Femoral nerve blocks rarely block the obturator nerve. Single-injection femoral nerve block improved multimodal analgesia after spinal anesthesia for TKA, but this effect did not persist beyond the day of surgery. Obturator nerve block alone was of no benefit.

We describe a patient in whom an aneurysm of the transverse thoracic aorta extended inferiorly into the aortopulmonary window with compression of the left mainstem bronchus and left pulmonary artery. Plain film findings revealed aneurysmal dilatation of the thoracic aorta, progressive atelectasis of the left lung, and a mass in the aortopulmonary window.CT and MA imaging showed that the obstructing lesion was a saccular aortic aneurysm with mural thrombus. Case ReportA 71-year-old man with longstanding systemic hypertension had a gradual onset of persistent cough and hoarseness over several months. He had no previous history of syphilis or thoracic trauma. CT of the chest, done to evaluate the thoracic aorta and exclude a mediastinal neoplasm, showed a 5-cm mass adjacent to the inferior aspect of the transverse thoracic aorta. The mass had peripheral calcification and its superior portion enhanced to the same degree as the aorta (Fig. 1C). Inferiorly, the mass was less dense than aorta (Fig. 1D) (Fig. 1F)

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Background With the current trend to reduce postoperative opioid use to enhance recovery and address perioperative opioid addiction concerns, the challenge of managing pain after total knee arthroplasty has increased. This study examined the effect of adding a preoperative medication regime to a multimodal postoperative analgesia protocol that included regional anaesthesia. Materials and methods Sixty patients undergoing elective first-time unilateral knee arthroplasty received celecoxib 100mg, gabapentin 600mg and dexamethasone 10mg po one hour before skin incision. They were compared to a sequential retrospective cohort of 49 patients. All patients routinely received acetaminophen 650mg po q6h, ibuprofen 400mg po q8h, patient-controlled opioid analgesia and continuous adductor canal blocks postoperatively. Pain scores and opioid consumption were recorded at 4, 8, 12, 24 and 48h. Results Pain scores and cumulative opioid use were statistically and clinically significantly reduced at all time points up to 48h. Conclusions Combining preoperative oral celecoxib, gabapentin and dexamethasone had a clinically significantly effect in reducing pain scores and opioid use for at least 48h. Most of this effect is probably due to dexamethasone.