SummaryIn this prospective, randomised, observer-blinded study we evaluated whether ultrasound guidance can shorten the onset time of popliteal sciatic nerve block as compared to nerve stimulation with a multiple injection technique. Forty-four ASA I-III patients undergoing posterior popliteal sciatic nerve block with 20 ml of 0.75% ropivacaine were randomly allocated to nerve stimulation or ultrasound guided nerve block. A blinded observer recorded onset of sensory and motor blocks, success rates, the need for fentanyl intra-operatively, the requirement for general anaesthesia, procedure-related pain, patient satisfaction and side-effects. Onset times for sensory and motor blocks were comparable. The success rate was 100% for ultrasound guided vs 82% for nerve stimulation (p = 0.116). Ultrasound guidance reduced needle redirections (p = 0.01), were associated with less procedural pain (p = 0.002) and required less time to perform (p = 0.002). Ultrasound guidance reduced the time needed for block performance and procedural pain. The multiple twitch technique is based on searching and identifying the targeted nerve by eliciting each nerve's motor component with nerve stimulation [1][2][3]. It has been associated with a reduction in sensory and motor block onset and a greater efficacy than a single injection technique [2]. Recently, ultrasound guidance has been introduced in order to improve the efficacy of peripheral nerve blocks, to shorten procedural time, to reduce the minimum local anaesthetic volume required for a successful block and to lower the incidence of complications and side-effects [4][5][6]. Ultrasound guidance may, theoretically, offer an advantage over conventional technique (anatomical landmarks and nerve stimulation) since it allows direct visualisation of nerve structures, needle pathway and local anaesthetic spread in real time [7,8]. Ultrasound guidance for upper limb nerve blocks has been showed to have a greater success rate than nerve stimulation alone and it also allowed a reduction in local anaesthetic dose for femoral nerve block [6]. While its role for proximal sciatic nerve block has been widely described [9], some authors still argue about the feasibility of ultrasound guidance for sciatic block at the popliteal fossa [10,11].We conducted a prospective, randomised, observerblinded study to test the hypothesis that ultrasound guidance can shorten the onset of posterior popliteal sciatic nerve block as compared with nerve stimulation guidance for nerve location when using the multiple injection technique. MethodsWith Local Ethics Committee approval (University of Parma, Parma, Italy) and written informed consent, 44 American Society of Anesthesiologist physical status 1-3 patients undergoing foot and ankle surgery were enrolled in the study in January-March, 2008. Patients with clinically significant coagulopathy, infection at injection site, allergy to local anaesthetics, severe cardiopulmonary disease, body mass index > 35 kg.m 2 , diabetes mellitus, or known neuropathies, as well a...

Intrathecal injection of 50 mg of preservative-free 2-chloroprocaine 1% resulted in quicker recovery of sensory/motor function, and unassisted ambulation, and fewer incidences of transient neurologic symptoms than the same dose of 1% lidocaine.

TAP block did not reduce morphine consumption during the first postoperative 24 hours after elective total laparoscopic hysterectomy.

The indications for continuous nerve blocks for the perioperative pain management in hospitalized and ambulatory patients have extended well beyond orthopaedics. These techniques are not only used to control pain in patients undergoing major upper and lower extremity surgery, but also to provide perioperative analgesia in patients undergoing abdominal, plastic, urological, gynaecological, thoracic, and trauma surgeries. Infusion regimens of local anaesthetics and supplements must take into consideration the condition of the patient before and after surgery, the nature and intensity of the surgical stress associated with the surgery, and the possible need for immediate functional recovery. Continuous nerve blocks have proved safe and effective in reducing opioid consumption and related side-effects, accelerating recovery, and in many patients reducing the length of hospital stay. Continuous nerve blocks provide a safer alternative to epidural analgesia in patients receiving thromboprophylaxis, especially with low molecular-weight heparin.

Unfortunately, NSAID-related AEs are mainly due to their mechanism of action, therefore the absence of risk associated with their use is a utopian target in daily practice. 14 This review aims at providing a summary of current literature relevant to the safety profile of available NSAIDs, mainly focusing on NSAID-related CV and cerebrovascular risk. The purpose is to support the clinician in NSAID prescription to minimize the risk, selecting the right drug according to each Cardiovascular and cerebrovascular risk with nonsteroidal anti-inflammatory drugs and cyclooxygenase 2 inhibitors: latest evidence and clinical implications Andrea Fanelli, Daniela Ghisi, Pierangelo Lora Aprile and Francesco LapiAbstract: Observational studies and meta-analyses have shown that the administration of nonsteroidal anti-inflammatory drugs (NSAIDs), especially when prescribed at high doses for long periods of time, can potentially increase the risk of cardiovascular diseases. The increased thrombotic risk related to the use of NSAIDs is mainly due to their cyclooxygenase 2 selectivity. The dosage use, the formulation selected and the duration of the therapy are other factors that can significantly impact on the cardiovascular risk. In order to minimize the risk, prescription of the right drug based on the patient's features and the different safety profiles of several NSAIDs that are available on the market is key for their appropriate administration. Despite the baseline cardiovascular and gastrointestinal risk of each patient, monitoring of patients is suggested for increases in blood pressure, development of edema, deterioration of renal function, or gastrointestinal bleeding during long-term treatment with NSAIDs.