Femoral nerve block is a reliable and effective method of providing anaesthesia and analgesia in the peri-operative period but there remains a small but serious risk of neurological complication. We aimed to determine incidence and outcome of neurological complications following femoral nerve block in patients who had major knee surgery. During the period January 2003 to August 2008, medical records of all patients undergoing knee surgery by Dr Myles Coolican and Dr David Parker, who had been administered femoral block for peri-operative analgesia, were evaluated. Patients with a neurological complication were invited take part in the study. A detailed physical examination including sensory responses, motor response and reflexes in both limbs was performed by an independent orthopaedic surgeon. Subjective outcome and pain specific questionnaires as well as clinical measurements were also collected. Out of 1393 patients administered with femoral nerve block anaesthesia during this period, 28 subjects (M:F= 5:23) were identified on the basis of persistent symptoms (more than three months) of femoral nerve dysfunction. All the patients had sensory dysfunction in the autonomous zone of femoral nerve sensory distribution. The incidence of neurological complications was 2.01%. One patient was deceased of unrelated causes and five patients declined to participate in the study. 14 patients out of the 22 have been examined so far. Nine cases had a one shot nerve block and five had continuous peripheral nerve block catheter. Areas of hypoesthesia/anaesthesia involving femoral nerve distribution occurred in 7 subjects and hyperaesthesia/paresthesia occurred in four. One subject had a combination of hypoesthesia and hyperesthesia in different areas of the femoral nerve distribution. Three subjects had bilateral symptoms following bilateral simultaneous nerve blocks. Dysesthesias in the affected dermatomes were found in seven cases and paresthesias were found in eight cases. Douleur Neuropathique en 4 questions (DN4) score of ï. 3. 4 was found in all the patients (average value: 5.55). The average scores for tingling, pins and needles and burning sensation (in a scale from 0 to 10) are 3.8, 3.1 and 2.9 respectively. The incidence of persistent neurological complication after femoral nerve block in our series is much higher compared to the reported incidence in the contemporary literature (Auroy Y. et al. Major complications of regional anesthesia in France: Anesthesiology 2002; 97:1274 80). The symptoms significantly influence the quality of life in the affected cases and question the value of the femoral nerve block in knee surgery

Purpose. Shoulder dislocations account for 50 % of all dislocations, of which 98% are anterior dislocations. Different techniques have been described in literature with variable success, which depends upon type of dislocation, technique used and muscle relaxation. Method. A retrospective review of data of all shoulder dislocations presented to accident and emergency department over a one-year period was undertaken. Over a 1-year period total of 52 patients presented with mean age of 41 years. Closed reduction was attempted in all patients by accident and emergency department using various techniques and combination of analgesia. Unsuccessful reductions and those with associated fractures were referred to orthopaedics department. This group had closed reduction utilising Sahas zero position technique in accident and emergency department. Post reduction all patients had two views of radiograph to confirm reduction and poly-sling for 2–3 weeks. Results. We had 37 (71.1%) males and 15(28.8%) females with shoulder dislocations. In our patients 98% were anterior dislocations and 14 % were dislocations associated with fractures. Of 52 patients 33 (63%) were first time dislocations and 17(33%) had recurrent dislocations In cohort of 52 patients 7(13.4%) had neurological deficit prior to reduction, which was sensory hypoesthesia along the regimental badge area, and 1(2%) had a post reduction neurology using modified Milch technique. Most of our patients 38 (73%) were reduced using various techniques for reducing shoulder dislocation. In these 38 patients analgesia varied from Entonox to combination of Entonox with intravenous morphine with or without diazepam. Our department was referred 14(27%) patients. Seven patients were referred due to failure of reduction where several attempts with different techniques were made and 7 were directly referred due to association of fracture with the dislocations. 14(27 %) of our patients were reduced using zero position of shoulder in first attempt without the need for additional analgesia. Of these 14 patients 7 had complex shoulder dislocation associated with fractures. We had only one failure of reduction using Sahas zero position of shoulder. This patient had recurrent dislocation with large Hill Sachs defect. This was reduced under general anaesthesia using zero position of shoulder as described by Saha. Conclusion. This study demonstrates that zero position of shoulder described by Saha is safe, effective and easy method for reducing both anterior, posterior and fracture dislocations of the shoulder. Given the principles of reduction in zero position no additional analgesia and traction is required. The feedback from patients in regards to discomfort and pain was also positive. We conclude that this data suggests the routine use of Sahas technique in reducing both simple and complex shoulder dislocations