The lower concentration of the anaesthetic solution avoids complications while increased volume provides good analgesic cover. The combination of the Winnie interscalene plexus block and the Pippa proximal cranial needle approach should contribute to fill up the scalene sheath overcoming the septa obstacles.

No abstract

Ninety patients undergoing scheduled upper limb orthopaedic surgery were studied to determine the optimal anaesthetic dose using the 'orthogonal two-needle technique'. The patients were randomly assigned to one of three groups to receive one of three different volumes (20, 30 and 40 mL) (n = 30) of anaesthetic solution (a mixture of equal parts of 0.5% bupivacaine with adrenaline 1:200,000 and 2% lignocaine). A significant correlation was found between the volume injected and the anaesthetic spread for all tested areas. A better analgesic spread to all the major branches of the plexus was obtained when increased volumes of anaesthetic solution were injected. The comparisons between the 20 mL group and the other two groups are significant in all the tested areas, as well as the comparisons between 30 and 40 mL groups in the areas innervated by radial and musculocutaneous nerves. Only the area innervated by the axillary nerve showed a weaker volume-analgesia relation, confirming the elusiveness of this area to anaesthesia in the axillary approaches. The improved results observed using greater amounts of anaesthetic solution might result from a higher intrasheath pressure with disruption of sheath septa, or from a greater availability of drug for all the terminal branches of brachial plexus, or both.

The optimal dose of local anaesthetic in the orthogonal two-needle technique. Extent of sensory block after the injection of 20, 30 and 40 mL of anaesthetic solution Summary two groups are significant in all the tested areas, as well as the comparisons between 30 and 40 mL groups Ninety patients undergoing scheduled upper limb in the areas innervated by radial and musculoorthopaedic surgery were studied to determine the cutaneous nerves. Only the area innervated by the optimal anaesthetic dose using the 'orthogonal twoaxillary nerve showed a weaker volume-analgesia reneedle technique'. The patients were randomly aslation, confirming the elusiveness of this area to ansigned to one of three groups to receive one of three aesthesia in the axillary approaches. The improved different volumes (20, 30 and 40mL) (n=30) of results observed using greater amounts of anaesthetic anaesthetic solution (a mixture of equal parts of 0.5% solution might result from a higher intrasheath presbupivacaine with adrenaline 1:200 000 and 2% ligsure with disruption of sheath septa, or from a greater nocaine). A significant correlation was found between availability of drug for all the terminal branches of the volume injected and the anaesthetic spread for all brachial plexus, or both. tested areas. A better analgesic spread to all the major branches of the plexus was obtained when increased

A randomized study was carried out on 160 patients aged 30-60 years with the aim of finding a method of preventing postdural puncture headache (PDPH). In Taylor's lumbosacral approach to the subarachnoid space, two different needle sizes were used (21-gauge versus 25-gauge) for injecting the anaesthetic solution. Our results show an overall incidence of PDPH in nearly 8% of patients, with no significant difference related to the size of the needle employed. Patients with PDPH showed mild symptoms which disappeared in a short time and none needed epidural blood patching. The possibility of using larger needles, facilitating the execution of the block without increasing PDPH incidence, renders this technique particularly attractive in patients where the midline approach is not feasible, or when pencil-point needles are not available.