Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Comment Letter
The oesophageal tracheal combitube for difficult intubation.
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The purpose of this study was to describe the relation of the lumbar plexus with the psoas major and with the superficial and deep landmarks close to it. Four cadavers were dissected and 22 computed tomography files of the lumbosacral region studied. Cadaver dissections demonstrated that the lumbar plexus, at the level of L5, is within the substance of the psoas major muscle rather than between this muscle and the quadratus lumborum. ⋯ However, while the lateral femoral cutaneous nerve is in the same fascial plane as the femoral nerve, the obturator nerve can be found in the same plane as the two other nerves or in its own muscular fold. Radiological data provided the following measurements: the femoral nerve is at a depth of 9.01 +/- 2.43 cm; the psoas major medial border is at 2.73 +/- 0.64 cm from the median sagittal plane; and its lateral border is at 6.41 +/- 1.61 cm from the same plane. It is concluded that the lumbar plexus is within the psoas major, that the obturator nerve localization within the psoas major varies and that computed tomography data define precisely the relationship of the lumbar plexus with superficial and deep landmarks.
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A combination of lumbar plexus block, by a posterior technique, and sciatic nerve block can be a useful technique for outpatient anaesthesia. The purpose of this study was to examine the clinical characteristics of these blocks using lidocaine and to measure the serum lidocaine concentrations. Forty-five patients, undergoing lower extremity surgery, were studied. ⋯ This was associated with a contra-lateral extension of the block. We conclude that this combination of blocks is a valuable alternative for unilateral lower extremity anaesthesia. However, clinicians must be aware of the implications of a contra-lateral extension of the block.
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Patients want safe and effective analgesia. Our goal is to prevent postoperative pain in an efficient and cost effective manner. For most patients, the pain can be managed using simple, non-invasive and inexpensive analgesic techniques. ⋯ There will be pressure to discharge patients as soon as they are able to take oral medications. Outpatient analgesia is the oldest and most widespread form of patient-controlled analgesia--We already have the knowledge and the analgesics necessary to prevent postoperative pain. What we need now is logical, rational, and universal application of this information.