ABSTRACT
Four out of 100 patients undergoing regional hip block (obturator nerve and nerve to obturator femoris) developed convulsions. These followed the injection of bupivacaine to block the nerve to the quadratus femoris muscle. The reasons for this are discussed. Not only has hip nerve regional blockade been shown to be ineffective in the relief of chronic pain of osteoarthritis but it must be concluded that the method described carries an unacceptably high morbidity.
Subject(s)
Bupivacaine/adverse effects , Epinephrine/adverse effects , Hip , Nerve Block/adverse effects , Seizures/etiology , Aged , Female , Hip/innervation , Humans , Male , Middle Aged , Obturator Nerve , Osteoarthritis/therapySubject(s)
Anesthesiology , Spinal Cord Injuries , Adolescent , Adult , Autonomic Nervous System Diseases/etiology , Blood Pressure , Chronic Disease , Fractures, Bone/therapy , Humans , Intubation, Intratracheal , Joint Dislocations/therapy , Male , Pulmonary Edema/etiology , Reflex, Abnormal/etiology , Respiration, Artificial , Spinal Cord Injuries/etiology , Spinal Cord Injuries/physiopathology , Spinal Cord Injuries/therapyABSTRACT
Eighteen patients with unilateral osteoarthrosis of the hip were investigated in a trial which involved the injection of nine with bupivacaine and nine with normal saline. All the patients completed daily pain analogue charts. Their pain, mobility and functional activity were assessed and gait characteristics analysed, once before the injection and then at three monthly intervals. All the patients recorded a decrease in pain level within two weeks of injection, but it subsequently rose to pre-injection levels. There were no other significant general improvements after the injection. A significant increase in the maximum force at toe-off for the good leg was recorded one month after the injection. However, no further significant differences were found in the gait performance of either group of patients throughout the study. It is concluded that the hip nerve regional blockade offers no useful relief to the pain of osteoarthrosis of the hip joint.
Subject(s)
Anesthesia, Local , Hip Joint , Osteoarthritis/therapy , Palliative Care/methods , Aged , Clinical Trials as Topic , Double-Blind Method , Female , Gait , Hip Joint/innervation , Humans , Male , Middle Aged , Nerve Block , Obturator Nerve , Prospective StudiesABSTRACT
The position of doctors with domestic commitments (DDCs) at present training in the specialty of anaesthesia in the British National Health Service is considered and proposals are made for their future employment in career grades.
Subject(s)
Anesthesiology , Career Mobility , Physicians, Women , Adult , Employment/trends , Family , Female , Humans , Male , State Medicine , Time Factors , United Kingdom , WorkforceABSTRACT
The effect of local nerve blockade on the relief of postoperative pain is reported in a series of 167 patients who underwent surgery of the arm, knee or foot. In 80% of cases analgesics were not required within 4 hours postoperatively, and in 39% analgesics were not required within 8 hours. Conventional methods of postoperative pain relief are not always effective. Local nerve blockade can be used to provide complete analgesia after limb surgery and is therefore of great value to postoperative care.
Subject(s)
Anesthesia, Local/methods , Nerve Block/methods , Pain, Postoperative/prevention & control , Arm/surgery , Bupivacaine/administration & dosage , Foot/surgery , Humans , Knee/surgery , Lidocaine/administration & dosageABSTRACT
The Faculty of Anaesthetists of the Royal College of Surgeons of England has made proposals on the training of anaesthetists. These proposals have been implemented by the Nuffield Department of Anaesthetics of the University of Oxford. The General Professional Training scheme was established in 1972 and is briefly described. Some of the results and the fate of those who joined as trainees are presented. Some conclusions are drawn.
Subject(s)
Anesthesiology/education , Education, Medical, Graduate , Anesthesiology/history , Curriculum , Education, Medical, Graduate/history , Educational Measurement , England , History, 20th Century , Time FactorsABSTRACT
The four phases of the Valsalva manoeuvre were studied before and after anaesthesia had been induced with a technique of either spontaneous breathing or controlled ventilation of the lungs. The Valsalva manoeuvre was found to be an unreliable predictor of a patient's ability to tolerate the upright or sitting position for neurosurgical procedures. However, a false negative response is more likely to occur than a false positive response.
