[Combined transgluteal ischial and femoral nerve block: retrospective data on 65 risk patients with leg amputation]. / Kombinierte transgluteale N.-ischiadicus- und N.-femoralis-Blockade: Retrospektive Datenerhebung an 65 Risikopatienten mit Beinamputationen.

For amputations of the lower limbs the combined blockade of the sciatic nerve (via the transgluteal approach) and the femoral nerve (via the inguinal route) may be a suitable alternative to general or neuroaxial anaesthetic methods. In highly comorbid, high risk patients this catheter-linked regional anaesthesia combines the advantages of avoiding controlled ventilation with decreased cardiovascular depression, as conveyed by the use of general anaesthesia or neuraxial techniques. Furthermore, improved postoperative analgesia may be achieved for several days. In our retrospective study, 65 patients who were scheduled for amputation of the lower limbs were analysed. In 58 patients (89%), a regional anaesthesia technique employing only a catheter technique was performed and only 7 patients (11%) required additional general anaesthesia. For postoperative pain management, local anaesthetics were administered via an indwelling nerve block catheter and excellent pain scores were achieved in these patients. However, successful employment of this technique necessitates sufficiently trained personnel as well as on-going training in the performance of catheter-based local analgesia.

Use of amifostine as a chemoprotectant during high-dose chemotherapy in autologous peripheral blood stem cell transplantation.

This report describes two patients with germ cell tumors who underwent tandem autologous peripheral stem cell transplants. The chemotherapy consisted of high-dose carboplatin and etoposide. Both patients developed chemotherapy-related toxicities, which included nephrotoxicity in one case and febrile neutropenia, thrombocytopenia, ototoxicity and mucositis in both. During the second transplant, both patients received amifostine 15 min before and 2 h after each dose of carboplatin. The patients had less mucositis and nephrotoxicity. The duration of neutropenia and thrombocytopenia was less in both cases resulting in a decreased use of antibiotics and platelet transfusions. These cases suggest that the use of amifostine may be of benefit in minimizing toxicities associated with high-dose chemotherapy.