Electric Nerve Stimulation Does Not Correctly Predict Needle-Nerve Distance and Potential Local Anesthetic Spread for Interscalene Brachial Plexus Blockade.

This study evaluated electric nerve stimulation as a nerve location tool. After eliciting motor response in 43 patients undergoing shoulder surgery, the needle tip's position, distance from the closest nerve, and spread of saline were evaluated using ultrasound imaging. The needle's tip resided 1 to 4 mm from the closest nerve in 21, in direct contact with it in 7, and 6 to 18 mm away in 15 patients. In 21 patients, subsequent saline dissection did not reach the brachial plexus. Thus, the success rate of electric nerve stimulation for correct needle-nerve distance identification was 48.8%, with correct fluid spread reached in only 51.2% of patients.

The influence of lifestyle (smoking and body mass index) on wound healing and long-term recurrence rate in 534 primary pilonidal sinus patients.

PURPOSE: With pilonidal sinus disease (PSD) incidence increasing, lifestyle issues have been suspected to be responsible to worsen the results of PSD surgery at the same time. The influence of smoking and body mass index (BMI) on long-term recurrence rate in primary PSD surgery has not been investigated yet. METHODS: A total of 534 patients (German military cohort) were analyzed, comparing the wound healing rates of non-smoker with smoker, as well as recurrence rates in either groups. Simultaneously, the impact of BMI on wound healing and recurrence was studied. Recurrence rate was determined by Kaplan-Meier calculation following up to 20 years after primary PSD surgery. RESULTS: Using primary open surgery, smokers' and non-smokers' recurrence rates did not differ statistically (p = 0.83; log rank). Comparable rates occurred following the primary midline closure technique (p = 0.14; log rank). A BMI of 25 and higher was not associated with adverse wound healing neither in the primary midline closure (p = 0.14) nor in the primary open treatment group (p = 0.3); nevertheless, a trend may be seen that a BMI of 25 and above could assist a favorable wound healing rate. CONCLUSIONS: The lifestyle parameter smoking and body weight statistically do not complicate wound healing or long-term recurrence rates for the first 20 years following primary PSD surgery in this study. As the BMI of 25 and above may have a beneficial influence on wound healing in primary open and primary midline closure, this observation has to be investigated for the today's surgical procedures of elective first choice-asymmetrical and flap procedures.

Impact of spinal versus general anesthesia on postoperative pain and long term recurrence after surgery for pilonidal disease.

STUDY OBJECTIVE: To assess the effect of the kind of anesthesia on postoperative pain and long term recurrence rate in pilonidal sinus disease. DESIGN: Retrospective study. SETTING: Surgical departments of German Armed Forces Hospitals in Hamburg, Bad Zwischenahn and Hamm. PATIENTS: 583 pilonidal sinus disease (PSD) surgery patients operated for pilonidal disease. INTERVENTION: Interview of randomly selected patients, who had been followed up to 20years after PSD surgery. MEASUREMENTS: Analysis of long term recurrence-free survival and postoperative pain scores among patients who received different anesthesia modalities. MAIN RESULTS: Recurrence occurred in 21.97% of patients who received general anesthesia with intubation (ITN), in 23.32% of spinal anesthesia (SPA), and in 31.91% of local- or cryoanesthesia. Our data indicate that there was no significant difference in recurrence-free time between the types of anesthesia in any of the surgical procedures applied. Pain scores of patients who underwent primary midline closure (4.74±2.63, 95% CI [4.36, 5.12]) were significantly lower than pain scores of patients who underwent marsupialization (6.12±2.71, 95% CI [5.17, 7.07]) or primary open treatment (6.09±2.79, 95% CI [5.79, 6.39]) (P<.0001). Post-operative pain scores did not differ between patients who received ITN or SPA. Cryo- or local anesthesia resulted in significantly lower post-operative pain scores compared to ITN (P=.0089) or SPA (P=.0031). CONCLUSION: The use of SPA or general anesthesia did not affect the long term recurrence rate in PSD. Postoperative pain experienced either in-hospital or after discharge did not differ between patients receiving ITN or SPA. With other cryo- or local anesthesia, postoperative pain score was significantly reduced in any surgical procedure. However, due to the higher recurrence rate after cryo- or local anesthesia, only SPA and general anesthesia should be applied. The decision whether spinal or general anesthesia is applied in PSD surgery remains a purely anesthesiological decision based on standard considerations.