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The factors responsible for the spreading pattern of a single paravertebral injection are still uncertain. In this study, 28 patients were randomly assigned to receive a paravertebral injection of radio-opaque dye (10 ml, with or without co-administration of 20 ml of local anaesthetics) either dorsal or ventral to the endothoracic fascia. The point of injection was determined by use of a nerve-stimulator and the radiographic distribution pattern was assessed blindly by a radiologist. Injections made in the more ventral part of the thoracic paravertebral space, supposedly anterior to the endothoracic fascia, resulted in a multisegmental longitudinal spreading pattern, whereas injections made dorsal to the endothoracic fascia resulted in a less predictable cloud-like spreading pattern, with only limited distribution over adjacent segments. The use of a nerve stimulator-guided technique appears to enhance the likelihood of achieving the more desirable longitudinal spreading pattern. [ABSTRACT FROM AUTHOR]

Summary Sixty patients scheduled for pilonidal sinus surgery were prospectively randomly assigned to receive general anaesthesia or sacrococcygeal local anaesthesia with a newly-described technique. Patients in the general anaesthesia group spent more time in the operating theatre and recovery room than did those in the local anaesthesia group (p < 0.05). Two thirds (67%) of the patients in the local anaesthesia group left hospital on the day of surgery compared to only 17% of patients in the general anaesthesia group (p < 0.05). Visual analogue scale pain scores performed during the 3-day follow-up period favoured the local anaesthetic technique (p < 0.05). Postoperative analgesia requirements were greater in the general anaesthesia group than in the local anaesthesia group (p < 0.05). The majority of patients and surgeons expressed satisfaction with local anaesthesia. Sacrococcygeal local anaesthesia appears to be a successful alternative to general anaesthesia for pilonidal sinus surgery. [ABSTRACT FROM AUTHOR]

Summary: Objective:: Tonsillectomy is frequently associated with post-operative pain of considerable duration. The aim of the current study is to corroborate our previous observational data by conducting a prospective double-blind placebo-controlled randomized clinical trial to determine the potential effect of pre-incision infiltration of local anesthesia on post-operative pain after tonsillectomy. Design:: Randomized double-blind controlled clinical trial. Setting:: Tertiary care facility in Beirut, Lebanon. Patients:: Ninety patients who underwent tonsillectomy allocated evenly in three groups. Interventions:: Pre-incision infiltration of 1.5 local anesthetic mixture in each tonsil was performed in conjunction with general anesthesia (infiltration, n =30). Pre-incision infiltration of 1.5ml of 0.9% of normal saline was applied with general anesthesia (placebo, n =30). GA received only general anesthesia. Outcome measures:: Post-operative pain at rest, eating soft diet, jaw opening at 0, 6, 12, and once daily for the 10-day follow-up period, hemodynamic stability, hospital stay, parent and surgeon satisfaction, ear pain and analgesics consumption were assessed. Results:: Hemodynamic stability was maitained during pre, per and post-operation. 93.1% of infiltration group left the hopital the same day compared to 60% in placebo groups and 41.4% in general anesthesia group (p =0.001). Surgeon''s satisfaction was significantly higher in infiltration group compared to placebo and general anesthesia groups (p =0.001). Parent''s satisfaction was significantly higher in infiltration group (89.65%) compared to general anesthesia group (13.8%) and placebo group (36.7%) (p =0.001). The average pain scores at rest, on jaw opening and when eating soft diet were significantly lower in infiltration group compared to placebo group and general anesthesia group (p &#60;0.05). Analgesic consumption in placebo and general anesthesia groups were significantly higher compared to infiltration group (p &#60;0.05). Conclusion:: This modified pre-incision infiltration of anesthetic mixture combined with general anesthesia reduces significantly post-tonsillectomy pain in children and provides a more rapid return to normal activity compared to general anethesia alone or in combination with a placebo infiltration. [Copyright &y& Elsevier]

Summary: Objective:: To introduce a modified infiltration technique of anesthetic mixture in order to reduce post-tonsillectomy pain based on histo-anatomic observations and tonsil''s innervation detection. Design:: Histo-anatomic, expanded case report. Setting:: Tertiary care facility in Beirut, Lebanon. Patients:: One hundred and seven patients who underwent tonsillectomy allocated in three groups. Interventions:: Histo-anatomic observations were studied in 62 patients (group I). Nerve-stimulator detection was performed in group II (20 children). An expanded case report of 25 children (group III) was conducted using a modified infiltration technique based on the findings of the histo-anatomic observations and nerve detection. Outcome measures:: Post-operative pain at 0, 6, 12h and once daily for the 10-day follow-up period, hemodynamic stability, hospital stay, patient satisfaction and analgesics consumption were assessed. Results:: The nerve-stimulator confirmed the histo-anatomic findings by strong contractions of the superior constrictor muscle, soft palate and uvula when the needle is mainly in the middle part of the peritonsillar area where the glossopharyngeal nerve branches predominate. No visual analogue scale median exceeded 1 for any child at any predetermined time interval, only three children (12%) required opoiods during the follow-up period. All children (100%) were discharged the same day, only 4% of parents were unsatisfied. Hemodynamic stability was maintained during pre- and post-operation. Conclusion:: This modified technique with minimal volume of anesthetic mixture seems to reduce post-operative pain in tonsillectomy patients; a randomized double-blinded prospective study was designed based on the findings in this initial series of children. [Copyright &y& Elsevier]