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Introduction: With the advent of ultrasound (US) guidance, this technique saw resurgence in the late 1990s. As US guidance provides real-time view of the block needle, the brachial plexus, and its spatial relationship to the surrounding vital structures; it not only increased the success rates, but also brought down the complication rates. Most of the studies show use of US guidance for performing brachial plexus block, results in near 100% success with or without complications. This study has been designed to examine the technique and usefulness of state-of-the-art US technology-guided supraclavicular brachial plexus block and compare it with routine nerve stimulator (NS)-guided technique. Aim: To note block execution time, time of onset of sensory and motor block, quality of block and success rates. Settings and Design: Randomized controlled trial. Materials and Methods: A total of 60 patients were enrolled in this prospective randomized study and were randomly divided into two groups: US (Group US) and NS (Group NS). Both groups received 1:1 mixture of 0.5% bupivacaine and 2% lignocaine with 1:200000 adrenaline. The amount of local anaesthetic injected calculated according to the body weight and not crossing the toxic dosage (Inj. bupivacaine 2 mg/kg, Inj. lignocaine with adrenaline 7 mg/kg). The parameters compared between the two groups are block execution time, time of onset of sensory and motor block, quality of sensory and motor block, success rates are noted. The failed blocks are supplemented with general anesthesia. Statistical Analysis: The data were analyzed using the SPSS (version 19) software. The parametric data were analyzed with student "t" test and the nonparametric data were analyzed with Chi-square test A P < 0.05 was considered significant. Results: There was no significant difference between patient groups with regard to demographic data, the time of onset of sensory and motor block. Comparing the two groups, we found that the difference in the block execution time and success rates is not statistically significant. A failure rate of 10% in US and 20% in NS group observed and is statistically insignificant (P = 0.278). No complication observed in either group. Conclusions: US and NS group guidance for performing supraclavicular brachial plexus blocks ensures a high success rate and a decreased incidence of complications that are associated with the blind technique. However our study did not prove the superiority of one technique over the other . The US-guided technique seemed to have an edge over the NS-guided technique. A larger study may be required to analyze the advantages of using US in performing supraclavicular brachial plexus blocks, which could help justify the cost of purchase of the US machine. [ABSTRACT FROM AUTHOR]

Background: As peripheral nerve blockade has increased significantly over the past decade, resident education and exposure to peripheral nerve blocks has also increased. This survey assessed the levels of exposure and confidence that graduating residents have with performing selected peripheral nerve blocks. Methods: All program directors of ACGME-accredited anesthesiology programs in the USA were asked to distribute an online survey to their graduating residents. Information was gathered on the number and types of nerve blocks performed, technique(s) utilized, perceived comfort level in performing nerve blocks, perceived quality of regional anesthesia teaching during residency, and suggested areas for improvement. Results: One hundred and seven residents completed the survey. The majority completed more than 60 nerve blocks. Femoral and interscalene blocks were performed most frequently, with 59% and 41% of residents performing more than 20 of each procedure, respectively. The least-performed block was the lumber plexus block, with just 9% performing 20 or more blocks. Most residents reported feeling "very" to "somewhat" comfortable performing the surveyed blocks, with the exception of the lumber plexus block, where 64% were "not comfortable." Overall, 78% of residents were "mostly" to "very satisfied" with the quality of education received during residency. Conclusions: Most of the respondents fulfilled the ACGME requirement and expressed satisfaction with the peripheral nerve block education received during residency. However, the ACGME requirement for 40 nerve blocks may not be adequate for some residents to feel comfortable in performing a full range of blocks upon graduation. Many residents felt that curriculums incorporating simulator training and didactic lectures would be the most helpful method of improving the quality of their education pertaining to peripheral nerve blocks. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To assess the effect of pre-emptive analgesia by bilateral nerve stimulator-guided pudendal nerve block (PNB) on pain intensity and consumption of analgesics following posterior colpoperineorrhaphy. Study design: Prospective randomized observer-blinded study. The study included 130 patients who were scheduled to undergo posterior colpoperineorrhaphy under general anesthesia (GA). They were invited to enroll in the study during the period from October 2009 to August 2011 at TAIBA Hospital in Kuwait. Patients were randomly allocated to two groups of 65 patients each: GA alone or GA combined with pre-emptive nerve stimulator-guided PNB with 10mL of 0.25% bupivacaine in each side. The primary outcome measures were VAS pain scores and postoperative analgesic consumption. Results: Postoperative average VAS pain scores, IM pethidine consumption and IV paracetamol consumption during the first 24h; were highly significantly lower in the PNB group compared to the GA alone group. This technique was also associated with a significantly higher overall patient satisfaction compared to GA alone, without obvious side effects. Conclusion: Pre-emptive analgesia by bilateral nerve stimulator-guided PNB is a simple and useful technique that when combined with GA was found to substantially reduce postoperative pain and consumption of analgesics during the first 24h postoperatively, and shorten the time to return to normal activities compared to GA alone for patients undergoing posterior colpoperineorrhaphy. The use of PNB was also associated with a high overall patient satisfaction. Thus, the results of the present study may recommend the use of nerve stimulator-guided PNB in posterior colpoperineorrhaphy patients. [Copyright &y& Elsevier]

Objective: Axillary brachial plexus block can be achieved through various techniques in upper extremity operations. The purpose of our study was to compare the efficacy of axillary brachial plexus block using an ultrasound technique with peripheral nerve stimulation technique. Material and Methods: Sixty patients for whom elective forearm and hand surgery was planned were included in the study. Group 1 (n=30) was given an axillary block by using ultrasonography, Group 2 (n=30) was given axillary block by using a peripheral nerve stimulator. The quality and time of onset of the sensorial and motor blockade were assessed. Results: The average time needed to perform the axillary brachial plexus block was similar in both groups. Although not significant statistically, it was observed that the sensory block was achieved earlier in Group 1. However, the degree of motor blockade was more intense in Group 1 than in Group 2. Conclusion: The ultrasound-guided axillary brachial plexus block is a preferable method with faster onset time and better quality of motor blockade compared to the PNS technique. [ABSTRACT FROM AUTHOR]

Abstract: Study Objective: To determine whether ultrasound guidance improves the quality of continuous popliteal block when compared with a nerve stimulator after major foot and ankle surgery. Design: Prospective, randomized, double-blinded clinical trial. Setting: Operating room, Postanesthesia Care Unit (PACU), and hospital wards of a university-affiliated hospital. Patients: 45 ASA physical status 1, 2, and 3 patients undergoing elective major foot and ankle surgery. Interventions: Placement of a popliteal sciactic nerve catheter using either nerve stimulator or ultrasound guidance. In the PACU, a continuous infusion of ropivacaine 0.2% was started at a basal rate of 4 mL/hr and adjusted in a standardized fashion to maintain visual analog scale (VAS) pain scores < 4. All patients also received intravenous (IV) patient-controlled analgesia with hydromorphone and oral opioids. Measurements: VAS pain scores at rest and with physical therapy, ropivacaine use, opioid use, and opioid-related side effects were recorded. Main Results: Cummulative ropivacaine use was lower in patients whose catheter was placed by ultrasound than by nerve stimulator guidance (mean 50 vs 197 mL, P < 0.001). Pain scores at rest and during activity were similar between groups. Cumulative opioid consumption (mean 858 vs 809 mg oral morphine equivalents) and daily frequencies of nausea (5% to 33% vs 0 to 24%) and pruritus (0 to 21% vs 0 to 24%) were similar between groups. Length of hospital stay was similar between groups (3.5 vs 3.7 days). Conclusions: Ultrasound guidance was associated with less local anesthetic consumption than with the nerve stimulator; however, there was little clinical benefit, as all other outcomes were similar between groups. [Copyright &y& Elsevier]

Abstract: Background: Thoracic paravertebral block (TPVB) is an effective intraoperative and postoperative technique for surgical anaesthesia and analgesia for breast surgery. It offers a long-lasting effective analgesia without increases in side effects, with a significant decrease in anaesthetic and analgesic consumption, and with a high degree of patient satisfaction and shorter recovery time. In this study, TPVB was done by using a nerve stimulator to measure the depth of needle insertion by eliciting intercostal muscle contraction, and a catheter was introduced preoperatively to allow for repeated injections and to maintain analgesia postoperatively. Methods: Two groups of patients undergoing unilateral cancer breast surgery (each 20 patients) were randomly assigned to the study; a study group (PVB) and a control (C) group. The study started by preoperative application of an epidural catheter by using the nerve stimulator at the fourth thoracic paravertebral space in the study group and injection of local anaesthetic started preoperatively. General anaesthesia was started for the two groups. Total intraoperative fentanyl and postoperative morphine consumption, and pain intensity at rest and with arm movement were recorded, together with recording of any undesirable side effects for 24h. Results: There were statistically highly significant decreases in intraoperative fentanyl consumption and postoperative morphine consumption in the PVB group than the C group. There were statistically significant decreases in the VAS in the PVB group than the C group both at rest and with shoulder movement. The incidence of adverse events was very low in both groups. Conclusion: Continuous TPVB provides effective pain relief, significant opioid sparing, and also less painful restricted movement of the shoulder, with few side effects after breast cancer surgery. Thoracic paravertebral somatic nerve block may be an alternative to general anaesthesia for major unilateral breast surgery with heavy sedation or to be combined with light general anaesthesia. [Copyright &y& Elsevier]

The article presents a study regarding the efficacy of a nerve stimulator as a brachial plexus block (BPB) in dogs. BDB is a procedure in veterinary medicine that provides surgical analgesia for the front limb distal to the shoulder which is often performed blindly with the use of anatomical landmarks. Likewise, a comparison between the nerve blocking effects of bupivacaine and ropivacaine for BVB is performed. The nerve blocking effects were assessed in the basis of sensory blockade in several cutaneous areas and knuckling of 12 beagles. The study concludes that the differences in the onset time and duration as well as the effects of perioperative analgesia depend on the intension of the use of bupivacaine and ropivacaine.

Patients with severe ankylosing spondylitis (AS) have difficulties in tracheal intubation. An 87-year-old man with severe AS was scheduled for Zenker diverticulum (ZD) excision. It was decided to proceed with combined bilateral cervical plexus blockade using a nerve stimulator. The surgery lasted about 3 h, with stable hemodynamics, ECG, and oxygen saturation. The use of a nerve stimulator-guided cervical block minimizes the risk of severe respiratory and/or airway compromise secondary to phrenic nerve or recurrent laryngeal nerve palsy, because it can elicit diaphragmatic muscle response, which helps to avoid the administration of local anesthetic directly to the area of the phrenic nerve, and guides correct needle placement. In conclusion, the nerve stimulatorguided bilateral cervical block in our ZD patient with AS was shown to be a safe and successful alternative anesthetic option. [ABSTRACT FROM AUTHOR]

Despite its well-known benefits, regional anesthesia has not attained the stature, simplicity, and safety of general anesthesia. Many of the challenges and clinical failures of regional anesthetic techniques can be attributed to fact that neurovascular anatomy is highly variable. Furthermore, current nerve localization techniques provide little or no information regarding the anatomical spread local anesthesia. Recently, ultrasound technology has been utilized by anesthesiologists in an attempt to minimize many of the drawbacks of traditional nerve block techniques. This review article will update the reader on the current status of ultrasound-guided regional anesthesia, provide an evidence-based context, and supply key facts regarding ultrasound physics. In the process, we will also highlight several possible limitations of ultrasound techniques including learning curve issues, costs, and artifact generation. [ABSTRACT FROM AUTHOR]

Abstract: Nerve stimulation typically employs charge-balanced current injection with a delay between the cathodal and anodal phases. Typically these waveforms are produced using a microprocessor. However, once appropriate stimulus parameters are chosen, they tend to remain fixed within an application, making computational power unnecessary. In such cases, it would be advantageous to replace the microprocessor with integrated circuitry and hardware controls for maintaining fixed pulse parameters. We describe here an architecture that generates controllable charge-balanced pulses but requires no computer processing components. The circuitry has been engineered such that minimum size and power consumption can be achieved when fabricated into an IC chip, making it ideal for many long term, portable nerve stimulation devices and applications. [Copyright &y& Elsevier]

Objective: To compare the clinical characteristics, quality, complications and patient satisfaction with interscalene brachial plexus block using a nerve stimulator versus the paresthesia technique for shoulder and proximal humerus surgery. Methods: A randomized clinical trial with two groups of participants was conducted at the National Center of Rehabilitation; group N stands for the neurostimulation group and group P for the paresthesia group. In both groups we used the same type, dose and volume of local anesthetic. Quality, success, latency, duration and complications in shoulder and proximal humerus bone surgery, were evaluated. Results: Seventy-eight patients participated in the study (N= 40; P= 38). Both groups were similar in their general characteristics. The block quality was the same in both groups. The success rate was 90% in group N and 89.47% in group P with no statistically significant difference (p > 0.05). Latency and duration were similar in both groups. No transient neurological symptoms or complications appeared in any group. Patients' satisfaction was higher in group N. Conclusions: There is no difference in localization of plexus by nerve stimulator method versus paresthesia method for interscalene block in shoulder and proximal humerus surgery. The quality, latency, duration, rate of success and complications were similar in both cases, but the patients' satisfaction was higher in the nerve stimulator group. [ABSTRACT FROM AUTHOR]

Background: Monitoring of the recurrent laryngeal nerve (RLN) has been claimed in some studies to reduce rates of nerve injury during thyroid surgery compared with anatomical dissection and visual identification of the RLN alone, whereas other studies have found no benefit. Continuous monitoring with endotracheal electrodes is expensive whereas discontinuous monitoring by laryngeal palpation with nerve stimulation is a simple and inexpensive technique. This study aimed to assess the value of nerve stimulation with laryngeal palpation as a means of identifying and assessing the function of the RLN and external branch of the superior laryngeal nerve (EBSLN) during thyroid surgery. Methods: This was a prospective case series comprising 50 consecutive patients undergoing total thyroidectomy providing 100 RLN and 100 EBSLN for examination. All patients underwent preoperative and postoperative vocal cord and voice assessment by an independent ear, nose and throat surgeon, laryngeal examination at extubation and all were asked to complete a postoperative dysphagia score sheet. Dysphagia scores in the study group were compared with a control group ( n = 20) undergoing total thyroidectomy without nerve stimulation. Results: One hundred of 100 (100%) RLN were located without the use of the nerve stimulator. A negative twitch response occurred in seven (7%) RLN stimulated (two bilateral, three unilateral). Postoperative testing, however, only showed one true unilateral RLN palsy postoperatively (1%), which recovered in 7 weeks giving six false-positive and one true-positive results. Eighty-six of 100 (86%) EBSLN were located without the nerve stimulator. Thirteen of 100 (13%) EBSLN could not be identified and 1 of 100 (1%) was located with the use of the nerve stimulator. Fourteen per cent of EBSLN showed no cricothyroid twitch on EBSLN stimulation. Postoperative vocal function in these patients was normal. There were no instances of equipment malfunction. Dysphagia scores did not differ significantly between the study and control groups. Conclusion: Use of a nerve stimulator did not aid in anatomical dissection of the RLN and was useful in identifying only one EBSLN. Discontinuous nerve monitoring by stimulation during total thyroidectomy confers no obvious benefit for the experienced surgeon in nerve identification, functional testing or injury prevention. [ABSTRACT FROM AUTHOR]

Abstract: Functionality of the nerve stimulator and integrity of the electrical circuit should be verified and confirmed before performing peripheral nerve blockade. The clinical cases reported here demonstrate that electrical disconnection or malfunction during nerve localization can unpredictably occur and a checklist is described to prevent the unknown electrical circuit failure. [Copyright &y& Elsevier]

Objective: To evaluate the efficacy of nerve stimulation as an adjunct to ultrasound-guided supraclavicular nerve blocks.Design: Prospective database review.Setting: Tertiary-care medical center.Measurements: The records of 94 consecutive adult patients requiring surgery below the elbow and consenting to receive regional anesthesia were studied. The focus of this study was on supraclavicular nerve block using ultrasound guidance for nerve identification and needle localization. A nerve stimulator with a motor response lower than 0.5 mA was used for confirmation of findings. An ultrasound image was considered adequate if two trunks of the brachial plexus were visualized and if the needle was completely seen on the long axis. A successful block was defined as one that sufficed as the sole anesthetic without conversion to general anesthesia. Motor and sensory examination findings on the upper extremity were also evaluated.Results: 74 patients had an adequate ultrasound image. Of the 64 patients with a positive motor response, 88% had a successful block, as compared with 90% of the 10 patients without a motor response (relative risk, 1.09; 95% confidence interval, 0.79-1.51; P = 0.52). Neither multivariate correction for baseline characteristics nor inclusion of the 20 patients with inadequate ultrasound images changed the results.Conclusion: For adequately imaged ultrasound-guided supraclavicular nerve blocks, a positive motor response to nerve stimulation does not increase the success rate of the block. In addition, the high false-negative rate suggests that these blocks are usually effective, even in the absence of a motor response. Nerve stimulation as an adjunct to ultrasound guidance may have a limited role. [ABSTRACT FROM AUTHOR]

Background: We prospectively evaluated direct analgesia-related costs of continuous sciatic nerve block using either a stimulating or conventional catheter after hallux valgus repair. Methods: The perineural catheter was inserted through a stimulating introducer either blindly (group Conventional, n= 38) or while stimulating via the catheter (group Stimulating, n= 38). Nerve block was induced with 25 ml of mepivacaine 15 mg/ml, and was followed 3 h later by a patient-controlled infusion of ropivacaine 2 mg/ml (basal infusion: 3 ml/h; incremental dose: 5 ml; lock-out time: 30 min). Rescue tramadol [100 mg intravenous (i.v.)] was given if required. Local anesthetic consumption, need for rescue tramadol and post-operative nausea and vomiting (PONV) treatment, and patient’s satisfaction were recorded during first 24-h infusion. Cost calculations were based on the acquisition cost of drugs and devices. Results: Both techniques were similarly effective, but local anesthetic consumption and need for rescue analgesics were lower in the Stimulating group [respectively, 120 vs. 153 ml ( P= 0.004) and 21% vs. 60% ( P= 0.001)]. The analgesia-related costs for 24 h were similar when 100-ml bags of ropivacaine 2 mg/ml were used (66 € vs. 67 €; P= 0.26). When 200-ml bags of ropivacaine were used, the analgesia-related costs were higher in the Stimulating group than the Conventional group (75 € vs. 55 €; P= 0.0005). Conclusions: Direct costs of continuous sciatic nerve block ranged from 55 to 75 €. Stimulating catheters reduced local anesthetic consumption and need for rescue analgesics. This was only cost effective when 100-ml bags of 2 mg/ml ropivacaine were used, while the cheapest combination was the use of conventional catheters and 200-ml bags of ropivacaine. [ABSTRACT FROM AUTHOR]

Randomized comparative study of the efficacy of nerve root infiltration (NRI) guided by neurostimulator to find the value of nerve stimulators in nerve root infiltration was undertaken. The response to nerve root infiltration using local anaesthetics and steroid is unpredictable, partly because the exact nerve root giving rise to pain may not be truly infiltrated. The nerve stimulator is advocated to identify the nerve root of concern prior to infiltration. The current study assessed the results of NRI with and without the nerve stimulator. Ninety-six patients with leg pain awaiting selective nerve root infiltration using long acting local aesthetic, were prospectively randomized into two groups, in the first one, the nerve root block was carried out without nerve stimulator (n = 39) and in the second group the block was carried out with the guidance of a nerve root stimulator (n = 57). Seventy-seven of the patients who had lateral canal stenosis (a total 81) responded to NRI; within this group nerve stimulator was used for 50 patients. Nerve root infiltration was used to relieve post-discetomy leg pain (ten), post-disc prolapse (four) and in one patient post-nucleotomy leg pain. Overall 89% of the patients were responders of NRI. Responders of around 65% had the NRI performed with the aid of stimulator. The response rate to pain was 96% when NRI was guided by a neurostimulator and 79% when no neurostimulator was used. When responded there was no significant statistical difference using the Oswestry disability score between both groups. After excluding disc bulge in patients who respond partially to NRI, it is worthwhile repeating the injection. There was a significant difference in response rate when NRI was done under guidance of a nerve stimulator, the stimulator is safe to use and increases the specificity of the block. [ABSTRACT FROM AUTHOR]

Copyright of Operative Orthopädie und Traumatologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

PURPOSE: Sexual dysfunction after total mesorectal excision may be caused by injury to the autonomic nerves. During surgery, nerve identification is not always achieved, and, to date, there has been no method to objectively confirm nerve preservation. The aim of this study was to assess the efficacy of a nerve-stimulating device (CaverMap®) to assist in the intraoperative identification of the autonomic nerves during total mesorectal excision, and objectively confirm nerve preservation after proctectomy is completed. PATIENTS AND METHODS: Sexually active consecutive male patients undergoing total mesorectal excision were prospectively enrolled in this study. During pelvic dissection, the surgeon attempted to localize the hypogastric and cavernous nerves. Cavermap® was used to confirm these findings and to facilitate the identification in cases of uncertainty. At the completion of proctectomy, the nerves were restimulated to ensure preservation. Factors that could affect the surgeons ability to localize the nerves and Cavermap® to confirm this were evaluated. RESULTS: Twenty-nine male patients with a median age of 58 years were enrolled in this study. An attempt to visualize the hypogastric nerves during dissection was made in 26 patients; the surgeon was able to identify the nerves in 19 (73 percent) patients. Cavermap® successfully identified the nerves in six of the seven remaining patients, and failed to identify them in only one case. An attempt to localize the cavernous nerves during dissection was made in 13 patients, of which localization was successful in 8 (61.5 percent) patients. Cavermap® improved the identification rate in four of the remaining five patients. After proctectomy, Cavermap® successfully confirmed the preservation of both hypogastric and cavernous nerves in 27 of 29 (93 percent) patients. A history of previous surgery statistically correlated with failure to identify the hypogastric nerves by the surgeon (P = 0.005). There were no adverse events related to use of the device. CONCLUSION: Cavermap® may be a useful tool to facilitate identification of the pelvic autonomic nerves during total mesorectal excision and to objectively confirm nerve preservation. [ABSTRACT FROM AUTHOR]

PURPOSE: Sexual dysfunction after total mesorectal excision may be caused by injury to the autonomic nerves. During surgery, nerve identification is not always achieved, and, to date, there has been no method to objectively confirm nerve preservation. The aim of this study was to assess the efficacy of a nerve-stimulating device (CaverMap®) to assist in the intraoperative identification of the autonomic nerves during total mesorectal excision, and objectively confirm nerve preservation after proctectomy is completed. PA- TIENTS AND METHODS: Sexually active consecutive male patients undergoing total mesorectal excision were prospectively enrolled in this study. During pelvic dissection, the surgeon attempted to localize the hypogastric and cayernous nerves. Cavermap® was used to confirm these findings and to facilitate the identification in cases of uncertainty. At the completion of proctectomy, the nerves were restimulated to ensure preservation. Factors that could affect the surgeon's ability to localize the nerves and Caver- map® to confirm this were evaluated. RESULTS: Twenty- nine male patients with a median age of 58 years were enrolled in this study. An attempt to visualize the hypogastric nerves during dissection was made in 26 patients; the surgeon was able to identify the nerves in 19 (73 percent) patients. Caverniap® successfully identified the nerves in six of the seven remaining patients, and failed to identify them in only one case. An attempt to localize the cavernous nerves during dissection was made in 13 patients, of which localization was successful in 8 (61.5 percent) patients. Cavermap® improved the identification rate in four of the remaining five patients. After proctectomy, Cavermap® successfully confirmed the preservation of both hypogastric and cavernous nerves in 27 of 29 (93 percent) patients. A history of previous surgery statistically correlated with failure to identify the hypogastric nerves by the surgeon (P = 0.005). There were no adverse events related to use of the device. CONCLUSION: Cavermap® may be a useful tool to facilitate identification of the pelvic autonomic nerves during total mesorectal excision and to objectively confirm nerve preservation. [ABSTRACT FROM AUTHOR]

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Background and objective: The efficiency of bilateral paravertebral blockade combined with general anaesthesia (active) vs. general anaesthesia alone (control) in reducing postoperative rain following laparoscopic cholecystectomy was evaluated using a prospective randomized study design. Methods: Patients were randomly assigned to either group. Nerve-stimulator guided paravertebral blockade at the T5-6 level was performed with a local anaesthetic mixture (0.30 mL kg-1). Twenty millilitres of the mixture contained lidocaine 2% 6 mL; lidocaine 2% 6 mL with epinephrine 1/200 000; bupivacaine 0.5% 5 mL; fentanyl 1 mL (50 μg mL-1) and clonidine 2 mL (150 μg mL -1). Postoperative pain and consumption of opioids were assessed during the first 72 h. Results: Two-times 30 patients were analysed. Patient characteristics data, and pre- and peroperative variables were similar in both groups. Mean pain scores visual analogue scale were significantly less with active compared with control (P < 0.05) at 6 h (1.56 ± 1.58 vs. 4.78 ± 1.67), at 12 h (1.52 ± 1.58 vs. 3.81 ± 1.63), at 24 h (1.16 ± 1.34 vs. 2.71 ± 1.50), at 36 h (0.68 ± 1.02 vs. 2.29 ± 1.41), at 48 h (0.60 ± 1.04 vs. 1.61 ± 1.33) and at 72 h (0.40 ± 0.86 vs. 1.19 ± 1 .16). The number of patients consuming supplemental analgesics was significantly less (P < 0.05) with active compared with control, at 6 h (6 vs. 29), at 12 h (2 vs. 26), at 24 h (1 vs. 23) and at 36 h (2 vs. 15). More patients were Free from nausea (P < 0.05) with active compared with control at 6 h (23 vs. 9) and at 12 h (29 vs. 19). Conclusion: When used as a complement to general anaesthesia, bilateral nerve-stimulator guided paravertebral blockade with lidocaine, bupivacaine, fentanyl and clonidine may improve postoperative pain relief. [ABSTRACT FROM AUTHOR]

Objective: To find out the incidence and type of external laryngeal nerves during operations on the thyroid, and to assess the role of a nerve stimulator in detecting them. Design: Prospective, non-randomised study. Setting: Teaching hospital, Malaysia. Subjects: 317 patients who had 447 dissections between early January 1998 and late November 1999. Main outcome measures: Number and type of nerves crossing the cricothyroid space, and the usefulness of the nerve stimulator in finding them. Results: The nerve stimulator was used in 206/447 dissections (46%). 392 external laryngeal nerves were seen (88%), of which 196/206 (95%) were detected with the stimulator. However, without the stimulator 196 nerves were detected out of 241 dissections (81%). The stimulator detected 47 (23%) Type I nerves (nerve > 1 cm from the upper edge of superior pole); 86 (42%) Type IIa nerves (nerve < 1 cm from the upper edge of superior pole); and 63 (31%) Type IIb nerves (nerve below upper edge of superior pole). 10 nerves were not detected. When the stimulator was not used the corresponding figures were 32 (13%), 113 (47%), and 51 (21%), and 45 nerves were not seen. If the nerve cannot be found we recommend dissection of capsule close to the medial border of the upper pole of the thyroid to avoid injury to the nerve. Conclusion: Although the use of the nerve stimulator seems desirable, it confers no added advantage in finding the nerve. In the event of uncertainty about whether a structure is the nerve, the stimulator may help to confirm it. However, exposure of the cricothyroid space is most important for good exposure in searching for the external laryngeal nerve. [ABSTRACT FROM AUTHOR]

Background: The primary objective of this study was to establish the relation between the post tetanic count (PTC) and the time to reappearance of the first response (T1) in train-of-four (TOF) nerve stimulation following rocuronium 0.6 mg/kg, 0.9 mg/kg, and 1.2 mg/kg. The secondary objective was to evaluate the intubation conditions after 1 min.Methods: One hundred and eight patients were randomised to one of three doses of rocuronium: 0.6, 0.9 or 1.2 mg/kg. Tracheal intubation was performed at 60 s by a blinded investigator. During propofol, fentanyl, midazolam anaesthesia the neuromuscular block was monitored by mechanography using TOF stimulation every 12 s. At 6 min intervals, a tetanic stimulation (50 Hz) was applied for 5 s preceded and followed by a 30 s period of 1 Hz stimulation until the reappearance of T1.Results: There was a significant difference in recovery following the high dose and the two lower doses. The relation between time (min) to reappearance of T1 (t) and PTC can be expressed as follows: t(0.6 and 0.9 mg/kg)(min)=18.8-6.46 PTC and t(1.2 mg/kg)(min)=26.1-9.12 PCT. T1 was seen at a mean PTC level of 8 or 9 in all three groups. The intubation conditions were graded as excellent or good in all patients except in two patients following the 0.6 mg/kg dose of rocuronium.Conclusion: The PTC method can be used to predict the time to first response to TOF nerve stimulation during intense rocuronium induced neuromuscular blockade. The relation between PTC and the time to T1 was prolonged after 1.2 mg/kg compared with 0.6 mg/kg and 0.9 mg/kg. No further improvement in intubation conditions at 60 s was evident by increasing the rocuronium dose from 0.9 mg/kg to 1.2 mg/kg. [ABSTRACT FROM AUTHOR]

Summary The results obtained in 3050 peripheric nerve blocks of the foot and the results obtained in 754 popliteal sciatic nerve blocks were compared. The technique performed was the blockade of the tibial nerve, common peroneal nerve and the sural nerve in the foot block group (FB) as well as the posterior popliteal block with only one puncture in the popliteal block group (PB). We found the results to be successful in both groups (91% in the FB group and 86% in the PB). We therefore conclude that both techniques are easy to carry out, with a few complications and providing long-lasting postoperative analgesia. The posterior popliteal sciatic nerve block is more comfortable for the patient than the peripheral nerve block, as only one puncture is needed. [ABSTRACT FROM AUTHOR]