Results of a randomized, double-blind pilot study indicate that transcranial electrotherapy stimulation may be an effective treatment for the temporary reduction of pain in osteoarthritis patients. Presently, the predominant method for pain management is medication. One very different approach is the application of micro- to milliamp current applied to specific areas of the head, resulting in a release of endogenous opioids from pain management regions of the brain. For the pilot study, 64 subjects suffering from osteoarthritis of the knee and/or hip were enrolled. For two weeks prior, then during and after treatment, subject pain was self-assessed using the visual scale (VS). In addition, subjects were globally assessed by a physician. All subjects, device operators and physicians were blinded as to whether subjects were treated with an active or sham device. Data collected from the study indicate both a decrease in VS pain scores and a significant improvement (p = 0.05) in physician assessment in subjects treated with active devices compared to those treated with the sham device.

Aim: to evaluate the effects of intravenous dexamethasone on postoperative analgesia in patients after arthroscopic knee joint surgery in conditions of peripheral regional blockade. Material and methods: 60 patients were included in the study, divided into 2 groups. In the first group, patients underwent peripheral regional blockade of the femoral and sciatic nerves with a 0.5% solution of levobupivacaine. In the second, the traditional peripheral regional blockade was supplemented by intravenous administration of 8 mg (0.4% - 2 ml) of dexamethasone immediately after catarrhization of the peripheral vein. Results: The duration of the sensory blockade in the group using dexamethasone was 25% greater than in the first group. In the postoperative period, patients who were intraoperatively injected with dexamethasone required 33% less additional anesthesia. The duration of motor blockade in the group with dexamethasone was 26.5% higher than in the patients of the first group. Conclusion: intravenous dexamethasone injection with levobupivacaine peripheral regional anesthesia with arthroscopic knee joint surgery, increases the duration of the sensory block and the duration of postoperative analgesia. The use of dexamethasone led to a decrease in the need for additional anesthesia in the early postoperative period.

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This study describes two clinical cases of unexpectedly long duration of motor block after anterior sciatic nerve block. In two patients who underwent total knee replacement, the motor block reversion in the area of sciatic nerve innervation did not occur at the expected time. Ultrasound examination revealed the deposition of a local anesthetic near the sciatic nerve. In these two clinical cases, unintentionally prolonged sciatic nerve blockade was caused by combined age-related factors of reduced tissue perfusion and the vasoconstrictor properties of levobupivacaine. Subsequently, the block was successfully resolved in 3638 h without any neurological consequences.

BACKGROUND: The proximal subclavian brachial plexus block is performed deep and posterior to the midpoint of the clavicle. Only a few studies evaluated the spread of local anesthetic when using a proximal subclavian approach to the brachial plexus. We performed a cadaveric study to evaluate the spread of the injection after performing proximal subclavian brachial plexus block using ultrasound navigation. AIM: To examine the spread of the stained solution in unfixed corpses, when it is administered using a modified technique of proximal subclavian access to the brachial plexus using ultrasound navigation. MATERIALS AND METHODS: Six ultrasound-guided injections were performed on three unfixed cadavers using 20 ml of a colored solution. The brachial plexus and its branches were distinguished from the level of the midpoint of the clavicle to the upper third of the shoulder. The boundaries of ink distribution in relation to the bundles and terminal branches of the brachial plexus from the intersection of the upper edge of the clavicle to the upper parts of the axillary region were assessed. RESULTS: In all cases of dye spread, the lateral, posterior, and medial bundles of the brachial plexus were stained. Terminal branch staining varied and was limited to the proximal portions of these nerves. The dye spread to the interstellar space in 2 (33%) out of 6 (100%) injections and to the level of the upper edge of the clavicle in 4 (67%) injections. The axillary and radial nerves were stained in all injections, and the ulnar nerve was stained in 4 (67%) of 6 (100%) injections. The musculocutaneous and median nerves were stained in only 2 (33%) of 6 (100%) injections. No phrenic nerve staining was observed in any case. CONCLUSIONS: On the basis of experiment results on unfixed cadavers, injection using a modified ultrasound-guided proximal subclavian approach can fill the fascial sheath surrounding the brachial plexus with the injection material, thus causing the dye to spread around all bundles of the brachial plexus to supraclavicular space. Additional research is needed to assess whether high injection volumes or multiple injection sites can affect distribution.