Case report: unusual complication during outpatient continuous regional popliteal analgesia.

PURPOSE: Continuous regional anesthesia applied as pain therapy at home is clinically established standard practice after upper and lower limb surgery. Persistent motor block at discharge or after continuous infusion of local anesthetics, however, might lead to complications related to the insensate extremity. We report a rare case of a foot fracture due to stumbling after continuous sciatic nerve block at home and discuss the related clinical implications. CLINICAL FEATURES: After uncomplicated ambulatory foot surgery under regional anesthesia, a patient was discharged with a continuous sciatic popliteal nerve block for pain therapy at home. After stumbling, the patient remained symptom-free even until catheter removal three days after surgery. Radiography done one week after surgery revealed a styloid fracture of the fifth metatarsal bone. Her subsequent recovery was uneventful. CONCLUSIONS: The true incidence of complications related to falls at home associated with lower extremity blockade remains unknown, as symptoms of possible complications may be masked by the effects of the local anesthetic. However, with increasing use of postoperative regional anesthesia, it is mandatory to develop and adhere to clinical care maps, and to elaborate and teach strategies to further enhance patient safety.

Patients' point of view on informed consent: a prospective study in carpal tunnel surgery.

Patients' perception of consent form (CF) is not well known and many patients tend to view the CF as an administrative act. As part of a prospective study, a questionnaire was sent to 188 consecutive patients within 1 month after carpal tunnel release. Questions focused on patients' recall about risks, benefits, alternative options, preferences about decisions process and global satisfaction with CF. Patient's understanding of the legal consequences of the CF was analysed. Risk's recall rate was 59%. CF reduced preoperative anxiety in 65% and the influence in patients' decision was relevant in 55% of cases. Patients have limited understanding of the legal consequences of the consensus and 29% of patients believed that primary function was to protect hospital. Ten percent believed that CF expunges patients' right to compensation in case of claims. Patient involvement in medical decision-making is a key aspect of patient centred care. A substantial uncertainty exists about legal implication of CF, leading to potential discord.

A reliable and simple solution for recalcitrant carpal tunnel syndrome: the hypothenar fat pad flap.

The incidence of failure in open carpal canal tunnel decompression is underestimated. Recurrence is often the result of scarring of the median nerve. Conservative treatment or careful neurolysis is usually insufficient. The hypothenar fat pad flap interposes adipose tissue from the hypothenar eminence and could offer a solution for patients with recalcitrant carpal tunnel syndrome. We reviewed the results of using this procedure in 20 patients with recalcitrant carpal tunnel syndrome and analyzed subjective and objective results, complications, and pitfalls. For 18 patients, pain disappeared completely. Two-point discrimination improved from an expanded range to normal in 16 of the 20 patients. Quick DASH (Disabilities of the Arm, Shoulder, and Hand) scores improved significantly. The hypothenar fat pad flap, a technically simple procedure, prevents median nerve readherence, produces excellent results, and should be included among the tools any surgeon uses for carpal tunnel surgery.