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Query: UMLS:C0030552 (paresis)
 5,831 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The presently existing local anesthetics (LA) do not guarantee a rapid onset and simultaneously a long duration of action. The combination of a medium-long acting LA with bupivacaine, a long-acting LA with slow onset, could be means to achieve these aims. Prilocaine was chosen as the medium-long acting LA because it has the lowest toxicity of this group and for pharmacological reasons. METHODS. In a prospective, controlled double-blind study 100 patients scheduled for axillary block for elective surgical procedures of the hand or wrist were randomly assigned to five groups. Twenty patients in each group received either 40 ml prilocaine 1.5%; 40 ml bupivacaine 0.375%; 20 ml prilocaine 1% + 20 ml bupivacaine 0.5%; 20 ml prilocaine 2% + 20 ml bupivacaine 0.5%; or 20 ml prilocaine 2% + 20 ml bupivacaine 0.375%. The LA mixtures were freshly mixed 15 min prior to the axillary block. The blocks were performed using an immobile, short-beveled needle by anesthesiologists who were familiar with this technique. Analgesia was classified using the pin-prick method with 0 = no analgesia, 1 = analgesia, 2 = anesthesia. Motor blockade was classified with 0 = no motor block, 1 = paresis, 2 = paralysis. The following nerves were analyzed: ulnar, radial, median, musculocutaneous, and medial antebrachial. In 6 patients of each group plasma levels of the LA were measured by gas chromatography and methemoglobinemia was determined. Statistical analysis of the data was performed using the Student t-test and chi-square test on a level of significance of P less than 0.05. Results. All surgical procedures could be performed as planned in regional anesthesia. Twenty minutes after injection of the LA only 15% of the blocks were sufficient in the bupivacaine group, while in the other four groups 40%-50% of the blocks were complete (P less than 0.05). The degree of analgesia was deeper in the groups with 2% prilocaine and prilocaine alone than in the group with 1% prilocaine. Forty minutes after injection there were no significant differences between the groups. Motor blockade after 20 min was significantly lower in the bupivacaine group than in the prilocaine group (P less than 0.05). After 4 h all three prilocaine-bupivacaine mixtures showed a significantly more pronounced analgesia of the median nerve than the prilocaine group (P less than 0.02-0.001).(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Clinical effectiveness and systemic toxicity of various mixtures of prilocaine and bupivacaine in axillary plexus block]. 304 71

Carotid endarterectomy in 39 elderly patients was carried out under local anesthesia and neuroleptic analgesia. There were no deaths within 30 days. Two patients required an intraoperative shunt because of signs of ischemic changes (aphasia, motor changes) during two-minute test cross-clamping. In two patients, transient vocal cord paresis was observed, and seven patients (18%) experienced immediate postoperative hypertension. Our results support the contention that in awake elderly patients the need for an intraoperative shunt can be accurately assessed by simple neurological monitoring. Carotid surgery under local anesthesia and neuroleptic analgesia appears to be a safe procedure, and is especially recommended for elderly patients with hypertension, diabetes mellitus or ischemic heart disease.
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PMID:Carotid surgery under local anesthesia in the elderly. 337 34

There is a lack of prospective studies for the long-term results of percutaneous stereotactic radiofrequency rhizotomy (PSR) in the treatment of patients with trigeminal neuralgia. The authors present results in 154 consecutive patients with trigeminal neuralgia treated by PSR and prospectively followed for 15 years. Ninety-nine percent of the patients obtained initial pain relief after one PSR. Dysesthesia occurred in 31 patients (23%): in 7% with mild initial hypalgesia; in 15% with dense hypalgesia; and in 36% with analgesia. Dysesthesia was mild and did not require treatment in most patients. The corneal reflex was absent or depressed in 29 patients, and keratitis developed in three patients. In 19 of 22 patients with trigeminal motor weakness, the paresis resolved within 1 year. Of 33 patients who had pain recurrence, 10 patients had pain that was mild or controlled with medications, and 23 patients required additional surgical treatment. The authors estimated using Kaplan-Meier analysis that the 14-year recurrence rate was 25% in the total group: 60% in patients with mild hypalgesia, 25% in those with dense hypalgesia, and 20% in those with analgesia. Timing of pain recurrence varied according to the degree of sensory loss. All pain recurrences in patients with mild hypalgesia occurred within 4 years after surgery; 10% more of the patients with dense hypalgesia had pain recurrences within the first 10 years compared with patients with analgesia. The median pain-free survival rate was 32 months for patients with mild hypalgesia and more than 15 years for patients with either analgesia or dense hypalgesia. Of the 100 patients followed for 15 years after one or two PSR procedures, 95 patients (95%) rated the procedure excellent (77 patients) or good (18 patients). The authors conclude that PSR is an effective, safe treatment for trigeminal neuralgia. Dense hypalgesia in the painful trigger zone, rather than analgesia, should be the target lesion.
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PMID:A prospective 15-year follow up of 154 consecutive patients with trigeminal neuralgia treated by percutaneous stereotactic radiofrequency thermal rhizotomy. 749 Jun 43

Efficacies of two methods of nondrug analgesia: acupuncture (1000 cases) and antipain transcutaneous electroneurostimulation (91 cases), as well as of narcotic analgesics omnopon and promedol (229 cases) were compared in the immediate and early postoperative period. In 229 cases acupuncture was used for the treatment of other functional complications of the postoperative period. The efficacies of the methods in question were assessed by formalized verbal estimation scales. Narcotic analgesics provided adequate analgesia in 75 to 79% of patients, electrostimulation in 61 to 64%, acupuncture in 50% of patients. Acupuncture, though less effective than narcotic analgesics, helped arrest or noticeably alleviate the severity of such postoperative complications as reflex retention of the urine, impairment of hte drainage function of the bronchi, intestinal paresis, bronchial asthma, vomiting, nausea, pain or itching in the stoma, chill, hyperthermia in 43 to 81% of cases. The authors come to a conclusion on the desirability of an integrative approach (combined use of drugs and nondrug methods of analgesia) in the management of postoperative pain.
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PMID:[Acupuncture analgesia and analgesic transcutaneous electroneurostimulation in the early postoperative period]. 764 87

Axillary block is a common anesthetic technique for operations on the hand and forearm. In our hospital, with many trainees in anaesthesia, only 250-300 axillary blocks per year are performed by about 30 colleagues. This implies a small number of blocks for each anaesthetist. The present study was designed to assess whether it is possible to teach this technique and use it with an adequate degree of success under these conditions. We used a nerve stimulator and studied whether the success of the block under these conditions is independent of anaesthetist's experience in this technique. Furthermore, we examined other factors involved in the success of the block. METHODS. The study included 112 patients subjected to elective surgery of the upper extremity; all received an axillary block. We used a nerve stimulator and injected mepivacaine 1% without adrenaline. The following parameters were recorded: the number of blocks to date performed by the anaesthetist; the minimal current required for nerve stimulation; the dose of local anaesthetic; the time between the end of injection and the beginning of surgery; the quality of sensory and motor blockade after 10, 20, and 30 min. Sensory blockade was assessed by the pinprick method (no blockade, analgesia, anaesthesia); motor blockade was judged by comparing the muscle strength of both arms (no blockade, paresis, paralysis). Data were analyzed using the Mann-Whitney test, with P < 0.05 considered statistically significant. RESULTS. Of the 112 blocks, 95 (85%) were successful; 17 (15%) failed and the patients required general anaesthesia. Eight of the successful blocks showed a decrease in analgesic quality after > or = 70 min and required additional analgesics or general anaesthesia. We found no correlation between the experience of the anaesthetist and the success of the block. The minimal required current for nerve stimulation in the success group was 0.4 mA and differed significantly from the value of 0.6 mA in the failure group (Table 3). The dose of mepivacaine was higher in the success group (5.9 vs. 5.3 mg/kg). Complete sensory blockade was more frequently achieved for the median, ulnar, and radial nerves than for the musculocutaneus and cutaneous brachii medialis (Fig. 3). The frequency of complete sensory blockade (anaesthesia) had increased by 21.9% between the 20th and 30th min. Complete motor blockade was less often achieved than sensory blockade (Fig. 4). CONCLUSIONS. Using the method of electrostimulation, the axillary block is an appropriate anaesthetic technique that can be applied in a hospital where each anaesthetist only occasionally performs it. Prior to injection of the local anaesthetic, the current for nerve stimulation should be reduced to < 0.5 mA. The time between the end of injection and the beginning of surgery should be no less than 30 min because complete sensory blockade can more often be achieved. The dose of mepivacaine should be no less than 6 mg/kg body weight.
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PMID:[Axillary blockade of the brachial plexus. A prospective study of blockade success using electric nerve stimulation]. 771 18

We evaluated the utility of medium molecular weight hyaluronic acid for prolonging the local anesthetic activity of lidocaine in a rabbit model of epidural analgesia. Equiviscous formulations were prepared as either a physical mixture of lidocaine hydrochloride and sodium hyaluronate (where drug release occurred via diffusion) or as a lidocaine-hyaluronate complex (where drug release occurred via diffusional and electrostatic processes). The novel hyaluronic acid formulations were functionally evaluated, relative to lidocaine solution, in an intact, conscious rabbit model. The hyaluronate formulations were well tolerated. The duration of sensory block and loss of weight-bearing was prolonged twofold by the lidocaine-hyaluronate complex relative to the solution (P < 0.05). In terms of motor block, flaccid paresis occurred after administration of the solution formulation, whereas only partial motor block was evident after administration of the viscous formulations. Pharmacokinetic modeling of the lidocaine plasma concentration-time data indicated that the rate of drug absorption from the lidocaine-hyaluronate complex was decreased fourfold relative to the solution (P < 0.05). These observations indicate that ionic complexes of local anesthetics with medium molecular weight hyaluronic acid may offer advantages for the prolongation of epidural analgesia.
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PMID:Prolongation of lidocaine-induced epidural anesthesia by medium molecular weight hyaluronic acid formulations: pharmacodynamic and pharmacokinetic studies in the rabbit. 789 28

Compartment syndrome is a serious potential complication of trauma to the extremities. Fractures, crush injuries, burns, and arterial injuries, among others, can result in increased tissue pressure within closed osseofascial or compartmental spaces. Prolonged exposure to elevated pressure can result in nerve and muscle necrosis. Extreme pain unrelieved with analgesia, subjective complaint of pressure, pain with passive muscle stretching, paresis, paresthesia, and intact pulses, in the presence of a physically tight compartment, should alert the physician to the presence of a compartment syndrome. The diagnosis is a clinical one, but it may be aided by measurements of intracompartmental tissue pressures. Compartment syndrome is a surgical emergency requiring prompt treatment by fasciotomy. Time is a critical factor; the longer the duration of elevated tissue pressure, the greater the potential for disastrous sequelae. Emergency medicine providers must be cognizant of this clinical syndrome so that early emergent surgical consultation can be obtained to avoid complications.
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PMID:Compartment syndrome: a complication of acute extremity trauma. 798 93

A 52-year-old woman with chronic back pain presented for lumbar extradural analgesia. The 'loss of resistance to air' technique was used to locate the extradural space. Prolonged paraesthesia and paresis of left leg occurred following the procedure. Urgent lumbar computed tomography scan revealed nerve root displacement due to extradural air.
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PMID:Extradural air as a cause of paraplegia following lumbar analgesia. 828 45

Postoperative pain after shoulder surgery is known to be intense and requires usually opioid administration. The recent use of regional anaesthesia for this type of surgery has contributed to the relief of acute postoperative pain occurring in the recovery room since the analgesic effects of block persist for several hours after surgery depending upon the selected drug. Moreover, the development of less invasive surgery (arthroscopy) and experience with regional blocks have permitted to perform minor shoulder surgery on an outpatient basis. For minor surgery, regional anaesthesia associated to a light sedation is sufficient. However, for more invasive surgery, regional anaesthesia should be associated to a light general anaesthesia as well as the insertion of a supraclavicular catheter for postoperative analgesia. A diaphragmatic paresis secondary to a blockade of the phrenic nerve is constant radiologically after interscalenic block but remains symptomless. However, in case of severe preoperative chronic respiratory insufficiency, decompensation may occur rapidly after performance of the interscalenic block.
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PMID:[Analgesia after surgery of the shoulder]. 874 51

Twenty-eight sheep suffering from dystocia, with complications including vaginal prolapse and emphysematous foetuses, were treated by caesarean operation. When tested by needle prick 30-40 min after injection, analgesia of the flank was present in 12 of 13 ewes and eight of nine ewes following either sacrococcygeal or lumbosacral extradural xylazine, respectively at a dose rate of 0.07 mg kg-1. Twelve of 13 ewes, which were ambulatory at the time of extradural injection, exhibited pelvic paresis in the interval before surgery. Vaginal prolapses associated with the dystocia in seven of 22 ewes which were replaced during surgery but not retained by suture, did not recur.
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PMID:Evaluation of extradural xylazine injection for caesarean operation in ovine dystocia cases. 926 54


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