A randomised controlled study was undertaken to assess the analgesic efficacy of continuous lumbar plexus block for the first 48 hours after total knee replacement surgery. Boluses of 0.5% bupivacaine with adrenaline 1 in 200,000 (0.3 ml/kg) were administered through a cannula inserted into the neurovascular sheath of the femoral nerve. Thirteen patients who received this block required significantly less morphine than a control group of 16 patients. Pain scores were similar and there were no complications related to this technique.

SummaryIn 30 ASA 1 and 2 patients undergoing general anaesthesia and neuromuscular paralysis, manual in-line stabilisation of the neck in a neutral position was performed and single-handed cricoid pressure was applied. Vertical displacement was measured from the midpoint of the neck (directly below the cricoid cartilage). Measurements were also made at the tragus of the ear and the shoulder, both of which acted as fixed reference points. Mean neck displacement was 4.6 mm with a range of 0-8 mm. Mean tragus and shoulder displacements were 0.5 mm and 0.9 mm, respectively, with a range of 0-2 mm at each point. Vertical displacement was also measured in 10 patients from a stylet fixed to the posterior aspect of the neck. Mean displacement measured at this point was 5.0 mm with a range of 2-9 mm. Single-handed cricoid pressure caused vertical displacement of the neck of between 4.6 and 5 mm with a range of 0-9 mm. Only some of this movement, i.e. 0.5-0.9 mm (range 0-2 mm) can be accounted for by displacement of the whole patient as determined from measurements at the two fixed reference points. These findings have implications for emergency management of the airway in trauma patients. Anaesthetics, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN, UK Accepted: 9 January 1997 The patient with multiple injuries may require urgent tracheal intubation before it has been possible to exclude significant injury to the cervical spine. Any manipulation or force applied to the potentially damaged neck should be avoided. In order to minimise the risk of cervical damage, intubation is best performed orally, in experienced hands, with the head held firmly in a neutral position after the cervical collar has been removed [1][2][3][4][5]. The majority of trauma victims also present with a full stomach and, thus, in addition to immobilising the cervical spine during intubation, regurgitation of gastric contents and aspiration into the lungs must be avoided. The application of cricoid pressure [6] is the method of choice for preventing aspiration by occlusion of the oesophageal lumen until the airway is secured. The technique can be performed using a single-or double-handed approach, with the second hand supporting the posterior cervical spine. The effect of cricoid pressure on movement of the unsupported cervical spine has not been studied in detail, although a bimanual approach in trauma patients has been recommended in an effort to provide some support and stabilisation to the posterior aspect of the neck [7]. Any unidirectional force applied directly to the cervical vertebrae, i.e. single-handed cricoid pressure, may cause significant neck movement and exacerbate pre-existing spinal cord injury.The aim of this study was to assess and quantify the effect of single-handed cricoid pressure on movement of the neutrally positioned cervical spine in anaesthetised patients. MethodsAfter obtaining local ethics committee approval, 30 ASA 1 and 2 patients, all undergoing elective general anaesthesia 586ᮊ 1997 B...

The modification of the gum elastic bougie allows a more objective assessment of correct placement than the previous tactile method. The current design of bougie is unsuitable but can be modified.

Conflict of InterestsThe authors declare no conflict of interests. AbstractPost-operative Acute Kidney Injury (AKI) is a common complication of surgery with

This case outlines the use of a continuous interscalene brachial plexus block to treat cancer-related pain. Using an elastomeric device, the patient's previously intractable pain was controlled and he was able to return home. Furthermore, the patient developed a pragmatic and effective method of balancing loss of power and sensation against pain control using the flow restrictor. This case illustrates the potential of an integrated approach to cancer pain management to obtain rapid pain relief in the acute hospital setting.