Adding corticosteroids to the pudendal nerve block for pudendal neuralgia: a randomised, double-blind, controlled trial.

OBJECTIVE: To compare the effect of corticosteroids combined with local anaesthetic versus local anaesthetic alone during infiltrations of the pudendal nerve for pudendal nerve entrapment. DESIGN: Randomised, double-blind, controlled trial. SETTING: Multicentre study. POPULATION: 201 patients were included in the study, with a subgroup of 122 women. METHODS: CT-guided pudendal nerve infiltrations were performed in the sacrospinous ligament and Alcock's canal. There were three study arms: patients in Arm A (n = 68) had local anaesthetic alone, those in Arm B (n = 66) had local anaesthetic plus corticosteroid and those in Arm C (n = 67) local anaesthetic plus corticosteroid with a large volume of normal saline. MAIN OUTCOME MEASURES: The primary end-point was the pain intensity score at 3 months. Patients were regarded as responders (at least a 30-point improvement on a 100-point visual analogue scale of mean maximum pain over a 2-week period) or nonresponders. RESULTS: Three months' postinfiltration, 11.8% of patients in the local anaesthetic only arm (Arm A) were responders versus 14.3% in the local anaesthetic plus corticosteroid arms (Arms B and C). This difference was not statistically significant (P = 0.62). No statistically significant difference was observed in the female subgroup between Arm A and Arms B and C (P = 0.09). No significant difference was detected for the various pain assessment procedures, functional criteria or quality-of-life criteria. CONCLUSIONS: Corticosteroids provide no additional therapeutic benefits compared with local anaesthetic and should therefore no longer be used. TWEETABLE ABSTRACT: Steroid infiltrations do not improve the results of local anaesthetic infiltrations in pudendal neuralgia.

[Prophylactic antibiotic therapy using oxacillin (Bristopen) in pediatric orthopedic surgery]. / Antibiothérapie prophylactique par oxacilline (Bristopen) en chirurgie orthopédique infantile.

The aim of this study was to evaluate the efficiency of oxacillin in the prophylaxis of bone infections in orthopaedic surgery in children. Staphylococcus is the usual pathogen in orthopaedics. This is the reason of our choice: oxacillin. 420 patients are included: 195 control patients did not receive any prophylactic antibiotherapy; 225 patients received oxacillin. The oxacillin treatment started at anaesthetic induction and was carried on for 72 hours. In the control group, 7 superficial and 4 deep infections were observed, while a single superficial infection was noted in the oxacillin-treated group. This easy and inexpensive prophylactic treatment gave excellent results. We think that it should be systematically administered in orthopedic surgery to ensure as little complication as possible to the child.