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Thermographic Investigations into the Physiological Basis of Regional Anaesthesia (Paperback, Softcover reprint of the original 1st ed. 1985)
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Thermographic Investigations into the Physiological Basis of Regional Anaesthesia (Paperback, Softcover reprint of the original 1st ed. 1985)
Series: Anaesthesiologie und Intensivmedizin Anaesthesiology and Intensive Care Medicine, 159
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The existence of a differential block is still part of the theory
of regional anaesthesia. In 1980 it was described in detail by
Cousins and Bridenbough in their standard work Neural Blockade. The
theory of differential sensitivity of fibres in the peripheral
nervous system essentially goes back to Gasser and Erlanger, who in
1929 established that when isolated peripheral nerves are electri-
cally stimulated in the presence of increasing concentrations of
co- caine, the compound action potentials of slow-conducting fibres
are blocked before those of fast-conducting fibres show any measur-
able changes. In man, regional anaesthesia begins subjectively with
a feeling of warmth, objectively with a corresponding increase in
skin tem- perature. There is then, in order of occurence, loss of
sensation of cold, heat and pain, and pressure and touch, and
fmally loss of voluntary motoricity. In recovery from anaesthesia,
these return in the reverse order. The theory of differential block
is by no means undisputed. In 1981, de Jong, commenting in
Anesthesiology on the work pub- lished in that journal by Gissen et
al. which showed a new sequence of differential sensitivity in the
rabbit, wrote, "There remains plen- ty to be done yet before the
book on differential nerve block can be closed".
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