Bilateral ultrasound-guided supraclavicular block in a patient with severe electrocution injuries of the upper extremities.

The performance of bilateral supraclavicular brachial plexus nerve blocks is controversial. We present the challenging case of a 29-year-old male who suffered bilateral high-voltage electrocution injuries to the upper extremities, resulting in severe tissue damage, sensory and motor deficits, and wounds in both axillae. This injury necessitated bilateral below-elbow amputations. His postoperative course was complicated by pain refractory to intravenous narcotics. The decision was made to attempt bilateral supraclavicular brachial plexus blocks. Our concerns with this approach included the risks of pneumothorax and respiratory failure due to phrenic nerve block. Initial attempts at brachial plexus blockade using nerve stimulation were unsuccessful; therefore, ultrasound guidance was employed. With vigilant monitoring in an intensive care unit setting, we were able to safely perform bilateral continuous supraclavicular brachial plexus nerve blocks with an excellent analgesic response and no noted complications.

Intraoperative and Postoperative Blood Glucose Concentrations in Diabetic Surgical Patients Receiving Lactated Ringer's Versus Normal Saline: A Retrospective Review of Medical Records.

BACKGROUND: Hyperglycemia is associated with poor postoperative outcomes after carotid endarterectomy. This retrospective study examined the effect of lactated Ringer's and normal saline solutions on intraoperative blood glucose control in diabetic patients undergoing carotid endarterectomy. METHODS: The anesthetic and surgical records of type 2 diabetic patients who underwent carotid endarterectomy and received either lactated Ringer's solution or normal saline exclusively during the case were reviewed, and 20 patients were randomly selected from each group for further analysis. The outcome of interest was preoperative to postoperative change in blood glucose. RESULTS: The preoperative to postoperative mean changes in glucose for the normal saline and lactated Ringer's groups were 34.4 ± 70.32 mg/dL and 64.5 ± 61.38 mg/dL, respectively. This slight difference in the mean change in glucose between the 2 groups was not statistically significant (P=0.157). CONCLUSION: Lactated Ringer's solution does not appear to cause a significant change in the mean blood glucose levels in diabetic patients undergoing carotid endarterectomy compared to patients receiving normal saline. Randomized controlled trials are needed to further determine whether lactated Ringer's solution adversely affects glucose control in diabetic surgical patients.

Multiple sclerosis and pain.

Despite the common belief that multiple sclerosis (MS) is a painless disease, several studies contradict this. There are a significant number of MS patients who actually suffer from painful conditions such as central and peripheral neuropathy, migraines, trigeminal neuralgia, painful tonic spasms, complex regional pain syndrome, glossopharyngeal neuralgia, and transverse myelitis. In addition, MS relapses are usually painful with many patients complaining of paroxysmal dystonia and neuropathic pain during these episodes. Additionally, treatments for MS such as use of beta-interferons may be associated with headache and pain at the injection site. The pathophysiology of pain in MS is poorly understood, but may be related to the development of demyelinating lesions involving certain neuroanatomic pathways such as the spinothalamic tract. Management of pain in MS patients is a therapeutic challenge for clinicians. Currently, various pharmacological agents such as antiepielptics, non-steroidal anti-inflammatory agents, and even corticosteroids are used to suppress various painful conditions associated with MS. Non-pharmacological procedures such as massage therapy have also been used in the treatment of MS patients. The authors present a review of recent findings in pathophysiology and management of pain in MS patients.