Triceps injury in non-bowling arm in cricket: an unusual mechanism.

Cricket is a non-contact sport that is popular worldwide and consists of repetitive throwing, bowling and fielding. Fast bowlers are prone to injury to the bowling arm due to repetitive stress, but this case study focuses on the damage caused to the bowler's non-bowling arm. This individual was a right-handed fast bowler who developed pain and dysfunction in his left arm after competing in more than 20 cricket tournaments. Following the stipulated bowling spell, he had severe pain in the posterior aspect of his left arm. On the field, he was managed with ice compression. Ecchymosis was seen on the distal part of his posteromedial arm. Diagnostic ultrasound revealed an acute triceps injury. The pain lasted 2 weeks and was gradually relieved with analgesics and anti-inflammatory medications. This observation led to the recommendation that elbow flexion of the non-bowling arm be checked for and avoided.

Efficacy of paravertebral block in "Fast-tracking" pediatric cardiac surgery - Experiences from a tertiary care center.

Introduction: Fast tracking plays a crucial role in reducing perioperative morbidity and financial burden by facilitating early extubation and discharge from hospital. Paravertebral block (PVB) is becoming more popular in paediatric surgeries as an alternative to epidural and caudal analgesia. There is scarcity of data regarding the efficacy and safety of PVB in paediatric cardiac surgery. Methods: We performed a review of records of paediatric cardiac patients who underwent cardiac surgery under general anaesthesia with single shot PVB and compared the analgesia and postoperative outcomes with matched historical controls who underwent cardiac surgery with same anaesthesia protocol without PVB. Results: The data from 200 children were analysed. 100 children who received paravertebral block were compared with a matched historical controls. The median time to extubation was shorter in the PVB group (0 hr, IQR 0-3 hrs) compared to the control group (16 hrs, IQR 4-20 hrs) (P value 0.017*). Intraoperative and postoperative fentanyl requirement was much lower in the PVB group (3.49 (0.91)) compared to the control group (9.86 (1.37)) P value <0.01*. Time to first rescue dose of analgesic was longer (7 hrs vs 5 hrs, P 0.01*), while time to extubation and duration of ICU stay were significantly less in PVB group . Mean postoperative pain scores were significantly lower in the PVB group at the time of ICU admission (0.85 vs 3.12, P 0.001*) till 4 hours (2.11 vs 3.32, P 0.001*). Conclusion: PVB provides an effective and safe anaesthetic approach which can form an important component of "fast-track" care in paediatric cardiac surgery.