Question

List and describe the advantages, risks, and complications of nerve conduction blockade. Your friend is worried about an impending surgical procedure, and tells you he's thinking about taking a few extra pills of his prescription Valium before surgery? What, if anything, do you say about it?

Answer 1

1ans) A motor nerve conduction block is defined as a reduction of either amplitude or area of the compound motor action potential elicited by proximal vs. distal motor nerve stimulation.

The goal of the nerve block is to prevent pain by blocking the transmission of pain signals from the surgical site. The block provides pain relief during and after the surgery. The advantages of nerve blocks over general anesthesia include faster recovery, monitored anesthesia care

Nerve conduction and electromyography studies are generally well tolerated and pose little risk to patients of serious adverse events in the hands of a well-trained competent practitioner. However, some patients and certain examinations do carry a higher risk of potential complications. It is good medical practice to inform patients of any risks, their potential severity and relative frequency. In order to obtain informed consent a dialogue should take place about the nature, purpose and effects of the studies, so patients can decide if they wish to undergo the proposed investigation.

✓The discomfort, or mild pain experienced by some patients, following the application of electrical stimulation during nerve conduction studies (NCS) is transient and self-limiting and will not initiate or aggravate pre-existing symptoms beyond the duration of the actual investigation. Adverse events such as self-limiting mild tenderness and/or bruising commonly follow an ‘uncomplicated’ needle.

✓Infection risk and the role of prophylactic antibiotics in immune compromised patients and endocarditis risk in vulnerable patients are largely unknown, but we are not aware of any incidences of procedure related infection.

✓It has been speculated that performing needle EMG in limbs with significant lymphoedema might theoretically carry an increased risk of infection

✓It is uncertain whether the electrical NCSs stimulation near metal osteosynthesis after bone fractures would present a potential risk of electrical injury.

✓recently received an inquiry from one of our clients regarding a practice the physicians want to initiate in their center. Specifically, the physicians believe that the patient would be best served by receiving 0.5mg of Valium to take at home the morning of surgery. This would relax them before they arrived in the pre-op area.

There are several issues going on here. When considering which drugs to use with any patient, one has to consider the age of the patient and all possible side effects inherent to the age. Obviously, the elderly and the very young have special considerations regarding their age whenever choosing a drug, but those to consider in this situation are adult and geriatric patients.

Valium is a benzodiazeprine and is used widely to reduce tension and anxiety and, in surgery or certain medical treatments, to induce amnesia. It is also used to treat seizures, restless leg syndrome, as a muscle relaxant, and for its sedative effects.

Adverse effects include anterograde amnesia. Cognitive deficits can persist for up to six months or longer. Paradoxical effects include excitement, rage, worsening of seizures in epileptic patients. In patients suffering from or prone to depression, these symptoms can worsen.

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