British journal of anaesthesia
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We describe the provision of postoperative analgesia for 6 days for a patient undergoing arthrolysis of the elbow joint. Mobilization of the elbow immediately after operation is essential to maintain movement achieved with surgery and this can be obtained only with effective pain relief. We used continuous infusion of 0.125% bupivacaine and subsequent addition of fentanyl to the infusate, via a catheter inserted supraclavicularly into the sheath of the brachial plexus.
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We describe the use of thrombelastography in HELLP syndrome (Haemolysis, Elevated Liver Enzymes, Low Platelets). It differentiated between two possible causes of significant haemorrhage and revealed an accompanying underlying fibrinolysis. This allowed specific therapy to be directed at both abnormalities and, we believe, helped prevent this patient from undergoing radical surgery to curb blood loss.