These results indicate that the incidence of serious complications after peripheral nerve blockade is uncommon and that the origin of neurologic symptoms/signs in the postoperative period is most likely to be unrelated to nerve blockade.

Peripheral nerve blockade (PNB) is gaining popularity as an analgesic technique across a range of surgical specialties. Peripheral nerve blockade provides superior levels of analgesia in the immediate postoperative period when compared with traditional opioid techniques and is associated with high levels of patient satisfaction 1-4. Continuous peripheral nerve blockade (CPNB) is an extension of the single-shot technique, requiring the placement of a perineural catheter and subsequent infusion of dilute local anaesthetic solution. A number of centres are reporting favourably on applications of CPNB in hospital practice 5-8 and other authors have adapted the technology to provide long-acting analgesia at home, following complex orthopaedic procedures 9,10. Improvements in disposable infusion equipment are likely to fuel the further expansion of ambulatory CPNB. Peripheral nerve and plexus blockade, while effective in selected patient groups, is not without its own unique set of complications. Acute events are generally well reported. Those associated with upper extremity blocks include systemic toxicity, cardiac arrest, pneumothorax and respiratory distress 11-16. Those associated with lower extremity techniques include cardiovascular collapse, convulsions, haematoma and inadvertent subarachnoid or epidural spread 17-20. Less commonly reported but equally concerning are the long-term neurological complications of PNB. Paralysis and nerve palsy associated with attempted nerve blockade have been the subject of recent case reports 21,22. All such reports are concerning in an environment of expanding usage. The true incidence of complications remains unclear Ho 23 the introduction of new techniques and retard the accumulation of the very data that might enable more accurate risk estimation. The aim of this study was to adverse events occurring after surgery associated with either single-injection PNB or CPNB techniques.

SUMMARYThis paper addresses global economic factors infl uencing the decisions leading to the development of super-tall towers, including population growth and urbanization, economic cycles and the 'Skyscraper Index', regulation and 'regulatory tax', and resource availability. The project economics of individual developments are then explored with respect to construction costs. The development, design and construction challenges that impact on cost are also discussed. Furthermore, a breakdown of costs is given in the form of an indicative cost model (for a central London landmark tower) from cost data collected by Davis Langdon in the course of their work as construction consultants.

This study determined the overall incidence of postoperative nausea and vomiting (PONV) in 38 patients undergoing laparoscopic gynaecological procedures who received a standardized propofol/isoflurane anaesthetic but no preoperative antiemetic. A further 166 patients similarly anaesthetized were then randomly allocated to receive either metoclopramide 10 mg, ondansetron 4 mg, or cyclizine 50 mg as an intravenous antiemetic immediately preinduction. Overall incidence of PONV was determined for all groups and the relative efficacy of the three antiemetic agents assessed. Fifty per cent of patients in the initial group (no antiemetic) reported significant nausea and/or vomiting up to 24 hours postoperatively. The incidence of PONV in the metoclopramide group was 24%, in the ondansetron group 20%, and in the cyclizine group 51%. There was no detectable difference in relative efficacy between ondansetron 4 mg and metoclopramide 10 mg. The incidence of PONV in the group who received cyclizine was similar to that found in the pilot group who received no PONV prophylaxis. Both metoclopramide and ondansetron may potentially decrease the incidence of PONV following gynaecologic laparoscopy by up to 50% when administered intravenously prior to a propofol/isoflurane anaesthetic.

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