The femoral 3-in-1 block revisited.

STUDY OBJECTIVE: To estimate the frequency of successful conduction blockade of the femoral, lateral femoral cutaneous, and obturator nerves following a femoral 3-in-1 block. DESIGN: Prospective observational study. SETTING: Operating room at Royal University Hospital, Saskatoon, Saskatchewan. PATIENTS: 32 patients having lower extremity surgery. INTERVENTIONS: Femoral 3-in-1 nerve blocks were performed on all patients. MEASUREMENTS AND MAIN RESULTS: Sensation and motor power in all 3 nerve distributions (femoral, lateral femoral cutaneous, obturator) were assessed before and after each femoral 3-in-1 nerve block. By our criteria, the femoral nerve block was successful in 26 of 32 patients (81%). The lateral femoral cutaneous nerve was successfully blocked in 25 of 26 patients (96%). Incidentally, the saphenous nerve which is classically described as the terminal branch of the femoral nerve, was successfully blocked in 20 of 26 patients (77%). The obturator nerve block was successful in only 1 of 26 patients (4%). CONCLUSIONS: The femoral 3-in-1 nerve block does not block the parent trunk of the obturator nerve.

Interest of a loading dose of milnacipran in endogenous depressive inpatients. Comparison with the standard regimen and with fluvoxamine.

A multicenter controlled study was designed to test the hypothesis that a loading dose of an antidepressant could shorten the latency of its clinical efficacy. Three parallel groups of about 40 endogenous depressive inpatients received either a loading dose of milnacipran (300 mg daily for 2 weeks and 150 mg daily during the 2 following weeks), the standard regimen of milnacipran in severe depression (200 mg daily for 4 weeks), or fluvoxamine (200 mg daily for 4 weeks). The duration of the study was 4 weeks, with assessments at baseline and after 4, 9, 14, 21, and 28 days of therapy by means of Montgomery and Asberg depression scale (MADS), the Hamilton depression scale, the Clinical Global Impressions (CGI), and a checklist of symptoms and side-effects. Results showed very similar evolution in the 3 treatment groups. In addition, the level of side-effects did not exhibit significant differences among the treatment groups, except for excitement-nervousness and akathisia which were more frequently reported with fluvoxamine. These results do not support the usefulness of a loading dose of an antidepressant such as milnacipran. They demonstrate however that milnacipran can be given at a 300 mg daily dose from the very first day of treatment with an excellent tolerance.

Controlled comparison of buspirone and oxazepam in generalized anxiety.

The anxiolytic activity, the tolerance, and the withdrawal symptoms of buspirone and oxazepam were compared in two groups of 14 and 12 outpatients, respectively, suffering from generalized anxiety in a double-blind study with random allocation of patients. The 6-week active period was preceded and followed by 1 and 2 weeks on placebo, respectively. Clinical assessments were performed before and after the predrug placebo period and every 2 weeks thereafter and included Hamilton anxiety and depression scales and AMDP anxiety subscale. The initial daily dose was 15 mg buspirone or 45 mg oxazepam in 3 intakes and the mean final daily doses were 22.2 and 55.8 mg, respectively. Results showed a slower anxiolytic activity of buspirone compared to oxazepam with less improvement after 2 weeks of treatment. The rebound anxiety following abrupt discontinuation of the drug and the level of side effects did not significantly differ between the two compounds.

Uricosuric properties of diflunisal in man.

1 The uricosuric effect of diflunisal was studied in eleven normal subjects. 2 Urine and serum uric acid levels were measured and used to assess the effect. 3 Diflunisal caused statistically significant decreases in serum uric acid levels and increases in uric acid clearance at 250 and 375 mg twice daily. 4 Diflunisal taken on an empty stomach caused epigastric discomfort in the high dose group which was obviated when the drug was taken with meals. 5 Diflunisal caused no abnormalities in the measured haematological, urological or biochemical parameters.

Effect of diflunisal on the human plasma levels and on the urinary excretion of naproxen.

A double-blind placebo controlled crossover study was performed in twelve healthy volunteers receiving multiple doses of naproxen (250 mg b.i.d.) and diflunisal (250 mg b.i.d.) to study the effect of diflunisal co-administration on the naproxen levels in plasma and urine. The naproxen steady-state level was reached between the second and the third day. The peak plasma level appeared about 2 hr after drug administration and varied from 68 to 75 microgram/ml. This maximum was not modified by a simultaneous administration of diflunisal neither in its position nor in its intensity. Statistical analysis using a parametric method, did not reveal a significant influence of diflunisal on the plasma kinetics or on the urinary elimination of naproxen.