Standardized Block Research Articles

Development of a standardized peripheral nerve block procedure note form

Despite the tremendous growth of peripheral nerve blocks, no standard format exists to document their performance. Our objective was to create a peripheral nerve block form based on key elements of literature evidence and on our own group consensus. We describe the process and results of our multi-institutional effort to construct a standardized peripheral nerve block procedure form. A form was developed to help meet the medical, legal, and billing requirements of documentation consistent with the performance of peripheral nerve block.

Beeinflusst die individuelle Anpassung standardisierter Sprachparadigmen für die klinische funktionelle Magnetresonanztomographie (fMRT) die Lokalisation der sprachdominanten Hemisphäre, des Broca- und des Wernicke-Sprachzentrums?

Functional magnetic resonance imaging (fMRI) localizes Broca's area (B) and Wernicke's area (W) and the hemisphere dominant for language. In clinical fMRI, adapting the stimulation paradigms to each patient's individual cognitive capacity is crucial for diagnostic success. To interpret clinical fMRI findings correctly, we studied the effect of varying frequency and number of stimuli on functional localization, determination of language dominance and BOLD signals. Ten volunteers (VP) were investigated at 1.5 Tesla during visually triggered sentence generation using a standardized block design. In four different measurements, the stimuli were presented to each VP with frequencies of 1/1 s, (1/2) s, (1/3) s and (1/6) s. The functional localizations and the correlations of the measured BOLD signals to the applied hemodynamic reference function (r) were almost independent from frequency and number of the stimuli in both hemispheres, whereas the relative BOLD signal changes (DeltaS) in B and W increased with the stimulation rate, which also changed the lateralization indices. The strongest BOLD activations were achieved with the highest stimulation rate or with the maximum language production task, respectively. The adaptation of language paradigms necessary in clinical fMRI does not alter the functional localizations but changes the BOLD signals and language lateralization which should not be attributed to the underlying brain pathology.

Private benefits, block transaction premiums and ownership structure

A simple model shows that both price premiums and standardized block premiums (SBPs) are biased measures of private benefits because they do not account for the transfer of control effectively taking place with the block. This depends not only on the fractional size of the block, but on the whole distribution of shareholdings. We propose an alternative methodology to measure private benefits which makes it possible to weight the size of traded blocks on the basis of their strategic power. We apply our method to a sample of Italian block transactions and show that the traditional method underestimates control rents. The sensitivity of private benefits to net worth, leverage, and nonvoting shares is also examined. Finally, we show how to forecast the price of out-of-sample blocks of shares on the basis of information on company capital and ownership structure.

Leg weakness is a complication of ilio-inguinal nerve block in children

Ilio-inguinal nerve block is commonly used in children to provide analgesia after surgery in the groin. Several case reports and clinical studies have described leg weakness after this technique and suggest that it may caused by inadvertent femoral nerve block. No prospective studies describing the incidence of this complication have been published. We carried out a prospective, observational study to find out how many children had leg weakness after ilio-inguinal nerve block. We studied 200 children having day-case surgery in the groin under a general anaesthetic with an ilio-inguinal nerve block. All children performed a simple leg-raising test with each leg before induction of general anaesthesia with a standardized ilio-inguinal nerve block on the side of surgery. When the child was awake and comfortable after surgery, they repeated the leg-raising test. Sixteen of 182 children (8.8%) had leg weakness after surgery on the side of the nerve block only, as detected by a leg-raising test. Leg weakness consistent with a femoral nerve block occurs after ilio-inguinal nerve block in approximately one in nine children.

AN ASSESSMENT OF QUADRICEPS ANGLE MEASUREMENT USING DUAL ENERGY X-RAY ABSORPTIOMETRY

The quadriceps angle (Q angle) measurement is suggested to be a predictor of knee injuries, especially in females. Currently, there is no widely accepted standardized method to measure Q angle. Therefore, it is hoped that developing and standardizing a new technique it may aid in the reduction of knee injuries in females. PURPOSE To quantitatively compare manually measured Q angle (conventional) to a more technologically advanced method of measurement using dual energy x-ray absorptiometry (DXA). METHODS Forty-nine healthy female subjects (17–25 yrs) participated in this study. All measurements were conducted on the subject's right leg. The manual techniques were performed in the standing (STN) position and supine (SUP) position. Manual measurements required palpitation and marking of the anterior superior iliac spine (ASIS), tibial tubercle (TT) and midpoint of the patella (PT) with a pen. The angle formed by the intersecting lines (ASIS to PT and TT to PT) was assessed with a long armed goniometer. During the STN measurement subjects' feet were in a self-selected position, while during the SUP measurement, feet were strapped together using a standardized foam block to keep the distance between feet equal for all subjects. The DXA technique required all subjects to have a total body scan using a Lunar DPX-IQ (software version 4.6b). A piece of metal was placed on the TT and the PT to define landmarks for the DXA analysis. DXA images were imported into Photoshop for Windows where the Q angle was digitally assessed. A one-way analysis of variance was used to compare the means of the three techniques. Significance was set at p < .05. RESULTS There were no significant differences among the three measurement techniques: STN 14.9 ± 3.2; SUP 15.7° ± 2.9; and DXA 14.8° ± 4.9. CONCLUSION The data supports the use of the DXA technique to measure Q angle in females as compared to manual techniques. DXA maybe used to assess bone health or body composition and now can provide a measurement of Q angle. The extent to which Q angle measurement predicts a knee injury warrants further investigation.

Private Benefits, Block Transaction Premiums and Ownership Structure

A simple parametric model shows that neither price premiums nor standardized block premiums measure private benefits, because they are affected by both the expected change in profits and the transfer of control effectively taking place with the block. The latter depends not only on the fractional size of the block, but on the whole distribution of shareholdings. The model is used to estimate control rents out of a sample of Italian block transactions. In this application, we measure the control transfer as the difference in the seller's (the buyer's) power index before and after the transaction. The sensitivity of private benefits to net worth, leverage and non-voting shares is examined. Finally, we show how to forecast the price of out-of-sample blocks of shares on the basis of information on company capital and ownership structure.

The use of EMLA reduces the pain associated with digital ring block for ingrowing toenail correction

Treatment of ingrowing toenail is commonly performed under local anaesthesia with a digital ring block. Ring block can be associated with significant pain, caused by needle insertion and deposition of the local anaesthetic agent. EMLA, a topical anaesthetic cream, is widely used to alleviate the pain of venepuncture. The aim of this study was to investigate whether the discomfort of digital block could be reduced by prior application of EMLA. Fifty-five patients who were scheduled for ingrowing toenail under local anaesthesia were randomized into two groups. In Group 1 (n = 30), EMLA was applied around the base of the affected hallux for at least 1 h before ring block. In Group 2 (n = 25), a placebo cream was used. In this double-blind study, patients assessed the pain caused by a standardized ring block using 100-mm visual analogue pain score. The mean visual analogue pain score in Group 1 was 28.1 and 50.1 in Group 2 (P < 0.0001). We conclude that EMLA significantly reduces the pain associated with digital ring block.

The use of EMLA reduces the pain associated with digital ring block for ingrowing toenail correction

Treatment of ingrowing toenail is commonly performed under local anaesthesia with a digital ring block. Ring block can be associated with significant pain, caused by needle insertion and deposition of the local anaesthetic agent. EMLA, a topical anaesthetic cream, is widely used to alleviate the pain of venepuncture. The aim of this study was to investigate whether the discomfort of digital block could be reduced by prior application of EMLA. Fifty-five patients who were scheduled for ingrowing toenail under local anaesthesia were randomized into two groups. In Group 1 (n = 30), EMLA was applied around the base of the affected hallux for at least 1 h before ring block. In Group 2 (n = 25), a placebo cream was used. In this double-blind study, patients assessed the pain caused by a standardized ring block using 100-mm visual analogue pain score. The mean visual analogue pain score in Group 1 was 28.1 and 50.1 in Group 2 (P < 0.0001). We conclude that EMLA significantly reduces the pain associated with digital ring block.

Doppler flow velocity waveforms of the umbilical arteries correlate with intravillous blood volume

OBJECTIVE: My purpose was to measure the volume of the fetoplacental vessel tree and to relate findings to Doppler flow patterns of the umbilical arteries. STUDY DESIGN: One hundred sixty placentas were examined by means of standardized random block placental histomorphometry after delivery and the results were compared with antenatal Doppler findings. RESULTS: There was a high correlation ( r = –0.703) between the intravillous blood volume obtained from measurements of intermediate and terminal villi and the Doppler flow velocity waveforms detected within the last week before delivery. Moreover, the reduced size of a vessel tree less than 85 mL is highly predictive of perinatal complications, such as fetal growth restriction, low umbilical artery pH values after birth, reduced Apgar scores, and cesarean section for fetal distress. CONCLUSION: These data suggest that reduced end-diastolic flow velocities in the umbilical arteries are associated with elevated fetoplacental impedance owing to reduced vascularization of intermediate and terminal villi. (Am J Obstet Gynecol 1998;179:540-3.)

Effect of inferior alveolar nerve block anaesthesia on the lower teeth

The aims of this study were to investigate the effects on pulpal blood flow and anaesthesia in mandibular teeth during inferior alveolar nerve block anaesthesia using 2% lignocaine with 1:80,000 adrenaline in 10 adult human subjects. Local anaesthetic solution was delivered close to the inferior alveolar nerve at the mandibular foramen using a standardized nerve block technique. The pulpal blood flow of the canine and first permanent molar was monitored by a laser Doppler flowmeter. At selected times pulpal anaesthesia was tested with an electric pulp tester. The injection of 2 ml of solution caused a decrease in pulpal blood flow in both teeth in every subject. The reduction in blood flow was of shorter duration than pulpal and soft tissue anaesthesia. A period of increased blood flow following the period of reduction was noted in several subjects. The mean reduction in pulpal blood flow in the canine at 15 min was 48% and lasted for a mean of 93 min. In contrast, the mean reduction in pulpal blood flow in the molar at 15 min was 25% and of 72 min mean duration. The mean duration of pulpal anaesthesia was 114 min in the canine compared with 88 min in the molar. Full soft tissue anaesthesia lasted for a mean of 151 min, whereas complete recovery took 255 min. This study indicated that lignocaine and adrenaline in block anaesthesia acted not only at the site of injection but also within the individual teeth.

Use of Standard Task Blocks to Simplify the Ship Production Process

A system of production planning with a built-in capability to monitor performance at all levels of the shipbuilding process is the focus of this paper. The heart of this system—the standardized task block—incorporates individual and comprehensive work packages from fabrication through project completion. The logic, procedure, and economy of the method are discussed with particular emphasis on the modular/zone concept of ship construction, which provides the basis for establishing the task block matrices.

A Performance Comparison of Japanese and American Hand Saws

This study examined, by measuring the time required and oxygen consumption, the efficiency of three types of hand saws cutting a standardized block of wood. An American saw which cuts on the push stroke was compared to a Japanese saw which cuts on the pull stroke and to a two handled bow saw whose teeth were clearly raked toward one handle. The bow saw was used twice, once cutting with the push stroke only and once with the pull stroke. The results showed no significant difference among saw types in the time it took to cut the wood, but did show differences in the amount of oxygen consumed. By this measure the Japanese saw was most efficient, the push bow saw and American saw second, and the bow saw cutting on the pull stroke the least efficient.

PLACENTAL TRANSFER OF LIDOCAINE FOLLOWING PARACERVICAL BLOCK

PETRIE, ROY H.; PAUL, WELLINGTON L.; MILLER, FRANK C.; ARCE, JUAN J.; PAUL, RICHARD H.; NAKAMURA, ROBERT M.; HON, EDWARD H. Author Information

Placental transfer of lidocaine following paracervical block

Following a standardized paracervical block (PCB), serial fetal and maternal blood concentrations of lidocaine were determined in 10 patients. The mean maternal and fetal lidocaine concentrations reached maximum values between 9 and 10 minutes. Post-PCB fetal bradycardia was encountered, once associated with elevated fetal lidocaine concentrations and once associated with low or normal concentrations. Post-PCB fetal bradycardia was not seen in the one instance when fetal lidocaine concentration exceeded the concomitant maternal concentration. Fetal acidosis was seen in one case of post-PCB fetal bradycardia. Apgar scores were uniformly good at 5 minutes. Preliminary studies indicate that the lidocaine metabolite (monoethylglycinexylidide)/lidocaine ratio is greater in the fetus than in the mother.