A randomized, observer-blinded determination of the median effective volume of local anesthetic required to anesthetize the sciatic nerve in the popliteal fossa for stimulating and nonstimulating perineural catheters.

Background And Objectives: Stimulating perineural catheters are developed to overcome technical problems of nonstimulating catheters, but their efficacy remains controversial. However, no volume-response study has compared success rates between stimulating and nonstimulating catheters. This study of stimulating versus nonstimulating catheters compares the minimal effective volume required to successfully block the sciatic nerve in 50% of patients scheduled for unilateral hallux valgus repair.

Ultrasound- or nerve stimulation-guided wrist blocks for carpal tunnel release: a randomized prospective comparative study.

Background And Objectives: We hypothesized that ultrasound-guided wrist blocks may be faster to perform, and may increase success rate, compared with nerve stimulation-guided wrist blocks.

Methods: Sixty patients undergoing ambulatory endoscopic carpal tunnel release were randomly allocated to receive median and ulnar nerve blocks using either sensory-motor nerve stimulation (n = 30) or ultrasound guidance (n = 30). Four mL of mepivacaine 1.

The safety and efficacy of extended thromboprophylaxis with fondaparinux after major orthopedic surgery of the lower limb with or without a neuraxial or deep peripheral nerve catheter: the EXPERT Study.

Background: The benefit-risk ratio of extended fondaparinux therapy has not been assessed in patients undergoing major lower limb joint arthroplasty. Few data on the concomitant use of fondaparinux and continuous neuraxial or deep peripheral nerve blockade are available. We performed a prospective intervention study in patients undergoing major orthopedic surgery primarily designed to assess the efficacy of fondaparinux when drug administration was withheld for 48 h to permit removal of a neuraxial or deep peripheral nerve catheter.

Emergency orthopaedic surgery under noninvasive ventilation after refusal for general anaesthesia.

In this observation, we report a novel use of noninvasive positive pressure ventilation in the operating room to support ventilation in an acidotic hypercapnic patient with severe acute chronic respiratory failure refuted for general anaesthesia, operated under spinal anaesthesia for a femoral fracture. The feasibility of noninvasive ventilatory assistance during surgery performed under regional anaesthesia is reported here. In selected cases, noninvasive ventilation can be used in the management of patients with acute or chronic respiratory failure requiring an urgent surgical intervention but in whom the respiratory status excluded a general anaesthesia.

Continuous peripheral nerve blocks in hospital wards after orthopedic surgery: a multicenter prospective analysis of the quality of postoperative analgesia and complications in 1,416 patients.

Background: Continuous peripheral nerve block (CPNB) is the technique of choice for postoperative analgesia after painful orthopedic surgery. However, the incidence of neurologic and infectious adverse events in the postoperative period are not well established. This issue was the aim of the study.

Using stimulating catheters for continuous sciatic nerve block shortens onset time of surgical block and minimizes postoperative consumption of pain medication after halux valgus repair as compared with conventional nonstimulating catheters.

Unlabelled: We prospectively tested the hypothesis that the use of a stimulating catheter improves the efficacy of continuous posterior popliteal sciatic nerve block in 100 randomized patients scheduled for elective orthopedic foot surgery. After eliciting a sciatic mediated muscular twitch at < or = 0.5 mA nerve stimulation output, the perineural catheter was advanced 2-4 cm beyond the tip of the introducer either blindly (Group C; n = 50) or stimulating via the catheter (Group S; n = 50).

Effects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia, and continuous femoral nerve sheath block on rehabilitation after unilateral total-hip arthroplasty.

Background And Objectives: Regional analgesic techniques allow better postoperative rehabilitation and shorter hospital stay after major knee surgery. The authors tested the hypothesis that similar results could be obtained after total-hip arthroplasty.

Methods: Forty-five patients scheduled for THA under general anesthesia were randomly divided into 3 groups.

Does the sciatic nerve approach influence thigh tourniquet tolerance during below-knee surgery?

In this prospective, randomized, blinded study we assessed thigh tourniquet tolerance when a Labat's or a posterior popliteal approach of the sciatic nerve was used for below-knee surgery. One-hundred-twenty patients were divided into two groups of 60. A posterior popliteal (Group 1) or a Labat's (Group 2) sciatic nerve block was performed with 25 mL 1% mepivacaine + epinephrine 1:200,000.

Unintentional neuromuscular blocking agent injection during an axillary brachial plexus nerve block.

Objective: We describe the consequences of an unintentional injection of atracurium instead of ropivacaine during an axillary brachial plexus nerve block.

Case Report: A 79-year-old woman was scheduled for wrist fracture repair. An axillary brachial plexus block was performed by use of a nerve stimulator.

Pain relief after arthroscopic shoulder surgery: a comparison of intraarticular analgesia, suprascapular nerve block, and interscalene brachial plexus block.

In this prospective, randomized, blinded study, we assessed the analgesic efficacy of interscalene brachial plexus block (ISB), suprascapular nerve block (SSB), and intraarticular local anesthetic (IA) after arthroscopic acromioplasty. One-hundred-twenty patients were divided into 4 groups of 30. In Group SSB, the block was performed with 10 mL of 0.

Single-injection applications for foot and ankle surgery.

Foot or ankle surgery is often performed in an ambulatory care setting. The post-operative pain that follows can be moderate to severe in intensity and difficult to control with oral analgesics. Regional anaesthetic techniques have been advocated for such procedures.

The analgesic efficacy of bilateral combined superficial and deep cervical plexus block administered before thyroid surgery under general anesthesia.

Unlabelled: In this study we evaluated the analgesic efficacy of combined deep and superficial cervical plexus block in patients undergoing thyroidectomy under general anesthesia. For this purpose, 39 patients undergoing elective thyroid surgery were randomized to receive a bilateral combined deep and superficial cervical block (14 mL per side) with saline (Group 1; n = 13), ropivacaine 0.5% (Group 2; n = 13), or ropivacaine 0.