We have demonstrated the successful use of real-time US guidance in combination with LOR to saline for paramedian epidural access with the epidural needle inserted in the plane of the US beam.

This article reports findings from a study which interviewed 36 undergraduate students about aspects of the teaching and learning environment which motivated or demotivated their study. It was found that students were motivated by a teaching environment characterized by eight main elements. This article reports in detail on the element of establishing relevance, as this seemed very important to the interviewees. The interviewees found that teaching abstract theory alone was demotivating. Relevance could be established through: showing how theory can be applied in practice, establishing relevance to local cases, relating material to everyday applications, or finding applications in current newsworthy issues. The traditional building block curriculum, which devotes substantial parts of initial courses to basic theory, could demotivate students if they could not see how the theory was applicable to the discipline or profession. The problem could be alleviated by a course which revealed a curriculum map showing the application of basic material in more advanced courses, or by early periods of exposure to professional practice in professional programmes. Professional programmes faced a double-edged sword with respect to relevance in that it could be established by demonstrating that material was relevant to a future career. However, students could easily become demotivated if they could not see the relevance of theoretical material, since they had chosen a professional programme in the expectation that it would prepare them well for their future career.

Lumbar plexus block (LPB) is frequently used in combination with an ipsilateral sacral plexus or sciatic nerve block for lower limb surgery. This is traditionally performed using surface anatomical landmarks, and the site for local anaesthetic injection is confirmed by observing quadriceps muscle contraction to peripheral nerve stimulation. In this report, we describe a technique of ultrasound-guided LPB that was successfully used, in conjunction with a sciatic nerve block, for anaesthesia during emergency lower limb surgery. The anatomy, sonographic features, technique of identifying the lumbar plexus, and the potential benefits of using this approach are discussed.