Effect of warming bupivacaine 0.5% on ultrasound-guided axillary plexus block. Randomized prospective double-blind study.

OBJECTIVE: To evaluate the effect of warming bupivacaine 0.5% on ultrasound-guided axillary brachial plexus block. STUDY DESIGN: Prospective, randomized, double-blind. PATIENTS AND METHODS: Eighty patients undergoing elective or emergency surgery beyond the distal third of the upper limb were divided into two groups of 40 patients: the warm group received 15mL bupivacaine 0.5% heated to 37°C; the cold group received 15mL 0.5% bupivacaine stored for at least 24hours in the lower compartment of a refrigerator at 13-15°C. Onset and duration of sensory and motor blocks were evaluated every 5minutes for 40minutes. Postoperative pain was evaluated at 1, 3, 6, 12 and 24hours. Effective analgesia time was recorded as the interval between anesthetic injection and the first analgesia requirement (VAS>30mm). RESULTS: Time to onset of sensory and motor block was significantly shorter in the warm group, and mean duration of sensory and motor block and of postoperative analgesia significantly longer. CONCLUSION: Warming bupivacaine 0.5% to 37°C accelerated onset of sensory and motor block and extended action duration.

[Multicentric giant cell tumor in the upper extremity]. / Tumeurs à cellules géantes à localisations multiples du membre supérieur.

Multicentric giant cell tumors of bone are rare; they represent less than 1% of all giant cell tumors. We report the case of a 24-year-old right-handed man, who presented in 1985 with a giant cell tumor of the upper end of the right humerus. After failure of conservative treatment (curettage and bone grafting), resection-arthrodesis of the shoulder with a free vascularised fibular autograft was performed. Three years later, the patient developed an osteolytic lesion of the lower end of the ipsilateral radius, involving the soft tissues and the wrist joint. He was treated with resection-arthrodesis of the wrist with a free vascularised fibular graft. View after 24 years for a new localization of the lower extremity of the humerus, which treated by curettage and bone grafting with a favorable postoperative (follow-up). The histologic study confirmed again the same diagnosis. After review of the literature, we report the uniqueness of this case report.

[Multicentric giant cell tumor of the upper arm]. / Tumeur à cellules géantes bifocale du membre supérieur.

Multicentric giant cell tumors of bone are rare; they represent less than 1% of all giant cell tumors. We report the case of a 35-year-old right-handed man, who presented in 1985 with a giant cell tumor of the upper end of the right humerus. After failure of conservative treatment (curettage and bone grafting), resection-arthrodesis of the shoulder with a free vascularized fibular autograft was performed. Three years later, the patient developed an osteolytic lesion of the lower end of the ipsilateral radius, involving the soft tissues and the wrist joint. He was treated with resection-arthrodesis of the wrist with a free vascularized fibular graft. The histologic study confirmed the diagnosis of giant cell tumor of similar grade. After 13 years follow-up, the patient had a satisfactory function of the limb and no recurrence of the tumor was noted.