No abstract

(Part I): The first part of the study established the feasibility of electrical identification of the saphenous nerve and demonstrated that the NS technique could be utilized to provide superior anaesthesia of the saphenous nerve when compared with a previously validated LOR technique. (Part II): The clinical utility of the NS technique of saphenous nerve block was successfully demonstrated.

Accepted for publication 25 February, 1995. There are few reports describing the epidural blood patch as a treatment for postdural puncture headache and subarachnoid-cutaneous fistula in children. 1,2 This clinical report describes an alternative blood patch technique with an epidural catheter introduced into the epidural space using the caudal approach in a paediata'ic patient. Case reportA four-year-old boy with acute lymphocytic leukaemia (ALL) presented with a persistent subarachnoidcutaneous fistula and a large collection of subcutaneous cerebrospinal fluid (CSF) following lumbar puncture for chemotherapy.He had undergone weekly lumbar punctures for intrathecal injection of methotrexate. These were performed by the paediatric oncologist with a #22-gauge Quincke spinal needle at the L3_ 4 interspace. Unfortunately, during the last intrathecal injection the child moved when the spinal needle was positioned in the intrathecal space and, subsequently, a subarachnoid-cutaneous fistula deveb oped.The patient did not seem to be distressed from the continuous leak of CSE The parents had noticed increasing oedema over the lower back and continuous saturation of the dressings over the puncture site. Physical examination of the child revealed a somewhat lethargic, balding and pale four-year-old with normal vital signs. The neurological examination was normal with no demonstrable meningeal signs. The subcutaneous tissue over the thoraco-lumbo-sacral spine was markedly oedematous. A continuous leak of clear fluid, presumed to be CSF, from the previous lumbar puncture site was apparent. The remainder of the examination was unremarkable. Laboratory examinations revealed mild anaemia, neutropaenia, normal platelet count and slightly increased PTI" (Hgb 108 g. L-~; WBC 4.5; platelets 138,000; INR 0.8; PTT control 30 see, patient 35 see).Various options are available for the treatment of subarachnoid-cutaneous fistula, 3-n3 including conservative management, surgical repair and epidural blood CAN J ANAESTH 1995 / 42: 7 / pp 625-7