Objectives: To compare the quality and the duration of analgesia produced by a supraclavicular brachial plexus blockade obtained with a mixture of lidocaine and bupivacaine when supplemented or not with sufentanil. Study design: Prospective, randomized, double-blind study. Patients: The study included 40 patients undergoing osteosynthesis of the upper limb under brachial plexus block, randomly assigned to two groups. Methods: The patients of the control group were given 0.5% bupivacaine 1 mg . kg(-1) and 1% lidocaine 2 mg . kg(-1). Those of the sufentanil group, received the same mixture supplemented with sufentanil 0,2 mg . kg(-1). During the postoperative period, the characteristics of analgesia were blindly evaluated every hour for 48 h with a visual analogic scale graduated from 0 to 100. Analgesia was considered satisfactory when the score was below 30. Adverse effects of opiates (drowsiness, pruritus, nausea and vomiting) were also assessed. Oxygen saturation was continuously monitored. Blood pressure, heart and respiratory rates were measured at the same intervals than analgesia. Duration of analgesia are expressed as medians (range) and compared using a Mann and Whitney's U test. Results: The respective durations of satisfactory analgesia were significantly different. 12.5 h (8-17) in the control group versus 24 h (8-48) for the sufentanil group. The adverse effects in the sufentanil group were nausea (2), vomiting (1) and pruritus (1). No respiratory depression was noted. Conclusion: Sufentanil added to a mixture of lidocaine and bupivacaine increases twofold the duration of postoperative analgesia following brachial plexus blockade.

A case of accidental selective intubation of a right upper lobar bronchus originating from the trachea, in a woman with a normal preoperative chest X-ray, is reported. The preoperative diagnosis of an asymptomatic tracheal bronchus is often difficult on a standard chest X-ray, especially since a chest X-ray is no longer systematically included in the preanaesthetic assessment. Therefore, the presence of a bronchial malformation should be considered as a cause of ventilatory problems, particularly those occurring after tracheal intubation.

OBJECTIVES:To compare the quality and the duration of analgesia produced by a supraclavicular brachial plexus blockade obtained with a mixture of lidocaine and bupivacaine when supplemented or not with sufentanil.STUDY DESIGN:Prospective, randomized, double-blind study.PATIENTS:The study included 40 patients undergoing osteosynthesis of the upper limb under brachial plexus block, randomly assigned to two groups.METHODS:The patients of the control group were given 0.5% bupivacaine 1 mg.kg-1 and 1% lidocaine 2 mg.kg-1. Those of the sufentanil group, received the same mixture supplemented with sufentanil 0.2 mg.kg-1. During the postoperative period, the characteristics of analgesia were blindly evaluated every hour for 48 h with a visual analogic scale graduated from 0 to 100. Analgesia was considered satisfactory when the score was below 30. Adverse effects of opiates (drowsiness, pruritus, nausea and vomiting) were also assessed. Oxygen saturation was continuously monitored. Blood pressure, heart and respiratory rates were measured at the same intervals than analgesia. Duration of analgesia are expressed as medians (range) and compared using a Mann and Whitney's U test.RESULTS:The respective durations of satisfactory analgesia were significantly different: 12.5 h (8-17) in the control group versus 24 h (8-48) for the sufentanil group. The adverse effects in the sufentanil group were nausea (2), vomiting (1) and pruritus (1). No respiratory depression was noted.CONCLUSION:Sufentanil added to a mixture of lidocaine and bupivacaine increases twofold the duration of postoperative analgesia following branchial plexus blockade.

We compared the duration of analgesia produced by a mixture of lignocaine and bupivacaine, either alone or combined with morphine (75 micrograms.kg-1), buprenorphine (3 micrograms.kg-1) or sufentanil (0.2 microgram.kg-1) in 80 patients after brachial plexus block for orthopaedic surgery of the upper limb. The characteristics of analgesia were evaluated hourly using a visual analogue scale. The analgesia was considered satisfactory for scores of 30 or less. The median duration (range) of satisfactory analgesia was: 11.5 (8-15) h without an opioid, 21 (9-27) h with morphine, 20 (14-34) h with buprenorphine and 24.5 (11-38) h with sufentanil. We conclude that the addition of an opioid to a local anaesthetic mixture lengthens the duration of analgesia.

A case of accidental selective intubation of a right upper lobar bronchus originating from the trachea, in a woman with a normal preoperative chest X-ray, is reported. The preoperative diagnosis of an asymptomatic tracheal bronchus is often difficult on a standard chest X-ray, especially since a chest X-ray is no longer systematically included in the preanaesthetic assessment. Therefore, the presence of a bronchial malformation should be considered as a cause of ventilatory problems, particularly those occurring after tracheal intubation.

We report the results of long-term cyclical clodronate therapy (200 mg IV infusion every 3 weeks) on 235 women with postmenopausal osteoporosis recruited over 6 years. A retrospective analysis of clinical and instrumental findings in 183 postmenopausal osteoporotic patients was used as control data. Clodronate was well-tolerated and compliance was good. Bone mineral density (BMD) increased significantly and the upward trend persisted for all 6 years of therapy (5.69 +/- 0.184%) vs. controls: -1.47% +/- 0.813%, p <0.0001). The increase in BMD was greater in the 145 patients without vertebral fractures before starting clodronate. From year 3 onward clodronate reduced the incidence of new vertebral fractures. In closed subsets of patients and controls monitored for 3 and 4 years, respectively, the number of patients developing new vertebral fractures fell significantly in the clodronate group (two-sided p value = 0.0671 and p <0.0026, respectively). This trend was more marked in patients who were fracture-free at the beginning of each year. Cyclical clodronate is a safe and effective therapy for established osteoporosis, but clinical trials are necessary to compare its efficacy versus continuous therapy and, as in the case of the other bisphosphonates, to investigate its mechanisms of action in depth.

An investigative study was carried out for 2 years involving 124 randomly selected early postmenopausal women with spine bone mineral density (BMD) below the mean value of a normal premenopausal subject. After random division into three groups, the first 42 patients were treated with transcutaneous 17-beta-estradiol (50 mu g daily), the second 42 were treated with cyclical intravenous clodronate (200 mg/month iv infusion), and the third group of 40 (controls) was left untreated. After 2 years, the total drop in BMD within the control group was more than 7% as opposed to the values of -0.14% +/- 0.93 in the estradiol group and 0.67% +/- 0.84 in the clodronate group. A change in BMD of < 1% was considered satisfactory, and this result was obtained in 32% of the controls, in 79% of the estradiol group where the percentage change in BMD moderately correlated with serum estradiol levels (r = 0.399), and in 90% of the clodronate-treated patients, in whom the percentage change in BMD inversely correlated with basal values of markers of bone turnover. Both estrogen and clodronate prevent postmenopausal bone loss. The response to transcutaneous hormone replacement therapy may be influenced by transcutaneous absorption and by a lower sensitivity to estrogen. Response to cyclical clodronate seems to be influenced by the rate of bone turnover. An interdosage interval ranging from 2-4 weeks appears suitable for most patients.