IMPORTANCE Patient-reported outcomes in the treatment of opioid dependence may differ between subcutaneously administered depot buprenorphine and daily sublingual buprenorphine.

SummaryLower limb compartment syndrome is a rare consequence of surgery where the lithotomy position is maintained for several hours. The aim of this study was to observe the effect of the lithotomy position on lower limb compartment pressure and blood flow to the lower limb in surgical patients having colorectal procedures. We prospectively studied 23 patients undergoing colorectal surgery requiring the lithotomy position and recorded lower limb compartment pressure, and the blood pressure in the upper and lower limbs. The lithotomy position led to a significant (p < 0.001) fall in blood pressure to the lower limb from 87 (SD 16) mmHg to 67.9 (SD 12) mmHg and a significant (p < 0.001) rise in lower limb compartment pressure from 13 (SD 7) mmHg to 31 (SD 12) mmHg. These two effects compromise blood flow to the lower limb in long surgical procedures where the lithotomy position is required. Intermittently lowering the legs and restoring blood flow may prevent compartment syndrome developing.

We have compared the effects of scalp infiltration with 0.5% lignocaine, 0.5% lignocaine with adrenaline 1:200,000, 0.9% saline and 0.9% saline with adrenaline 1:200,000, in a prospective, randomized, double-blind study. Direct arterial pressure, heart rate and bleeding at incision were recorded in 80 patients undergoing craniotomy or craniectomy. Arterial pressure decreased by more than 20% from preinfiltration values in 40% of patients in the saline with adrenaline group, and in 55% of patients in the lignocaine with adrenaline group. It did not decrease in patients who did not receive adrenaline.

The use of iloprost in the treatment of NFCI is discussed and its use in a condition which physicians consistently struggle to treat effectively is considered. Careful counselling is recommended as symptoms may be worsened.