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Nielsen, Thomas Dahl, Bernhard Moriggl, Jeppe Barckman, Jan Mick Jensen, Jens Aage Kolsen-Petersen, Kjeld Søballe, Jens Børglum, and Thomas Fichtner Bendtsen. "Randomized trial of ultrasound-guided superior cluneal nerve block." Regional Anesthesia & Pain Medicine 44, no. 8 (May 6, 2019): 772–80. http://dx.doi.org/10.1136/rapm-2018-100174.
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Background and objectivesThe superior cluneal nerves originate from the dorsal rami of primarily the upper lumbar spinal nerves. The nerves cross the iliac spine to innervate the skin and subcutaneous tissue over the gluteal region. The nerves extend as far as the greater trochanter and the area of innervation may overlap anterolaterally with the iliohypogastric and the lateral femoral cutaneous (LFC) nerves. A selective ultrasound-guided nerve block technique of the superior cluneal nerves does not exist. A reliable nerve block technique may have application in the management of postoperative pain after hip surgery as well as other clinical conditions, for example, chronic lower back pain. In the present study, the primary aim was to describe a novel ultrasound-guided superior cluneal nerve block technique and to map the area of cutaneous anesthesia and its coverage of the hip surgery incisions.MethodsThe study was carried out as two separate investigations. First, dissection of 12 cadaver sides was conducted in order to test a novel superior cluneal nerve block technique. Second, this nerve block technique was applied in a randomized trial of 20 healthy volunteers. Initially, the LFC, the subcostal and the iliohypogastric nerves were blocked bilaterally. A transversalis fascia plane (TFP) block technique was used to block the iliohypogastric nerve. Subsequently, randomized, blinded superior cluneal nerve blocks were conducted with active block on one side and placebo block contralaterally.ResultsSuccessful anesthesia after the superior cluneal nerve block was achieved in 18 of 20 active sides (90%). The area of anesthesia after all successful superior cluneal nerve blocks was adjacent and posterior to the area anesthetized by the combined TFP and subcostal nerve blocks. The addition of the superior cluneal nerve block significantly increased the anesthetic coverage of the various types of hip surgery incisions.ConclusionThe novel ultrasound-guided nerve block technique reliably anesthetizes the superior cluneal nerves. It anesthetizes the skin posterior to the area innervated by the iliohypogastric and subcostal nerves. It improves the anesthetic coverage of incisions used for hip surgery. Among potential indications, this new nerve block may improve postoperative analgesia after hip surgery and may be useful as a diagnostic block for various chronic pain conditions. Clinical trials are mandated.Trial registration numberEudraCT, 2016-004541-82.
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SATOH, Yutaka. "Ultrasound-Guided Nerve Blocks (2)Practice of Lower Extremity Nerve Blocks - I : Lumbar Plexus Block, Femoral Nerve Block, Obturator Nerve Block, Fascia Iliaca Compartment Block." JOURNAL OF JAPAN SOCIETY FOR CLINICAL ANESTHESIA 33, no. 4 (2013): 598–605. http://dx.doi.org/10.2199/jjsca.33.598.
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Bigeleisen, Paul E. "Nerve Puncture and Apparent Intraneural Injection during Ultrasound-guided Axillary Block Does Not Invariably Result in Neurologic Injury." Anesthesiology 105, no. 4 (October 1, 2006): 779–83. http://dx.doi.org/10.1097/00000542-200610000-00024.
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Background Nerve puncture by the block needle and intraneural injection of local anesthetic are thought to be major risk factors leading to neurologic injury after peripheral nerve blocks. In this study, the author sought to determine the needle-nerve relation and location of the injectate during ultrasound-guided axillary plexus block. Methods Using ultrasound-guided axillary plexus block (10-MHz linear transducer, SonoSite, Bothel, WA; 22-gauge B-bevel needle, Becton Dickinson, Franklin Parks, NJ), the incidence of apparent nerve puncture and intraneural injection of local anesthetic was prospectively studied in 26 patients. To determine the onset, success rate, and any residual neurologic deficit, qualitative sensory and quantitative motor testing were performed before and 5 and 20 min after block placement. At a follow-up 6 months after the blocks, the patients were examined for any neurologic deficit. Results Twenty-two of 26 patients had nerve puncture of at least one nerve, and 21 of 26 patients had intraneural injection of at least one nerve. In the entire cohort, 72 of a total of 104 nerves had intraneural injection. Sensory and motor testing before and 6 months after the nerve injections were unchanged. Conclusions Under the conditions of this study, puncturing of the peripheral nerves and apparent intraneural injection during axillary plexus block did not lead to a neurologic injury.
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Lee, Kevin, Michael J. Herr, and Jerry W. Jones. "Safety and Efficacy of Rescue Nerve Blocks." Journal of Clinical and Biomedical Investigation 2, no. 1 (March 3, 2022): 9–14. http://dx.doi.org/10.52916/jcbi224012.
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Background: The overall incidence of complications following peripheral nerve blocks is very low. Peripheral nerve blocks performed under ultrasound guidance are widely thought to present a lower risk to direct needle trauma than paresthesia and nerve stimulation techniques and have been shown to decrease opioid consumption by providing analgesia directly to the site of injury. Currently, when a nerve block fails altogether or provides inadequate analgesia, pain and opioid consumption increases which in turn decrease patient satisfaction and increases healthcare costs. Concerns remain whether the benefits of opioid reduction outweigh the risk of inadvertent needle trauma and other potential complications when performing a nerve block replacement, or ‘rescue block’. Objective: Examine whether performing a rescue peripheral nerve block provides adequate analgesia to elicit a decrease in opioid consumption. Analyze the incidence of nerve injury following ultrasound-guided ‘rescue’ continuous peripheral nerve blocks. Methods: Data was retrospectively collected from patient electronic medical records from a Level 1 academic Trauma Center at Regional One Hospital in Memphis, Tennessee from March 1, 2019 to May 31 2021. Inclusion criteria was patients over 18 years of age at time of admission who received consecutive continuous peripheral nerve blocks in the same relative location during a time when the peripheral nerves were likely partially or fully anesthetized (a rescue block). The primary outcomes assessed were 24-hour opioid consumption prior to the initial continuous nerve block, just prior to and after the ‘rescue’ block. Adverse outcomes potentially due to performing a ‘rescue’ block were also examined, including direct needle trauma, nerve injury related to extended exposure to local anesthetics, and local anesthetic systemic toxicity. Types of nerve blocks performed, range and median number of catheter days, and reason for rescue block was recorded for all patients. All available electronic healthcare records were reviewed to identify potential injury. Nerve blocks were categorized into low and high risk for direct needle trauma based on the incidence of needle trauma found in the literature and whether the needle was required to be adjacent to a discrete nerve or nerve bundle in order to perform the procedure. Results: 55 patients were examined. Of the 55 patients, 5 had multiple locations both blocked and rescued, bringing the total rescue procedures examined up to 60. Additionally, 10 patients had their rescue site re-blocked multiple times due to either multiple surgeries, displacements, or duration of analgesia required bringing the total number of rescue blocks performed to 74. Patients that received an initial continuous peripheral nerve block consumed significantly fewer opioids during the 24 hour period following the block than the 24-hour period before the block was performed (P=0.033). Continuous peripheral nerve blocks (CNPB) were replaced or ‘rescued’ for two general reasons: Failed or Inadequate Analgesia (21) and to Extend the Utilization of adequately functioning infusions (35). Once a rescue nerve block was performed, there was no significant change in opioid consumption than after the original block (P=0.64). Of the 60 rescue blocks that were recorded, there were 0 adverse outcomes that were attributed to the rescue block procedure. Conclusion: Following failed CPNB or when performed to extend the utilization of CPNB infusions, ultrasound-guided ’rescue’ nerve blocks result in reduced opioid consumption to a similar level as the initial peripheral nerve block, and do not result in an increase in the incidence direct needle trauma. Given the relatively low incidence of needle trauma and other nerve block-related complications, larger studies are needed to confirm these initial findings, however, ultrasound provides numerous clinical strategies that can be employed that may reduce the incidence of direct needle trauma compared with traditional nerve localization techniques.
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Lee, Kevin, Michael J. Herr, and Jerry Jones. "Safety and Efficacy of Rescue Nerve Blocks." Research and Practice in Anesthesiology – Open Journal 6, no. 1 (December 30, 2022): 8–14. http://dx.doi.org/10.17140/rpaoj-6-132.
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Background: The overall incidence of complications following peripheral nerve blocks is very low. Peripheral nerve blocks performed under ultrasound guidance are widely thought to present a lower risk to direct needle trauma than paresthesia and nerve stimulation techniques and have been shown to decrease opioid consumption by providing analgesia directly to the site of injury. Currently, when a nerve block fails altogether or provides inadequate analgesia, pain and opioid consumption increases which in turn decrease patient satisfaction and increases healthcare costs. Concerns remain whether the benefits of opioid reduction outweigh the risk of inadvertent needle trauma and other potential complications when performing a nerve block replacement, or ‘rescue block’. Objective: Examine whether performing a rescue peripheral nerve block provides adequate analgesia to elicit a decrease in opioid consumption. Analyze the incidence of nerve injury following ultrasound-guided ‘rescue’ continuous peripheral nerve blocks. Methods: Data was retrospectively collected from patient electronic medical records from a Level 1 academic Trauma Center at Regional One Hospital in Memphis, Tennessee from March 1, 2019 to May 31 2021. Inclusion criteria was patients over 18-years of age at time of admission who received consecutive continuous peripheral nerve blocks in the same relative location during a time when the peripheral nerves were likely partially or fully anesthetized (a rescue block). The primary outcomes assessed were 24-hour opioid consumption prior to the initial continuous nerve block, just prior to and after the ‘rescue’ block. Adverse outcomes potentially due to performing a ‘rescue’ block were also examined, including direct needle trauma, nerve injury related to extended exposure to local anesthetics, and local anesthetic systemic toxicity. Types of nerve blocks performed, range and median number of catheter days, and reason for rescue block was recorded for all patients. All available electronic healthcare records were reviewed to identify potential injury. Nerve blocks were categorized into low and high-risk for direct needle trauma based on the incidence of needle trauma found in the literature and whether the needle was required to be adjacent to a discrete nerve or nerve bundle in order to perform the procedure. Results: Fifty-five (55) patients were examined. Of the 55 patients, 5 had multiple locations both blocked and rescued, bringing the total rescue procedures examined up to 60. Additionally, 10 patients had their rescue site re-blocked multiple times due to either multiple surgeries, displacements, or duration of analgesia required bringing the total number of rescue blocks performed to 74. Patients that received an initial continuous peripheral nerve block consumed significantly fewer opioids during the 24-hour period following the block than the 24-hour period before the block was performed (p=0.033). Continuous peripheral nerve blocks (CNPB) were replaced or ‘rescued’ for two general reasons: Failed or inadequate analgesia (21) and to extend the utilization of adequately functioning infusions (35). Once a rescue nerve block was performed, there was no significant change in opioid consumption than after the original block (p=0.64). Of the 60 rescue blocks that were recorded, there were 0 adverse outcomes that were attributed to the rescue block procedure. Conclusion: Following failed CPNB or when performed to extend the utilization of CPNB infusions, ultrasound-guided ’rescue’ nerve blocks result in reduced opioid consumption to a similar level as the initial peripheral nerve block, and do not result in an increase in the incidence direct needle trauma. Given the relatively low incidence of needle trauma and other nerve block-related complications, larger studies are needed to confirm these initial findings, however, ultrasound provides numerous clinical strategies that can be employed that may reduce the incidence of direct needle trauma compared with traditional nerve localization techniques.
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Li, Zhengwei, Ling Zhao, Wutao Wang, and Ling Zheng. "Application of Intelligent Ultrasound in Real-Time Monitoring of Postoperative Analgesic Nerve Block." Contrast Media & Molecular Imaging 2021 (December 9, 2021): 1–6. http://dx.doi.org/10.1155/2021/3309382.
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In order to monitor the effect of nerve block in postoperative analgesia more accurately, this paper puts forward the application research of ultrasonic real-time intelligent monitoring of nerve block in postoperative analgesia. Ultrasonic real-time intelligent monitoring of nerve block in upper limb surgery, lower limb surgery, and abdominal surgery combined with the nerve stimulator. The experiments show that there are 5 cases of adverse reactions when the nerve stimulator is only used, but no adverse reactions occur when combined with ultrasound-guided block. Continuous subclavian brachial plexus block with the ultrasound-guided nerve stimulator can clearly see the subclavian brachial plexus and its surrounding tissue structure, the direction of needle insertion in the plane, and the diffusion of narcotic drugs. The average success rate of block was up to 95.2%, which was significantly higher than that of nerve stimulator alone, and the success rate of recatheterization after the first failure was also improved. The average postoperative analgesia satisfaction was 85.6%, the average operation time was only 20 min, and the subclavian artery and pleura were avoided effectively. No pneumothorax and other complications occurred. The average success rate of ultrasound-guided subclavicular brachial plexus block in 1-2-year-old children was 97%, which was much higher than the average success rate of nerve stimulator localization with 63%. Ultrasound-guided nerve block not only directly blocks nerves under visual conditions but also helps to observe the structures around nerves and dynamically observe the diffusion of local anesthetics, which can significantly improve the accuracy and success rate of nerve block and reduce the incidence of complications.
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Jacobs, AM, R. Esper, R. O'Leary, ZM Duda, and W. Yorzyk. "Thermographic evaluation of the autonomic effects of nerve blocks in the foot." Journal of the American Podiatric Medical Association 79, no. 3 (March 1, 1989): 107–15. http://dx.doi.org/10.7547/87507315-79-3-107.
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The authors evaluated regional skin temperatures of the foot following the administration of a variety of local anesthetic nerve blocks with either Xylocaine (lidocaine hydrochloride) or Sensorcaine (bupivacaine hydrochloride). The study was carried out on ten randomized parallel groups of five subjects, each group being tested with one drug and one regional nerve block. The results indicated that both Xylocaine and Sensorcaine, when administered as a posterior tibial block, result in a significantly increased blood flow to the foot. Nerve blockade of the remaining nerves of the foot did not significantly increase the sympatholytic effect obtained by posterior tibial nerve block alone.
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Elbermway, Mahmoud Saeed, Sherif Farouk Elshantory, Rania Magy Aly, and Mostafa Gamale Mahran. "Published- Comparison between supra-scapular nerve block combined with axillary nerve block and interscalene brachial plexus block for postoperative analgesia following shoulder arthroscopy." Anaesthesia, Pain & Intensive Care 26, no. 5 (December 1, 2023): 674–80. http://dx.doi.org/10.35975/apic.v26i5.2026.
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Background & objective: Inter-scalene brachial plexus block (ISB) is the gold standard for postoperative pain management in shoulder surgery. Although, this method has its side-effects and possibly complications. Supra-scapular nerve block and axillary nerve block have also been used in upper limb procedures. We compared ISB with the blockade of supra-scapular and axillary nerves (called shoulder block) for postoperative analgesia after shoulder arthroscopic surgical operation under ultrasound guidance (USG) and nerve stimulators.
Methodology: It was a prospective, randomized, comparative study.
Results: The VAS pain scores at different times postoperatively were not significantly different between the ISB and ShB groups (P = t 0.071, 0.28, 0.378, 0.358, 0.451 at 2, 4, 8, 16, and 24 h respectively. VAS 0 was significantly difference (P = 0.029) but still the VAS score was less than 3, so no pain killers were given.
Conclusion: Ultrasound guided supra-scapular and axillary nerve blocks ae equally effective as inter-scalene brachial plexus block for postoperative analgesia in shoulder arthroscopic surgery with less side-effects.
Abbreviations: ANB: Axillary Nerve Block; ISB: Interscalene Block; MAC: Minimum OR: Operating Room; REC: Research Ethics Committee; ShB: Shoulder Block; SSB: Supra-scapular Nerve Block; VAS: Visual Analogue Scale
Citation: Elbermway MS, Elshantory SF, Aly RM, Mahran MG. Comparison between supra-scapular nerve block combined with axillary nerve block and interscalene brachial plexus block for postoperative analgesia following shoulder arthroscopy. Anaesth. pain intensive care 2022;26(5):674−680; DOI: 10.35975/apic.v26i5.2026
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YAMAGUCHI, Shinobu, Noritaka YOSHIMURA, Shigemi MATSUMOTO, Motoyasu TAKENAKA, and Hiroki IIDA. "Nerve Block in Spinal Nerves." JOURNAL OF JAPAN SOCIETY FOR CLINICAL ANESTHESIA 34, no. 7 (2014): 938–46. http://dx.doi.org/10.2199/jjsca.34.938.
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Benzon, Honorio T., Charles Kim, Hazel P. Benzon, Mark E. Silverstein, Barbara Jericho, Katherine Prillaman, and Ricardo Buenaventura. "Correlation between Evoked Motor Response of the Sciatic Nerve and Sensory Blockade." Anesthesiology 87, no. 3 (September 1, 1997): 547–52. http://dx.doi.org/10.1097/00000542-199709000-00014.
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Background Incomplete sensory blockade of the foot after sciatic nerve block in the popliteal fossa may be related to the motor response that was elicited when the block was performed. We investigated the appropriate motor response when a nerve stimulator is used in sciatic nerve block at the popliteal fossa. Methods Six volunteers classified as American Society of Anesthesiologists' physical status I underwent 24 sciatic nerve blocks. Each volunteer had four sciatic nerve blocks. During each block, the needle was placed to evoke one of the following motor responses of the foot: eversion, inversion, plantar flexion, or dorsiflexion. Forty milliliters 1.5% lidocaine was injected after the motor response was elicited at < 1 mA intensity. Sensory blockade of the areas of the foot innervated by the posterior tibial, deep peroneal, superficial peroneal, and sural nerves was checked in a blinded manner. Motor blockade was graded on a three-point scale. The width of the sciatic nerve and the orientation of the tibial and common peroneal nerves were also examined in 10 cadavers. Results A significantly greater number of posterior tibial, deep peroneal, superficial peroneal, and sural nerves were blocked when inversion or dorsiflexion was seen before injection than after eversion or plantar flexion (P < 0.05). Motor blockade of the foot was significantly greater after inversion. Anatomically, the tibial and common peroneal nerves may be separate from each other throughout their course. The sciatic nerve ranged from 0.9-1.5 cm in width and was divided into the tibial and common peroneal nerves at 8 +/- 3 (range, 4-13) cm above the popliteal crease. Conclusions Inversion is the motor response that best predicts complete sensory blockade of the foot. Incomplete blockade of the sciatic nerve may be a result of the size of the sciatic nerve, to separate fascial coverings of the tibial and common peroneal nerves, or to blockade of either the tibial or common peroneal nerves after branching from the sciatic nerve.
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Dieguez-Garcia, Paula, Servando Lopez-Alvarez, Jorge Juncal, Ana M. Lopez, and Xavier Sala-Blanch. "Comparison of the effectiveness of circumferential versus non-circumferential spread in median and ulnar nerve blocks. A double-blind randomized clinical trial." Regional Anesthesia & Pain Medicine 45, no. 5 (March 11, 2020): 362–66. http://dx.doi.org/10.1136/rapm-2019-101157.
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Background and objectivesCircumferential (C) spread of local anesthetic around the nerve is recommended for a successful nerve block. We tested the hypothesis that C spread produces a more complete block than non-circumferential (NC) spread.MethodsWe randomized 124 patients undergoing open carpal tunnel syndrome surgery to receive C or NC spread ultrasound-guided median and ulnar nerve blocks. The primary outcome was the proportion of patients who developed complete sensory block measured at 5, 15 and 30 min. The loss of cold sensation was graded as: 0 (complete block), 1 (incomplete block), or 2 (no block). Secondary outcomes included motor block, nerve swelling and adverse events.ResultsIn group C, complete sensory block at 5 min was 2.4 (95% CI 1.0 to 5.7; p=0.04) times more frequent in the median nerve and 3.0 (95% CI 1.2 to 7.2; p=0.01) times more frequent in the ulnar nerve compared with group C. However, at 15 and 30 min, it was similar between groups. Complete motor block was more frequent in group C than in group NC for both the median nerve: 1.5 (95% CI 1.1 to 2.2; p<0.01) at 15 min, 1.1 (95% CI 1.0 to 1.2; p=0.02) at 30 min, and the ulnar nerve: 1.7 (95% CI 1.2 to 2.6; p<0.01) at 15 min, 1.2 (95% CI 1.0 to 1.4; p<0.01) at 30 min. The incidence of nerve swelling and adverse effects was similar between groups.ConclusionsC spread around the median and ulnar nerves at the level of the antecubital fossa generates more complete sensory and motor blocks compared with NC spread.Trial registration numberEudraCT 2011-002608-34 and NCT01603680
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Altıparmak, Başak, Melike Korkmaz Toker, Ali İhsan Uysal, and Semra Gümüş Demirbilek. "Double axillary vein variation diagnosed with ultrasound guidance during infraclavicular nerve block intervention." BMJ Case Reports 12, no. 1 (January 2019): bcr—2018–227495. http://dx.doi.org/10.1136/bcr-2018-227495.
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The use of ultrasound guidance increases the safety of peripheral block interventions by allowing anaesthesiologists to simultaneously see the position of block needle, the targeted nerves and surrounding vessels. In this report, we represented three patients diagnosed with double axillary vein variation with ultrasound guidance during infraclavicular nerve block intervention. The patients were scheduled for different types of upper limb surgeries. All patients received infraclavicular nerve block for anaesthetic management. A double axillary vein variation was diagnosed with ultrasound during block interventions. Hydro-location technique was used in all cases and the procedures were completed uneventfully. In the current literature, there is limited number of reports concerning double axillary vein variation. Detailed knowledge of the axillary anatomy is important to avoid complications such as intravascular injection during peripheral nerve block interventions. The use of ultrasound guidance and hydro-location technique should be considered for nerve blocks, especially in the axillary area.
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OGAWA, SETSURO. "Nerve block. Pursuit of safe and exact nerve block technique. Trigeminal nerve block." JOURNAL OF JAPAN SOCIETY FOR CLINICAL ANESTHESIA 18, no. 7 (1998): 637–40. http://dx.doi.org/10.2199/jjsca.18.637.
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YUDA, YASUMASA. "Nerve block. Pursuit of safe and exact nerve block technique. Nerve root block." JOURNAL OF JAPAN SOCIETY FOR CLINICAL ANESTHESIA 18, no. 7 (1998): 643–47. http://dx.doi.org/10.2199/jjsca.18.643.
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Kilicaslan, Alper, Ahmet Topal, Atilla Erol, Hale Borazan, Onur Bilge, and Seref Otelcioglu. "Ultrasound-Guided Multiple Peripheral Nerve Blocks in a Superobese Patient." Case Reports in Anesthesiology 2014 (2014): 1–4. http://dx.doi.org/10.1155/2014/896914.
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The number of obese patients has increased dramatically worldwide. Morbid obesity is associated with an increased incidence of medical comorbidities and restricts the application choices in anesthesiology. We report a successfully performed combined ultrasound-guided blockade of the femoral, tibial, and common peroneal nerve in a superobese patient. We present a case report of a 31-year-old, ASA-PS II, super obese man (190 kg, 180 cm, BMI: 58 kg/m2) admitted to the emergency department with a type II segmental tibia shaft fracture and ankle dislocation after a vehicle accident. After two failed spinal anesthesia attempts, we decided to apply a femoral block combined with a sciatic block. Femoral blocks were successfully performed with US guided in-plane technique. Separate blocks of the tibial and common peroneal nerves were planned after the sciatic nerve could not be located due to the thick subcutaneous tissue. We performed a tibial nerve block at 2 cm above the popliteal crease and common peroneal nerve at the level of the fibular head with US guided in-plane technique. The blocks were successful and no block-related complications were noted. Ultrasound guidance allows new approaches for multiple peripheral nerve blocks with low local anesthetic doses in obese patients.
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Legel, Steven C. "NERVE BLOCK." Journal of the American Dental Association 142, no. 3 (March 2011): 244. http://dx.doi.org/10.14219/jada.archive.2011.0148.
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Morley, Michael. "NERVE BLOCK." Journal of the American Dental Association 143, no. 2 (February 2012): 107–8. http://dx.doi.org/10.14219/jada.archive.2012.0108.
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Meyer, Tufi Neder, Leonardo Lima Lemos, Carolina Neder Matuck do Nascimento, and William Ricardo Ribeiro de Lellis. "Effectiveness of nasopalatine nerve block for anesthesia of maxillary central incisors after failure of the anterior superior alveolar nerve block technique." Brazilian Dental Journal 18, no. 1 (2007): 69–73. http://dx.doi.org/10.1590/s0103-64402007000100015.
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The purpose of this study was to assess the effectiveness of nasopalatine nerve block for anesthesia of maxillary central incisors after failure of the anterior superior alveolar nerve (ASAN) block technique. Secondarily, the possible innervation of the maxillary central incisors by the nasopalatine nerve was also investigated. Twenty-seven healthy, young adult volunteers (age: 17-26 years; gender: 9 males and 18 females) were enrolled in this study. All participants were undergraduate dental students of the University of Vale do Rio Verde de Três Corações. The volunteers had the anterior superior alveolar nerves anesthetized and a thermal sensitivity test (cold) was performed on the maxillary central incisors. The volunteers that responded positively to cold stimulus received a nasopalatine nerve block and the thermal sensitivity test was repeated. All participants were anesthetized by a single operator. Three patients presented sensitivity after both types of bilateral blocks and were excluded from the percentage calculations. In the remaining 24 patients, 16 had their maxillary central incisors anesthetized by the anterior superior alveolar block and 8 remained with sensitivity after the ASAN block. All these 8 patients had their maxillary central incisors successfully anesthetized by the nasopalatine block. In this study, 33.3% of the subjects had the innervation of one or both maxillary central incisors derived from the nasopalatine nerve, whilst most subjects (66.7%) had such teeth innervated by the anterior superior alveolar nerve. The nasopalatine nerve block was effective in anesthetizing the maxillary central incisors when the anterior superior alveolar nerve block failed.
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Paqueron, Xavier, Marc E. Gentili, Jean Claude Willer, Pierre Coriat, and Bruno Riou. "Time Sequence of Sensory Changes after Upper Extremity Block." Anesthesiology 101, no. 1 (July 1, 2004): 162–68. http://dx.doi.org/10.1097/00000542-200407000-00025.
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Background Sensory assessment to estimate spread and effectiveness of a peripheral nerve block is difficult because no clinical test is specific for small sensory fibers. Occurrence of a swelling illusion (SI) during a peripheral nerve block corresponds to the impairment of small sensory fibers. The authors investigated the usefulness of SI in predicting successful peripheral nerve block by assessing the temporospatial correlation between progression of sensory impairment in cutaneous distributions anesthetized and localization of SI during peripheral nerve block installation. Methods Interscalene, infracoracoid, or sciatic nerve blocks were performed using a nerve stimulator and 1.5% mepivacaine in 53 patients, with a total of 201 nerves to be anesthetized. Pinprick, cold, warm, touch, and proprioception were assessed every 3 min, while patients were asked to describe their perception of size and shape of their anesthetized limb and localization of these illusions. Data are presented as mean +/- SD and percentage (95% confidence interval). Results Failure occurred in 12 cutaneous distributions out of a total of 201 theoretically blocked nerves. SI appeared earlier than warmth impairment (4.3 +/- 2.7 vs. 6.2 +/- 2.0 min; P < 0.05), always corresponding to successfully anesthetized cutaneous distributions, with the exception of 1 patient, who developed SI in 2 cutaneous distributions while sensory testing indicated failure in 1 distribution. SI successfully predicted the blockade of a cutaneous distribution with a sensitivity of 1.00 (0.98-1.00), a specificity of 0.92 (0.65-0.99), and an accuracy of 0.99 (0.97-1.00). Conclusions Swelling illusion may provide an early assessment of the success of a peripheral nerve block in unsedated patients.
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Paqueron, Xavier, Gilles Boccara, Mouhssine Bendahou, Pierre Coriat, and Bruno Riou. "Brachial Plexus Nerve Block Exhibits Prolonged Duration in the Elderly." Anesthesiology 97, no. 5 (November 1, 2002): 1245–49. http://dx.doi.org/10.1097/00000542-200211000-00030.
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Background Upper limb trauma occurs frequently in elderly patients for whom peripheral nerve blocks are often preferred for anesthesia. The characteristics of such regional blocks have, however, never been described in an elderly population. Therefore, the authors assessed prospectively the onset and duration of upper extremity peripheral nerve block (the mid-humeral block) in elderly and young patients undergoing emergency upper extremity surgery. Methods Consecutive patients aged > 70 yr or < 70 yr received a mid-humeral block with a small volume of ropivacaine, 0.75%. Five milliliters was injected onto each of the musculocutaneous, radial, ulnar, and median nerves. Time to complete sensory and motor block and durations of complete sensory and motor block were assessed. Results are shown as median and its 95% confidence interval. Results Median ages were 77 yr (95% CI, 72-81 yr) and 39 yr (95% CI, 27-46 yr) in the two groups. Both groups had similar times to complete sensory blockade. The elderly group had longer durations of complete sensory (390 min [range, 280-435 min] vs.150 min [range, 105-160 min]; P< 0.05) and motor (357 min [range, 270-475 min] vs. 150 min [range, 90-210 min]; P< 0.05) blockade. Duration of complete sensory block was significantly correlated with age (rho = 0.56; P< 0.05). Conclusions Age is a major determinant of duration of complete motor and sensory blockade with peripheral nerve block, perhaps reflecting increased sensitivity to conduction failure from local anesthetic agents in peripheral nerves in the elderly population.
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Kim, Eugene, and Giovanni Cucchiaro. "Occipital Nerve Blocks for Relief of Headaches in Patients With Ventriculoperitoneal Shunts: A Case Series." Journal of Child Neurology 34, no. 11 (June 6, 2019): 674–78. http://dx.doi.org/10.1177/0883073819853079.
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Pediatric patients with ventriculoperitoneal shunts commonly present with headaches. We report 7 children with ventriculoperitoneal shunts and occipital headaches who received occipital nerve blocks. Eighty-six percent of patients had a history of at least 1 ventriculoperitoneal shunt revision. Headaches improved in every patient after the block. Two patients (29%) were symptom free 11 and 12 months after the block. Four patients (57%) required repeat occipital nerve blocks. Two underwent pulsed radiofrequency ablation. No complications were noted. When patients with ventriculoperitoneal shunts present with headaches, a detailed physical examination is necessary. Persistent occipital headaches with tenderness and radiation in the path of the occipital nerves can be indicative of occipital neuralgia resulting from the shunt having crossed over the path of the greater or lesser occipital nerve. Occipital nerve blocks can help as both diagnostic and therapeutic interventions in these patients.
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Piacherski, Valery G., and Lidiya V. Muzyka. "Comparison of the effectiveness of ultrasound-guided and ultrasound-guided subgluteal nerve blocks with peripheral nerve electrical stimulation: A randomized controlled feasibility trial." Regional Anesthesia and Acute Pain Management 16, no. 1 (July 20, 2022): 71–77. http://dx.doi.org/10.17816/1993-6508-2022-16-1-71-77.
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AIM: The efficacy of sciatic nerve blockade with subchondral access under ultrasound guidance (USG) versus ultrasound guidance in combination with EPN (USEPN) is unknown. Data on studies of these techniques for blockade of other peripheral nerves are inconsistent. This study evaluated the feasibility of a randomized trial to compare the efficacy of sciatic nerve blockade with USG-guided sciatic access with the current practice of USEPN.
MATERIALS AND METHODS: Forty patients were randomized into two groups in which USG or USEPN guidance was used to perform sciatic nerve blockade with sciatic access. The primary endpoint was the quality of the sensory block. The secondary endpoint was the quality of the motor block.
RESULTS: Two groups of 20 patients each were analyzed. All patients developed successful motor and sensory blocks of the sciatic nerve when using USG and USEPN. All cases were followed. Three patients were excluded before randomization because of the unsatisfactory ultrasound imaging of the sciatic nerve.
CONCLUSION: The results show that a prospective study of alternative techniques of sciatic nerve block by subchondral access is possible. In our pilot study, sciatic nerve block performed under USG guidance without EPN was effective in all cases.
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Morozov, Dmitry V., I. V. Boronina, and A. A. Ryabtseva. "Effects of different analgesia methods on early mobilization after knee join replacements." Regional Anesthesia and Acute Pain Management 14, no. 1 (September 17, 2020): 12–18. http://dx.doi.org/10.17816/1993-6508-2020-14-1-12-18.
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Rationale. Knee join replacement is accompanied by intensive pain syndrome. Prolonged blocks of branches of sciatic and femoral nerves are the most effective. Apart from sensory block and analgesia some types of blocks cause motor block of lower extremities, particularly quadriceps muscle of thigh which may prevent patients mobilization. In this connection, the choice of anesthesia strategy is significant concerning the use of prolonged blocks of the branches of sciatic and femoral nerves maintaining the motor function of the lower extremities with adequate analgesia.
The goal of the study is to select a method of pain relief after knee replacement that provides adequate analgesia while maintaining the motor function of the lower limb muscles.
Material and methods. The investigation was carried out in patients undergone knee join replacement according to standard procedure. The operation was performed under combined anaesthesia: spinal anaesthesia plus prolonged block of tibial nerve and femoral nerve or femoral triangle block with perineural space catheterization. The block with the use of local anesthetic in the analgesic concentration for postoperative analgesia during 3 postoperative days. All participants were divided into four groups according to the combinations of the blocks.
Results. The combination of block of branches of sciatic and femoral nervessignificantly improves the quality of postoperative analgesia on the first postoperative day. The block in femoral triangle (subsartorial) in comparison with the block of femoral nerve is accompanied by significantly less weakness of quadriceps muscle of thigh at the equal analgesic potency.
Conclusions. Maintaining the motor function of quadriceps muscle of thigh with the use of the prolonged block in femoral triangle for analgesia can be of certain advantage for patients mobilization in the early postoperative period (fast track).
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Melton, Natalie, Robert Talarico, Faraj Abdallah, Paul E. Beaulé, Sylvain Boet, Alan J. Forster, Shannon M. Fernando, et al. "Peripheral Nerve Blocks and Potentially Attributable Adverse Events in Older People with Hip Fracture: A Retrospective Population-based Cohort Study." Anesthesiology 135, no. 3 (June 15, 2021): 454–62. http://dx.doi.org/10.1097/aln.0000000000003863.
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Background Peripheral nerve blocks are being used with increasing frequency for management of hip fracture–related pain. Despite converging evidence that nerve blocks may be beneficial, safety data are lacking. This study hypothesized that peripheral nerve block receipt would not be associated with adverse events potentially attributable to nerve blocks, as well as overall patient safety incidents while in hospital. Methods This was a preregistered, retrospective population-based cohort study using linked administrative data. This study identified all hip fracture admissions in people 50 yr of age or older and identified all nerve blocks (although we were unable to ascertain the specific anatomic location or type of block), potentially attributable adverse events (composite of seizures, fall-related injuries, cardiac arrest, nerve injury), and any patient safety events using validated codes. The study also estimated the unadjusted and adjusted association of nerve blocks with adverse events; adjusted absolute risk differences were also calculated. Results In total, 91,563 hip fracture patients from 2009 to 2017 were identified; 15,631 (17.1%) received a nerve block, and 5,321 (5.8%; 95% CI, 5.7 to 6.0%) patients experienced a potentially nerve block–attributable adverse event: 866 (5.5%) in patients with a block and 4,455 (5.9%) without a block. Before and after adjustment, nerve blocks were not associated with potentially attributable adverse events (adjusted odds ratio, 1.05; 95% CI, 0.97 to 1.15; and adjusted risk difference, 0.3%, 95% CI, –0.1 to 0.8). Conclusions The data suggest that nerve blocks in hip fracture patients are not associated with higher rates of potentially nerve block–attributable adverse events, although these findings may be influenced by limitations in routinely collected administrative data. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New
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Benimeli-Fenollar, María, José M. Montiel-Company, José M. Almerich-Silla, Rosa Cibrián, and Cecili Macián-Romero. "Tibial Nerve Block: Supramalleolar or Retromalleolar Approach? A Randomized Trial in 110 Participants." International Journal of Environmental Research and Public Health 17, no. 11 (May 29, 2020): 3860. http://dx.doi.org/10.3390/ijerph17113860.
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Of the five nerves that innervate the foot, the one in which anesthetic blocking presents the greatest difficulty is the tibial nerve. The aim of this clinical trial was to establish a protocol for two tibial nerve block anesthetic techniques to later compare the anesthetic efficiency of retromalleolar blocking and supramalleolar blocking in order to ascertain whether the supramalleolar approach achieved a higher effective blocking rate. A total of 110 tibial nerve blocks were performed. Location of the injection site was based on a prior ultrasound assessment of the tibial nerve. The block administered was 3 mL of 2% mepivacaine. The two anesthetic techniques under study provided very similar clinical results. The tibial nerve success rate was 81.8% for the retromalleolar technique and 78.2% for the supramalleolar technique. No significant differences in absolute latency time (p = 0.287), percentage of effective nerve blocks (p = 0.634), anesthetic block duration (p = 0.895), or pain level during puncture (p = 0.847) were found between the two techniques. The greater ease in locating the tibial nerve at the retromalleolar approach could suggest that this is the technique of choice for tibial nerve blocking, especially in the case of professionals new to the field. The supramalleolar technique could be worth considering for those more experienced professionals.
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Tokat, O., YG Türker, N. Uckunkaya, and A. Yilmazlar. "A Clinical Comparison of Psoas Compartment and Inguinal Paravascular Blocks Combined with Sciatic Nerve Block." Journal of International Medical Research 30, no. 2 (April 2002): 161–67. http://dx.doi.org/10.1177/147323000203000208.
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The extent of inguinal paravascular blockade and psoas compartment blockade with sciatic nerve block was evaluated in 60 patients. Volumes of 30 ml and 20 ml 0.35% bupivacaine with 1/200 000 epinephrine were injected for lumbar plexus and sciatic nerve block, respectively. Complete lumbar plexus blockade was achieved in 73% of the group who were treated with the psoas compartment technique and 43% of the group who were treated with the inguinal paravascular technique. Sensory blockade of the femoral, lateral femoral cutaneous and obturator nerves was obtained in 100%, 97% and 77% of the patients in the psoas compartment group, and 93%, 63% and 47% of the patients in the inguinal paravascular group, respectively. Sensory blockade of the lateral femoral cutaneous and obturator nerves was more rapid with psoas compartment block. The study suggests that the psoas compartment block is effective in blocking the femoral, lateral femoral cutaneous and obturator nerves, but the inguinal paravascular block is only effective in blocking the femoral nerve.
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HARADA, Shuto, Keiya TAKAHASHI, and Keiko MAMIYA. "Ultrasound-Guided Nerve Blocks (5)Practice of Nerve Blocks in Head and Neck Area : Cervical Plexus Block, Stellate Ganglion Block, Greater Occipital Nerve Block." JOURNAL OF JAPAN SOCIETY FOR CLINICAL ANESTHESIA 33, no. 4 (2013): 619–28. http://dx.doi.org/10.2199/jjsca.33.619.
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Sun, Changjiao, Xiaofei Zhang, Xiaolin Ji, Peng Yu, Xu Cai, and Huadong Yang. "Suprascapular nerve block and axillary nerve block versus interscalene nerve block for arthroscopic shoulder surgery." Medicine 100, no. 44 (November 5, 2021): e27661. http://dx.doi.org/10.1097/md.0000000000027661.
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Szederjesi, Janos, Alexandra Lazar, Paul Rad, and Emoke Almasy. "Radial Nerve Injury after Brachial Nerve Block - Case Series." Acta Medica Marisiensis 62, no. 1 (March 1, 2016): 128–29. http://dx.doi.org/10.1515/amma-2015-0088.
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AbstractAdding epinephrine to local anesthetics is recommended to extend the duration of peripheral nerve blocks. We describe in this article two cases of radial nerve injury possible due to coadministration of epinephrine during brachial plexus block.
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Kaya, Cengiz, Burhan Dost, and Yasemin Burcu Ustun. "Anaesthesia Experience for Breast Surgery with Ultrasound-Guided Pecs Block II in High-Risk Elderly Patients - Two Case Reports." Journal of Evolution of Medical and Dental Sciences 10, no. 10 (March 8, 2021): 739–42. http://dx.doi.org/10.14260/jemds/2021/158.
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The incidence of breast cancer has increased significantly over recent years.1 Surgery is the gold standard treatment for most cases, and general anaesthesia (GA) is the preferred anaesthetic technique. However, regional anaesthesia may be an alternative to GA in multimodal regimens in high-risk patients to avoid GA-related cardiovascular or pulmonary side effects.2 The use of neuraxial techniques [thoracic epidural or thoracic paravertebral block (TPVB)] or an intercostal nerve block can therefore be suggested.3 However, novel approaches that are easier, safer, and more effective have been proposed to overcome possible complications and difficulties of these techniques. One approach, the pectoral nerve (Pecs) II block, is a fascial plane block that has shown promising results in anterolateral chest wall 2 analgesia.3,4 The aim of this technique is to block the pectoral nerves, intercostobrachial, intercostals3- 6 and the long thoracic nerve.4 The Pecs block II has been used successfully as part of the multimodal regimen for postoperative analgesia, but not yet as a primary anaesthetic technique in breast surgery.3 Here, we describe breast cancer resection with ultrasound (US)-guided Pecs block II and sedation in two high-risk elderly patients. Both patients provided written consent for publication of the case reports and related images. Here, we present two breast cancer resection cases with multiple comorbidities who underwent ultrasound-guided Pecs II blocks under sedation. Additional analgesic and / or local anaesthetic infiltration was required for parasternal region pain (simple mastectomy, Case 1) and axillary region pain (sentinel node biopsy, Case 2). However, Pecs II blocks may not block the anterior cutaneous intercostal nerve branches or the intercostobrachial nerve in operations involving the medial part of the breast or extending to the axilla.
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Stith, Andrew, Matthew Griffin, Thomas Haytmanek, and Christopher Hirose. "A Comparison of Two Methods of Regional Anesthesia." Foot & Ankle Orthopaedics 3, no. 3 (July 1, 2018): 2473011418S0046. http://dx.doi.org/10.1177/2473011418s00464.
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Category: Other Introduction/Purpose: Poorly controlled post-operative pain is a common cause of patient dissatisfaction. With future emphasis on value-based medicine, optimization of cost-effectiveness and patient satisfaction is critical. Popliteal and saphenous nerve blocks are routinely use in foot and ankle orthopaedic surgery and have become the gold standard for immediate post-operative analgesia. Traditionally a single long-acting local anesthetic agent is utilized which achieves analgesia for 6-24 hours. Recent evidence has shown that multimodal anesthesia with combined anesthetic agents remains effective for a longer duration compared to single-medication nerve blocks. The purpose of this study is to determine if patients undergoing foot and ankle surgery safely benefit from multi-modal compared with traditional single-medication nerve blocks. Methods: This was a two-armed, prospective, randomized, double-blinded study. The study population consisted of 70 patients from a single institution undergoing foot and ankle surgery by two fellowship-trained orthopaedic foot and ankle surgeons. 34 patients received a local anesthetic only popliteal and saphenous nerve block (Bupivacaine) and the other 36 patients received a triple additive nerve block (Dexamethasone, Clonidine, and Buprenorphine) in addition to Bupivacaine. Pre- and Post-operative assessments were performed to determine VAS pain scores, numbness, duration of anesthesia, patient satisfaction with analgesia, and oral pain medication use. Results: Triple additive (TA) nerve block mean duration to onset of pain was longer than for single agent (LA) nerve blocks (40.2 hrs vs 24.3 hrs respectively). Time to complete block resolution was also longer for the TA nerve blocks (82.3 hours) compared to LA blocks (38.7 hrs). 17/34 TA block patients had residual numbness at 1 week compared to 5/36 LA block patients. However, by 3 months there was no difference (8/34 TA and 7/36 LA). There was no significant difference in VAS scores or patient satisfaction rates at 1 week or 3 months. 7/34 TA block patients required narcotic refills compared to 6/36 LA block patients. There was no significant difference in complications between the groups. Conclusion: Triple agent nerve blocks give a longer duration of effective postoperative analgesia compared to single agent blocks. There was a higher rate of lingering numbness in the triple agent blocks at one week but not at 3 months. Patient satisfaction was very high for both groups regardless of their VAS pain scores. Triple agent nerve blocks demonstrate equivalent safety compared with single agent nerve blocks.
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Wadhwa, Anupama, Sunitha Kanchi Kandadai, Sujittra Tongpresert, Detlef Obal, and Ralf Erich Gebhard. "Ultrasound Guidance for Deep Peripheral Nerve Blocks: A Brief Review." Anesthesiology Research and Practice 2011 (2011): 1–6. http://dx.doi.org/10.1155/2011/262070.
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Nerve stimulation and ultrasound have been introduced to the practice of regional anesthesia mostly in the last two decades. Ultrasound did not gain as much popularity as the nerve stimulation until a decade ago because of the simplicity, accuracy and portability of the nerve stimulator. Ultrasound is now available in most academic centers practicing regional anesthesia and is a popular tool amongst trainees for performance of nerve blocks. This review article specifically discusses the role of ultrasonography for deeply situated nerves or plexuses such as the infraclavicular block for the upper extremity and lumbar plexus and sciatic nerve blocks for the lower extremity. Transitioning from nerve stimulation to ultrasound-guided blocks alone or in combination is beneficial in certain scenarios. However, not every patient undergoing regional anesthesia technique benefits from the use of ultrasound, especially when circumstances resulting in difficult visualization such as deep nerve blocks and/or block performed by inexperienced ultrasonographers. The use of ultrasound does not replace experience and knowledge of relevant anatomy, especially for visualization of deep structures. In certain scenarios, ultrasound may not offer additional value and substantial amount of time may be spent trying to find relevant structures or even provide a false sense of security, especially to an inexperienced operator. We look at available literature on the role of ultrasound for the performance of deep peripheral nerve blocks and its benefits.
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Weyker, Paul David, Christopher Allen-John Webb, and Thoha M. Pham. "Workup and Management of Persistent Neuralgia following Nerve Block." Case Reports in Anesthesiology 2016 (2016): 1–6. http://dx.doi.org/10.1155/2016/9863492.
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Neurological injuries following peripheral nerve blocks are a relatively rare yet potentially devastating complication depending on the type of lesion, affected extremity, and duration of symptoms. Medical management continues to be the treatment modality of choice with multimodal nonopioid analgesics as the cornerstone of this therapy. We report the case of a 28-year-old man who developed a clinical common peroneal and lateral sural cutaneous neuropathy following an uncomplicated popliteal sciatic nerve block. Workup with electrodiagnostic studies and magnetic resonance neurography revealed injury to both the femoral and sciatic nerves. Diagnostic studies and potential mechanisms for nerve injury are discussed.
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Clark, Stephen, Al Reader, Mike Beck, and William J. Meyers. "Anesthetic efficacy of the mylohyoid nerve block and combination inferior alveolar nerve block/mylohyoid nerve block." Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 87, no. 5 (May 1999): 557–63. http://dx.doi.org/10.1016/s1079-2104(99)70133-2.
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Morris, Sara Elizabeth, Haley McKissack, Leonardo V. M. Moraes, Gean C. Viner, James R. Jones, Chandler Tedder, Promil Kukreja, Karthikeyan Chinnakkannu, Aaradhana J. Jha, and Ashish B. Shah. "Landmark Technique vs Ultrasound Guided Approach for Posterior Tibial Nerve Block in Cadaver Models." Foot & Ankle Orthopaedics 4, no. 4 (October 1, 2019): 2473011419S0031. http://dx.doi.org/10.1177/2473011419s00314.
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Category: Ankle, Basic Sciences/Biologics Introduction/Purpose: Until recently, many regional anesthetic blocks were performed without the assistance of ultrasound, relying on methods such as anatomical landmarks and nerve stimulation. The use of ultrasound for peripheral nerve blocks has proven extremely useful for improving the efficacy of many regional anesthetic techniques. There remain a few nerve blocks which have lagged in employing the assistance of ultrasound consistently, one of which is the ankle block. This block is commonly utilized for either surgical anesthesia or post-operative analgesia for a variety of foot and ankle procedures. In this study, we compared the accuracy of traditional landmark technique with an ultrasound guided approach for ankle block by assessing the spread of injectate (dye) along the posterior tibial nerve (PTN) in cadaver models. Methods: Ten below-knee cadaver specimens were used for this study. Five were randomly chosen to undergo landmark guided PTN blocks, and five were selected for ultrasound-guided PTN blocks. The landmark technique was performed by identifying the medial malleolus and Achilles tendon and inserting the needle (4 cm long, 21G Braun® Stimuplex) at the midpoint of the two structures, aiming toward the medial malleolus and advancing until bone was contacted. 2 cc of blue acrylic dye was injected at this location. The ultrasound technique was performed with a linear probe identifying the medial malleolus and the PTN. The needle was advanced in-plane with a posterior to anterior trajectory until the tip of the needle was adjacent to the nerve. 2 cc of blue acrylic dye was injected surrounding the nerve. The extremities were then dissected to determine which nerves had been coated with dye. Results: 100% of the ultrasound guided blocks resulted in completely stained PTN with dye. In the landmark group, only 40% of the landmark technique blocks resulted in completely stained PTN with dye. Of the nerves not stained with dye, 2 were noted to have had dye injected posterior to the nerve and 1 was noted to have had dye injected into the flexor digitorum longus tendon. Conclusion: The base of evidence has dramatically increased in recent years in support of the use of ultrasound in regional anesthesia. This study substantiates the superiority of ultrasound guidance for ankle block by demonstrating a 100% success rate amongst the ultrasound guided group.
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Price, D. J. "The Shoulder Block: A New Alternative to Interscalene Brachial Plexus Blockade for the Control of Postoperative Shoulder Pain." Anaesthesia and Intensive Care 35, no. 4 (August 2007): 575–81. http://dx.doi.org/10.1177/0310057x0703500418.
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This report describes the development of the shoulder block, an alternative to interscalene brachial plexus blockade for the control of postoperative pain following shoulder surgery. Included is a review of the relevant anatomy of the shoulder joint and its associated structures. Two nerves provide the bulk of the innervation to this area: the suprascapular nerve and the axillary (circumflex) nerve. The shoulder block technique involves selective blockade of both of these nerves instead of general blockade of the entire brachial plexus via the interscalene route. The technique of Meier is used to block the suprascapular nerve in the supraspinous fossa. No descriptions of axillary nerve block were available in the literature, so a technique for blocking this nerve as it travels across the posterior surface of the humerus was developed and is described, along with a discussion of the author's initial clinical experience.
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Lam, Nicholas C. K., Matthew Charles, Deana Mercer, Codruta Soneru, Jennifer Dillow, Francisco Jaime, Timothy R. Petersen, and Edward R. Mariano. "A Triple-Masked, Randomized Controlled Trial Comparing Ultrasound-Guided Brachial Plexus and Distal Peripheral Nerve Block Anesthesia for Outpatient Hand Surgery." Anesthesiology Research and Practice 2014 (2014): 1–7. http://dx.doi.org/10.1155/2014/324083.
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Background. For hand surgery, brachial plexus blocks provide effective anesthesia but produce undesirable numbness. We hypothesized that distal peripheral nerve blocks will better preserve motor function while providing effective anesthesia.Methods. Adult subjects who were scheduled for elective ambulatory hand surgery under regional anesthesia and sedation were recruited and randomly assigned to receive ultrasound-guided supraclavicular brachial plexus block or distal block of the ulnar and median nerves. Each subject received 15 mL of 1.5% mepivacaine at the assigned location with 15 mL of normal saline injected in the alternate block location. The primary outcome (change in baseline grip strength measured by a hydraulic dynamometer) was tested before the block and prior to discharge. Subject satisfaction data were collected the day after surgery.Results. Fourteen subjects were enrolled. Median (interquartile range [IQR]) strength loss in the distal group was 21.4% (14.3, 47.8%), while all subjects in the supraclavicular group lost 100% of their preoperative strength,P= 0.001. Subjects in the distal group reported greater satisfaction with their block procedures on the day after surgery,P= 0.012.Conclusion. Distal nerve blocks better preserve motor function without negatively affecting quality of anesthesia, leading to increased patient satisfaction, when compared to brachial plexus block.
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Altug, Hasan Ayberk, Metin Sencimen, Altan Varol, Necdet Kocabiyik, Necdet Dogan, and Aydın Gulses. "The Efficacy of Mylohyoid Nerve Anesthesia in Dental Implant Placement at the Edentulous Posterior Mandibular Ridge." Journal of Oral Implantology 38, no. 2 (April 1, 2012): 141–47. http://dx.doi.org/10.1563/aaid-joi-d-10-00037.
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The aim of this study is to evaluate the anesthetic efficacy of mylohyoid and buccal nerve anesthesia at the posterior edentulous mandible versus regional anesthetic block to the inferior alveolar nerve in dental implant surgery. The study was composed of 2 groups. In the first group (group A), 14 voluntary adults (7 female and 7 male) received local infiltrations of 1 mL articaine HCl 4% with epinephrine 1/200 000 to the ipsilateral mylohyoid and buccal nerves. In the second group (group B, control; 9 female and 5 male adults), the inferior alveolar and the buccal nerve blocks were performed. Visual analog scales were obtained from patients to determine the level of pain during incision, drilling, implant placement, and suturing stages of implant surgery. A combination of buccal and mylohyoid nerve block offered an acceptable level of anesthesia. Two patients from group A stopped the ongoing surgery and had extraregional anesthesia by inferior alveolar nerve block. In group B, patients were operated on successfully. Local anesthetic infiltrations of the mylohyoid and the buccal nerve may be considered alternative methods of providing a convenient anesthetic state of the posterior mandibular ridge.
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Dangle, Jyoti, Promil Kukreja, and Hari Kalagara. "Review of Current Practices of Peripheral Nerve Blocks for Hip Fracture and Surgery." Current Anesthesiology Reports 10, no. 3 (May 26, 2020): 259–66. http://dx.doi.org/10.1007/s40140-020-00393-7.
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Abstract Purpose of Review This article aims to describe the anatomical and technical aspects of various regional techniques used for fracture hip and hip surgery. We reviewed the commonly used nerve blocks, interfascial plane blocks and current evidence of their utility in hip fracture patients. Recent Findings Fascia iliaca compartment block (FICB) and femoral nerve block (FNB) are the most commonly used nerve blocks for providing pain relief for hip fracture patients. Supra-inguinal FICB has more consistent spread to all nerves and can enable better pain control. Both the FICB and FNB have shown analgesic efficacy with reduced pain scores, opioid sparing effect, and they enable better patient positioning for spinal in the operating room. These nerve blocks in the elderly patients can also have beneficial effects on delirium, reduced hospital length of stay, and decreased incidence of pneumonia. Some of the novel interfascial plane blocks like PEricapsular Nerve Group (PENG) blocks are now being explored to provide pain relief for fracture hip. Summary Hip fracture in the elderly has associated morbidity and mortality. Early surgical intervention has shown to reduce morbidity and mortality. Pain management in this elderly population poses a unique challenge and complementing with regional anesthesia for analgesia has shown numerous benefits.
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Bartholomew, Ania, Michael Ciesa, Tyler Slone, Nicholas A. Cheney, and Brian C. Clark. "Nerve Complications after Regional Anesthesia in Foot and Ankle Surgery Avoiding the Popliteal Fossa." Foot & Ankle Orthopaedics 7, no. 2 (April 2022): 2473011421S0052. http://dx.doi.org/10.1177/2473011421s00520.
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Category: Ankle; Arthroscopy; Hindfoot; Lesser Toes; Midfoot/Forefoot; Other Introduction/Purpose: Popliteal nerve blocks are a common procedure employed by anesthesiologists to augment intraoperative anesthesia as well as provide postoperative pain control. Unfortunately, these can be associated with unintended complications. These complications may be sensory or motor including pain, numbness, and foot drop, sometimes without clear resolution. Studies suggest complications higher than previously reported, Lauf (2020). Our study looked to address the complication rates from an alternative anesthetic procedure, a distal ankle nerve block which involves anesthesia to the five nerve(s) more intimately involved in the surgical procedure. This alternative technique may provide equivalent anesthetic properties and pain relief as the popliteal blocks, with less motor and sensory complications for many patients across various demographics. Methods: We retrospectively reviewed patient charts and messaging from 2019 to 2021 that received a distal ankle field block for various surgical procedures including ankle arthroscopy, ankle fractures, and lateral ankle stabilizations. The five nerves anesthetized in the distal ankle nerve block included the tibial, superficial and deep peroneal, sural, and saphenous. Thus far, 90 surgeries have been reviewed and analyzed for neuropathic complications and confirmed via EMG. Results: Of the 90 patients analyzed, 3 patients were found to have a superficial peroneal neuropathy that included dorsal numbness as a result of the distal ankle block, resulting in a 3.33% complication rate. 1 patient required a rescue block to be performed post-operatively for pain. The remaining 87 patients recovered appropriately and without complications. No motor complications have been found from patients receiving distal ankle nerve blocks, as performed by the senior author. Conclusion: With the absence of motor complications and markedly reduced incidence of sensory complications, distal ankle nerve blocks may be a beneficial alternative to popliteal nerve blocks for various foot and ankle orthopedic surgeries. As motor complications can result in life altering disability, an anesthetic procedure with reduced negative motor outcomes can improve surgery and recovery prognosis. Future directions for this study include adding more patients to increase the sample size, as well as continuing to follow current patients, monitoring symptoms or complications.
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Bartholomew, Ania, Tyler Slone, Michael Ciesa, Nicholas A. Cheney, and Brian C. Clark. "Analysis of Complications Following Distal Ankle Nerve Blocks for Foot and Ankle Procedures." Foot & Ankle Orthopaedics 7, no. 1 (January 2022): 2473011421S0010. http://dx.doi.org/10.1177/2473011421s00104.
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Category: Ankle; Arthroscopy; Bunion; Hindfoot; Midfoot/Forefoot; Other Introduction/Purpose: Popliteal nerve blocks are a common procedure employed by anesthesiologists to augment intraoperative anesthesia and provide postoperative pain control. Unfortunately, these can be associated with unintended complications including pain, numbness, and foot drop, sometimes without clear resolution. Studies from Kahn (2017), Anderson (2015), Park (2018), Lauf (2020) suggest complications higher than previously reported with Lauf (2020) finding short-term complication rates of 10.1% and 4.1% long-term as confirmed by EMG. Our study looked to address the complication rates from an alternative anesthetic procedure, a distal ankle nerve block involving anesthesia to the five nerve(s) more intimately involved in the surgical procedure. This alternative technique may provide equivalent anesthetic properties and pain relief as popliteal blocks, with fewer complications for many patients across various demographics. Methods: We retrospectively reviewed patient charts and messaging from 2019 to 2021 that received a distal ankle field block for various surgical procedures including ankle arthroscopy, ankle fractures, and lateral ankle stabilizations. The five nerves anesthetized in the distal ankle nerve block included the tibial, superficial and deep peroneal, sural, and saphenous. Thus far, 61 surgeries have been reviewed and analyzed for neuropathic complications and confirmed via EMG. Results: Of the 61 patients analyzed, 3 patients were found to have a superficial peroneal neuropathy that included dorsal numbness as a result of the distal ankle block, resulting in a 4.92% complication rate. 1 patient required a rescue block to be performed postoperatively for pain. The remaining 57 patients recovered appropriately and without complications. No motor complications have been found from patients receiving distal ankle nerve blocks, as performed by the senior author. Conclusion: With the absence of motor complications and markedly reduced incidence of sensory complications, distal ankle nerve blocks may be a beneficial alternative to popliteal nerve blocks for various foot and ankle orthopedic surgeries. As motor complications can result in life-altering disability, an anesthetic procedure with reduced negative motor outcomes can improve surgery and recovery prognosis. Future directions for this study include adding more patients to increase the sample size, as well as continuing to follow current patients, monitoring symptoms or complications.
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Morozov, Dmitry Vladimirovich, Irina Vladimirovna Boronina, Anna Alexandrovna Ryabtseva, and Tatyana Alexandrovna Nikulina. "The influence of different branches of sciatic and femoral nerves blocks on the postoperative analgesia quality after knee join replacement." Vestnik of Experimental and Clinical Surgery 11, no. 2 (June 30, 2018): 110–13. http://dx.doi.org/10.18499/2070-478x-2018-11-2-110-113.
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Topicality: knee join replacement is accompanied by intensive pain syndrome. Prolonged blocks of branches of sciatic and femoral nervesare the most effective. Apart from sensory block and analgesia some types of blocks cause motor block of lower extremities, particularly quadriceps muscle of thigh which may prevent patients’ mobilization. In this connection, the choice of anesthesia strategy is significant concerning the use of prolonged blocks of the branches of sciatic and femoral nerves maintaining the motor function of the lower extremities with adequate analgesia.
The aim of work: the choice of optimal combination of prolonged blocks of branches of sciatic and femoral nervesensuring adequate analgesia with motor function of quadriceps muscle of thigh maintenance.
Material and methods: the investigation was carried out in patients undergone knee join replacement according to standard procedure. The operation was performed under combined anaesthesia: spinal anaesthesia and intravenous sedation with propofol and midazolam plus prolonged block of tibial nerve and femoral nerve or adductor canal with perineural space catheterization. The block with the use of local anesthetic in the analgesic concentration for postoperative analgesia during 72-hour period after the end of the operation. The patients were divided into the investigation groups according to the combinations of the blocks.
Results and discussion: the combination of block of branches of sciatic and femoral nervessignificantly improves the quality of postoperative analgesia on the first postoperative day. The block of adductor canal in comparison with the block of femoral nerve is accompanied by significantly less weakness of quadriceps muscle of thigh at the equal analgesic potency.
Conclusions: maintaining the motor functionof quadriceps muscle of thigh with the use of the adductor canal prolonged block for analgesia can be of certain advantage for patients’ mobilization in the early postoperative period.
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Muzquiz, M. Ivette, Landan Mintch, M. Ryne Horn, Awadh Alhawwash, Rizwan Bashirullah, Michael Carr, John H. Schild, and Ken Yoshida. "A Reversible Low Frequency Alternating Current Nerve Conduction Block Applied to Mammalian Autonomic Nerves." Sensors 21, no. 13 (July 1, 2021): 4521. http://dx.doi.org/10.3390/s21134521.
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Electrical stimulation can be used to modulate activity within the nervous system in one of two modes: (1) Activation, where activity is added to the neural signalling pathways, or (2) Block, where activity in the nerve is reduced or eliminated. In principle, electrical nerve conduction block has many attractive properties compared to pharmaceutical or surgical interventions. These include reversibility, localization, and tunability for nerve caliber and type. However, methods to effect electrical nerve block are relatively new. Some methods can have associated drawbacks, such as the need for large currents, the production of irreversible chemical byproducts, and onset responses. These can lead to irreversible nerve damage or undesirable neural responses. In the present study we describe a novel low frequency alternating current blocking waveform (LFACb) and measure its efficacy to reversibly block the bradycardic effect elicited by vagal stimulation in anaesthetised rat model. The waveform is a sinusoidal, zero mean(charge balanced), current waveform presented at 1 Hz to bipolar electrodes. Standard pulse stimulation was delivered through Pt-Black coated PtIr bipolar hook electrodes to evoke bradycardia. The conditioning LFAC waveform was presented either through a set of CorTec® bipolar cuff electrodes with Amplicoat® coated Pt contacts, or a second set of Pt Black coated PtIr hook electrodes. The conditioning electrodes were placed caudal to the pulse stimulation hook electrodes. Block of bradycardic effect was assessed by quantifying changes in heart rate during the stimulation stages of LFAC alone, LFAC-and-vagal, and vagal alone. The LFAC achieved 86.2±11.1% and 84.3±4.6% block using hook (N = 7) and cuff (N = 5) electrodes, respectively, at current levels less than 110 µAp (current to peak). The potential across the LFAC delivering electrodes were continuously monitored to verify that the blocking effect was immediately reversed upon discontinuing the LFAC. Thus, LFACb produced a high degree of nerve block at current levels comparable to pulse stimulation amplitudes to activate nerves, resulting in a measurable functional change of a biomarker in the mammalian nervous system.
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Koriachkin, V. A., D. V. Zabolotskii, D. V. Gribanov, and T. A. Antoshkova. "Obturator nerve block." Regional Anesthesia and Acute Pain Management 14, no. 3 (January 7, 2021): 130–40. http://dx.doi.org/10.17816/1993-6508-2020-14-3-130-140.
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One of the forgotten techniques of regional anesthesia is blockade of the obturator nerve, which was performed using anatomical landmarks and neurostimulation. In recent years, ultrasonic navigation methods have gained wide popularity when using regional blockades. The purpose of the review is to present the current understanding of the use of obturator nerve block in clinical practice. The review presents the anatomical features of the obturator nerve passage, surgical and therapeutic indications for the use of its blockade. The technique for performing obturator blockade using ultrasound navigation is described in detail. Blockade of the obturator nerve using ultrasound navigation can reduce the likelihood of surgical complications during transurethral resection of a tumor located on the lateral wall of the bladder, improve analgesia after hip and knee surgery, and effectively relieve spastic conditions of the adductor muscles of the hip.
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Parris, Winston C. V. "Nerve Block Therapy." Clinics in Anaesthesiology 3, no. 1 (January 1985): 93–109. http://dx.doi.org/10.1016/s0261-9881(21)00139-7.
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Sesma, Julio, Melodie Álvarez, Carlos Gálvez, Sergio Bolufer, Francisco Lirio, Juan José Mafé, Jone Miren Del Campo, et al. "Intercostal nerve block." ASVIDE 6 (September 2019): 273. http://dx.doi.org/10.21037/asvide.2019.273.
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WASSEF, M. R. "Suprascapular nerve block." Anaesthesia 47, no. 2 (February 1992): 120–24. http://dx.doi.org/10.1111/j.1365-2044.1992.tb02007.x.
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Brown, David L., Donald R. Cahill, and L. Donald Bridenbaugh. "Supraclavicular Nerve Block." Anesthesia & Analgesia 76, no. 3 (March 1993): 530???534. http://dx.doi.org/10.1213/00000539-199303000-00013.
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BERRISFORD, R. G., and S. S. SABANATHAN. "THORACIC NERVE BLOCK." British Journal of Anaesthesia 64, no. 1 (January 1990): 124. http://dx.doi.org/10.1093/bja/64.1.124.
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Parkinson, S. K., and S. L. Bailey. "SCIATIC NERVE BLOCK." Anesthesiology 71, Supplement (September 1989): A720. http://dx.doi.org/10.1097/00000542-198909001-00720.
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