Purpose The saphenous nerve, a branch of the femoral nerve, is a pure sensory nerve that supplies the anteromedial aspect of the lower leg from the knee to the foot. There is limited evidence of the effectiveness of ultrasoundguided techniques to block the saphenous nerve. We therefore undertook a retrospective case series to investigate the efficacy of an ultrasound-guided subsartorial approach to saphenous nerve block. Methods During a four-month period, all patients receiving a subsartorial saphenous nerve block for lower extremity surgery at our institution had their medical records reviewed. Patient demographics and data were recorded, including block characteristics, intraoperative anesthetic management, pre-block, post-block, and postoperative pain scores, as well as postoperative analgesic dosing. Preoperative block success was defined by minimal intraoperative analgesic administration and a pain score of 0 in the postanesthesia care unit not requiring analgesic supplementation. Postoperative block success was defined by reduction of pain score to 0 without need for additional analgesic dosing. Results Thirty-nine consecutive patients were identified as receiving an ultrasound-guided subsartorial saphenous nerve block. Overall, this ultrasound-guided technique was found to have a 77% success rate.Conclusion This case series shows that an ultrasoundguided subsartorial approach to saphenous nerve blockade is a moderately effective means to anesthetize the anteromedial lower extremity. The success rate is based on stringent criteria with an endpoint of postoperative analgesia. A randomized prospective study would provide a more definitive answer regarding the efficacy of this technique for surgical anesthesia. RésuméObjectif Le nerf saphe`ne interne, une branche du nerf fe´moral, est un nerf purement sensitif qui innerve la partie ante´rome´diale de la jambe, du genou jusqu'au pied. Il existe peu de preuves quant a`l'efficacite´des techniques guide´es par ultrason pour l'anesthe´sie du nerf saphe`ne interne. Nous avons donc entrepris une revue re´trospective d'une se´rie de cas afin d'examiner l'efficacite´d'une approche sous-sartoriale guide´e par ultrason pour l'anesthe´sie du nerf saphe`ne interne. Méthodes Pendant une pe´riode de quatre mois, les dossiers me´dicaux de tous les patients ayant be´ne´ficie´d'un bloc sous-sartorial du nerf saphe`ne interne pour une chirurgie du membre infe´rieur a`notre institution ont e´teŕ evus. Les donne´es de´mographiques et des renseignements sur ces patients ont e´te´recueillis, dont les caracte´ristiques du bloc, la prise en charge de l'anesthe´sie perope´ratoire, les scores de douleur pre´-anesthe´sie, postanesthe´sie et postope´ratoire, ainsi que la posologie analge´sique postope´ratoire. La re´ussite du bloc en pe´riode pre´ope´ratoire a e´te´de´finie par une administration perope´ratoire minime de substances analge´siques et un score de douleur a`0 ne nécessitant aucun apport analge´sique supple´mentaire a`la salle de re´veil. La re´ussite du bloc en pe´r...
A lateral soft tissue neck X-ray is a helpful tool in the management of patients presenting with upper aero-digestive tract foreign bodies. Junior doctors need better radiology training.
Objectives: Children with aerodigestive disorders often have many of the reported risk factors for development of perioperative respiratory adverse events. This study sought to evaluate the incidence of such events in this group of patients undergoing general anesthesia for "triple endoscopy" (flexible bronchoscopy with bronchoalveolar lavage, rigid laryngoscopy and bronchoscopy, and esophagogastroduodenoscopy) and to identify any patient-specific or procedure-specific risk factors associated with higher incidence of perioperative respiratory adverse events. Methods:We performed a retrospective chart review of children 18 years or younger who underwent triple endoscopy as part of an aerodigestive evaluation. Data collected from medical records included: preoperative polysomnography, symptoms of acute respiratory illness, medical comorbidities, demographics, postoperative hospital or intensive care unit admission, and all respiratory events and interventions in the perioperative period. Patient-specific and procedure-specific factors were investigated via univariate analysis for any correlations with perioperative respiratory adverse events. Results:Of the 122 patients undergoing triple endoscopy, 69 (57%) experienced a perioperative respiratory adverse event. We found no difference in the incidence of perioperative respiratory adverse events among children with documented lung disease compared with those with no lung disease (OR: 0.89, p = .8 95% CI: 0.43, 1.8), and no significant difference between those children who had a respiratory illness at the time of surgery, 1-2 weeks prior, 3-4 weeks prior, and those with no preceding respiratory illness. A higher percentage of males had a perioperative respiratory adverse event, compared with females (OR: 2.7, p = .01 95% CI: 1.3, 5.09). Conclusion:Patients undergoing triple endoscopy for evaluation of aerodigestive disorders at our institution experienced perioperative respiratory adverse events at a rate of 57%.
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