Infraclavicular versus axillary nerve catheters: A retrospective comparison of early catheter failure rate.

STUDY OBJECTIVES: Continuous brachial plexus catheters are often used to decrease pain following elbow surgery. This investigation aimed to assess the rate of early failure of infraclavicular (IC) and axillary (AX) nerve catheters following elbow surgery. DESIGN: Retrospective study. SETTING: Postoperative recovery unit and inpatient hospital floor. PATIENTS: 328 patients who received IC or AX nerve catheters and underwent elbow surgery were identified by retrospective query of our institution's database. MEASUREMENTS: Data collected included unplanned catheter dislodgement, catheter replacement rate, postoperative pain scores, and opioid administration on postoperative day 1. Catheter failure was defined as unplanned dislodging within 24 h of placement or requirement for catheter replacement and evaluated using a covariate adjusted model. MAIN RESULTS: 119 IC catheters and 209 AX catheters were evaluated. There were 8 (6.7%) failed IC catheters versus 13 (6.2%) failed AX catheters. After adjusting for age, BMI, and gender there was no difference in catheter failure rate between IC and AX nerve catheters (p = 0.449). CONCLUSIONS: These results suggest that IC and AX nerve catheters do not differ in the rate of early catheter failure, despite differences in anatomic location and catheter placement techniques. Both techniques provided effective postoperative analgesia with median pain scores < 3/10 for patients following elbow surgery. Reasons other than rate of early catheter failure should dictate which approach is performed.

Multilevel lumbar spine infection due to poor dentition in an immunocompetent adult: a case report.

BACKGROUND: Although spinal infections have been reported following dental procedures, development of a spinal infection attributed to poor dentition without a history of a dental procedure in an immunocompetent adult has not been previously reported. Here we provide a case report of a multilevel lumbar spine infection that developed in an immunocompetent adult with poor dentition. CASE PRESENTATION: A 63-year-old white male man with past medical history of hypertension presented to a hospital emergency department with a 4-month history of progressively worsening low back pain. A musculoskeletal examination demonstrated diffuse tenderness in his lumbar spine area and the results of a neurological examination were within normal limits. Computed tomography and magnetic resonance imaging of his lumbar spine demonstrated a prevertebral and presacral fluid collection ventral to the L4 to L5 and L5 to S1 interspaces. Blood cultures grew pan-sensitive Streptococcus intermedius in four of four bottles within 45 hours. Using computed tomography guidance, three core biopsies of the L4 to L5 interspace were taken and subsequent cultures were positive for Streptococcus intermedius. He reported that his last episode of dental care occurred more than 20 years ago and a dental panoramic radiograph demonstrated significant necrotic dentition. Ten teeth were extracted and the necrotic dentition was assumed to be the most likely source of infection. On hospital dismissal, he received a 12-week course of intravenously administered ceftriaxone followed by an 8-week course of orally administered cefadroxil pending repeat imaging. CONCLUSIONS: This case report demonstrates the importance of determining the source of infection in a patient with a spontaneous spinal infection. Even in the absence of a recent dental procedure, dentition should be considered a possible source of infection in an immunocompetent patient who presents with a spontaneous spinal infection.