Infraclavicular block causes less discomfort than axillary block in ambulatory patients.

BACKGROUND: This randomized study was designed to compare discomfort caused by axillary or infraclavicular blocks in ambulatory patients. We identified which of the three block components, needle passes, local anesthetic (LA) injections, and electrical stimulations, is most painful and quantified pain intensity on a visual analog scale (VAS 0-100). We also assessed onset and quality of analgesia, adverse events and patients' acceptance. METHODS: Eighty patients were studied. In axillary group-A, four LA injections were made after stimulating median, musculocutaneous, ulnar and radial nerves. In infraclavicular group-I, the whole LA volume was injected after stimulating median or ulnar or radial nerves. Patients were ready for surgery when they had analgesia/anesthesia distal to the elbow. RESULTS: Median intensity of block discomfort was 22 in A group and 10 in I group (P < 0.01). There was no difference in distribution of the most painful block components between the groups. Block performance times were 4 min in I group and 7 min in A group (P < 0.01). Block onset times were 18 min in A group and 20 min in I group (NS). There was one block failure in I group. Three patients in A group and five in I group required supplementary blocks (NS). Transient adverse events occurred in 14 A-group and two I-group patients (P<0.01). Thirty-seven I-group and 33 A-group patients were satisfied with the block (NS). CONCLUSIONS: Infraclavicular block by single injection caused less discomfort and fewer adverse events than axillary block by multiple injections. Block effectiveness, onset time and patients' acceptance were similar.

Patent urachus complicating pregnancy: a review and report of a case.

A congenital abnormality of the urachus is extremely rare in pregnancy. We reviewed the English literature since 1877 and found only 12 case reports of urachal complications during pregnancy. Eight patients developed complications from a urachal cyst or sinus, and four patients had a patent urachus with urinary fistula. We report an additional case of a patent urachus which uniquely presented for the first time during pregnancy with urinary drainage from the umbilicus. Urodynamic changes in pregnancy which may have produced this complication are discussed. Abdominal wall ultrasonography is extremely helpful in the diagnostic evaluation of suspected urachal tract complications during pregnancy.