The World Federation of Societies of Anaesthesiologists Global Anesthesia Workforce Survey is the most comprehensive study of the global anesthesia workforce to date. It is the first step in a process of ongoing data collection and longitudinal follow-up. The authors recommend an interim goal of at least 5 specialist physician anesthesia providers (anesthesiologists) per 100,000 population. A marked increase in training of PAPs and NPAPs will need to occur if we are to have any hope of achieving safe anesthesia for all by 2030.

Mucopolysaccharide inJiltration oJ tissues in Hurler, Hunter, San Filippo, Maroteaux-Lamy, Morquio and Scheie syndromes causes problems to anaesthetists in the management oJ the airway and in myocardial Junction. Recent experience at the Royal Children's Hospital, Melbourne, is presented with illustrations highlighting these problems.

Analgesia below the knee can be achieved by blocking the tibial nerve and the common peroneal nerve in the popliteal fossa, and the saphenous nerve adjacent to the knee. The anatomy and technique of nerve block in the popliteal fossa is described, the nerve being located prior to blockade using a peripheral nerve stimulator. The block as described has been used in children for postoperative analgesia, as a diagnostic block, and as an adjunct to the physiotherapy management of severe equinus deformity after brain injury.

Summary Continuous interpleural analgesia provided by 4 hourly injectionsPain relief after unilateral thoraco-abdominal operations may be provided by the administration of bupivacaine into the pleural space.'" A duration up to 27 hours after a single injection of 0.5% bupivacaine 20 ml with adrenaline 5 pg/ml has been reported,l but recent studies suggest that analgesia is usually shorter-lived.4.s In our experience, analgesia invariably wears off within 5 hours of administration of the above dose, although 4 hours of pain relief is consistently achieved. Patients who require little or no opioid supplementation may experience extremely painful episodes because the effect of the local anaesthetic wears off rapidly and there is no background analgesia. This intermittent absence of pain relief tends to exaggerate the efficacy of the technique and the possible beneficial effects on respiratory function.2S6 It needs to be shown that interpleural analgesia has advantages compared to current regimens before it is adopted for widespread clinical use. The plasma concentrations of bupivacaine attained when interpleural block is maintained using repeated bolus injections of local anaesthetic for prolonged periods remain to be determined.The aims of this study were to compare interpleural analgesia to placebo in a randomised, double-blind manner and assess whether a combined interpleural and systemic opioid technique provides better pain relief than opioid alone. Local anaesthetic blockade was maintained, and episodes of severe pain were avoided. We examined the effects of interpleural analgesia on respiratory function and measured the plasma concentrations of bupivacaine that may be expected when an intermittent bolus technique is used in an optimal fashion. MethodsTwenty patients (aged 24-70 years, ASA 1 or 2), undergoing cholecystectomy were admitted to the study, which was approved by the local ethics committee. All patients received instruction before operation in the use of the Cardiff Palliator and visual analogue scales for scoring pain. Baseline measurements of FEV,, FVC and the FEV,/ FVC ratio were made with the patient in the sitting position using a wedge spirometer (Vitalograph).

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