The recent 3 articles abstracts on lipid therapy for local anesthesia toxicity were interesting. I hope I never have to us lipids for LA toxicity, though it’s nice to know it is available. I am amazed at the abstract by Ludot,et al,. on using a Lumbar Plexus Block (LPB) for knee surgery on a 13 yr old. First, it stated that the patient was anesthetized with general anesthesia and then the block was performed. As you know LPB is an advanced block and should never be performed under general anesthesia for lots of reasons includng nerve injury; as simple femoral/sciatic under sedation would have sufficed. Second, I am pussled at the choice of 0.75% Naropin. Since the LPB was used for analgesia the 0.75% naropin is a much greater concentration than is needed for postoperative analgesia.

The second article by Litz, RJ -I was surprized that infraclavicular block (ICB)was used for should surgery- do you or any of the editors have experinece using ICB for shoulder surgery? Mark A. Williams, CRNA ,MS, FAAPM, CMI III