Ultrasound-guided supraclavicular blockade with 30 mL of 0.5% ropivacaine produced complete hemidiaphragmatic paralysis in approximately one-third of patients. The infraclavicular approach greatly reduced this risk but did not eliminate it. These data may aid in the selection of the approach to brachial plexus blockade, particularly in ambulatory patients and/or those with respiratory comorbidities.

SummaryThe widespread use of highly active antiretroviral therapy (HAART) has dramatically reduced HIV-associated morbidity and mortality where treatment has been made available. Very high levels of adherence to HAART are a prerequisite for a successful virological and immunological response. Low adherence increases the risk of treatment failure and disease progression. It is also likely to lead to further transmission of resistant viruses, and to have a negative impact on the cost effectiveness of HAART. Low adherence is difficult to predict, and this has two key implications for service provision. Firstly, HAART should not be withheld on the basis of assumptions about adherence. Secondly, support with adherence should be provided to all patients prescribed HAART. Our understanding of barriers to and enablers of high adherence, and the evidence base regarding effective interventions, is limited. Meta-analysis of randomized controlled trials available from the general literature suggests multiple interventions are required to maintain high adherence to chronic therapy. This document recommends a series of measures for adoption within HIV clinical care settings, based on evaluation of existing data. High adherence is a process, not a single event, and therefore adherence support must be integrated into clinical follow up. Every prescribing unit should have a written policy on provision of adherence support, and ensure that staff are appropriately trained to make delivery of such services possible.

Patients who received sBPBs for ambulatory wrist fracture surgery had a higher rate of unplanned health care resource utilization caused by pain after hospital discharge than those undergoing GA. These findings warrant confirmation in a prospective trial and emphasize the need for a defined postdischarge analgesic pathway as well as the potential merits of perineural home catheters.

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Adherence to once daily abacavir/lamivudine was good with no evidence of an association between nonadherence and virologic rebound. Acceptability of once daily drugs was best when the whole regimen was dosed once daily.

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In this randomized trial, we found no differences in nerve visibility, block success rate, or onset between the AC and Peri-SBDGA techniques of ultrasound-guided saphenous nerve blockade, although the former technique provided superior vascular landmark visibility. Neither technique produced a sufficiently high success rate to provide reliable surgical anesthesia per se.

A regional anesthesia-based ''swing'' operating room model reduces non-operative time in a mixed orthopedic inpatient/ outpatient population Un modèle de salle « en rotation » basée sur l'anesthésie régionale en orthopédie réduit le temps non-opératoire dans une population mixte de patients ambulatoires et hospitalisés Abstract Purpose We recently reported on the efficacy of a new ''swing'' room model involving two alternating ORs and regional anesthesia in increasing operating room (OR) throughput in a dedicated ambulatory orthopedic surgery facility. The purpose of this study was to evaluate this model in a main OR suite setting with typical mixed inpatient/outpatient cases. Methods We conducted a retrospective matched-pair cohort study of 133 upper extremity surgery patients treated in the swing room model under ultrasound-guided brachial plexus blockade. We compared this cohort with case-matched historical controls treated in the traditional single OR model under general anesthesia. The primary endpoint was non-operative time, defined as the interval between skin closure and incision in the following case.Secondary endpoints included throughput estimated as the median number of cases per eight-hour day, postanesthesia care unit (PACU) bypass rates, and postoperative pain/ nausea and vomiting (PONV) intervention rates. Results Compared with the control group, non-operative times in the swing room group were faster (swing: median 19 min; interquartile range [IQR 8-31] vs control: median 57 min; IQR [49-65]; P \ 0.0001). In the swing room model, the estimated daily throughput was 33% greater (swing: median 5.6 cases; IQR [5.0-6.2] vs control: median 4.2 cases; IQR [4.0-4.4]; P \ 0.0001), and the PACU bypass rate was higher (swing: 60% vs control: 0%; P \ 0.0001). Fewer patients received postoperative opioids (swing: 20% vs control: 82%; P \ 0.0001) and treatment for PONV (swing: 2% vs control: 20%; P \ 0.0001) in the swing room model. Conclusion The implementation of a ''swing'' room care model based on ultrasound-guided regional anesthesia in a typical mixed inpatient/outpatient population decreased non-operative times, increased throughput, and improved recovery profiles compared with case-matched historical controls in the traditional model under general anesthesia. RésuméObjectif Nous avons re´cemment parle´de l'efficaciteṕ our l'augmentation du nombre de cas traite´s d'un nouveau mode`le de salle « en rotation » impliquant l'utilisation en alternance de deux salles d'ope´ration et l'utilisation de l'anesthe´sie re´gionale dans un centre spe´cialise´en chirurgie orthope´dique ambulatoire. L'objectif de cette e´tude e´tait d'e´valuer ce mode`le dans le cadre d'un ensemble de salles d'ope´rations accueillant aussi bien des patients hospitalise´s que des patients ambulatoires.