[Effective Use of Combination of Ultrasound-guided Femoral Nerve Block and Lateral Femoral Cutaneous Nerve Block for Harvesting Skin Grafts: Three Case Reports].

The pain of skin graft site after surgery is compara- tively severe. We present three cases of combined of ultrasound-guided femoral nerve block and lateral fem- oral cutaneous nerve block that was effective for har- vesting skin grafts. Case 1 : a 32-year-old man had a split-thickness skin grafting of lateral upper arm harvested from outside of the thigh under general anesthesia, brachial nerve block, femoral nerve block and lateral femoral cutane- ous nerve block. Case 2 : a 39-year-old man had split-thickness skin grafting of lower thigh harvested from outside of the thigh under general anesthesia, femoral nerve block and lateral femoral cutaneous nerve block. Case 3 : a 94-year-old man had split-thickness skin grafting of acrotarsium harvested from outside of the thigh under spinal anesthesia, femoral nerve block, lat- eral femoral cutaneous nerve block and sciatic nerve block. In all cases, there was no pain just after surgery, and postoperative pain was controlled well through the hospitalization with administration of oral analgesic agents.

[A case of transfusion-related acute lung injury following platelet transfusion during the cervical supine surgery].

We report a case of possible transfusion-related acute lung injury (TRALI). The patient is a 69-year-old man who underwent cervical supine surgery Platelet products were transfused pre-and intra-operatively. At the end of the operation, he was fully awake and extubated. Shortly after extubation he showed low oxygen saturation, and we started bag-mask ventilation. A chest X-ray revealed bilateral diffuse pulmonary edema without cardiac enlargement. Thus we inserted endotracheal tube and started positive pressure assist ventilation. Hypoxemia was improved gradually, and he was re-extubated on the fourth day after the operation. The prevalence of TRALI reactions is reported to be high for platelet product and is influenced by patients' underlying clinical condition. Serum anti-leukocyte antibody was negative, but we suspected the possibility of TRALI based on the clinical findings.