Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine.

Study Design. Retrospective review of a prospectively collected multicenter database. Objective. To assess how “overcorrection” of the main thoracic curve without control of the proximal curve increases the risk for shoulder imbalance in Lenke type 1 Adolescent Idiopathic Scoliosis (AIS). Summary of Background Data. Postop shoulder imbalance is a common complication following AIS surgery. It is thought that a more cephalad upper-instrumented vertebra (UIV) decreases the risk of shoulder imbalance in Lenke type 1 and 2 curves; however, this has not been proven. Methods. Thirteen surgeons reviewed preop and 5-year postop clinical photos and PA radiographs of patients from a large multicenter database with Lenke type 1 and 2 AIS curves who were corrected with pedicle screw/rod constructs. Predictors of postop shoulder imbalance were identified by univariate analysis; multivariate analysis was done using the classification and regression tree method to identify independent drivers of shoulder imbalance. Results. One hundred forty-five patients were reviewed. The UIV was T3-T5 in 87% of patients, with 8.9% instrumented up to T1 or T2. Fifty-two (36%) had shoulder imbalance at 5 years. On classification and regression tree analysis when the proximal thoracic (PT) Cobb angle was corrected more than 52%, 80% of the patients had balanced shoulders. Similarly, when the PT curve was corrected less than 52% and the main thoracic (MT) curve was corrected less than 54%, 87% were balanced. However, when the PT curve was corrected less than 52%, and the MT curve was corrected more than 54%, only 41% of patients had balanced shoulders (P = 0.05). This relationship was maintained regardless of the UIV level. Conclusion. In Lenke type 1 and 2 AIS curves, significant correction of the main thoracic curve (>54%) with simultaneous “under-correction” (<52%) of the upper thoracic curve resulted in shoulder height imbalance in 59% of patients, regardless of the UIV. This suggests the PT curve must be carefully scrutinized in order to optimize shoulder balance, especially when larger correction of the MT curve is performed. Level of Evidence: 2

Background: A brachial plexus block (BPB) provides anesthesia and analgesia with limited duration. Various opioids have been used as adjuvants of local anesthetics to improve the effects. Objective: The objective of this study was to evaluate the safety and effectiveness of nalbuphine used as an adjuvant to local anesthetic during the supraclavicular BPB. Materials and Methods: In this prospective, double-blinded, randomized controlled study, 90 American Society of Anesthesiology (ASA) Physical Status I and II patients (aged 20 to 65 y) of either sex undergoing upper limb orthopedic surgeries under ultrasound-guided supraclavicular BPB were randomly allocated into 3 groups: group C (n=30), group NL (n=30), and group NH (n=30) for analyses. Each patient received 18 mL of 100 mg ropivacaine solution combined with 2 mL of normal saline, 2 mL of 10 mg nalbuphine, or 2 mL of 20 mg nalbuphine. The time of onset and block duration of sensory block (SB) and motor block (MB), duration of analgesia, hemodynamic variables, and any adverse effects were assessed. Results: Compared with group C, the onset time of both SB and MB were significantly shortened. The SB and MB duration were significantly prolonged in group NL and group NH. There was no significant difference between the duration of analgesia in group NL and NH although the analgesia duration of both groups was longer than group C. But the incidence of side effects in group NH such as vomiting was significantly higher than group NL. Conclusions: Nalbuphine is an effective adjuvant to 0.5% ropivacaine in ultrasound-guided supraclavicular BPB. The dosage of 10 mg improves the quality of the anesthesia with less incidence of side effects.