There is little published work on the assessment of supraclavicular brachial plexus block using modern local analgesic drugs. Furthermore, although the addition of adrenaline and hyaluronidase have been recommended by a number of workers 132 there has been little assessment of the advantages of any of these additives. This study utilises a double blind technique to compare the effect of adding either adrenaline, hyaluronidase, or both of these drugs to 1 % mepivacaine for brachial plexus block. A latin square approach was used so that half the patients received adrenaline with the local analgesic and half the patients received hyaluronidase with the local analgesic. METHOD41 patients were studied. They were unselected other than for the site of operation. There were 26 males and 15 females and the body-weight ranged from 50 to 90kg. All the patients were premedicated with atropine 0.5mg and promethazine 5Omg. 41 brachial plexus blocks were performed on these patients by the classical supra-clavicular method using the anterior approach.

Currently, there is limited information to guide occupational therapy or physical therapy treatment of high-risk neonates with secondary orthopedic conditions in the Neonatal Intensive Care unit (NICU). This article describes one master of occupational therapy student capstone project that aimed to develop intervention protocols and parent education materials for the treatment of brachial plexus injuries (BPI) and clubfoot for a hospital NICU. A literature review and needs assessment were conducted to determine whether clinical practices and standards existed and to inform the development of the intervention protocols. The critical need to document, define, and examine best practices was validated. Clinical treatment protocols and parent education materials were developed and are presented.

Although block of the sciatic and femoral nerves to produce analgesia of the lower limb was described as long ago as 19021, the technique has never enjoyed popularity equivalent to that of brachial plexus block. A variety of techniques have been described for locating the nerves2-4. The technique used in the present series follows that described by Moore5. There have been few publications concerning the effects of the combined nerve blocks 1'4,6-8. The present study is an attempt to evaluate sciatic and femoral nerve block with mepivacaine for surgery on the lower limb. M E T H O D SThe study includes 999 patients, unselected other than for site of operation, treated at Sundsvall's Hospital during the 5 year period 1961-5. (table 1). The anaesthetic course was thoroughly evaluated. A questionnaire was sent to one hundred of the varicose vein patients, one year after the operation, requesting information concerning the after effects of analgesia and operation, such as pain and paraesthesiae. It is seen in table I that there were more females than males in the series, that varicose vein operations were most common and that operations for fractures were more common in males than in females. The age distribution of the patients is shown in figure 1, with a maximum in the 40-49 years group.

Background Airway clearance techniques (ACTs) for individuals with bronchiectasis are routinely prescribed in clinical practice and recommended by international guidelines, especially during an acute exacerbation. However, there is limited evidence of the efficacy of these techniques during an exacerbation to improve sputum expectoration, health-related quality-of-life (HRQOL) or exercise tolerance. The primary aim of this study is to compare the effects of the active cycle of breathing technique (ACBT), oscillating positive expiratory pressure (O-PEP) therapy, and walking with huffing on sputum expectoration for adults hospitalised with an acute exacerbation of bronchiectasis. Secondary aims are to compare the effects of these interventions on HRQOL, health status, exacerbation rates and hospital admissions in a six-month period following hospital discharge. Methods This multi-centre randomised controlled trial will recruit adults with an acute exacerbation of bronchiectasis requiring hospital admission. Participants will be randomised to receive one of three interventions: ACBT, O-PEP therapy, and walking with huffing. Outcome measures including sputum volume during and 1-h post ACT session, and 24-h sputum, as well as health status, HRQOL and exercise capacity will be completed during inpatient stay on day 2 and day 6 of admission, and within 24 h of hospital discharge. Time to first exacerbation, and time to first hospitalisation will be monitored via monthly phone calls for six months post hospital discharge. Health status and HRQOL will be assessed after discharge at two and six months, and exercise capacity will be assessed at six months post hospital discharge. Discussion Despite recommendations regarding the importance of ACT for individuals with bronchiectasis during an acute exacerbation, there is a gap in the literature regarding effectiveness of ACT when undertaken by individuals in this clinical state. This study will add to the evidence base regarding the effectiveness of commonly implemented ACTs during a hospital admission with an exacerbation of bronchiectasis. Additionally, it will contribute to knowledge of the long term effects on important and patient-centred outcomes, including incidence of future exacerbations, and HRQOL, which has not been previously established. Trial registration Registered on the Australian and New Zealand Clinical Trials Registry (ACTRN12621000428864).

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