Conventional teaching advises against using adrenaline with local anaesthetic near end-arteries due to risks of irreversible vasospasm, however there are benefits of adjunctive adrenaline including enhanced anaesthetic effect, prolonged duration and temporary haemostasis.

Retrospective analysis was undertaken for all elective finger and distal palmar surgery using digital nerve or field blocks performed by four orthopaedic hand surgeons, during a two-year period in a large teaching hospital. Data collected from theatre databases and clinical notes included procedure type, anaesthetic agent, adrenaline use, tourniquet use and evidence of post-operative digital ischaemia or wound complications.

230 procedures (mean age 59 years) were performed, including 158 cases with plain anaesthetic only (2%, 1% Lidocaine or 0.25% Bupivicaine in 150, 4 and 4 cases respectively) and 72 cases with 0.25% Bupivicaine and adrenaline (1:200,000.) Mean anaesthetic volume was 7.5ml (7.2ml vs 8.0ml without and with adrenaline respectively.) Tourniquet was used in all cases without adrenaline but was not used in 21 (29%) of cases with adrenaline. Mean tourniquet time in each group was 16 minutes. Two post-operative infections occurred in the group without adrenaline with none in the adrenaline group and there were no cases of digital necrosis in either group

In the elective setting, adjunctive adrenaline with local anaesthetic does not increase the risk of post-operative infections or digital ischaemia. For proximal finger surgery, where digital tourniquets are often restrictive, using adrenaline can prevent the need for painful arm tourniquets.

The purpose of this prospective study is to evaluate the benefits of intra discal electrothermal treatment (IDET) for discogenic back pain.

40 patients with chronic discogenic back pain underwent this therapy. All the patients had a failed trial of conservative treatment. Patients with a positive provocative discogram were selected for IDET. The outcome is assessed using a SF36 questionnaire pre-procedure and then at 3,6,12,18 and 24 months post-operatively.

The mean age group of the patients was 37 years (range 15–58 years). All the patients had a minimum follow up of 18 months. Out of the 40 patients 5(12.5%) had no improvement and had to undergo an interbody fusion within 6 months following IDET and hence were excluded from the study. No patient developed any neurological complications. Of the rest of the 35 patients at a minimum of 18 months follow-up 56 % (p=0.042) patients had improvement in physical function scores and 52% (p=0.034) had improvement in pain scores as per the SF36.

Conclusion: IDET appears to be an effective alternative to control pain in patients who might otherwise be candidates for spinal fusion.

There is limited evidence for the effects of ordering and length on responses to questionnaires used in the health field. Multiple outcome measures used in back pain studies have implications for respondent burden and response quality. This randomised study assessed the effect of questionnaire ordering and length on missing data and internal reliability for two health outcome measures.

Back pain patients were recruited from 26 UK practices in the UK BEAM feasibility study. Patients were randomised to receive a 27 page self-completed questionnaire with the Roland Disability Questionnaire (RDQ) at the front and SF-36 at the back of the questionnaire, or vice versa.

The mean number of missing items for the SF-36 was 0.07 (sd=0.68) and 0.56 (sd=2.73) at the front and back of the questionnaire; this difference was statistically significant (p< 0.05) for the general health perception scale. The internal consistency (Cronbach’s Alpha) of the RDQ was unaffected by questionnaire positioning; but was generally higher when the SF-36 (mean difference = 0.03) was at the start of the questionnaire and statistically significant for the vitality scale (p< 0.01).

The positioning of instruments affects patients’ responses. Researchers should consider the influence of questionnaire design. Primary measures should be positioned at the front of questionnaires.