The case of a 77-year-old woman is described, who was found unconscious, with decreased respiration and miotic pupils, having previously experienced dizziness, nausea and drowsiness before. In the emergency room a fentanyl patch was detected, which had obviously been mistakenly applied by the patient the day before. Opioid intoxication was assumed and successfully treated with naloxon. The patient was supervised in an ICU for 24 h and sent home the next day without serious sequelae. The consequences following inappropriate use of transdermal fentanyl are discussed.

It was possible to implement a standardized perioperative pain therapy concept in three hospitals of a consortium. Whether an adequate pain relief can be improved with the help of standard measurements and documentation, could not be evaluated in this study.

This presented technique can provide benefits for operators experienced in in-plane puncture.

A patient received an interscalene plexus catheter before shoulder surgery. After induction of general anesthesia catheter placement was performed with Winnie's technique and 5 ml of ropivacaine was injected via the catheter. In the recovery room slight dyspnea without wheezing was observed which improved spontaneously. Following another bolus of ropivacaine, dyspnea and paralysis of the contralateral arm developed and the patient became hypotensive. The tomography scan showed epidural malpositioning of the catheter. Neuraxial complications of interscalene regional anesthesia are especially possible with medially directed insertion of the needle and have been described many times in the literature. The symptoms and recommendations for prevention are discussed.