Optimizing postoperative pain control is an important aspect in perioperative patient care. The aim of this study was to investigate the efficacy of preincision local anesthetic infiltration in postoperative pain management for thyroid surgery and its relationship to bruising and wound cosmesis. In a randomized single-blinded study, 39 consecutive patients listed for thyroid surgery were assigned into two groups. Group I (n = 19) received subcuticular preincision infiltration with 10 ml of bupivacaine (0.5%) and Group II (n = 20) received no infiltration. Postoperatively, the pain experienced was evaluated by two methods: verbal response scores and linear analogue scores (0-100 mm) at different time intervals following surgery. Bruising and cosmetic effects resulting from surgery were assessed using a linear analogue score at discharge. The two groups were well matched for confounding variables. Pain scores were significantly different at 6 hours post operatively (p = 0.0341) with mean scores Group I = 33 and Group II = 50, but this difference disappeared at 24 hours. No patients (0%) received IV morphine in Group I compared to 5 patients (25%) in Group II. There was no significant difference in the mean bruising scores (p = 0.8864) and mean cosmetic scores (p = 0.3339) at discharge. Preincision infiltration with bupivacaine provides easy and better analgesic control postoperatively in patients following thyroid surgery with no effects on bruising or wound cosmesis.

Few studies have examined the roles of dorsal penile nerve block (DPNB) and penile ring block (PRB) in surgery of inflatable penile prosthesis (IPP) placement. We sought to compare the postoperative pain outcomes of two different medications used in DPNB plus PRB. We thus carried out a prospective study of patients with erectile dysfunction who underwent "de novo" IPP placement between January 2013 and June 2013. Patients were divided to one of three groups: 1-DPNB plus PRB with bupivacaine injection; 2-DPNB plus PRB with ropivacaine injection and, 3-Control group without DPNB or PRB injection. Postoperative pain score and pain medication usage were recorded 2 h postoperatively, and every 24 h, for a week. The Visual Analog Scale (VAS) was used as pain scale measurement. A total of 131 patients were included in this study: 40 to bupivacaine, 47 to ropivacaine, and the rest were controls. Two hours postoperatively, mean VAS was significantly different (p < 0.0001) between medicated patients and the control group, however, no significant differences were observed between medication groups. Mean VAS was not significantly different among the groups from post-surgical day 2 thru 7. In conclusion, DPNB plus PRB during IPP provided effective analgesia in the immediate post-operative recovery.

Epithelioid sarcoma (ES) is a rare malignant mesenchymal neoplasm that accounts for less than one percent of all soft-tissue sarcomas. Only two cases of ES involving the adrenal gland were found after a literature review. We report a case of an 82-year-old female initially presenting with right flank pain who was subsequently found to have an incidental left adrenal mass on CT imaging. After appropriate diagnostic workup, the patient underwent surgical resection. A diagnosis of ES was made from the histopathological analysis. The characteristic findings of ES are epithelioid cells with rhabdoid morphology and moderate eosinophilic cytoplasm. Immunohistochemical findings are significant for positive staining for epithelial markers, cytokeratins, vimentin, and CD34, and loss of INI-1 stain. Due to the aggressive nature and limited data of ESs, the standard treatment continues to remain wide surgical excision.

A total of 235 toes were amputated during 125 operations on 100 consecutive patients with lower limb ischaemia. The overall amputation wound healing rate for the series was 58.4 per cent and limb salvage was achieved in 66 patients. Toe amputation was performed under local anaesthesia in 57 cases and 32 (56 per cent) of these healed primarily, not significantly different from the healing rate of 41 (60 per cent) of 68 under general anaesthesia. Reconstructive arterial surgery was performed in conjunction with toe amputation in 39 patients; the healing rate with reconstruction was 32 (82 per cent) of 39, significantly better than the 41 (48 per cent) of 86 patients not undergoing bypass surgery (P less than 0.001). There was no difference in healing rates when comparing diabetic and non-diabetic patients. Multiple regression analysis demonstrated that reconstructive arterial surgery was the only factor which had an independent and significant influence on toe amputation healing. The use of local anaesthesia for distal amputation has no deleterious effects on wound healing.

INTRODUCTION AND OBJECTIVES:The perineal area has been evasive to office based approaches given its sensitivity, difficult access requiring lithotomy or exacerbated lithotomy positioning. Indeed, general or spinal anesthesia is commonly required for a prostate biopsy if performed thru the perineum. The emergence of MRI-Ultrasound (MR/ US) fusion biopsies has led to an increased precision in the diagnosis of prostate cancer. However, this fusion technology is mostly implemented using the transrectal technique. Herein, we present our method to block the perineum making it feasible to perform procedures (Prostate Biopsy and Cryoablation) safely in the office setting under local anesthesia METHODS: This study evaluated consecutive men who presented to our office for a transperineal procedure, either MR/US Fusion Biopsy or Cryoablation performed using a novel perineal block. The procedures were performed between August 2014 and September 2017. The information was collected prospectively using the Focalyx App (ISO, Android). For this report we queried diagnostic and treatment information such as: age, PSA, DRE findings, clinical stage, WHO Modified Gleason scores, co-morbidities, biopsy and treatment duration, Pain -measured with wonker baker pain faces scale -and claviendindo system 30 day outcomes post procedure outcomes.RESULTS: A total of 1,015 procedures were performed, 626 were Transperineal Biopsies (TBX) and 389 Transperineal Cryoablations (TPC). There was a statistically significant difference in the mean times of the procedures 22' and 60' for TBX and TPC, respectively. However, pain measures were similar as the median and mean pain referred after TBX were 2 and 2.5 with respective pain measures for TPC of 2 and 1.7. A total of 33 (3%) adverse events within 30 days were recorded, 18 (2.8%) after TBX and 15 after TPC (3.9%). There was one episode of UTI after TBX requiring admission due to presumptive sepsis, however, blood cultures were negative. In the TPC group 4 of the 11 patients with urinary retention greater than 3 weeks required a TURP. There was one patient (TPC) who developed a vasovagal episode and sustained a fall requiring hospital admission CONCLUSIONS: Our study shows that transperineal procedures performed under local anesthesia are well tolerated and harbor low rates (<4%) of adverse events. This novel block provides the urologist to access the perineum safely in the office setting