The nerve: A fragile balance between physiology and pathophysiology.

Regarding nerves as simple cables and electrical conduits is a gross error that does not allow us to understand the anomalies and disorders observed postoperatively. Instead, nerves should be seen as a living tissue of which physiological regulation is as complex as that of the blood-brain barrier. This review describes the basic structure and functions of this blood-nerve barrier and highlights the mechanisms of its breakdown and the resultant disorders.

Brachial Plexus Blockade Causes Subclinical Neuropathy: A Prospective Observational Study.

The objective of this study is to determine subclinical changes in hand sensation after brachial plexus blocks used for hand surgery procedures. We used Semmes-Weinstein monofilament testing to detect these changes. We hypothesized that patients undergoing brachial plexus nerve blocks would have postoperative subclinical neuropathy detected by monofilament testing when compared with controls.

Spinal Anesthesia Improves Early Pain Levels After Surgical Treatment of Tibial Plateau Fractures.

Objectives: To determine the effect of spinal anesthesia (SA) on short-term outcomes when compared with general anesthesia in operatively managed tibial plateau fractures.

Design: This is an institutional review board-approved retrospective review of prospectively collected data.

Setting: Two level-1 trauma centers.

Minimum local anesthetic volumes for a selective saphenous nerve block: a dose-finding study.

Background: Saphenous nerve block contributes to analgesia after knee and lower leg surgery. However, literature reports a wide range of volumes of local anesthetic being used for this block.

Methods: A non-randomized controlled trial in a single university hospital in March 2015.

Regional versus general anaesthesia for improved cognitive function after procedures other than cardiac surgery or neurosurgery in adult and paediatric patients.

This is the protocol for a review and there is no abstract. The objectives are as follows: The objective of this review is to compare the effects of regional versus general anaesthesia on cognitive function after procedures other than cardiac surgery or neurosurgery in adult and in paediatric patients.

Prilocaine spinal anesthesia for ambulatory surgery: A review of the available studies.

Transient neurologic symptoms (TNS) led to the abandonment of intrathecal lidocaine. We reviewed the published literature for information about the duration of action and side effects of intrathecal prilocaine, which has been recently reintroduced in Europe. Medline and EMBASE databases were searched for the time period from 1966 to 2015.

Plasma concentrations of ropivacaine following ultrasound-guided or nerve-stimulator-guided femoral nerve block: A prospective randomised study.

Objective: Our aim was to establish a plasma concentration curve for ropivacaine following femoral nerve blockade and to ascertain whether the resulting plasma concentrations differ significantly depending on whether neurostimulation (NS) or ultrasound (US) guidance was used.

Methods: Sixteen male and female subjects aged 18 to 80 who were scheduled to undergo unilateral total knee replacement or anterior cruciate ligament reconstruction under general or spinal anaesthesia, and for whom a femoral nerve block was indicated for postoperative analgesia, were enrolled in this prospective, randomised study. Patients were randomised to undergo either US or NS-guidance femoral nerve blocks.

Regional analgesia for improvement of long-term functional outcome after elective large joint replacement.

Background: Regional analgesia is more effective than conventional analgesia for controlling pain and may facilitate rehabilitation after large joint replacement in the short term. It remains unclear if regional anaesthesia improves functional outcomes after joint replacement beyond three months after surgery.

Objectives: To assess the effects of regional anaesthesia and analgesia on long-term functional outcomes 3, 6 and 12 months after elective major joint (knee, shoulder and hip) replacement surgery.

Efficacy and safety of ultrasound-guided distal blocks for analgesia without motor blockade after ambulatory hand surgery.

Purpose: To assess the suitability of ultrasound-guided (USG), single-injection distal block(s) for pain management after outpatient hand and wrist bone surgery.

Methods: We conducted a retrospective review of 125 of 198 consecutive ambulatory surgery patients who underwent hand and wrist bone surgery between June 2010 and January 2012. All patients received a USG axillary block using a short-acting local anesthetic (lidocaine) and secondary 1, 2, or 3 (median, radial, or ulnar) USG distal analgesic block(s) using a long-acting local anesthetic (ropivacaine).

Consensus of the Orthopedic Anesthesia, Pain, and Rehabilitation Society on the use of peripheral nerve blocks in patients receiving thromboprophylaxis.

Evidence supports the concept that patients undergoing major orthopedic surgery benefit from either thromboprophylaxis or peripheral nerve blocks, especially continuous techniques. A group of anesthesiologists with significant experience in orthopedic anesthesia and peripheral nerve blocks reviewed the literature related to thromboprophylaxis and peripheral nerve blocks and their combination in orthopedics. Major bleeding, including retroperitoneal hematoma, is an established complication of thromboprophylaxis.

Out-of-hospital traumatic cardiac arrest: an underrecognized source of organ donors.

Whereas the gap between organ supply and demand remains a worldwide concern, resuscitation of out-of-hospital traumatic cardiac arrest (TCA) remains controversial. The aim of this study is to evaluate, in a prehospital medical care system, the number of organs transplanted from victims of out-of-hospital TCA. This is a descriptive study.

The initial management of trauma patients is an especially relevant setting to evaluate professional practice patterns.

The initial management of trauma patients in a dedicated location is a crucial step in the treatment of these patients. The characteristics of this phase are such that they meet all the criteria for a professional practice patterns evaluation (PPPE or PPE): formalized protocols, clear-cut timeframes, specific roles of different stakeholders, and multidisciplinary medical and paramedical team. In addition, the expected result of the PPE approach, improved care, will have a direct impact on patient outcomes.

Update on prehospital emergency care of severe trauma patients.

The prognosis of severe trauma patients is determined by the ability of a healthcare system to provide high intensity therapeutic treatment on the field and to transport patients as quickly as possible to the structure best suited to their condition. Direct admission to a specialized center ("trauma center") reduces the mortality of the most severe trauma at 30 days and one year. Triage in a non-specialized hospital is a major risk of loss of chance and should be avoided whenever possible.

Balloon treatment of posterior shoulder dislocation with reverse Hill-Sachs injury: description of a new technique.

Purpose: Posterior shoulder dislocations are rare, and are usually the result of seizures. Anterior defects of the humeral head known as "reverse Hill-Sachs lesions" may increase the risk of recurrent dislocation and are difficult to treat. We developed a percutaneous technique for reduction of the dislocation or reduction of the anterior impaction fracture, using percutaneous balloon dilatation and cement fixation.

Balloon reduction and cement fixation in calcaneal articular fractures: a five-year experience.

Purpose: Balloon reduction and cement fixation of displaced articular fractures of the calcaneus have been described elsewhere but support for it lacks clinical evidence. We have been performing the technique since October 2006 and describe here our clinical experience including three to five-year follow up of our first ten cases with no patient lost to follow up.

Methods: From September 2006 to September 2009, ten patients were admitted with a calcaneus fracture, six were female and four male, one case was bilateral (11 fractures).

The use of 2-chloroprocaine for spinal anaesthesia.

Spinal anaesthesia is a safe and reliable anaesthetic modality for surgical procedures on the lower part of the body. However, because of the description of transient neurologic symptoms (TNS), most practitioners have abandoned intrathecal lidocaine. Chloroprocaine (2-chloroprocaine, CP) has been one candidate to replace lidocaine for short procedures, despite the fact that neurologic sequelae have been described following the intrathecal injection of large doses of preservative-containing CP intended for epidural use.

Refractory cardiac arrest in a rural area: mechanical chest compression during helicopter transport.

Background: Out-of-hospital refractory cardiac arrest patients can be transported to a hospital for extracorporeal life support (ECLS), which can be either therapeutic or performed for organ donation. Early initiation is of vital importance and the main limitation when considering ECLS. This explains that all reported series of cardiac arrest patients referred for ECLS were urban ones.

Objective assessment of the immediate postoperative analgesia using pupillary reflex measurement: a prospective and observational study.

Background: The evaluation of pain intensity during the immediate postoperative period is a key factor for pain management. However, this evaluation may be difficult in some circumstances. The pupillary dilatation reflex (PDR) has been successfully used to assess the analgesic component of a balanced anesthetic regimen.

Balloon reduction and cement fixation in intra-articular calcaneal fractures: a percutaneous approach to intra-articular calcaneal fractures.

Purpose: The management of calcaneal fractures remains challenging and often controversial. Open reduction and internal fixation with a lateral plate has been established as a standard therapy for displaced articular fractures. However, accurate subtalar joint reduction, while mandatory, is difficult to achieve, requires an extensive lateral approach, and clinical results may not be up to the difficulty of the task.