76
|
Cappellino A, Jokl P, Ruwe PA. Regional anesthesia in knee arthroscopy: a new technique involving femoral and sciatic nerve blocks in knee arthroscopy. Arthroscopy 1996; 12:120-3. [PMID: 8838743 DOI: 10.1016/s0749-8063(96)90233-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
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.
Collapse
|
77
|
|
78
|
|
79
|
Kopacz DJ. A simple model to teach three basic regional anesthesia principles. Anesth Analg 1995; 81:167-9. [PMID: 7598248 DOI: 10.1097/00000539-199507000-00033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
|
80
|
Skjellerup N. Respiratory monitoring for regional anaesthesia. Anaesthesia 1994; 49:1097. [PMID: 7864334 DOI: 10.1111/j.1365-2044.1994.tb04369.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
|
81
|
Pippa P, Rucci FS. Preferential channelling of anaesthetic solution injected within the perivascular axillary sheath. Eur J Anaesthesiol 1994; 11:391-6. [PMID: 7988583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Preferential channelling of anaesthetic solution injected into the perivascular axillary sheath was investigated in 40 patients undergoing elective orthopaedic upper-limb surgery. Three needles, with different approaches and inclinations, were inserted near the three main terminal branches of the brachial plexus using an axillary approach. Separate boluses of anaesthetic solution (12 ml of a mixture of equal parts of 0.5% bupivacaine with 1:200,000 adrenaline and 2% lignocaine) were injected in random order through each needle, and back flow through the other two needles was noted. Back flow was observed, mainly in the needle nearest to the radial nerve during injection of the anaesthetic solution in the superior and inferior aspects of the brachial artery, and in the needle close to the ulnar nerve when the injection was performed posterior to the artery, near the radial nerve. These results could be related to the trapping of anaesthetic solution in unconnected compartments and to the slope of the needle injecting the anaesthetic solution which spreads preferentially along a gradient following the needle shaft direction.
Collapse
|
82
|
|
83
|
Wagner DL. A simple and effective depth marker for regional block. REGIONAL ANESTHESIA 1994; 19:294-295. [PMID: 7947436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
|
84
|
Domanskiĭ VL. [Electric nerve stimulation devices in anesthesiology: research and development]. MEDITSINSKAIA TEKHNIKA 1994:14-20. [PMID: 7799747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
|
85
|
Weeks L, Barry A, Wolff T, Firrell J, Scheker L. Regional anaesthesia and subsequent long-term pain. JOURNAL OF HAND SURGERY (EDINBURGH, SCOTLAND) 1994; 19:342-6. [PMID: 8077825 DOI: 10.1016/0266-7681(94)90086-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The incidence of long-term pain (between 1 and 48 weeks and at 2 year follow-up) unrelated to the surgical site following either regional brachial plexus or general anaesthesia was determined. In 834 patients with regional anaesthesia, the incidence (11.1%) was significantly higher than in the 86 patients with general anaesthesia (3.6%; P = 0.03). The incidence of pain was not significantly different among four common techniques of positioning the needle tip in the axillary sheath (9.9 to 11.1%). Parascalene blocks had a slightly but not significantly higher rate (16.3%). A regional re-block was not associated with a higher incidence when compared to those blocked only once. A more distal local re-block was associated with a higher incidence of pain (23%). 2 years post-operatively, 0.5% of patients had pain related to the regional block. A significant proportion of patients developed some long-lasting post-operative pain following regional brachial plexus anaesthesia, although ultimate morbidity was minimal.
Collapse
|
86
|
Iwama H, Tase C, Kawamae K, Akama Y, Okuaki A. Catheter location and patient position affect spread of interpleural regional analgesia. Anesthesiology 1993; 79:1153-4. [PMID: 8239003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
|
87
|
Gilbertson L, Datta S. Regional anesthesia and analgesia in obstetrics. Curr Opin Obstet Gynecol 1993; 5:652-6. [PMID: 8241442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Regional analgesia and anesthesia for obstetrical patients are undergoing revolutionary changes which will, ultimately, benefit parturients and neonates. These changes have taken place in the arena of techniques, equipment, as well as in medications. This review will cover the management techniques both for vaginal delivery and cesarean section.
Collapse
MESH Headings
- Analgesia, Obstetrical/adverse effects
- Analgesia, Obstetrical/instrumentation
- Analgesia, Obstetrical/methods
- Analgesia, Obstetrical/trends
- Anesthesia, Conduction/adverse effects
- Anesthesia, Conduction/instrumentation
- Anesthesia, Conduction/methods
- Anesthesia, Conduction/trends
- Anesthesia, Obstetrical/adverse effects
- Anesthesia, Obstetrical/instrumentation
- Anesthesia, Obstetrical/methods
- Anesthesia, Obstetrical/trends
- Cesarean Section
- Delivery, Obstetric/methods
- Female
- Humans
- Hypotension/prevention & control
- Obstetric Labor Complications/prevention & control
- Pain/prevention & control
- Pneumonia, Aspiration/epidemiology
- Pneumonia, Aspiration/prevention & control
- Pregnancy
- Risk Factors
Collapse
|
88
|
Abstract
The role of anaesthetists in providing local anaesthesia for intraocular surgery has changed over the past decade. No longer confined to the interested few, more and more anaesthetists are involved in monitored care and/or are performing eye block anaesthesia. This review summarizes the information related to eye block anaesthesia. The salient features of the orbital anatomy important for safe conduct of eye block anaesthesia are described. The techniques for retrobulbar and peribulbar anaesthesia, including facial nerve blocks, anaesthetic mixture, types of needles, and softening the eye are presented. Complications such as retrobulbar haemorrhage, globe penetration/perforation, visual impairment, brainstem anaesthesia, muscle injury, and oculocardiac reflex are explored. The implications of anticoagulant therapy are examined. The choice between retrobulbar and peribulbar blocks and the role of anaesthetists are discussed.
Collapse
|
89
|
Berry CB, Murphy PM. Regional anaesthesia for cataract surgery. Br J Hosp Med (Lond) 1993; 49:689, 692-701. [PMID: 8324590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Growing waiting lists and pressure on inpatient resources promote the need for cataract surgery to be undertaken on a day surgery basis. Retrobulbar and peribulbar anaesthesia are well suited for cataract surgery and are easily performed by both anaesthesists and ophthalmologists. This article reviews the methods, efficacy and safety of these techniques.
Collapse
|
90
|
|
91
|
|
92
|
Rice AS, McMahon SB. Peripheral nerve injury caused by injection needles used in regional anaesthesia: influence of bevel configuration, studied in a rat model. Br J Anaesth 1992; 69:433-8. [PMID: 1467070 DOI: 10.1093/bja/69.5.433] [Citation(s) in RCA: 117] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
We have studied the immediate and long term (up to 28 days) effects of short and long bevelled needle impalement of the rat sciatic nerve. Three techniques were used to assess neural trauma and its consequences: stained longitudinal nerve sections were assessed by light microscopy and scored for injury; the extravasation of Evan's Blue dye, after antidromic electrical nerve stimulation, was used as a test of unmyelinated fibre function; the flexion withdrawal times from a noxious stimulus were measured. The results of all three experiments suggested that, should a nerve fascicle become accidentally impaled during regional anaesthesia, the lesions induced by short bevelled needles are more severe, more frequent and take longer to repair than those induced by long bevelled needles. Nerve injury induced by short bevelled needles was associated with persisting signs of injury 28 days after the injury. These results suggest that the current practice of using short bevelled needles to prevent nerve injury complicating regional anaesthesia be reassessed.
Collapse
|
93
|
Read MS. Insulated regional block needles. Br J Anaesth 1992; 69:423-4. [PMID: 1419462 DOI: 10.1093/bja/69.4.423-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
|
94
|
Friedl W, Fritz T. [Ultrasound assisted brachial plexus anesthesia]. Chirurg 1992; 63:759-60. [PMID: 1395881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Plexus brachialis anaesthesia is a common technique for hand and forearm surgery. If the distance between puncture site and plexus brachialis is to long the anaesthesia will be incomplete. If there happens a direct puncture and injection of anaesthetics in the nerves, neurological deficit can occur. Intravascular injection causes cardial complications. This problems can occur mainly in obese patients in whom the brachial artery cannot be identified well by clinical examination. In these patients we perform the plexus brachialis anaesthesia under sonographical control. For the examination we use a linear 7.5-MHz transducer. The technique is presented.
Collapse
|
95
|
Rudenko MI, Pas'ko VG. [Anesthesia of the cervical plexus in surgical interventions on the neck and its organs]. VOENNO-MEDITSINSKII ZHURNAL 1992:31-3. [PMID: 1455773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The author proposes a new method for anesthesia of neck plexus, which is seen to be more safe, has reliable points of reference, and is administered by "one-touch" injection. The article gives a description of this method, results of its clinical application, indications and counter-indications. The anesthesia of neck plexus was applied on 71 patients. No complications were marked. This method makes it possible to produce an adequate anesthesia in vast operations on neck and its organs.
Collapse
|
96
|
Jones RP, De Jonge M, Smith BE. Voltage fields surrounding needles used in regional anaesthesia. Br J Anaesth 1992; 68:515-8. [PMID: 1642942 DOI: 10.1093/bja/68.5.515] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Using a bench model, we have studied the voltage fields surrounding both insulated and uninsulated needles used in regional anaesthesia. The findings were compared with earlier computer predictions which suggested that the fields would be markedly different for the two types of needle. The results confirm that the fields differ markedly and suggest that the use of insulated needles may not necessarily improve the accuracy of nerve location and that uninsulated needles may be more appropriate.
Collapse
|
97
|
Blomfield D, Futter M. Using a peripheral nerve stimulator as a nerve locator. Anaesth Intensive Care 1991; 19:608. [PMID: 1750652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
98
|
Goodison R. Sprotte spinal needle. Anaesth Intensive Care 1991; 19:477. [PMID: 1767931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
99
|
März P. [In electric nerve stimulation can the distance from the nerves be inferred from the intensity of muscle contraction? Possible parameters and sources of error]. REGIONAL-ANAESTHESIE 1990; 13:179-85. [PMID: 2236716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Electrical nerve stimulation is a useful tool in regional anesthesia; it assists in locating the nerves. This investigation deals with electrical resistances at adhesive electrodes attached to the skin. The influence of external electrical resistance on the stimulating impulse is demonstrated. A new type of nerve stimulator is described; which integrates a measuring device that indicates the electrical impulse actually flowing in the patient. With this device, relationships between stimulating impulse, intensity of muscle contraction, and distance of the puncture cannula from the nerve can be assessed. MATERIALS AND METHODS. The electrical curve I = f (R) was determined using 3 different nerve stimulators (R = 1 - 15k omega). On each of five test persons, five adhesive electrodes were attached to the skin 10 cm apart. The resistance was assessed between these electrodes and a subcutaneously inserted puncture needle. The right and left brachial plexuses of the 5 subjects were punctured, using the axillary approach. A synchronized video camera simultaneously recorded the following values: (1) electrical impulse; (2) corresponding muscle contraction; and (3) the position of the puncture cannula. A scale ranging from 0-5 was applied to define the strength of the muscle contractions. RESULTS. The external resistance as measured under clinical conditions may limit the output impulse of nerve stimulators. In this case, the exerting impulse is lower than that indicated by the appliance. This error can only be identified using an impulse-measuring device. Nerve stimulators not equipped with a measuring device increase the risk of malpuncture, potentially resulting in nerve lesions. Skin resistance at adhesive electrodes varied from patient to patient within a range of 1.1 to 8.2 K omega. Preparing the skin appropriately (wiping with sandpaper) decreased the resistance by only 6% during the first 30 min. Within a distance of 50 cm to the puncture needle, the position of the adhesive electrode did not play a significant role. Axillary puncture of the brachial plexus resulted in the following values: (1) A stimulating impulse (cross-wave) of 1 mA and 1 ms exerted at a distance of 4 mm to the nerve induced a contraction of strength 3. (2) Reducing the impulse at this site by one-half (0.55 mA) resulted in just-visible contractions (strength 1). (3) Advancing the cannula at a stimulating impulse of 0.55 mA inside the neurovascular sheath again produced contractions of strength 3. (4) Performing the puncture with a blunt needle and tracing a distinct resistance, the impulse of 0.6 mA elicited contractions of strength 2. The needle tip was still outside the vascular nerve sheath. If this resistance was overcome and the needle tip lay inside the neurovascular sheath, the impulse could be reduced by one-half (0.32 mA) to produce contractions of strength 2.
Collapse
|
100
|
Kaiser H, Niesel HC, Hans V. [Fundamentals and requirements of peripheral electric nerve stimulation. A contribution to the improvement of safety standards in regional anesthesia]. REGIONAL-ANAESTHESIE 1990; 13:143-7. [PMID: 2236709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The use of a nerve stimulator allows an injection cannula to be located without the cooperation of the patient. Regional anesthesia thus becomes safer because the basic condition "no paresthesia, no anesthesia" becomes irrelevant. In accordance with the basic electrophysiological conditions, a stimulator should have the following properties: (1) adjustable constant current at resistances of 0.5-10 kOhm; (2) monophasic square-wave initial impulse; (3) impulse duration selectable (0.1 ms + 1 ms, and exactly adjustable; (4) impulse amplitude (0-5 mA) exactly adjusted, unequivocal scale graduation or current indicator, in particular in the range of 0.05-1.0 mA; (5) impulse frequency 1-2 (-3) Hz; (6) alarm at high impedance and check on electrical circuit; (7) battery test (indication of battery voltage); (8) unequivocal assignment of load end; (9) high-quality connecting cable and plug; and availability of (10) instructions for use with relevant parameters (tolerated variations, steady-state characteristic curves, etc.).
Collapse
|