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Purpose: The aim of this study is to apply combination of axillary plexus block with "selective" injection of nerves and continuous catheter technique, and to compare the anesthetic and postoperative analgesic effects of bupivacaine and levobupivacaine., Methods: In 30 scheduled patients for unilateral hand or forearm surgery, an axillary brachial plexus block with "selective" injection of nerves and continuous catheter technique was performed with 40 ml of 2.5 mg/ml of bupivacaine, or levobupivacaine. After catheter placement, motor and sensory block were scored, and the patient was interviwed in the postoperative first 24 hours. The postoperative first analgesic need, total analgesic needs, pain scale and side-effects were registered., Results: At the 30th min, complete sensory block was more frequent in the inervation area of the median nerve in the Bupivacaine group than Levobopivacaine group, and in the Bupivacaine group, complete sensory block was more frequent in the inervation area of the median nerve than the other nerves (P < 0.05). Simultaneously, partial motor block of radial nevre was more frequent in the levobupivacaine group (P < 0.05). Tourniquet was well tolerated in all patients with successful block in both groups. Mean duration of analgesia was similar to the bupivacaine and levobupivacaine groups at 14.2 h, and 18.4 h, respectively (NS)., Conclusion: In this tecnique, for median and radial nevre, bupivacained 0.25% produced slightly beter sensory and motor block intensity than levobupivacaine 0.25% in onset of the block. General success in relation to surgery and in the duration of the analgesia was identical in the two groups.

We prospectively investigated the outcome of a combination therapy of oral amitriptyline and sympathetic ganglion blockade on 10 patients suffering from reflex sympathetic dystrophy of the upper extremity for at least three months. The efficacy of the treatment was evaluated by clinical examination, pain ratings on the visual analogue scale (VAS) and grip strength measurements using the Jamar dynamometer. The results were statistically analysed with Wilcoxon signed-ranks test for comparison of the before and after treatment grip strength measurements and with paired t-test for comparison of the mean of initial and consecutive pain ratings on the VAS. Values of p < 0.01 were considered to be statistically significant. Combination therapy proved beneficial in this particular patient population, which, as far as previously documented studies are concerned, would otherwise respond less favourably to a treatment consisting solely of sympathetic blockade.

Background and Objective: Epidural analgesia is the most effective method for pain relief during labour. The aim was to elucidate the efficacy of ropivacaine 0.05% and bupivacaine 0.05%, which were both combined with fentanyl 0.00015% to provide analgesia in labour., Methods: Forty nulliparous females were enrolled into the study. After insertion of an epidural catheter, patients were randomly assigned into two groups. Once the os uteri had dilated to 4-5 cm, a bolus of bupivacaine 0.125% 10mL + fentanyl 50 microg (1 mL) in Group 1 patients, and ropivacaine 0.125% 10mL + fentanyl 50 microg (1 mL) in Group 2 patients was administered via the epidural catheter. Then, patient-controlled epidural analgesia was started with a basal infusion of bupivacaine 0.05% 10 mLh(-1) + fentanyl 0.00015% 1.5 pgmL(-1) in Group 1, and ropivacaine 0.05% + fentanyl 1.5 microgmL(-1) in Group 2. When needed, a 10 mL bolus infusion could be given and the lockout time was 20 min. Maternal and fetal haemodynamic variables were monitored before induction and subsequently at 5 min intervals. Using a visual analogue scale assessed the degree of pain., Results: Maternal haemodynamic variables and Apgar scores were not different between the two groups. The second stage of the labour was shorter in Group 2 (P < 0.01). There were no significant differences in patients' assessment of motor block or mode of delivery between groups., Conclusions: An epidural infusion (10 mLh(-1)) of bupivacaine 0.05% or ropivacaine 0.05% together with fentanyl 1.5 microg mL(-1) provided good and safe analgesia during labour.