Local Nerve Blocks for Postoperative Analgesia

The effect of local nerve blockade on the relief of postoperative pain is reported in a series of 167 patients who underwent surgery of the arm, knee or foot. In 80% of cases analgesics were not required within 4 hours postoperatively, and in 39% analgesics were not required within 8 hours. Conventional methods of postoperative pain relief are not always effective. Local nerve blockade can be used to provide complete analgesia after limb surgery and is therefore of great value to postoperative care.

Biomechanical and Clinical Assessment of Hip Nerve Block in Unilateral Osteoarthrosis

This paper combines a biomechanical analysis with a clinical assessment of eighteen patients with unilateral hip osteoarthrosis. A double blind trial was established to evaluate the potential of a regional hip nerve block in relieving pain. The characteristics of the vertical ground-reaction forces were analysed using two Kistler force plates, once before the injection and at three-monthly intervals following it. At the same time pain, mobility and functional activity were assessed clinically.

A significant change in some of the gait parameters for the good leg was recorded for the total patient group one month after the injection. However, no further significant differences were found. When the symmetry of gait was evaluated no significant differences at the 1 per cent level were observed at any period. These results suggest that gait symmetry is not a significant factor in assessment of patients with hip osteoarthrosis.

There was a transient decrease in subjective pain level following the injection, but this rose to pre-injection levels by the fourth week. There were no other significant general improvements after the injection.

It is concluded that the biomechanical/clinical assessment has demonstrated that the hip nerve block does not provide any useful long-term pain relief.

Convulsions following regional hip blockade with bupivacaine and adrenaline

Four out of 100 patients undergoing regional hip block (obturator nerve and nerve to obturator femoris) developed convulsions. These followed the injection of bupivacaine to block the nerve to the quadratus femoris muscle. The reasons for this are discussed. Not only has hip nerve regional blockade been shown to be ineffective in the relief of chronic pain of osteoarthritis but it must be concluded that the method described carries an unacceptably high morbidity.

Regional hip blockade in osteoarthrosis. Effects on pain perception

Eighteen patients with unilateral osteoarthrosis of the hip were investigated in a trial which involved the injection of nine with bupivacaine and nine with normal saline. All the patients completed daily pain analogue charts. Their pain, mobility and functional activity were assessed and gait characteristics analysed, once before the injection and then at three monthly intervals. All the patients recorded a decrease in pain level within two weeks of injection, but it subsequently rose to pre-injection levels. There were no other significant general improvements after the injection. A significant increase in the maximum force at toe-off for the good leg was recorded one month after the injection. However, no further significant differences were found in the gait performance of either group of patients throughout the study. It is concluded that the hip nerve regional blockade offers no useful relief to the pain of osteoarthrosis of the hip joint.

Career opportunities in anaesthesia for doctors with domestic commitments. A report of a working party

The position of doctors with domestic commitments (DDCs) at present training in the specialty of anaesthesia in the British National Health Service is considered and proposals are made for their future employment in career grades.

The Oxford Training Scheme in Anaesthesia and other matters

The Faculty of Anaesthetists of the Royal College of Surgeons of England has made proposals on the training of anaesthetists. These proposals have been implemented by the Nuffield Department of Anaesthetics of the University of Oxford. The General Professional Training scheme was established in 1972 and is briefly described. Some of the results and the fate of those who joined as trainees are presented. Some conclusions are drawn.

Anaesthesia and the Valsalva manoeuvre. A test of circulatory responses in neurosurgical patients including those in the sitting position

The four phases of the Valsalva manoeuvre were studied before and after anaesthesia had been induced with a technique of either spontaneous breathing or controlled ventilation of the lungs. The Valsalva manoeuvre was found to be an unreliable predictor of a patient's ability to tolerate the upright or sitting position for neurosurgical procedures. However, a false negative response is more likely to occur than a false positive response.