Fascia Iliaca Blocks: A Cadaveric Study Comparing the Suprainguinal Approach to the Loss of Resistance Technique.

Background Local anesthetic fascia iliaca blocks (FIB) are used for peri- and post-operative analgesia in hip fracture patients. The loss of resistance technique (LORT) and the suprainguinal approach (SIA) are two techniques commonly used. We present a pilot, first cadaveric study model that compares both techniques. Methods Methylene blue dye was injected as a local anesthetic substitute. This dye is easily visible. Both hips on each of the seven cadavers were injected with one of the two techniques used per side. Single-blinded randomization was conducted to determine the technique to be administered in each hip. Ten minutes after injection, the dissection of the femoral, obturator, and lateral femoral cutaneous nerves (LFCN) revealed the dye spread around these nerves. The SIA and the LORT were compared in their area of dye distribution using the Wilcoxon matched-pairs signed-rank test. The hips of a single cadaver were matched, since these received the injection via a different technique. Results The area of dye spread was greater in the SIA for five cadavers. Dye spread was greater following the LORT in two cadavers. However, the Wilcoxon matched-pairs signed-ranked test revealed no statistically significant difference in the area of dye spread following both techniques (p= 0.866). The SIA showed that the femoral, obturator, and LFCN were stained in six, three, and seven cadavers, respectively. The LORT resulted in five, two, and five of these nerves being stained, respectively. Conclusion This study found no statistically significant difference in terms of the area of dye spread between the SIA and the LORT. The number of nerves stained was greater following the SIA. This suggests that the SIA may lead to superior anesthetic outcomes. This conclusion is limited by the low sample size in this study. This work warrants the collection of more data through the same method to support or challenge our findings.

Subjective scar assessment scales in orthopaedic surgery and determinants of patient satisfaction: A systematic review of the literature.

PURPOSE: Scar assessment tools can be utilized during the post-operative period to monitor scar progress. The primary aim of this systematic review was to evaluate current subjective scar assessment scales utilized in orthopaedic surgery. The secondary aim was to identify determinants of patients' satisfaction with their scars and evaluate current measurement scales. METHODS: The preferred reporting items for systematic reviews and meta-analyses checklist was followed. Electronic databases, currently registered studies, conference proceedings and the reference lists of included studies were searched. There were no constraints based on language or publication status. A narrative synthesis provided a description and evaluation of scales utilized in orthopaedic surgery. Determinants of patient satisfaction were identified along with the scales used to measure satisfaction. RESULTS: A total of 6059 records were screened in the initial search. Twenty-six articles satisfied the inclusion criteria, assessing 7130 patients. In the literature, six validated subjective scar scales were identified, including the Vancouver scar scale, patient and observer scar assessment scale, Manchester scar scale, Stony Brook scar evaluation scale, visual analogue scale, and Hollander wound evaluation scale. Studies utilizing these scales to evaluate scars following orthopaedic procedures did so successfully. These were total hip arthroplasty, total knee arthroplasty, and limb reconstruction. The scales demonstrated satisfactory validity. Functional outcomes such as restoration of movement ranked among patients' highest concerns. Scar cosmesis was found to be amongst patients' lowest priorities. CONCLUSIONS: Subjective scar assessment scales identified in the literature were not designed specifically for orthopaedic surgery. However, these were able to appropriately assess scars in the studies identified in this review. Current evidence suggests the effect of scar cosmesis on patient satisfaction with orthopaedic procedures is limited.

A New Arterial Variation Involving a Pentafurcated Coeliac Trunk.

We present a newly found variation of the coeliac trunk. The variation may have clinical implications during surgery and radiological investigations. Open abdominal dissection of an embalmed 65-year-old female cadaver, whose cause of death was metastatic breast carcinoma, was performed in the King's College London dissection laboratory. Standard, student issue cadaveric dissection equipment was used. A new variation of the coeliac trunk was observed. The variation was a pentafurcated coeliac trunk, with additional arterial variations. The left gastric artery, splenic artery, gastroduodenal artery, middle colic artery, and jejunoileal artery emerged directly from the coeliac trunk. The proper hepatic artery emerged directly from the superior mesenteric artery. The literature review did not reveal the combination of variations that we report. This case reports a new combination of arterial variations. It adds to the knowledge of surgeons and radiologists and highlights the importance of awareness of anatomical variations. Knowledge of anatomical variations may improve patient outcomes.