Adductor canal blockade with bupivacaine 0.25% with epinephrine 1:300,000 effectively reduces pain and opioid requirement in the postoperative period after TKA. Adductor canal blockade is an effective pain management adjunct for patients undergoing TKA.

An 86-year-old female with previously diagnosed congenitally absent right internal carotid artery presented for total shoulder arthroplasty. Bedside ultrasonography confirmed the anomaly and identified several arterial collateral vessels. No aberrant vessels were seen traversing the brachial plexus. The patient received brachial plexus blockade and general anesthesia for the procedure. Carotid agenesis is associated with increased prevalence of intracranial aneurysm. Patients are often asymptomatic due to adequate blood supply from collateral vessels. Ultrasonography for brachial plexus blockade or central line access may yield initial diagnosis or confirm a preexisting anomaly that has anesthetic implications. These prospects encourage vigilance in perioperative imaging.

The concept of DP is subjective and unreliable as a method to mitigate missed C-spine injuries. If it is to be considered for use, DP should be defined as VNRS ≥5. Reliance on clinical impressions regardless of the presence or absence of NP or PP, distracting or otherwise, is accurate and safe.

Electrophilic trisubstituted ethylene monomers, halogen ring-disubstituted 2-phenyl-1,1-dicyanoethylenes, RC 6 H 3 CH5 5C(CN) 2 (where R is 2,3-diCl, 2,4-diCl, 2,6-diCl, 3,4-diCl, 3,5-diCl, 2,4-diF, 2,5-diF, 2,6-diF, 3,4-diF, 3,5-diF, 2-Cl, 6-F) were synthesized by piperidine catalyzed Knoevenagel condensation of ring-substituted benzaldehydes and malononitrile, and characterized by CHN elemental analysis, IR, 1 H-and 13 C-NMR. Novel copolymers of the ethylenes and vinyl acetate were prepared at equimolar monomer feed composition by solution copolymerization in the presence of a radical initiator (ABCN) at 708C. The composition of the copolymers was calculated from nitrogen analysis, and the structures were analyzed by IR, 1 H and 13 C-NMR, GPC, DSC, and TGA. High T g of the copolymers, in comparison with that of polyvinyl acetate, indicates a substantial decrease in chain mobility of the copolymer due to the high dipolar character of the trisubstituted ethylene monomer unit. The gravimetric analysis indicated that the copolymers decompose in the 220-8008C range.

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