The use of regional anaesthesia for upper limb surgery has been increasing in popularity recently. It is safe, effective and has financial benefits. We report the activity in a tertiary hand surgery unit over one year. This department performs elective and trauma surgery between 8am and 7pm. Out of hours surgery is performed in main theatres.

A total of 3335 cases were performed in Hand Surgery theatres between 1st August 2008 and 1st August 2009. Of these, 1791 had a regional block. The ages of these patients ranged from 13 to 92 years (Median = 46 years, Mean = 47 years). 1030 were male and 761 were female. 1011 regional block procedures were performed by a Consultant Anaesthetist, with 266 performed by a trainee and 472 by non-career grade. 646 procedures were for trauma surgery with 1145 for elective surgery. 87 procedures were arthroscopic. A vast range of surgery was safely performed under regional block. There were no significant complications.

All regional nerve blocks were performed with the aid of ultrasound. Training of junior anaesthetists was benefited by performing the nerve blocks. Patients required very little time to recover following nerve block when compared to recovery after general anaesthesia, with resultant reduction in resource requirements.

We conclude that the use of regional nerve block anaesthesia for hand surgery benefits both the patient and the hospital.

INTRODUCTION: Median Nerve has small vessel on the volar aspect of the nerve which is filled with blood and results in so called ‘ BLUSHING’ of the nerve once it has been decompressed. It was thought that the nerve which didnot blush meant an inadequate decompression was carried out.

PURPOSE: To evaluate whether ‘Blushing’ of the Median Nerve is correlated with adequate decompression and level of recovery in Carpal Tunnel Syndrome through Mini Palmar Incision.

METHODS & MATERIALS: Retrospective analysis of a Single Surgeon practise where it was documented in operation notes whether the nerve was seen to ‘Blushed’ at the time of surgery.They were assessed postoperatively from notes for complete resolution of symptoms and whether there was any recurrence of symptoms.

RESULTS: n=330 Carpal Tunnel Decompressions were reviewed. It was noted that those who had complete resolution of symptoms had ‘Blushing’ noted at the time of surgery compared to those who had partial or incomplete resolution of symptoms wher ‘No BUSHING’ was noticed. Average time of follow up = 6 weeks. Blushing Noted at the time of decompression 192, Recovery/ improvement of symptoms 189, Blushing not noted at the time of surgery 38, NO documentation about Blushing in 100

CONCLUSION: Blushing of Median Nerve intraoperatively is a reliable sign for complete decompression of the nerve and is correalted with good final outcome.

Background: Symptomatic patellofemoral osteoarthritis is a challenge to the orthopaedic surgeon. In comparison to Total Knee Arthroplasty (TKA), little has been written about unicompartmental patellofemoral arthroplasty. Although, recent reports have shown more promise, the procedure has not gained wide acceptance.

Materials and Methods: We present the outcome of 23 unicompartmental patellofemoral arthroplasties on 19 patients performed in a district general hospital in the UK. The procedures were performed by a single surgeon (RSG), with a special interest in knee surgery. All the patients had failed a trial of non-operative treatment which included non-steroidal anti-inflammatory analgesia and physiotherapy. Some knees had undergone previous surgical procedures including arthroscopy (12), carbon fibre patch implantation (5), tibial tubercle transfer (1), lateral release (1), medial release (1) and excision of patellar bursa (1). Multiple arthroscopies had been performed on 4 knees.

The arthroplasty was performed via an anterior midline incision and medial parapatellar approach. All patients received Leicester Patellofemoral Prosthesis (Corin). One patient had a revision procedure following a failed PFJR performed elsewhere. The age of the patient at the time of operation ranged from 31–68 years (Mean age 50.3 years). The duration of follow-up was 6 months to 88 months (Mean 36 months). The results were evaluated using the Oxford Knee Score.

Results: One patellofemoral arthroplasty was converted to TKA after 41 months. There was no infection or loosening of the components in any patient. All patients reported relief of post-operative discomfort by 6 months except for one patient who developed hypersensitive skin lateral to the scar at 6 months. All patients said that their knees were significantly better after the procedure. Oxford Knee Scores ranged from 17 to 54 (Median 29). All except one patient reported that they would to undergo the procedure on their other knee (unilateral cases) and would recommend the procedure to friends/family.

Conclusion: The early and medium term results of uni-compartmental patellofemoral arthroplasty in our study are encouraging with patients reporting significant improvement in knee symptoms. We feel that careful patient selection and meticulous attention to surgical detail contribute to better outcomes.