Anaesthesia
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The anatomy of the lumbar plexus and the various approaches used to perform lumbar plexus blockade are reviewed. A single needle technique for a posterior approach to the plexus at the L2-3 interspace is described. This technique was used bilaterally in six intact cadavers, and the extent of spread of an injected dye was documented photographically during a subsequent detailed dissection of the region. ⋯ No dye was seen anterior to the psoas, around the sympathetic chain, on the sacral plexus or in the extradural or subarachnoid spaces. Further studies in patients with needle position and drug disposition being confirmed using computerised tomography and X ray scanning were in agreement with the results observed in the cadavers. This technique represents a simple approach to the lumbar plexus which does not require needle localisation by X ray screening.
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Randomized Controlled Trial Comparative Study Clinical Trial
Zingiber officinale (ginger)--an antiemetic for day case surgery.
The effect of powdered ginger root was compared with metoclopramide and placebo. In a prospective, randomised, double-blind trial the incidence of postoperative nausea and vomiting was measured in 120 women presenting for elective laparoscopic gynaecological surgery on a day stay basis. The incidence of nausea and vomiting was similar in patients given metoclopramide and ginger (27% and 21%) and less than in those who received placebo (41%). ⋯ The requirements for postoperative analgesia, recovery time and time until discharge were the same in all groups. There was no difference in the incidence of possible side effects such as sedation, abnormal movement, itch and visual disturbance between the three groups. Zingiber officinale is an effective and promising prophylactic antiemetic, which may be especially useful for day case surgery.
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Comparative Study
Laryngeal mask airway insertion. A comparison of the standard versus neutral position in normal patients with a view to its use in cervical spine instability.
The ease of insertion of the laryngeal mask airway with the patient's head in the standard position and the neutral position was compared, in a study of 80 healthy patients. Successful insertion was assessed by fibreoptic bronchoscopy and the functioning of the airway. ⋯ There were no significant differences in scores as assessed by fibreoptic bronchoscopy. The laryngeal mask airway may have a role in the management of some patients with cervical spine instability, although confirmation of this ultimately depends on the results of outcome studies.