Ultrasound guided repositioning of a new suture-method catheter for adductor canal block - a randomized pilot study in healthy volunteers.

BACKGROUND: We performed a randomized, blinded pilot study in 12 volunteers to assess the feasibility to reposition an intentionally displaced suture-method catheter for two different insertion techniques for adductor canal block. METHODS: Each volunteer had an ultrasound-guided suture-method catheter placed in the adductor canal (AC) in both legs. The catheters were placed using a perpendicular technique in one leg and a parallel technique in the other leg, according to randomization. 15 mL lidocaine 1% (LA) was injected in each catheter. Successful primary placement was defined as combined LA spread within the AC and loss of cold sensation 15 min after injection. All catheters were intentionally displaced, and subsequently repositioned using ultrasound. Another dose of lidocaine (15 mL 1%) was injected through the catheters and assessed for successful repositioning. RESULTS: Successful primary placement was achieved in 83% (95% CI 55-95%) of catheters placed perpendicular to the AC, and in 75% (95% CI 47-91%) of catheters placed parallel to the AC. Of those with successful primary placement, 100% (95% CI 72-100%) of catheters placed perpendicular to the AC, and 67% (95% CI 35-88%)) placed parallel to the AC could be repositioned. CONCLUSIONS: Placement and secondary repositioning after displacement of a suture-method catheter within the adductor canal is achievable. A perpendicular technique seems more reliable. TRIAL REGISTRATION: NCT03315481 clinicaltrials.gov . The study was submitted on March 1, 2017. Due to clerical error, the study was posted on October 20, 2017.

Reversal of a Suspected Paradoxical Reaction to Zopiclone with Flumazenil.

We describe the care for an elderly woman who was admitted to the intensive care unit (ICU) to receive noninvasive ventilation for acute exacerbation of chronic obstructive pulmonary disease. After administration of the sleeping pill zopiclone, a nonbenzodiazepine receptor agonist (NBRA), the patient became agitated and was confused, a possible paradoxical reaction to benzodiazepines. These symptoms were immediately resolved after treatment with flumazenil, usually used to reverse the adverse effects of benzodiazepines or NBRAs and to reverse paradoxical reactions to benzodiazepines. This case indicates that zopiclone induced behavioral changes resembling a paradoxical reaction to benzodiazepines and these symptoms may be treated with flumazenil.