PubMed · 5646412
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R B Clark, F E Greifenstein. 1968. "Saddle block" poor term.. https://pubmed.ncbi.nlm.nih.gov/5646412/
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The spread of regional anesthesia in America was greatly facilitated by the work of Gaston Labat. Recruited to work at the Mayo Clinic, Dr. Labat there published his seminal textbook, Regional Anesthesia, in which he laid out his techniques to the next generation of physician specialists, notably John Lundy, Ralph Waters, and Emery Rovenstine. It was Rovenstine who was responsible for creating the specialty of anesthesiology in the 1920s and 1930s. John Lundy continued Labat's work at the Mayo Clinic when Labat left for Bellevue Hospital in New York. There, while teaching, Labat further developed and refined his techniques for delivering regional anesthesia.
INTRODUCTION: Regional anesthesia of a single finger is commonly achieved by the traditional ring block. The major drawback of this technique is the need for at least two painful injections in the digit. Single injection techniques have been described. A comparison of their results could help health professionals select the most appropriate technique. MATERIAL AND METHODS: A prospective randomized study was designed to compare three techniques in term of patient tolerance, distribution of anesthesia and efficiency: the modified transthecal digital block, the subcutaneous digital block and a combination of the two. Digits were randomized in three groups (n = 30). Blocks were performed by a single investigator. A visual analogic scale was used to evaluate pain associated with the injection. Prick-testing was used to evaluate anesthesia at the volar and dorsal aspects of the phalanxes. Statistical analysis of the results was performed. RESULTS: All techniques allowed surgery to be performed without complementary injection most of the time (25/30). The dorsum of the proximal phalanx, however, was unpredictably included in the anesthetized territory. The highest rate of full digital block was achieved with the combined technique. DISCUSSION: The least invasive of equally effective techniques should be considered as the first choice. The subcutaneous single injection digital block is safe, efficient and easy to perform. It allows treatment of all conditions on the volar aspect of the finger and on the dorsal aspect of the distal and middle phalanxes. For surgery on the dorsal aspect of the proximal phalanx, a supplementary dorsal block should be used.
A postal survey investigating the administration of supplemental oxygen to women undergoing Caesarean section under regional anaesthesia was sent to 262 lead consultant obstetric anaesthetists in the UK. Two hundred and fifteen (82) completed questionnaires were returned. In 139 units (65) supplemental oxygen was administered routinely to all Caesarean sections under regional techniques, while in 71 (33), supplemental oxygen was given only if the procedure is an emergency or if there was evidence of fetal or maternal compromise. In 196 units (91), the common gas outlet was used as the source of supplemental oxygen, with the standard anaesthetic breathing circuit disconnected in 194 (90) and the vaporisers left on the back bar in 191 (89). Critical incidents had occurred in 39 (18) of units using the common gas outlet as a source of supplemental oxygen and 63 (30) had experience of critical incidents with this practice in a non-obstetric setting. We suggest that supplemental oxygen is more safely administered from a separate and dedicated source.