The use of peripheral nerve blocks at the elbow for carpal tunnel release.

This case report illustrates that median, radial, and ulnar nerve blocks at the elbow provides anesthesia for ambulatory carpal tunnel release surgery. This report discusses 3 patients with medical conditions, including vascular access problems and morbid obesity, which made nerve blocks at the elbow advantageous compared with other anesthetic techniques. Peripheral nerve blocks at the elbow were done before surgery in a block room, so the patients spent less time in the operating room. Nerve blocks at the elbow are effective anesthesia for hand procedures with no patient requiring further local anesthetic injection and opioids for pain or expressing any discomfort during surgery. The blocks are easy to perform and set up quickly, and using long-acting local anesthetics, elbow blocks provide postoperative pain control for approximately 10 hours. The nerve blocks at the elbow facilitate the perioperative process by being done out of the operating room and providing prolonged pain control without the need for opioids, so nausea may be avoided.

Effect of lithotomy positions on strain of the obturator and lateral femoral cutaneous nerves.

The purpose of this study was to determine if various lithotomy positions increase strain on the obturator and lateral femoral cutaneous nerves in fresh adult cadavers. A static load cell was used to record strain changes of the obturator and lateral femoral cutaneous nerves in the pelvis and anterior thigh when the lower limbs were placed in three sets of positions of varying hip abduction and flexion. The means of the strain measurements, which were measured in grams in all positioning angles were compared to the baseline 0 degrees measurements. Analysis of variance was calculated for the differences. Flexion of the hip did not increase strain on either nerve. Abduction to 30 degrees or 45 degrees increased strain by more than 30 g on the obturator nerve (P < 0.05) but not the lateral femoral cutaneous nerve. The addition of 45 degrees or more of flexion to abduction negated the strain increase on the obturator nerves seen with abduction alone. Nerve strain >30 g has been associated consistently with nerve dysfunction, disrupting axonal transmission, and causing structural neural damage. Our findings suggest that concomitant hip flexion should be used when placing anesthetized patients in a lithotomy position that includes abduction of the lower limbs to >30 degrees to decrease the risk for perioperative neuropathy of the obturator nerve.

Pott's disease in children - abstract

The authors present their experience with the treatment of tuberculosis of the spine in children during the past ten years in Haiti. Two hundred and fifty-three patients under the age of fifteen have been treated. Initial treatment has consisted of bed rest and chemotherapy. Isoniazid and para-aminosalicylic acid in appropriate dose have been continued for two years. Most were begun on streptomycin initially, but this was usually discontinued after two to three months. One hundred and ninety patients had a surgical fusion. Sixteen of these were re-explored for pseudoarthrosis. One patient died postoperatively and one has a persistent pseudarthrosis; the remainder showed solid fusion within four months on a continued postoperative program of bed rest and chemotherapy. Ninety-eight patients had neurological involvment ranging from slight spasticity to total paraplegia. None had any emergency surgery and ninety-two patients recovered with no serious residuum. Of the remaining six all were able to walk although three who has long-standing paraplegia still required crutches anbd braces for ambulation. No laminectomies were done. Many children, even with several vertebrae involved, will not get well on a program of supportive, recumbent therapy with chemotherapy. The authors' indications for surgical fusion now are: (1) failure to heal properly on conservative therapy, (2) increasing deformity during treatment, (3) lumbar destruction likely to impair stability, (4) to ensure immobilization when the follow-up treatment is doubtful. (Au)