Southern medical journal
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Southern medical journal · Apr 1995
Case ReportsSubdural injection of a local anesthetic with steroids: complication of epidural anesthesia.
We describe the unintentional injection of a small amount of local anesthetic with steroids into the subdural space during an attempted lumbar epidural injection for low back pain. When small volumes of local anesthetic are injected into the subdural space, a patchy and unilateral block of greater magnitude than expected will result. When larger volumes of local anesthetic are injected, a massive motor and sensory block can occur due to the small confines of this space. Accidental subdural injection must be recognized early and treated appropriately to avoid serious complications, especially in an outpatient setting.
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Southern medical journal · Apr 1995
Ventral hernia and other complications of 1,000 midline incisions.
We report the outcome in 1,079 consecutive clean or clean-contaminated midline abdominal incisions closed with running 0-loop nylon suture after both elective and emergency operations done between 1984 and 1991. Postoperatively, 79 patients were lost to follow-up, resulting in 1,000 having long-term follow-up. Mean follow-up among these patients was 22 months. ⋯ By chi-square analysis, wound infection, dehiscence, class of clean-contaminated wound, patient age > 65, or previous midline abdominal incision were not identified as risk factors for development of a ventral hernia. Reuse of a previous midline incision in combination with any wound infection was associated with an increased risk of subsequent ventral hernia (stepwise regression). In our experience, running closure of a vertical midline abdominal wound has not been associated with an excessive incidence of wound complications or of ventral hernia.