Introduction: There is still controversy regarding the treatment of acute Lumbar Radicular pain. Most authorities recommend bed rest, anti-inflammatory medication and physical therapy (Riew et al JBJS 1982 and Tulder ET AL Spine 22–1997) Comparing the outcome of operative and conservative treatment in selected patients many authors (Weber et al, Hakelius et al) did not find any significant difference after first year and no difference after 4 years. However many patients treated conservatively complains of persistent pain and seek further intervention.

Aim: We did a prospective study to determine the effectiveness of selective nerve root injection in relieving pain in patients with Lumbar radicular pain.

Material and Methods: We included 27 consecutive patients in our study, who had selective nerve root block. Inclusion criteria were Degenerative Lumbar Radicular pain or spinal stenosis, MRI correlating with Lumbar radiculopathy and no benefit from 6 weeks Anti-inflammatory medication, Rest, Physical treatment and activity modification. Informed consent taken from all patients for this study. Each patient was given Low Back Pain outcome score questionnaire of Greenough and Fraser and Oswestry Disability index of Fairbank, to be filled pre and post injection in day ward and at regular intervals up to 3 months post-injection. Adcortyl 20mg with 1 ml of 1% Lignocaine were injected under image in theatre after confirming the site with radioculogram and pain replication.

Results: From the total of 27 patients, 25 (92%) showed improvement in their symptoms in first week. Out of these 25 patients, 18(66%) had long-term improvement and 7(26%) showed short-term relief. Statistically significant improvement at every stage of assessment was observed.

Conclusion: The selective nerve root block combined with careful history, physical examination and quality radiolographic studies, is an important tool in the diagnosis and treatment of patients with predominant Lumbar radicular symptoms. It gives acceptable results in form of pain relief in 3 months. It has a role in lumbar Radicular pain largely in patients where surgery is not appropriate for whatever reasons.

Standard protocol following total hip arthroplasty dictates that the hip is kept in a position of abduction until soft tissue healing is sufficient to provide stability. This is maintained by use of an abduction pillow while in bed, meaning that the patient must sleep on their back. Many patients find this position uncomfortable and have significant difficulty in sleeping.

Aims: To assess the impact of sleep deprivation on recovery of the patient and quality of life in the peri-operative period.

Methods: Patient cohort consisted of elective admissions for total hip replacement. All were assessed using the Epworth sleep scale, SF-36 as well as the Hospital Anxiety and depression score. Body mass index and history of insomnia or obstructive sleep apnoea were recorded. Baseline oxygen saturation was compared with postoperative overnight saturation and request for night sedation.

Results: 64 consecutive patients undergoing total hip arthroplasty surgery were eligible for inclusion in the study. Mean age 68 (43 to 85), 42 females, 22 males, 62 patients were satisfied with the result of surgery, 1 patient with hip dysplasia had a persistent leg length inequality and one complained of back pain. All patients were nursed according to standard protocol with abduction pillow while in hospital and instructions to sleep on their back while at home. 18 patients did not fully comply with this instruction while at home. There were no early dislocations with a mean follow up of 5.4 months. Mean hospital anxiety and depression scores were significantly increased following surgery mean pre-operatively (5.2), to highest level (3.4) at two weeks, (8.5) at six weeks, returning to normal levels after three months (4.2). Epworth sleep scores were similarly increased with sleep patterns returning to normal at the three month stage. Increasingly, body mass index correlated significantly with poor scores and low oxygen saturation readings. This group of patients had a predisposition to obstructive sleep apnoea, which was predicated by sleeping on their backs, they require more night sedation and analgesia.

Conclusions: Standard precautions following total hip arthroplasty are not without morbidity. Sleep deprivation leading to increased anxiety and decreased satisfaction. Increased demand for night sedation and analgesia with their resultant costs and dependence. Sleeping in the supine position may also precipitate obstructive sleep apnoea in at risk patients.