Background: The use of psoas compartment block provides good analgesia but poor surgical anaesthesia. In Ortho-geriatric care different nerve blockade had been used to avoid the systemic adverse effect of centrally acting agents and provide long duration of unilateral limb analgesia after arthroplasty.

Aim: The aim of the study is to establish the quality of pain control, incidence of side effects and complications achieved with a psoas compartment block (PCB) following surgery for fractured neck of femur.

Study design: Prospective, Non randomised, longitudinal, Cohort. A Pilot Study period January 2003 -December 2004

Materials & Method: 10 patients of mean age 74.8 years (Range 23–93), 3 males and 9 females had unilateral hip surgery with general or a spinal (with no intrathecal opiate administration) as the main anaesthesia and a psoas Compartment Block for continuous infusion of bupivacaine for postoperative pain control (a total dose of 2mg/kg given in theatre and received a continuous infusion of bupivacaine 0.1% at a rate of 25ml/hour for 48 hours) and assessed by nurse led pain team.

Result & analysis: All the patients in this study group had excellent pain control. On the first post operative day only one patient had mild pain, and another had moderate pain. On the second day 3 patients had mild pain [chart 1].

Conclusion: These patients had excellent to good post operative pain control without having any adverse side effects. This study will help us to treat pain among elderly geriatric patients particularly in the demented group in immediate post-operative period. We need randomised comparative study to advocate this practice.

Aim: To establish the effectiveness of using the intra-operative cell saver in spinal surgery.

Methods: Patients undergoing posterior instrumental lumber spine fusion with iliac crest bone graft were selected to have intra-operative red cell salvage using the cell saver machine (Dideco Electra-Auto-transfusion Cell Separator). 20 patients were in the study group. The control group consisted of 28 patients who had undergone similar surgery prior to introducing the cell saver. The parameters identified were: pre and post operative haemoglobin, clotting state, volume of transfused allogenic blood, volume of transfused autollogous blood using the cell saver and indications for transfusion. Statistical analysis: the chi-square and the t-test.

Results: The average age in the cell saver group was 43.8 years and in the control group 48.3 (p> 0.09). The number of levels fused was comparable between the two groups (p> 0.1). There was no difference in the pre and post operative haemoglobin level in the two groups (p> 0.7 & p> 0.3 respectively). No patient had a pre-operative coagulopathy. Two patients (10%) in the cell saver group received an intra-operative allogenic transfusion, 14 patients (50%) in the non-cell saver group received a transfusion. The difference was significant (p< 0.004). Conclusion: The use of the cell saver significantly reduces the need for allogenic blood transfusion in major spinal surgery. We therefore recommend its routine use in such procedures.