This paper seeks to assess the potential use of blocking the lateral cutaneous femoral nerve (LCN) for patients undergoing hip surgery. In this study, ultrasound guidance was used to specifically block the LCN using a small volume of local anaesthetic in 20 healthy volunteer anaesthetists. An orthopaedic surgeon then drew lines on the volunteers reflecting three common cutaneous incision lines (anterolateral, lateral, and posterior approach) for hip arthroplasty using an ultraviolet reflecting pen invisible in normal lighting. The relationship between the anaesthesia produced by this block and the marked incision lines was then assessed. More than half (32 of 60) of the drawn incision lines fell completely outside of the anaesthesia produced by the LCN block. Of the remaining incision lines drawn, most were less than half covered by LCN blockade with only three lines more than 50% covered and none more than 75% covered. The skin anaesthesia produced by LCN blockade was usually anterior and inferior to the surgical lines marked. This significant lack of overlap between common hip arthroplasty incision lines and the anaesthesia produced by blockade of the lateral cutaneous femoral nerve draws into question the utility of this block for hip surgery.

No abstract

intrafascicular spread, but no evidence of infiltration into the spinal cord. Moreover, in a comparative retrospective analysis of 5436 peripheral nerve blocks steered either by surface landmarks or by ultrasound enhancement, Orebaugh and colleagues 8 found significantly fewer adverse outcomes associated with the ultrasound-guided interventions.Unfortunately, the description of current case report fails to note patient habitus, use of auxiliary equipment (nerve stimulation or ultrasound), and clinical interpretation of the post-positioning haemodynamic instability (such as Bezold-Jarisch reflex). The combination of an increased neck girth, general anaesthesia, and absent ultrasound-guidance increases the likelihood of needle misadventure. Real-time ultrasound identification of the needle tip and pattern of LA spread should reduce the incidence of this catastrophic complication. 1 Mostafa RM, Mejad A. Quadriplegia after interscalene block for shoulder surgery in sitting position. Br J Anaesth 2013; 111: 846-7 2 Benumof JL. Permanent loss of cervical spinal cord function associated with interscalene block performed under general anesthesia. Anesthesiology 2000; 93: 1541-4 3 Bogdanov A, Loveland R. Is there a place for interscalene block performed after induction of general anaesthesia? Eur J Anaesthesiol 2005; 22: 107-10 4 Sardesai AM, Patel R, Denny NM, et al. Interscalene brachial plexus block: can the risk of entering the spinal canal be reduced? Anesthesiology 2006; 105: 9-13 5 Russon KE, Herrick MJ, Moriggl B, et al. Interscalene brachial plexus block: assessment of the needle angle needed to enter the spinal canal. Anaesthesia 2009; 64: 43-5 6 Orebaugh SL, Mukalel JJ, Krediet AC, et al. Brachial plexus root injection in a human cadaver model-injectate distribution and effects on the neuraxis. Reg Anesth Pain Med 2012; 5: 525-9 7 Selander D, Sjostrand J. Longitudinal spread of intraneurally injected local anesthetics. Acta Anaesthesiol Scand 1978; 22: 622-34 8 Orebaugh SL, Williams BA, Vallejo M, et al. Adverse outcomes associated with stimulator-based peripheral nerve blocks with versus without ultrasound visualization.

Aims: Approximately half of patients undergoing Total Knee Arthroplasty (TKA) experience severe perioperative pain. The ideal analgesic regimen for perioperative pain control in patients undergoing TKA is yet to be determined. Methods: A prospective, double-blinded, randomised clinical trial was performed, comparing adductor canal blocks versus intra-articular pain catheters in 100 patients undergoing unilateral total knee replacement by a single surgeon. All other analgesic aspects of the perioperative care were kept standard. Patients underwent an identical surgical approach and all received an Attune TKA (Depuy etc). Post-operative pain levels, Range of Movement (ROM) and opioid equivalent breakthrough analgesia were recorded. All assessors were blinded to group allocation. In addition patients completed WOMAC and Oxford knee scores. Southampton wound score was used to detect adverse outcomes.Results: There were no differences in baseline demographics between the groups preoperative Visual Analogue Pain Score (VAS), Oxford Knee Scores (OKS) or WOMAC scores. Conclusion:A single shot adductor canal block is not inferior to an intra-articular catheter for perioperative pain management in total knee arthroplasty.