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Three-in-one femoral nerve block as analgesia for fractured neck of femur in the emergency department: A randomized, controlled trial

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ANNALS OF EMERGENCY MEDICINE 2003年第2期41卷 227-233页

作者： Fletcher, AK Rigby, AS Hayes, FLP Rotherham Gen Hosp Dept Emergency Med Rotherham S Yorkshire England Univ Sheffield Dept Stat Sheffield S Yorkshire England

Study objective: We determine whether 3-in-1 femoral nerve block is effective as analgesia for fractured neck of femur when administered by emergency physicians. Methods: This was a prospective, randomized controlled trial with blinded assessors conducted in a district general hospital emergency department in the United Kingdom. Over a 6-month period, all patients with fractured neck of femur were considered for study. Patients were randomly assigned to receive 3-in-1 nerve block with bupivacaine plus intravenous morphine or intravenous morphine. An accreditation package for all ED medical staff was devised to ensure competence in the technique of 3-in-1 nerve block. Pain scores were recorded on arrival and at intervals up to 24 hours after admission. Morphine consumption in the first 24 hours was recorded. Results: Ninety-four patients sustained fractured neck of femur during the study period;50 were studied. Of 44 not studied, 42 were confused, I did not consent, and I was overlooked. Patients receiving 3-in-1 nerve blocks recorded a faster time to reach the lowest pain score: 2.88 hours for patients with nerve block and 5.81 hours for control patients (mean difference -2.93 h;95% confidence interval [CI] -5.48 to -0.38 h). Nerve block recipients required significantly less morphine per hour than control patients (mean of 0.49 mg/h versus 1.17 mg/h;mean difference -0.68 mg/h;95% Cl -1.23 to -0.12 mg/h). Conclusion: Three-in-one femoral nerve block is an effective method of providing analgesia to patients with fractured neck of femur in the ED. All grades of medical staff were able to apply and consolidate this skill.

关键词：急诊室医院股骨颈骨折神经传导阻滞/方法老年人女(雌)性人类男(雄)性

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REGIONAL NERVE BLOCK FOR MAXILLARY PERMANENT MOLARS

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BRITISH DENTAL JOURNAL 1976年第3期140卷 87-92页

作者： ADATIA, AK UNIV BRISTOL DENT SCHBRISTOL BS1 2LYENGLAND

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Obstetric analgesia

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PRIMARY CARE 2000年第1期27卷 203-+页

作者： Stephens, MB Fenton, LA Fields, SA Uniformed Serv Univ Hlth Sci Dept Family Med Bethesda MD 20814 USA

Several analgesic options are available for patients during labor. Selection of the appropriate technique must be individualized. Education and preparation begins during prenatal care. If medications are to be used, the risks and benefits to the mother and infant must be considered. Continued patient-doctor communication throughout labor is essential. Patient preferences, tempered by sound medical judgement, should guide the selection of the optimal modality for pain control during labor.

关键词：镇痛硬膜外/方法镇痛产科/历史镇痛药阿片类/治疗应用麻醉/方法神经传导阻滞/方法疼痛/药物疗法疼痛/病理生理学疼痛/治疗女(雌)性历史 19世纪历史 20世纪人类妊娠

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Dental nerve blocks - Toothache remedies for the acute-care setting

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POSTGRADUATE MEDICINE 2000年第1期107卷 229-+页

作者： Powell, SL Robertson, L Doty, BJ Alaska Family Practice Residency Anchorage AK 99508 USA

Ideally, tooth pain is managed by a competent dentist, who can provide definitive care. However, timely access to such care may not be available late at night, on weekends, or in rural practice settings. This article introduces primary care physicians to dental nerve blocks that can be learned without extensive training and used in the acute-care setting to provide temporary relief of oral, dental, and facial pain.

关键词：知情同意神经传导阻滞/方法病人遴选初级卫生保健牙痛/治疗人类

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Regional anesthesia - Nerve blocks of the extremities and face

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POSTGRADUATE MEDICINE 1999年第4期106卷 69-+页

作者： Smith, DW Peterson, MR DeBerard, SC Univ Washington Sch Med Seattle WA 98195 USA Univ Arizona Coll Med Tucson AZ 85721 USA

Regional nerve blocks are useful far anesthetizing the hand and fingers, the foot and toes, and the face and mouth. These simple procedures may be performed prior to wound repair or surgery of the affected area. The a... 详细信息

关键词：踝/神经支配四肢/神经支配面部/神经支配指/神经支配神经传导阻滞/方法趾/神经支配人类

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The management of cancer pain

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CA-A CANCER JOURNAL FOR CLINICIANS 2000年第2期50卷 70-116页

作者： Cherny, NI Shaare Zedek Med Ctr Dept Med Oncol Jerusalem Israel

Any therapeutic strategy developed for patients experiencing cancer pain depends on the goals of care, which can be broadly categorized as prolonging survival, optimizing comfort, and optimizing function. The relative priority of these goals for any individual should direct therapeutic decision-making. By combining primary treatments, systemic analgesic agents, and other techniques, most cancer patients can achieve satisfactory relief of pain. In cases where pain appears refractory to these interventions, invasive anesthetic or neurosurgical maneuvers may be necessary, and sedation may be offered to those with unrelieved pain at the end of life. The principles of analgesic therapy are presented, as well as the practical issues involved in drug administration, ranging from calculating dosage to adverse effects, and, when necessary, how to switch and/or combine therapies. Adjuvant analgesics, which are drugs indicated for purposes other than relief of pain but which may have analgesic effects, are also listed and discussed in some detail. Surgical and neurodestructive techniques, such as rhizotomy or cordotomy, although not frequently required or performed, represent yet other options for patients with unremitting pain and diminished hope of relief. Although cancer pain can be a complex medical problem arising from multiple sources, patients should be assured that suffering is not inevitable and that relief is attainable.

关键词：肾上腺皮质激素类/投药和剂量抗菌药/投药和剂量消炎药非甾类/投药和剂量消炎药非甾类/副作用抗肿瘤药/投药和剂量中枢神经系统抑制药/投药和剂量剂型投药途径用药计划表肾疾病/并发症肝疾病/并发症肿瘤/并发症肿瘤/外科学肿瘤/治疗神经传导阻滞/方法疼痛/病因学疼痛管理病人遴选物质相关性障碍/预防和控制人类

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PARACERVICAL-BLOCK IN OBSTETRICS AN IMPROVED INJECTION METHOD - CLINICAL AND RADIOLOGICAL STUDY

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ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA 1975年第1期54卷 9-27页

作者： JAGERHORN, M CENT HOSP VASTERVIK DEPT OBSTET & GYNECOLLASARETTET593 01 VASTERVIKSWEDEN

An attempt was made to illustrate radiologically the absorption of the anesthetic preparation after injection for paracervical block (PCB). 20 women were studied who were admitted for legal abortion in the 14th to 19th wk of pregnancy. The mixture of contrast medium and anesthetic was injected at various sites and at various depths in order to study the absorption from the paracervical space during pregnancy. The experiences gained were used as a basis for an improved injection technique. The importance of the injection depth of no more than 3 mm was particularly emphasized. This means that the anesthetic preparation should always be deposited paracervically just below the epithelium. From here, a slow diffusion of the anesthetic preparation into the loose intravascular connective tissue occurs instead of, with deeper injections, being deposited directly into the venous plexus of the paracervical tissue, where the risk of intravascular injection is extremely great. At the same time, when the correct technique is used, the risk of depositing the anesthetic preparation in the lower uterine segment, the fetal presenting part, or the nervous plexus of the pelvic wall is avoided. Some other practical aspects are discussed. The improved injection technique was also used for a personal series of consecutive deliveries, over a 6 mth period including 134 patients who were given a total of 204 paracervical blocks. The anesthetic solution bupivacaine chloride (Marcaine) was used in a 0.25% solution with the addition of adrenaline 1 : 400,000 in a dose of 10 ml distributed at 4 injection sites in the lateral fornices. Apart from a considerably better analgesic effect than previously reported, maternal side effects were also completely lacking. Any PCB induced fetal effect was also extremely slight and is subjected to a detailed analysis in the work. With meticulous application of technique and dosage, paracervical block appears to be free from risk; but with the reservation tha

关键词：酸碱平衡麻醉产科阿普加评分血压布比卡因子宫颈/神经支配子宫颈/放射摄影术剖宫产术氯化物造影剂胎儿心脏胎儿/药物作用注射产式母体胎儿间交换神经传导阻滞/方法静脉造影术体位妊娠初期妊娠中期青少年成年人女(雌)性人类妊娠

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EEG changes during awake carotid endarterectomy

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ANNALS OF VASCULAR SURGERY 2002年第1期16卷 6-11页

作者： Illig, KA Sternbach, Y Zhang, RY Burchfiel, J Shortell, CK Rhodes, JM Davies, MG Lyden, SP Green, RM Univ Rochester Med Ctr Div Vasc Surg Rochester NY 14642 USA Univ Rochester Med Ctr Dept Neurol Rochester NY 14642 USA

To determine the reason for differing shunt rates based on electroencephalographic (EEG) and neurologic changes during general and regional anesthetic, respectively, we compared simultaneous EEG tracings and neurologic status in 135 patients undergoing carotid endarterectomy (CEA) under cervical block over a 30-month period. The decision to shunt in these patients was made on the basis of neurologic changes only irrespective of EEG findings. This group was then compared to the 288 patients undergoing CEA under general anesthetic with EEG monitoring over the same period. EEG changes occurred in 7.4% of awake patients and 15.3% of asleep patients (p < 0.03). The rates of ipsilateral hemispheric changes were similar, but no awake patient manifested global EEG changes with clamping while 3.5% of patients under general anesthesia did (p < 0.04). Global, but not hemispheric, changes were correlated with systolic blood pressure variability during clamping. This implies that global EEG changes in anesthetized patients may be the result of the anesthetic technique itself, and that cervical block may in fact be cerebroprotective.

关键词：麻醉全身/方法颈动脉疾病/外科学交流障碍/病因学交流障碍/外科学意识障碍/病因学意识障碍/外科学脑电描记术颈动脉内膜切除术/方法监测手术中/方法神经传导阻滞/方法神经病学检查轻瘫/病因学轻瘫/外科学回顾性研究感觉障碍/病因学感觉障碍/外科学治疗结果老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Combined fluphenazine and lidocaine for pain relief in head and neck cancers

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TROPICAL DOCTOR 2000年第2期30卷 69-70页

作者： Desai, PM Desai, KP Savitribai Fule Municipal Hosp Kolhapur 416002 Maharashtra India

A successful method of treating intractable neoplastic pain in 12 cases is discussed. A completely new method was tried combining long-acting phenothiazine and lidocaine to achieve long-lasting pain relief. This combi... 详细信息

关键词：麻醉药局部/治疗应用多巴胺拮抗剂/治疗应用药物疗法联合氟奋乃静/治疗应用头颈部肿瘤/并发症注射病灶内利多卡因/治疗应用神经传导阻滞/方法疼痛测定疼痛顽固性/病因学疼痛顽固性/预防和控制治疗结果女(雌)性人类男(雄)性

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Rapid modulation of GABA in sensorimotor cortex induced by acute deafferentation

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ANNALS OF NEUROLOGY 2002年第6期52卷 755-761页

作者： Levy, LM Ziemann, U Chen, R Cohen, LG Natl Inst Neurol Disorders & Stroke Neuroimaging Branch NIH Bethesda MD 20892 USA George Washington Univ Med Ctr Neuroradiol Sect Washington DC 20037 USA Natl Inst Neurol Disorders & Stroke Human Cort Physiol Sect NIH Bethesda MD 20892 USA Goethe Univ Frankfurt Neurol Clin D-60590 Frankfurt Germany Toronto Western Hosp Div Neurol Toronto ON M5T 2S8 Canada

Recovery of function after acute injury to the central nervous system may be controlled by the availability of gamma-aminobutyric acid (GABA), the main inhibitory neurotransmitter in the cerebral cortex. Acute lesions as well as manipulation of sensory inputs can lead to rapid reorganization of the cerebral cortex, occurring within minutes to hours. Reduction of cortical inhibitory tone through a decrease in the availability of GABA has been suggested as a possible mechanism;however, the degree and temporal course of the changes in brain GABA are not known. A novel method using two-dimensional J-resolved magnetic resonance spectroscopy showed that GABA levels in the human sensorimotor cortex are quickly reduced within minutes of deafferentation. This finding strongly supports the view that the release of latent corticocortical projections from tonic inhibition through decreased GABA availability is a mechanism of rapid cortical plasticity. Reduction of brain GABA can play a pivotal role in regulating the extent of rapid cortical reorganization after lesions or changes in sensory input.

关键词：传入通路/生理学方差分析大脑皮质/代谢前臂/生理学磁共振波谱学/方法神经传导阻滞/方法 γ氨基丁酸/分析 γ氨基丁酸/代谢成年人女(雌)性人类男(雄)性

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