Although US guided injections have a higher accuracy of drug placement in the subacromial bursa, there is no difference in terms of clinical outcomes or safety profile of either of the method. Hence US guided injections seems to be unjustified, when compared to equally efficacious and cost effective LMG steroid injection.

Introduction: Cesarean section is a commonly performed operation and postoperative analgesia is needed so the mother can bond and look after her newborn. Transversus abdominis plane (TAP) blocks have been shown to improve postoperative analgesia in laparoscopic cholecystectomy and hysterectomies. The purpose of this article is to review the evidence for the use of TAP blocks in cesarean sections. Methods: A literature search identified four randomized controlled trials that looked at the use of TAP blocks in cesarean section. Copies were obtained and critically appraised. Results: Four randomized controlled trials were found that looked at the use of TAP blocks in cesarean sections. Two studies showed that TAP blocks reduced the postoperative analgesic requirements of patients compared to a placebo; one paper showed no difference when TAP blocks were used. In a study comparing TAP blocks with subarachnoid morphine, TAP blocks were associated with poorer postoperative pain scores and higher rescue analgesia. There was no consistent local anesthetic dose used amongst the trials. None of the studies revealed any statistically significant side effects from TAP blocks. Discussion: TAP blocks have been shown to offer improved pain relief after cesarean sections when compared to a placebo, but have been shown to be inferior to subarachnoid morphine. Standardization of local anesthetic and dosage may result in an improved evidence base from which to draw clinically relevant conclusions.

Background: There is little information regarding inter- and intra-observer variation when classifying tibial plateau fractures using Schatzker classification system. There is paucity of literature regarding morphological characteristics of each Schatzker subtype on computerized tomography. Materials and Methods: Fifty-three patients (age 18–70 years) of either sex with fresh (<3 weeks old), closed tibial plateau fracture were included after obtaining their informed consent. Patients with previous surgery around tibia or knee and the ones with pathological fractures were excluded from the study. Standard plain radiographs (anterior, posterior, and lateral views) and an additional noncontrast computed tomography (CT) scan (with three-dimensional reconstruction) of knee and leg of the affected side were done. Five different surgeons classified these fractures as per Schatzker classification on two separate occasions. The intra- and inter-observer variations were calculated using the kappa test of Cohen. Additional morphological characteristics were also evaluated on CT scan. Results: The mean kappa values for five observers (A to E) for inter-observer agreement on Schatzker classification were 0.41 (moderate). The mean kappa value for intra-observer agreement was 0.71 (substantial). Six morphological characteristics were defined on CT scan-lateral condylar impaction (79.2%), tibial tuberosity fracture (3.8%), coronal plane (3.8%), tibial spine avulsion (22.6%), medial condylar impaction (17%), and posteromedial shear fracture (7.5%). Conclusion: There is inter- and intra-observer variation in Schatzker classification of tibial plateau fracture. The intra-observer variation (kappa 0.71) was found to be greater than the inter-observer variation (kappa 0.41). The additional morphological characteristics of tibial plateau fractures are better evaluated on CT scan. The articular depression, splits, and fracture geometry are better delineated on a CT scan than on plain X-rays alone.

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