Compartment syndrome as a complication of the prolonged use of the Lloyd-Davies position.

Compartment syndrome in the legs is a rare complication of the prolonged use of the lithotomy position. We report two cases of compartment syndrome developing as a complication of the prolonged use of the Lloyd-Davies position. Both patients received combined general and epidural anaesthesia and postoperative epidural analgesia. The diagnosis was delayed in the first case, resulting in the avoidable complications of renal failure and permanent neuromuscular dysfunction.

Acute airway obstruction following facial scalding: differential diagnosis between a thermal and infective cause.

A 16-month-old boy received a 6 per cent hot water scald to his face and chest. The child had been suffering from an upper respiratory tract infection for 10 days prior to the injury. However, as the child rapidly developed respiratory tract obstruction, a differential diagnosis between acute infective epiglottitis and thermal injury to the hypopharynx was required. In fact, the hot water had reached the epiglottis and the aryepiglottic folds causing significant damage, whilst sparing the tongue and mouth. The child was admitted to the intensive care unit, intubated and ventilated for 4 1/2 days. The external burns eventually healed spontaneously. This case report demonstrates the rare occurrence of a minor scalding injury resulting in significant obstruction to the upper airway. Of additional interest is the presence of pre-existing symptoms of an upper respiratory tract infection and the total absence of any signs of intraoral burning. These additional factors demonstrate the necessity for absolute vigilance in the management of any scald in the region of a child's mouth. Intubation can be life saving and should be considered in any case of scalding associated with increasing respiratory distress.

Transcutaneous electrical nerve stimulation in the management of acute postoperative pain.

Twenty patients undergoing decompressive lumbar laminectomy were randomly allocated, in a double-blind manner, to receive active or inactive transcutaneous electrical nerve stimulation (TENS) as part of the management of their postoperative pain. All patients received the same non-narcotic general anaesthetic. The efficacy of the TENS was assessed by using a patient-controlled analgesia system (PRODAC) which delivered morphine i.v. This system recorded the number of demands for analgesia and the total dose administered in the first 24 h. In addition, plasma morphine concentrations were measured hourly for the first 6 h and again at 24 h. There was no statistical difference between the two groups in the number of patient demands for analgesia, morphine dose or plasma morphine concentration. TENS offered no advantage over a placebo in the management of acute postoperative pain in these patients.

Intercostal neuralgia following stellate ganglion block. An infrequent complication.

The case is described of a 78-year-old female patient who experienced temporary but severe chest wall pain following stellate ganglion block. The possible mechanisms and treatment of this complication are discussed.