We describe the use of non-invasive positive pressure ventilation combined with spinal anaesthesia to allow the insertion of a dynamic hip screw in an obese patient with advanced chronic obstructive pulmonary disease. The technique avoided the hazards of intubation and general anaesthesia in this high-risk patient.

Total knee arthroplasty is commonly associated with moderate to severe postoperative pain. Patients undergoing these procedures are often elderly with multiple co-morbidities and an effective pain management strategy will reduce pain intensity, limit unwanted side effects, and improve surgical outcome by facilitating postoperative rehabilitation (Capdevila et al, 1999). The control of postoperative pain is not only important to the patient, an important humane aspect, but can hasten recovery and hence hospital discharge.