Letters to the Editorper cent which indicates presence of arterial pulsations. There was no obvious neurological deficit, so decision to manage conserva tively was taken. We utilised finger probe for continuous SpOi assessment during next 24 hours. SpO? values showed gradual improvement over next 24 hours and reached normal values of 94 per cent. Surgical interference in a major arterial injury at elbow is not far from risk. Borderline cases of contusion or temporary spasm need no exploration but close observation. In such cases continuous SpŪ2 measurements can give better idea about peripheral circulator)' status than clinical assessment [3]. A deterioration in the SpOi values over a time gives correct idea about progress and extent of damage and appropriate decision can be taken. Gradual improve ment in SpŪ2 values in our case indicated temporary spasm or contusion, thus unnecessary exploration was avoided. We feel that in the present circumstances where doppler technique is not rou tinely available in our hospitals, therefore noninvasive monitoring of Sp02 for atleast first 24 hours can be a better and safe method of assessing peripheral circulation, specially in borderline cases and children as oximetry has not only dignostic but prognostic value [4].
Lt Col AK AGASHEClassified Specialist (Anaesthesia) Command Hospital (Eastern Command) Calcutta REFERENCES 1. Kellehcr JH.I nterpleural analgesia (IPA) for surgeries over areas innervated by intercostal nerves, is a relatively new technique described less than two decades ago [IJ. Thc technique is simple, avoids multiple intercostal nerve blockade, allows catheter placement and therefore continuous and high quality analgesia. Adverse effects including pneumo-thorax are extremely uncommon. A brief account of a case is presented where IPA was used to provide analgesia following surgery on the breast.A 49-y ear-old lady weighing 60 kg was posted for excision of a lump measuring 5x3 cm in breast on the right side. She was given anaesthesia in accordance with the standard policy. During surgery, the lump appeared to be precancerous hence a wide excision was carried out by extending the incision over upper quadrant upto anterior axillary line. After completion of the surgery the patient was turned into lateral decubitus position with operated side up and a mild head down tilt. A 16G catheter was passed in 7lh intercostal space on the right side about 8 cm from central spine. The catheter was placed in the pleural cavity and secured. 20 mL of 0.5 per cent bupivacainc was injected after taking due precaution. After main taining the position for 5 minutes, the patient was straightened and residual myoneural blockade was reversed. The patient remained absolutely comfortable for 24 hours and did not demand analgesia. There was no untoward event. After 24 hours, 10 mL of 0.5 per cent bupivacainc was repeated in the same position as described above and thereafter the catheter was removed. She did not require any analgesic medication subsequently and had an uneventful recover...
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