of time. [source] Effect of needle insertion site on ilioinguinal-iliohypogastric nerve block in childrenACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2006P. Kundra Background:, Three different sites of needle insertion have been proposed for ilioinguinal-iliohypogastric (ILIH) nerve block. This double-blind study was designed to assess the quality of analgesia produced from these different sites. Methods:, One hundred and thirty-two children of ASA grade I and II were randomly allocated into four groups to receive no nerve block (control group, n = 30) or ILIH block at 1 cm inferio-medial to the anterior superior iliac spine (ASIS) in group IM (n = 34), 1,2 cm medial to the ASIS in group M (n = 34) and 2 cm superio-medial to the ASIS in group SM (n = 34) with 0.25 ml/kg of 0.25% bupivacaine after induction of anaesthesia. Pain was assessed using the All India Institute of Medical Sciences (AIIMS) pain discomfort scale (APDS) score. The amount and pattern of fentanyl consumed over the ensuing 24-h period was noted. Results:, APDS score and fentanyl requirement were similar in all the study groups but significantly higher until 8 h after surgery in the control group, P < 0.05. Twenty-two out of 102 children in the study groups and all patients in the control group received additional fentanyl during the post-operative period. Only 6 out of 22 children required additional fentanyl supplementation beyond the 30-min interval. Overall failure rate of ILIH nerve block was 6%. Conclusion:, ILIH block can be successfully accomplished from any point if the needle bevel lies between the two muscle planes above and below the internal oblique. [source] Dextrose 5% in water: fluid medium for maintaining electrical stimulation of peripheral nerves during stimulating catheter placementACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 10 2005B. C. H. Tsui It is well documented that a higher electrical current is required to elicit a motor response following a normal saline (NS) injection during the placement of stimulating catheters for peripheral nerve block. We present three cases of continuous brachial plexus catheter placement in which Dextrose 5% in water (D5W) was used to dilate the perineural space instead of NS. Three brachial plexus blocks (two interscalene and one axillary) were performed in three different patients for pain relief. In each case, an insulated needle was advanced towards the brachial plexus. A corresponding motor response was elicited with a current less than 0.5 mA after needle repositioning. A stimulating catheter was advanced with ease after 3,5 ml of D5W was injected to dilate the perineural space. A corresponding motor response was maintained when the current applied to the stimulating catheter was less than 0.5 mA. Local anesthetic was then injected and the motor response immediately ceased. All blocks were successful and provided excellent pain relief with the continuous infusion of local anesthetics. [source] Anterior sciatic nerve block , new landmarks and clinical experienceACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2005M. Wiegel Background: Anterior sciatic nerve blocks can be complicated by several problems. Pain can be caused by bony contacts and, in obese patients, identification of the landmarks is frequently difficult. Methods: In a first step, 100 normal anterior-posterior pelvic X-rays were analyzed. The landmarks of the classical anterior approach were drawn on these X-rays and assessed for their sufficiency. Then, in a prospective case study, 200 consecutive patients undergoing total knee replacement were investigated. These patients received femoral and sciatic nerve catheters for postoperative pain management. Using modified anatomical landmarks, sciatic nerve catheters were inserted 5 cm distal from the insertion site of the femoral nerve block perpendicularly in the midline of the lower extremity. This midline connected the insertion site of the femoral nerve catheter to the midpoint between the medial and lateral epicondyle. Correct catheter positioning was verified by magnetic resonance imaging (MRI) in six patients. Results: Evaluation of pelvic X-rays showed that puncture following the classical landmarks pointed in 51% at the lesser trochanter, in 5% medial to the lesser trochanter and in 42% directly at the femur. In the latter patients, location of the sciatic nerve would have been difficult or even impossible. Using our modified anterior approach, the sciatic nerve could be blocked in 196 patients (98%). In nine patients (4.5%) blockade of the posterior femoral cutaneous nerve failed. Vascular puncture happened in 10 (5%) and bony contact in 35 patients (17.5%). Median puncturing depth was 9.5 (7.5,14) cm. Correct sciatic nerve catheter positioning was verified in all patients who underwent MRI. Conclusion: Our landmarks for locating the sciatic nerve help to avoid bony contacts and thereby reduce pain during puncture. Our method reliably enabled catheter placement. [source] Tetrodotoxin-induced conduction blockade is prolonged by hyaluronic acid with and without bupivacaineACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2004M. F. Stevens Background:, In isolated nerves, tetrodotoxin (TTX) blocks nerve conduction longer than bupivacaine. In vivo, however, both substances block nerve conduction to an equal duration, presumably because the hydrophilic TTX binds only weakly to the perineural tissue. High molecular weight hyaluronic acid (HA) prolongs the action of local anaesthetics several-fold. We tested whether admixture of HA enhances the binding of TTX to the perineural tissue and thus induces an ultralong conduction block after a single application. Methods:, In 12 anaesthetized rabbits, the minimal blocking concentrations of TTX, TTX and HA (TTX/HA) and bupivacaine with HA (bupivacaine/HA) were determined by blocking the natural spike activity of the aortic nerve. In 18 other animals, equipotent concentrations of either TTX, TTX/HA or TTX/bupivacaine/HA were applied topically to the aortic nerve. After disappearance of the spike activity, the wound was closed to simulate the clinical situation of a single shot nerve block. The time until recovery of spike activity was determined. The nerves were examined for signs of neurotoxicity 24 h after the application of the drugs. Data are presented as means ± SD and compared by ANOVA and Student's t -test for unpaired data. Results:, The conduction block by TTX/bupivacaine/HA (10.1 ± 1.9 h) or TTX/HA (9.3 ± 1.0 h) was significantly longer than that of plain TTX (7.9 ± 1.0 h). Neurotoxicity was not observed. Conclusions:, Both HA and HA/bupivacaine prolong the TTX-induced conduction blockade of the aortic nerve of rabbits in vivo. No signs of neurotoxicity were observed. [source] Transient locked-in syndrome resulting from stellate ganglion block in the treatment of patients with sudden hearing lossACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2003M. Tüz Stellate ganglion blockage (SGB) is a local anesthetic procedure intended to block the lower cervical and upper thoracic sympathetic chain and is one of the treatment modalities for a wide range of disorders such as sudden hearing loss, Menier's disease, stroke, sudden blindness, shoulder/hand syndrome and vascular headache. The complications of SGB are recurrent laryngeal or phrenic nerve block, pneumothorax, unconsciousness, respiratory paralysis, convulsions and sometimes severe arterial hypotension. We present a case with transient locked-in syndrome following SGB for the management of sudden hearing loss. The risk of an intra-arterial injection can be eliminated by rotating the needle, as is described in this report. [source] Voiding reflex in chronic spinal cord injured cats induced by stimulating and blocking pudendal nerves,,NEUROUROLOGY AND URODYNAMICS, Issue 6 2007Changfeng Tai Abstract Aims To induce efficient voiding in chronic spinal cord injured (SCI) cats. Methods Voiding reflexes induced by bladder distension or by electrical stimulation and block of pudendal nerves were investigated in chronic SCI cats under ,-chloralose anesthesia. Results The voiding efficiency in chronic SCI cats induced by bladder distension was very poor compared to that in spinal intact cats (7.3,±,0.9% vs. 93.6,±,2.0%, P,<,0.05). In chronic SCI cats continuous stimulation of the pudendal nerve on one side at 20 Hz induced large amplitude bladder contractions, but failed to induce voiding. However, continuous pudendal nerve stimulation (20 Hz) combined with high-frequency (10 kHz) distal blockade of the ipsilateral pudendal nerve elicited efficient (73.2,±,10.7%) voiding. Blocking the pudendal nerves bilaterally produced voiding efficiency (82.5,±,4.8%) comparable to the efficiency during voidings induced by bladder distension in spinal intact cats, indicating that the external urethral sphincter (EUS) contraction was caused not only by direct activation of the pudendal efferent fibers, but also by spinal reflex activation of the EUS through the contralateral pudendal nerve. The maximal bladder pressure and average flow rate induced by stimulation and bilateral pudendal nerve block in chronic SCI cats were also comparable to those in spinal intact cats. Conclusions This study shows that after the spinal cord is chronically isolated from the pontine micturition center, bladder distension evokes a transient, inefficient voiding reflex, whereas stimulation of somatic afferent fibers evokes a strong, long duration, spinal bladder reflex that elicits efficient voiding when combined with blockade of somatic efferent fibers in the pudendal nerves. Neurourol. Urodynam. 26:879,886, 2007. © 2007 Wiley-Liss, Inc. [source] Inexpensive Phantom for Fluoroscopy Guided Nerve Block Training,PAIN MEDICINE, Issue 7 2008Satoki Inoue MD ABSTRACT Objective., Regional anesthesia simulation manikins with phantom skeletal structures are commercially available. Unfortunately, they are quite expensive. This article introduces our handmade, low cost, phantom for training of nerve block with fluoroscopic guidance. Materials., The phantom consisted of artificial bone models to resemble human lumbar vertebrae with disks, covered with 5,7 sheets of self-adhesive sponge. Posteriorly, mobility between sheets was retained in order to deflect needles and provide practice of redirecting needles. Conclusions., Although it might lack radiographic fidelity, our inexpensive phantom can be used for basic training of nerve block with fluoroscopic guidance. [source] A Retrospective Study of the Incidence of Neurological Injury after Axillary Brachial Plexus BlockPAIN PRACTICE, Issue 2 2006B. Ben-David MD Abstract Background: It has been suggested that performing a nerve block under general anesthesia, as customary in pediatric population, may predispose to nerve injury. However, few clinical data exist to either support or refute this assertion. Methods: We retrospectively reviewed data on all patients who received an axillary block for upper extremity surgery in our institution during an eight-year period. The blocks were performed under sedation or general anesthesia, without using a nerve stimulator. Perioperative records from the Hand Surgery Unit Clinic were reviewed for postoperative complaints and complications. Results: In the eight-year period of the review, 336 patients had axillary block. In total, 230 received the block with sedation and 106 during general anesthesia. All the sedated patients were older than 14 years (mean age 45.2), while of the general anesthesia patients 48 were older than 14 years (mean age 13.9 years). There were six cases of postoperative nerve injury in sedated patients (2.6%) vs. eight cases (7.5%) in the general anesthesia patients. Most patients recovered fully within several weeks. One patient had permanent nerve injury. Conclusions: Definitive conclusions cannot be drawn because of disparities in patient group demographics (majority of pediatric patients were in the general anesthesia group) and the retrospective nature of this study. Nevertheless, the findings suggest that the conduct of axillary block under general anesthesia in pediatric patients holds a greater potential for nerve injury than when the block is performed under sedation in adults. [source] Does intraarticular morphine improve pain control with femoral nerve block after anterior cruciate ligament reconstruction? (Vanderbilt University Medical Center, Nashville, TN) American Journal of Sports Medicine 2001;29:327,332.PAIN PRACTICE, Issue 4 2001Eric C. McCarthy In a prospective, randomized, double-blinded manner, the authors of this study compared the effects of a preoperative intraarticular injection of morphine (5 mg) or a placebo, combined with a postoperative femoral nerve block, on postoperative pain. Sixty-two patients underwent an arthroscopically assisted anterior cruciate ligament reconstruction using patellar tendon autograft under general anesthesia. No statistical difference between the 2 groups was evident in terms of age, sex, weight, operative time, volume of bupivacaine received with the femoral nerve block, or tourniquet use or tourniquet time. A comparison of the visual analog pain scale scores revealed no statistical difference between the groups at any point after the operation. Both groups had a significant decrease in visual analog scale scores after the femoral nerve block. No significant difference in postoperative narcotic medication use was evident in the recovery room or at home. A post hoc analysis revealed that the study power reached 87% with a significance level of 5%. Conclude that the postoperative femoral nerve block was effective and intraarticular morphine provided no additional benefit. Comment by Alan David Kaye, M.D., Ph.D., and Erin Bayer, M.D. This prospective, randomized, double blinded study compared the effects of preoperative intraarticular injection of morphine or a placebo along with postoperative femoral "three-in-one" block on postoperative pain. 62 patients underwent arthroscopic ACL reconstruction under general anesthesia. After induction of anesthesia, patients were injected with either morphine 5 mg or placebo along with local anesthetics intraarticularly. Femoral nerve blocks were performed in the recovery room with a total of 3 mg/kg bupivacaine. The VAS of pain was assessed immediately postoperatively and at six time points afterward up to 24 hours. This study concluded that there were no statistical differences between the two groups comparing VAS. Also no significant difference was observed in postoperative narcotic use in the recovery room or at home. The study included antiemetics; however, the results did not include if the morphine group had a larger incidence of nausea or vomiting postoperatively. Finally, the authors suggest that there are no advantages to use of intraarticular morphine with a femoral nerve block post-operatively. A future study employing preoperative femoral nerve block with or without use of intraarticular morphine might be interesting to see on arthroscopic ACL repairs to obtain adequate analgesia as the authors suggested. [source] | |||||||||||||||||||||||||||||||