Ultrasound imaging accurately identifies the lateral femoral cutaneous nerve

BACKGROUND: Anesthesia of the lateral femoral cutaneous nerve (LFCN) is useful in surgery involving the anterolateral thigh. We investigated the accuracy of ultrasound compared with anatomical landmarks in identifying the LFCN in human cadavers and volunteers. METHODS: Twenty cadavers were examined. A needle was inserted targeting the LFCN with ultrasound guidance and green dye was injected. A second needle was inserted using anatomical landmarks. The LFCN was identified by dissection, and coloring of the LFCN and needle positions were evaluated. A volunteer study with 10 individuals was performed. Transdermal nerve stimulation was used to identify the LFCN bilaterally. Its position was compared with marked positions identified in advance using ultrasound and anatomical landmarks. RESULTS: Sixteen of 19 needles inserted under ultrasound guidance in the cadavers were in contact with the LFCN. The median horizontal distance from the needle tip to the nerve was 0.0 mm (interquartile range [IQR], 0.0-0.0 mm). Only 1 of 19 needles inserted using anatomical landmarks was in contact with the LFCN. The median horizontal distance from the needle tip to the nerve was 18.0 mm (IQR, 11.0-23.0 mm). Sixteen of 20 marked positions made using ultrasound guidance corresponded to the identified LFCN in volunteers. The median horizontal distance from the pen-mark to the LFCN was 0.0 mm (IQR, 0.0-0.0 mm). None of the 20 marked positions made with anatomical landmarks corresponded to the LFCN. The median horizontal distance from the pen-mark to the LFCN was 15.0 mm (IQR, 10.8-20.0 mm). CONCLUSIONS: Identification of the LFCN by ultrasound is technically feasible and more accurate than anatomical landmarks

A quantification of discharge readiness after outpatient anaesthesia: patients’ vs nurses’ assesment

Objectives: Criteria for discharge after outpatient surgery do not take into consideration the patients’ assessment of discharge readiness. Our aim was to compare discharge readiness as determined by nurses with that determined by patients against the modified Aldrete score as a benchmark.Design and setting: In this prospective study, a single observer followed 194 outpatients in the PACU. A modified Aldrete score was assigned and further assessments were made at 15-min intervals in parallel with those made by nursing staff. Nurses and patients were blinded to each other’s assessments . Discharge readiness was quantified according to three different approaches: 1) time to reach a modified Aldrete score of >9, 2) time to discharge readiness according to the patient’s own evaluation and, 3) time to discharge readiness according to nursing assessments.Results: All three times were significantly different from each other. a) Time to achieve a modified Aldrete score >9 was 8.3+7.6 min, b) Time the patient felt discharge ready was 45.3+39.5 min, c) Time the patient was actually discharged by nurses was 86.8+45.8 min. Conclusions: Nursing staff tend to keep patients an additional 41.5 + 36.6 min in the PACU compared to the patients’ own evaluation. Significant cost saving could be potentially realised if outpatients who achieve a modified Aldrete score >9 are allowed some freedom in the determination of their own discharge readiness