Circumcision supplemented by dorsal penile nerve block with 0.75% ropivacaine: a complication.

BACKGROUND AND OBJECTIVES: Dorsal penile nerve block is a common procedure and can provide effective analgesia after penile surgery. Ischemic complications are rare and generally result from trauma or inadvertent administration of vasoconstrictive solutions. CASE REPORT: We describe a period of temporary ischemia of the glans penis occurring 40 minutes after dorsal penile nerve block with 0.75% ropivacaine. This was successfully treated with an intravenous infusion of iloprost (a PGI2 analogue), and at 43 hours appearances were normal. CONCLUSION: Theoretical concerns over the vasoconstrictive properties of ropivacaine may be sufficient to avoid its use where the potential for ischemia to end organs is present.

Temperature-mediated regulation of calcium flux and motility in fowl spermatozoa.

The motility of fowl spermatozoa at various temperatures was shown to be a function of their intracellular calcium content, measured after hypotonic lysis of the cells. Retention of calcium by spermatozoa, with consequent enhancement of motility, increased as the temperature was lowered from 40 degrees to 30 degrees C. Raising the temperature within this range subsequently reduced calcium retention and motility again. The temperature-dependent retention of calcium was a function of the rate of calcium efflux rather then influx. The temperature-sensitive efflux mechanism appeared to involve a Ca2+ ATPase which was relatively inactive at 30 degrees C, but active at 40 degrees C.

Comparison of lumbar plexus block versus conventional opioid analgesia after total knee replacement.

A randomised controlled study was undertaken to assess the analgesic efficacy of continuous lumbar plexus block for the first 48 hours after total knee replacement surgery. Boluses of 0.5% bupivacaine with adrenaline 1 in 200,000 (0.3 ml/kg) were administered through a cannula inserted into the neurovascular sheath of the femoral nerve. Thirteen patients who received this block required significantly less morphine than a control group of 16 patients. Pain scores were similar and there were no complications related to this technique.

Comparison of piroxicam with placebo in the management of pain after total hip replacement.

A randomized double-blind controlled study was undertaken to assess the analgesic efficacy of piroxicam. Twenty-four patients underwent total hip replacement under spinal anaesthetic; after operation, they received a 3-day course of either placebo (n = 12) or piroxicam (n = 12). Adequate analgesia was provided for 48 h by a patient-controlled analgesia system delivering morphine. Patients receiving piroxicam required 50% less morphine than the control group (38 mg compared with 76 mg (P less than 0.002]. This technique was tolerated well and there were no significant side effects.

Elucidation of the mechanism responsible for the temperature-dependent reversible inactivation of the motility of fowl spermatozoa.

1. When washed fowl spermatozoa were held at 30 degrees C in a Ca++-free medium they retained internal Ca++, assimilated from the seminal plasma in vivo, which maintained their motility. 2. When this preparation was warmed to 40 degrees C, Ca++ was lost to the medium and the spermatozoa became immotile. 3. On subsequent cooling to 30 degrees C, the spermatozoa were capable of re-sequestering the Ca++, which restored their motility. 4. Removal of internal Ca++, with subsequent reduction of cellular activity, improved the survival of fowl spermatozoa held at 30 degrees C.

Anaesthesia and intra-ocular pressure: a comparative of total intravenous anaesthesia using etomidate with conventional inhalation anaesthesia.

Intra-ocular pressure (IOP) was measured in two comparable groups of anaesthetised patients under standardised conditions. Group 1 received etomidate 0.3 mg/kg fentanyl 100 micrograms and droperidol 5 mg. with etomidate 20 microgram/kg/minute for maintenance. Group 2 received thiopentone 3.5 mg/kg and were maintained with halothane 0.5% in nitrous oxide (60%) with oxygen. Both groups of patients were ventilated to normocapnia. Blood pressure, heart rate, central venous pressure and IOP were measured in 5 minute intervals from pre-induction to 30 minutes postinduction. A significantly greater reduction in mean IOP (p less than 0.05) occurred in group 1. A maximum fall in IOP of 61% was obtained, compared to a maximum fall of 45% in group 2. Blood pressure fell in both groups. The fall was greater (23%) in group 2 than in group 1 (18%) and in no case was considered excessive. Total intravenous anaesthesia using etomidate is suggested as a useful technique for open eye surgery.