Litigation related to regional anaesthesia: an analysis of claims against the NHS in England 1995-2007.

We analysed 366 claims related to regional anaesthesia and analgesia from the 841 anaesthesia-related claims handled by the National Health Service Litigation Authority between 1995 and 2007. The majority of claims (281/366, 77%) were closed at the time of analysis. The total cost of closed claims was pound12,724,017 (34% of the cost of the anaesthesia dataset) with a median (IQR [range]) of pound4772 (pound0-28,907 [pound0-2,070,092]). Approximately half of the claims (186/366; 51%) were related to obstetric anaesthesia and analgesia and of the non-obstetric claims, the majority (148/180; 82%) were related to neuraxial block. The total cost for obstetric closed claims was pound5,433,920 (median (IQR [range]) pound5678 (pound0-27,690 [pound0-1,597,565]) while that for non-obstetric closed claims was pound7,290,097 (pound3337 (pound0-31,405 [pound0-2,070,062]). Non-obstetric claims were more likely to relate to severe outcomes than obstetric ones. The maximum values of claims were higher for claims related to neuraxial blocks and eye blocks than for peripheral nerve blocks. Despite many limitations, including lack of clinical detail for each case, the dataset provides a useful overview of the extent, patterns and cost associated with the claims.

Detection of inner tube defects in co-axial circle and Bain breathing systems: a comparison of occlusion and Pethick tests.

The performance of the occlusion and Pethick tests in detecting faulty inner tubes in co-axial circle and Bain systems was compared. Twelve co-axial circle and 12 Bain anaesthetic breathing systems were tested using the occlusion and the Pethick tests. For each system, three tubes were intact, and the remaining nine had a defect deliberately created in the inner tube (three proximal, three middle and three distal). The investigators were blinded to which of the tubes were defective, and to each other's results. The results showed 100% specificity for both tests. The sensitivity of the occlusion test for detecting faulty breathing systems was found to be good (98%). Our results suggest that the occlusion test should be performed in preference to the Pethick test when testing co-axial circle and Bain systems.

Comparison of EMLA and lidocaine iontophoresis for cannulation analgesia.

BACKGROUND AND OBJECTIVE: Eutectic mixture of local anaesthetic cream and lidocaine iontophoresis are effective in providing analgesia for peripheral venous cannulation with small gauge cannulae in adults and children. The objective of this study was to compare the analgesic efficacy of the two techniques directly in patients using larger cannulae. METHODS: In a double-blind, randomized, controlled study we compared the two techniques directly. Twenty-eight patients had the eutectic mixture of local anaesthetic cream applied to the dorsum of one hand for 60 min followed by sham iontophoresis (group EMLA); the other hand had a sham cream applied for 60 min followed by 10 min of 2 mA iontophoresis with lidocaine 4% and epinephrine 1 in 50,000 (group iontophoresis). Within 5 min of completion of iontophoresis an anaesthetist, unaware of treatment allocation, inserted 18-G venous cannulae into veins of both hands. The patient then scored the amount of pain on cannulation using a 10 point verbal rating scale. RESULTS: Eight patients were excluded from analysis due to failed cannulation (two group EMLA, two group iontophoresis), intolerable burning sensation from iontophoresis (one), protocol violation (one), and changes in surgical schedule (two). Pain scores were lower for the EMLA treated hand than for the iontophoresis side (median (range) 1 (0-7) vs. 3 (0-6); P = 0.023). Erythema and paraesthesia were common but short lived on the iontophoresis side. CONCLUSIONS: Although lidocaine iontophoresis is effective more quickly than the eutectic mixture of local anaesthetic cream, the superior quality of analgesia produced by the eutectic mixture in this study should be borne in mind if these treatments are used electively.