Summary Sixtj, adult jeniules of'
SummarySciatic nerve block was performed in two groups of patients using a low power peripheral nerve stimulator to aid nerve location. The demonstration that greater accuracy of needle placement can be achieved by use of a low power peripheral nerve stimulator during sciatic blockade, should permit the use of smaller volumes and, therefore, higher concentrations of local anaesthetic solutions. Accurate needle placement and the use of concentrated solutions should result both in a reduction of latency and in greater duration of the block. This study was undertaken to test this hypothesis in the clinical setting. Patients and methodsForty adult patients scheduled for either elective or emergency surgery of the lower limb were studied. Patients with arterial hypertension or known hypersensitivity to local anaesthetic agents were excluded from the study. Formal consent was obtained in all cases. All patients were premedicated with diazepam 10 mg orally approximately 2 hours pre-operatively. Patients were allocated according to a random number sequence to one of two groups. In group A sciatic block was performed using 1% prilocaine with felypressin 0.01 IU/ml using a volume of 0.25 ml/kg body weight. In group B the block was performed using 3% prilocaine with felypressin 0.03 IU/ml at a volume of 0.08 ml/kg body weight. Sciatic block was performed via the posterior approach described by Raj et aL2 using a 22-gauge uninsulated needle. A low power peripheral nerve stimulator3 was used, as described by Smith and Allison.' Onset of block was specified as loss of sensation to pinprick in both the tibial and common peroneal nerve territories. The degree of motor block was assessed using 10-cm visual analogue scores based on both the power and degree of plantar and dorsiflexion of the foot, that ranged from power normal to power absent. Testing was performed a t 3-minute intervals for pinprick and 10-minute intervals for motor block by an observer blind to the patient grouping. Any block not effective a t 45 minutes was deemed to have failed and alternative anaesthetic techniques were employed. The duration of block was assessed on the basis of analgesia to pinprick as above and assessments were done at approximately 2-hourly intervals, again by an observer blind to the patient grouping. Recovery of sensation in either the tibial or peroneal nerve territory was taken as regression of the block. Similarly, any complaint of pain in the sciatic distribution was noted and this point taken as the time to recovery of the block. Arterial blood pressure was monitored at 3-5-minute intervals throughout the period of anaesthesia and surgery, using automated oscillotonometry (Dinamap), and the electrocardiograph monitored continuously. The data were analysed using Wilcoxon rank sum testing or Chi-square testing (with Yates' correction) as appropriate. ResultsThere were no significant differences between the two groups in respect of age, weight, sex or the duration and nature of surgery undertaken. The results for latency of B.E. Smit...
SummaryEighty patients who presented for surgery of the forearm or hand were allocated randomly to one of two groups. In Group A , surgery was performed under supraclavicular brachial plexus block only; a mixture of equal parts of prilocaine 1 % and bupivacaine 0.5% without adrenaline was used. In Group B, supraclavicular brachial plexus block was performed using prilocaine I% alone, but in addition discrete nerve blocks were performed at elbow level using 0.5% bupivacaine without adrenaline. Patients in Group B had a signijicantly shorter duration of unwanted postoperative motor blockade and a sign@cantly longer duration of postoperative analgesia ( p < 0.005). Key wordsPain; postoperative. Anaesthetic techniques, regional; brachial plexus block, median nerve block, radial nerve block, ulnar nerve block.Most surgery of the forearm and hand can be performed under regional anaesthesia, particularly brachial plexus block. Ideally, any technique should provide rapid onset of surgical anaesthesia, analgesia of the upper arm to prevent tourniquet pain (if a tourniquet is used), adequate muscular relaxation, a relatively ischaemic field and, if possible, good postoperative analgesia. Prolonged postoperative analgesia may be produced by brachial plexus block with bupivacaine, but the latency may be unacceptably long and unwanted motor block may persist well into the postoperative period. Lignocaine and prilocaine produce a rapid onset of action, but provide analgesia for a relatively short time in the postoperative period.Many clinicians compromise by using a mixture of local anaesthetic agents for brachial plexus block to produce rapid onset and prolonged duration. There is an alternative approach. Supraclavicular brachial plexus block can be performed with either prilocaine or lignocaine to provide analgesia of the upper arm in order to obtund tourniquet pain, complemented by discrete nerve blocks at the elbow with bupivacaine. Unwanted postoperative motor block of the shoulder and elbow is reduced to a minimum, both in degree and duration, whilst both intra-and postoperative analgesia is improved both in latency and duration.This study was undertaken to compare these techniques. Patients and methodsThe study was approved by the district ethics committee. Eighty adult patients of ASA grades 1 to 3 who presented for surgery of the forearm or hand were studied. All patients were premedicated with temazepam 20 mg orally 1-2 hours pre-operatively. Each patient was then allocated to one of two groups according to a random number sequence. Patients in Group A received a supraclavicular brachial plexus block alone using Ball's technique' with a peripheral nerve stimulator.2 The local anaesthetic solution comprised equal volumes of prilocaine 1% and bupivacaine 0.5%, without adrenaline, in a volume of 0.5 ml/kg body weight to a maximum of 40 ml. In Group B, supraclavicular brachial plexus block was performed by the same method but using prilocaine 1% without adrenaline as the sole agent; the volume used was 0.5 ml/kg to a ma...
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