全膝关节置换术后采用时间治疗法服用塞来昔布的镇痛效果

目的:观察时间治疗法服用塞来昔布在全膝关节置换手术后的镇痛效果。方法:于2005-08/2006-04选择沈阳军区总医院骨科收治的双侧全膝关节置换女性患者48例为观察对象,随机数字表法分为盐酸哌替啶肌注镇痛组,塞来昔布常规治疗组和塞来昔布时间治疗组,各组16例。患者均知情同意。盐酸哌替啶肌注镇痛组患者在术后疼痛并要求镇痛时肌注盐酸哌替啶50mg,每次间隔4h以上;塞来昔布常规治疗组患者术前8h口服塞来昔布(西乐葆,西尔大药厂波多黎各分厂,批号:0408064)400mg,术后禁食水期过后给予口服塞来昔布200mg,次日起按每日2次常规服药,期间可按患者要求给予肌注盐酸哌替啶50mg镇痛,每次间隔4h以上;塞来昔布时间治疗组患者术前3～7d每日通过目测类比评分法测定疼痛周期及峰值,术后在峰值时间前35min口服塞来昔布200mg,2次/d,对无明显疼痛周期的患者,参照Labrecque的研究结果确定服药时间。记录3组患者术后应用盐酸哌替啶肌注镇痛次数,术后12d疼痛目测类比评分,膝关节功能锻炼后的屈曲角度。结果:纳入患者48例,均进入结果分析。①塞来昔布常规治疗组、塞来昔布时间治疗组术后注射盐酸哌替啶镇痛次数明显低于盐酸哌替啶肌注镇痛组[以24～48h为例,分别为(0.750±0.173),(0.625±0.143),(1.125±0.121)次,P<0.05]。②功能锻炼同期患者疼痛目测类比评分盐酸哌替啶肌注镇痛组>塞来昔布常规治疗组>塞来昔布时间治疗组,组间差异有显著性意义(以术后第4天为例,分别为7,5,4分,P<0.05)。③塞来昔布时间治疗组在术后第6,7,9天时膝关节功能锻炼的屈曲角度高于塞来昔布常规治疗组、盐酸哌替啶肌注镇痛组,差异有显著性意义[以术后第6天为例,分别为(87±2)°,(76±2)°,(64±1)°,P<0.05]。结论:塞来昔布可提高患者围手术期痛阈,明显减少术后注射盐酸哌替啶镇痛的次数,缓解功能锻炼期关节疼痛。采用时间治疗法服用,可更为明显地降低患者功能锻炼期疼痛目测类比评分,并在一定程度上有利于更早达到功能锻炼目标。     

全膝关节置换术后采用时间治疗法服用塞来昔布的镇痛效果

目的：观察时间治疗法服用塞来昔布在全膝关节置换手术后的镇痛效果。方法：于2005—08／2006—04选择沈阳军区总医院骨科收治的双侧全膝关节置换女性患者48例为观察对象，随机数字表法分为盐酸哌替啶肌注镇痛组，塞来昔布常规治疗组和塞来昔布时间治疗组，各组16例。患者均知情同意。盐酸哌替啶肌注镇痛组患者在术后疼痛并要求镇痛时肌注盐酸哌替啶50mg，每次间隔4h以上；塞来昔布常规治疗组患者术前8h口服塞来昔布（西乐葆，西尔大药厂波多黎各分厂，批号：0408064）400mg，术后禁食水期过后给予口服塞来昔布200mg，次日起按每日2次常规服药，期间可按患者要求给予肌注盐酸哌替啶50mg镇痛，每次间隔4h以上；塞来昔布时间治疗组患者术前3—7d每日通过目测类比评分法测定疼痛周期及峰值，术后在峰值时间前35min口服塞来昔布200mg，2次／d，对无明显疼痛周期的患者，参照Labreeque的研究结果确定服药时间。记录3组患者术后应用盐酸哌替啶肌注镇痛次数，术后12d疼痛目测类比评分，膝关节功能锻炼后的屈曲角度。结果：纳入患者48例，均进入结果分析。①塞来昔布常规治疗组、塞来昔布时间治疗组术后注射盐酸哌替啶镇痛次数明显低于盐酸哌替啶肌注镇痛组[以24-48h为例，分别为（0．750&;#177;0．173），（0．625&;#177;0．143），（1．125&;#177;0．121）次，P〈0．051。②功能锻炼同期患者疼痛目测类比评分盐酸哌替啶肌注镇痛组〉塞来昔布常规治疗组〉塞来昔布时间治疗组，组间差异有显著性意义（以术后第4天为例，分别为7，5，4分，P〈0．05）。⑧塞来昔布时间治疗组在术后第6，7，9天时膝关节功能锻炼的屈曲角度高于塞来昔布常规治疗组、盐酸哌替啶肌注镇痛组，差异有显著性意义[以术后第6天为例，分别为（87&;#177;2）&;#176;，（76&;#177;2）&;#176;，（64&;#177;1）&;#176;，P〈0．05]。结论：塞来昔布可提高患者围手术期痛阈，明显减少术后注射盐酸哌替啶镇痛的次数，缓解功能锻炼期关节疼痛。采用时间治疗法服用，可更为明显地降低患者功能锻炼期疼痛目测类比评分，并在一定程度上有利于更早达到功能锻炼目标。     

角膜绷带镜在翼状胬肉患者中的应用价值

目的探讨翼状胬肉切除术+羊膜移植术+角膜绷带镜对翼状胬肉患者角膜上皮的修复情况及术后复发率的影响。方法分析102例翼状胬肉患者的临床资料。随机分为观察组(胬肉切除术+羊膜移植术+角膜绷带镜,102只眼)和对照组(胬肉切除术+羊膜移植术,102只眼)。比较2组患者的临床资料、术后视觉模拟评分法(VAS)及愈合情况、复发率。结果 2组患者的术前临床资料比较无显著差异(P0.05)。术后观察组患者的VAS评分均较对照组显著较低(P0.01)。观察组患者术后角膜愈合情况均显著优于对照组(P0.01)。2组术后复发率无显著差异(P0.05)。结论翼状胬肉切除术+羊膜移植术+角膜绷带镜对翼状胬肉患者的角膜修复具有显著的促进作用,可以有效缓解其眼部不适感,复发率低。     

预注帕瑞昔布对子宫切除患者术后镇痛的影响

目的:观察帕瑞昔布对子宫切除患者术后镇痛效应.方法:子宫切除术患者36例,分为两组(n=18),A组术前静注帕瑞昔布40 mg,B组空白对照组.记录各组患者术毕即刻(T1),1(T2),3(13),6(T4),12(T5)h后VAS评分.结果:术毕即刻(T1),1(T2),3(T3),6(T4)h,A组VAS评分显著低于B组各同一时点的VAS评分(3.2±0.4vs 4.8±0.5,2.7±0.3 vs 3.6±0.5.2.5±0.4 vs 3.3±0.4,2.3±0.4 vs 2.7±0.3),均P<0.05.结论:预注帕瑞昔布能为子宫切除患者提供较好的术后镇痛,且无明显不良反应.     

腰椎围手术期病人应用塞来昔布的镇痛效果评估

目的观察腰椎手术病人围手术期应用塞来昔布的镇痛效果。方法62例腰椎手术病人随机分为两组,塞来昔布组30例,术前8h口服塞来昔布400mg,术后6h禁食禁水期过后再次给药,每次200mg,每日2次,术后3～5d视病人疼痛情况停药;镇痛泵组32例,术后常规使用镇痛泵进行镇痛,维持至术后第2天,所有病人术后可根据需要肌注盐酸哌替啶以缓解疼痛。观察两组病人术后6、12、24、48、72h的VAS评分,并记录药物不良反应及盐酸哌替啶援助情况。结果两组病人术后镇痛药物不良反应发生率比较差异有显著性（x^2=5．37,P〈0．05）,两组术后镇痛药物援助情况比较差异无显著性（P〉0．05）,镇痛泵组术后6、12h的VAS评分显著低于塞来昔布组（t=4．021、4．724,P〈0．01）,术后24、48及72h两组VAS评分比较差异无显著意义（P〉0．05）。结论腰椎手术病人围手术期应用塞来昔布有一定镇痛效果,但其镇痛效果并不优于镇痛泵。     

塞来昔布在髋膝关节置换手术后多模式镇痛的应用

目的 观察塞来昔布在髋膝关节置换手术后联合自控镇痛(PCA)的多模式镇痛中的作用.方法 选择2007年5 ～6 月北京大学人民医院收治的行髋膝关节置换手术患者60 例,按随机数字表法分为塞来昔布组和对照组,每组30 例,塞来昔布组麻醉诱导前8 h 口服塞来昔布400 mg,手术后当天进食后口服200 mg,手术后第1 ～5 天,200 mg/次,2 次/d;对照组不服用塞来昔布.两组在手术后均不限制使用静脉或硬膜外自控止痛泵、肌内注射或口服阿片类药物.观察两组术后疼痛的VAS 评分、止痛泵药物用量、阿片类药物用量以及药物副作用情况.结果 纳入患者60 例,均进入结果分析.塞来昔布组在术后第1 ～3 天手术切口疼痛的VAS 评分低于对照组,差异有统计学意义(P ＜0.05);术后当天、术后第4、5 天,手术切口疼痛的VAS 评分与对照组相比无统计学意义.在术后当天至术后第5 天内,塞来昔布组止痛泵药物用量和阿片类药物用量均少于对照组(P ＜0.05),出现药物副作用的次数也低于对照组(P ＜0.05).结论 塞来昔布在髋膝关节置换手术后联合PCA 的多模式镇痛中可以提高镇痛效果、减少镇痛药物用量及减轻其副作用.     

下肢游离皮瓣移植术患者超前镇痛的效果观察及护理

目的观察下肢游离皮瓣移植术患者术前应用塞来昔布,联合术后使用自控静脉镇痛的镇痛效果,总结护理经验。方法选择2011年7月—2013年6月在本院创伤骨科择期行下肢游离皮瓣移植术的患者120例,按手术时间随机分为单次给药组、双次给药组和常规给药组,每组40例。单次给药组在常规术后镇痛的基础上于术前2 h口服塞来昔布400 mg;双次给药组在单次给药组的基础上,术前24h增加口服塞来昔布400mg1次;常规给药组不进行超前给药,只使用常规术后镇痛方法。结果 3组患者术后各时点芬太尼使用总量以及镇痛药物不良反应发生率差异均无统计学意义(P0.05)。单次给药组和双次给药组术后8 h开始疼痛评分显著低于对照组(P0.05)。单次给药组和双次给药组患者满意度显著高于对照组(P0.05)。结论下肢游离皮瓣移植术患者术前应用塞来昔布,联合术后使用自控静脉镇痛的镇痛效果明显优于常规镇痛,能显著提高患者的舒适度及满意度。由于单次给药组和双次给药组在疼痛评分、药物不良反应发生率方面无统计学差异,而单次给药组在给药次数及减少患者医疗费用方面有其优势,笔者建议临床使用单次给药的方式。     

羊膜移植术与自体角膜缘干细胞移植术治疗翼状胬肉的效果比较

目的比较羊膜移植术与自体角膜缘干细胞移植术对翼状胬肉患者术后屈光状态、美容效果的影响及安全性。方法选取84例翼状胬肉患者作为研究对象,采用随机数字表法分为对照组和观察组,每组42例。对照组采用翼状胬肉切除联合自体角膜缘干细胞移植术治疗,观察组采用翼状胬肉切除联合羊膜移植术治疗,比较2组患者手术前后视力、屈光度情况,并比较2组创面愈合时间、术后并发症发生情况和美容效果。结果术后1周、1个月时, 2组视力均高于术前,屈光度均低于术前,差异有统计学意义(P0.05); 2组术后1个月时的视力、屈光度与术后1周时比较,差异无统计学意义(P0.05);术前、术后1周、术后1个月时, 2组间视力、屈光度比较,差异无统计学意义(P0.05)。观察组创面愈合时间长于对照组,复发率高于对照组,差异有统计学意义(P0.05)。2组总并发症发生率比较,差异无统计学意义(P0.05)。结论羊膜移植术、自体角膜缘干细胞移植术均为翼状胬肉安全有效的手术治疗方法,均可促进患者视力恢复,改善角膜屈光状态,但相较于羊膜移植术,自体角膜缘干细胞移植术可促进创面愈合,降低翼状胬肉术后复发率,获得满意的美容效果。     

针刺内麻点联合塞来昔布超前镇痛对全膝关节置换术后VAS疼痛评分及IL-6含量的影响

目的:探讨针刺内麻点联合塞来昔布超前镇痛对全膝关节置换(TKA)术后患者疼痛及炎性因子的影响。方法:选取2016年1~11月我院收治的45例单侧膝关节置换患者,随机分成针刺内麻点联合塞来昔布组(A组)、针刺非内麻点联合塞来昔布组(B组)和空白对照组(C组),每组15例。A组在术前3 d开始针刺内麻点并联合塞来昔布口服,B组在术前3 d开始针刺非内麻点(无关穴位)并口服塞来昔布,C组术前不作任何特殊处理。比较三组术前24 h及术后6、12、24、48 h的VAS疼痛评分,三组术前24 h及术后24 h白细胞介素-6的含量。结果:A组与B组术后VAS疼痛评分、白细胞介素-6含量均低于C组(P0.05),且A组显著低于B组(P0.05)。结论:针刺内麻点联合塞来昔布超前镇痛应用于全膝关节置换术后镇痛效果显著,能降低术后患者外周血中炎性因子的水平,其作用优于单纯使用塞来昔布镇痛。     

针刺内麻点联合塞来昔布超前镇痛对全膝关节置换术后患者VAS疼痛评分及IL-6含量的影响

目的:探讨针刺内麻点联合塞来昔布超前镇痛对全膝关节置换(TKA)术后患者疼痛及炎性因子的影响。方法:选取2016年1~11月我院收治的45例单侧膝关节置换患者,随机分成针刺内麻点联合塞来昔布组(A组)、针刺非内麻点联合塞来昔布组(B组)和空白对照组(C组),每组15例。A组在术前3 d开始针刺内麻点并联合塞来昔布口服,B组在术前3 d开始针刺非内麻点(无关穴位)并口服塞来昔布,C组术前不作任何特殊处理。比较三组术前24 h及术后6、12、24、48 h的VAS疼痛评分,三组术前24 h及术后24 h白细胞介素-6的含量。结果:A组与B组术后VAS疼痛评分、白细胞介素-6含量均低于C组(P0.05),且A组显著低于B组(P0.05)。结论:针刺内麻点联合塞来昔布超前镇痛应用于全膝关节置换术后镇痛效果显著,能降低术后患者外周血中炎性因子的水平,其作用优于单纯使用塞来昔布镇痛。     

Effect of analgesia administration timing on early post-operative period characteristics: a randomized, double-blind, controlled study

This study investigated the effect of time of analgesia administration in 64 patients undergoing total abdominal hysterectomy. Patients received standard general anaesthesia and were divided randomly into two equal groups. At the time of fascia closure, patients in the intra-operative (Iop) group received 0.5 mg/kg pethidine intravenously. On arrival in the post-anaesthesia care unit, the same dose of pethidine was given to patients in the post-operative (Pop) group. All patients then used a patient-controlled analgesia pump to administer pethidine analgesia as required. Times to extubation, response to verbal stimulation and orientation, post-operative pain scores and analgesic consumption were recorded. Times to extubation and response to verbal stimulation were significantly longer in the Iop group. Pain scores, analgesic consumption and additional analgesic requirements were significantly higher in the Pop group in the first 2 h post-operatively. In conclusion, intra-operative administration of pethidine provided better pain management than post-operative administration.     

A comparison of 50, 100 and 200 mg of intra-articular pethidine during knee joint surgery, a controlled study with evidence for local demethylation to norpethidine

Pethidine (meperidine) is a compound with both local anaesthetic and opioid agonist properties. We have in a recent study demonstrated that pethidine could be an interesting alternative to prilocaine in arthroscopy with local anaesthetic technique. Therefore, we investigated, in a controlled randomized double-blind study, the effect of three doses of pethidine compared with a standard local anaesthetic, in patients subjected to arthroscopic knee joint surgery. Ten patients in each group received 50 mg (P50), 100 mg (P100), 200 mg (P200) of pethidine or prilocaine (5 mg/ml) + adrenaline (4 mg/ml) (PC), injected intra-articularly (i.a.) before surgery. We measured pain intensity and discomfort during arthroscopy and pain intensity at rest and at movement, nausea and tiredness for 3 days post-operatively at regular intervals using the VAS-technique. We also measured the concentration of pethidine and its demethylated metabolite, norpethidine, in plasma by collecting blood samples at 20, 40, 60, 80, 140 and 200 min following injection, and in synovial fluid which was collected through the arthroscope at the start and the end of the surgery. It was found that significantly more patients in the P50 group (n = 6) needed general anaesthesia due to intense pain than those in the P100 group (n = 1), P200 group (n = 0) or the PC group (n = 1). The PC group required significantly more analgesics and had a significantly higher calculated total sum of pain scores at movement post-operatively, than the other three groups. The P200 group more often reported tiredness post-operatively than the other three groups. We conclude that 100 or 200 mg pethidine i.a. produces satisfactory anaesthesia for surgery. There was a rapid transfer of pethidine from synovial fluid to plasma, resulting in plasma levels earlier reported to produce centrally mediated effects, such as analgesia and tiredness. We found much higher concentrations of norpethidine in the synovial fluid than in plasma, suggesting a local demethylation in the knee joint tissues. This site of drug oxidation has not earlier been demonstrated neither in vitro nor in vivo. The results suggest that pethidine given i.a. in the dose range of 50 to 200 mg results in analgesia due to both peripheral and central mechanisms. The significant systemic uptake of pethidine can cause unwanted side-effects.     

The effect of pre-operative lornoxicam and ketoprofen application on the morphine consumption of post-operative patient-controlled analgesia

We compared the efficacy of pre-operative intramuscular lornoxicam and ketoprofen for post-operative analgesia in patients undergoing abdominal hysterectomy. This randomized, double-blind, placebo-controlled, parallel-group study investigated 60 patients who received lornoxicam (group L, 8 mg), ketoprofen (group K, 100 mg) or saline (group C) 60 min before standard anaesthesia. All patients received patient-controlled analgesia (intravenous morphine) during the post-operative period. Visual analogue scale (VAS) scores recorded 2, 4, 6 and 12 h after surgery in groups L and K patients were significantly lower than in group C patients, and VAS scores at 2, 4 and 6 h in group L patients were significantly lower than those in group K patients. Morphine consumption in groups L and K was significantly lower than in group C. Pre-emptive administration of lornoxicam and ketoprofen effectively reduced post-operative pain and morphine consumption, and lornoxicam was more effective than ketoprofen in the early post-operative period.     

Comparison of the antiemetic efficacy of tropisetron and droperidol with patient-given tramadol

We compared the antiemetic efficacy of tropisetron versus droperidol in women given tramadol after total hysterectomy. Forty patients were randomly allocated to group 1 (n = 20, tropisetron 0.05 mg/kg intravenously) or group 2 (n = 20, droperidol 15 micrograms/kg intravenously). Tramadol infusion (intravenously), for post-operative analgesia, was started at fascia closure. Incidences of post-operative nausea and vomiting, pain intensity, tramadol use, and the need for a rescue antiemetic (metoclopramide 10 mg) were recorded 0 h, 2 h, 6 h, 12 h, 24 h and 48 h post-operatively. Vomiting and nausea incidences were reported fewer in group 1 than in group 2, but statistical significance was only reached for vomiting incidence 6 h post-operation. Tropisetron seems to have better antiemetic properties than droperidol in patients receiving tramadol because of the length of its duration of action. Further studies, investigating alternative ways of managing post-operative nausea and vomiting, and the use of tramadol for post-operative analgesia, are needed.     

术前口服曲马多在神经外科手术超前镇痛的应用

目的:观察颅脑手术病人术前口服不同剂量曲马多对术后镇痛的效果以及副作用的发生率,探讨曲马多用于神经外科手术超前镇痛的合理用量.方法:采用随机、双盲、平行对比的研究方法,择期神经外科全麻颅脑手术患者175例,随机分为三组:安慰剂组、曲马多100mg组、曲马多200mg组.各组药物分别于术前2h口服.所有病人术后采用相同剂量的曲马多PCA镇痛.于术后48h内定时观察VAS疼痛评分,记录镇痛药用量、副作用.结果:术后VAS疼痛评分各组间无统计学差异,术后4h内安慰剂组疼痛例数高于超前镇痛组(P＜0.05).口服曲马多各剂量组术后恶心呕吐发生率以曲马多200mg组较高.结论:口服曲马多用于神经外科手术有明确的超前镇痛作用,术前口服曲马多100mg术后镇痛效果好,术后恶心及呕吐发生率较低,是较适宜的术前口服剂量.     

多沙普仑和哌替啶治疗全麻苏醒期寒战的对比研究

目的：研究多沙普仑和哌替啶对于全麻后寒战患者的治疗效果及对苏醒质量的影响。方法将全麻苏醒期进入术后恢复室后发生寒战的51例全麻病人随机分三组治疗：多沙普伦针1.0 mg/kg （多沙普仑组）、哌替啶针0.5 mg/kg（哌替啶组）及0.9％氯化钠注射液（对照组）,比较三组患者的降低寒战分级、寒战终止率,并观察对镇静、镇痛的影响及不良反应发生率。结果治疗1 min、2.5 min和5 min后多沙普仑组和哌替啶组寒战等级相比对照组均有明显降低,差异均有统计学意义（H分别=18.97、24.96、30.85,P均＜0.05）。治疗1 min后,多沙普仑组和哌替啶组寒战终止率明显高于对照组,差异均有统计学意义（χ2=5.04、11.10,P＜0.05）。而哌替啶组24 h内恶心、呕吐的发生率明显高于多沙普仑组和对照组,经Fisher精确检验,差异均有统计学意义（P均＜0.05）。三组之间术后恢复室停留时间比较,差异无统计学意义（F=8.63,P＞0.05）。结论全麻术后寒战患者使用多沙普仑和哌替啶都有明显中止寒战效果,哌替啶会增加术后恶心呕吐的发生。对已经苏醒的患者,两药对全麻的恢复无明显影响。     

Relationship between plasma B-type natriuretic peptide and ventricular function in adult cardiac surgery patients

Plasma concentrations of B-type natriuretic peptide (BNP) were analysed during the peri- and post-operative periods in cardiac surgery patients, and the relationship between plasma BNP concentrations and various clinical parameters was explored. Thirty patients (17 women, 13 men) of age 54.5 +/- 17.1 years undergoing cardiac surgery between June 2004 and March 2005 were enrolled. Plasma BNP concentrations were measured pre-operatively, immediately post-operatively, and on the first, second, fourth and seventh post-operative days. On the first post-operative day, the BNP level was significantly increased but levels returned to baseline values by the seventh post-operative day. The pre-operative BNP level correlated with left ventricular ejection fraction and age, and the level 24 h after surgery correlated with left ventricular end-diastolic dimension and pre-operative BNP levels. These results showed that the plasma BNP concentration becomes markedly and acutely elevated after cardiac surgery, reflecting temporary ventricular dysfunction.     

The effect of weight loss, operation and parenteral nutrition on fat clearance in patients with colorectal cancer

1. Fractional fat clearance rate (K2) in 21 patients with colorectal cancer was studied using the intravenous fat tolerance test. 2. K2 showed a negative correlation with weight change (r = -0.736, P less than 0.001) with the tumour in situ. 3. Fourteen patients were retested 12 weeks after curative resection of their tumours. Eight of the fourteen patients had raised K2 values pre-operatively; in all these the K2 values were reduced post-operatively (pre-operative median 3.94%/min, range 2.63-7.20%/min, post-operative median 2.31%/min, range 1.57-5.36%/min, P less than 0.01 by Wilcoxon's signed rank test). A high pre-operative K2 value was associated with a large reduction in K2 post-operatively (r = -0.844, P less than 0.001). 4. Seven patients with relatively high K2 values received a pre-operative course of intravenous nutrition after which K2 values were significantly reduced (pre-feeding median 7.20%/min, range 4.72-12.12%/min, post-feeding median 4.44%/min, range 2.17-6.83%/min, P less than 0.05).     

Addition of ketamine to propofol–fentanyl anaesthesia can reduce post-operative pain and epidural analgesic consumption in upper abdominal surgery

The aim of this study was to confirm whether intravenous anaesthesia supplemented with the N-methyl- -aspartate (NMDA) antagonist ketamine could reduce post-operative pain after elective open cholecystectomy. Fifty patients were randomised double-blind to one of the following two groups: PF Group received propofol and fentanyl supplemented with saline infusion; PFK Group received propofol and fentanyl supplemented with ketamine (total dose 2 mg/kg). During the first 48 post-operative hours, epidural analgesia was provided for all patients with patient-controlled epidural analgesia (PCEA) using 0.125% bupivacaine and morphine (0.05 mg/ml). Pain assessments at rest and movement, and cumulative PCEA volume consumed, were recorded at 5, 24 and 48 h post-operatively. The visual analogue scale (VAS) scores at rest were significantly less in the PFK Group than in the PF Group at 5, 24 and 48 h (P<0.001, P<0.001 and P=0.02, respectively). The VAS score at movement were also significantly (P<0.001) less throughout this study than in the PF Group. The difference in PCEA analgesic consumption at 0–5 and 5–24 h reached statistical significance (P<0.001 and P=0.008, respectively). Our results show that an intra-operative ketamine dose provides advantages for post-operative analgesia beyond its duration of action after an open cholecystectomy.     

An evaluation of clinical aspects of post-operative autotransfusion, either alone or in conjunction with pre-operative aspirin, in cardiac surgery.

Two groups of 21 otherwise healthy patients undergoing coronary artery bypass grafting (CABG) for the first time were studied in order to evaluate the advantages and disadvantages of post-operative autotransfusion using a red cell 'salvage' method. Group 1 patients (control group) were transfused using donor blood only. Group 2 patients were transfused with their own (autologous) blood, salvaged post-operatively, although donor blood was also available to them if needed. The two groups were further subdivided according to whether the patients received aspirin pre-operatively or not. The four subgroups thus formed were comparable pre- as well as intra-operatively, with respect to all available clinical and laboratory criteria. The post-operative data, however, showed that the combination of pre-operative aspirin and autotransfusion leads to excessive post-operative bleeding, together with increased donor blood requirement. It was also shown that autotransfusion without aspirin does reduce the need for donor blood transfusion without any increase in post-operative bleeding. Although aspirin alone did not increase post-operative bleeding or donor blood requirement, its combination with autotransfusion should be avoided.