Summary
This study compared the posterior and popliteal fossa approaches for sciatic nerve block. Patients scheduled to undergo foot surgery were allocated randomly into one of two groups: group A (n = 20) received sciatic nerve block via the posterior approach and group B (n = 20) received a block using the popliteal fossa approach. All blocks were performed with the aid of a peripheral nerve stimulator and alkalinised 0.5% bupivacaine with 1 in 200 000 adrenaline was injected in a dose of 2 mg.kg Nineteen of 20 blocks in group A were successful compared with nine of 20 in group B (p < 0.01). There was no significant difference between the groups in respect of time to onset or duration of block. Patients in group B reported less discomfort during performance of the sciatic nerve block but required supplementary nerve blocks more frequently. We recommend the use of the posterior approach for sciatic nerve block.
SummaryThis observational study examined whether specijic characteristics of I168 patients admitted to a general intensive therapy unit had changed over 4 years.
SummaryThis study was undertaken to investigate the outcome of epidural catheter insertion in the sitting or lateral position in mothers during labour. An initial prospective randomised study period (144 patients) suggested that the sitting position offered some superiority over the lateral in terms of technical ease of insertion. It was concluded, by minimising the subjective aspects in a follow-up, prospective nonrandomised study period (152 patients), that the determining factor lies in the skill and experience of the anaesthetist. There was no signiJicant difference in complication rates or maternal discomfort between the two positions in either study period.
Key wordsAnaesthetic techniques, regional; epidural.
Complications.The insertion of epidural catheters for analgesia in labour may be carried out with the patient in the sitting or lateral position. The position used is primarily related to the preference of the anaesthetist and is based on the technique taught during the anaesthetist's initial training period. No previous studies have been undertaken to evaluate the effect of position with respect to successful identification of the epidural space. The aim of this study was to investigate the effect of maternal posture on the ease of insertion of epidural catheters for analgesia in labour, the associated complication rates and patient discomfort.
MethodsTo minimise the subjective aspects of the study it was divided into two sections. In the first study period the position of the patient was randomly allocated, and in the second the anaesthetist used the position that he (she) considered appropriate.Randomised study period. One hundred and fifty patients who had requested epidural analgesia during labour consented to take part in the study. They were randomly allocated to have the epidural sited in the sitting or lateral position. All epidurals were performed by anaesthetists who had at least completed their training period in obstetric anaesthesia and were happy to perform the technique in either position.Nonrandomised study period. Anaesthetists were asked to perform epidurals with the patient in the position which they considered to be most appropriate, to record details of the position used, whether it was chosen as the anaesthetist's preference, patient's preference or for any other reason. The anaesthetist's usual preference, if any, was stated and any reason for deviation from this. One hundred and fifty two patients were studied in this manner.The methods were as outlined below during the two study periods. At least 16 anaesthetists, from registrar to consultant grade, participated in the study. A standardised epidural technique was employed, using loss-of-resistance via a midline approach. On identification of the epidural space, 5 ml of 'solution' (normal saline or local anaesthetic) were injected via the needle before an attempt was made to pass the epidural catheter 5 cm into the epidural space. The needle was then removed and the catheter withdrawn to the desired position. Tuohy needles 16-...
Pituitary adenomas are often diagnosed as incidental findings on brain imaging. We present the case of a 52-year-old African American female patient with long standing depressed mood prior to the incidental finding of a pituitary adenoma. We explore the possibility of certain mood symptoms prompting an early diagnosis of pituitary adenoma.
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