Preoperative diclofenac sodium reduces postlaparoscopy pain

Post-laparoscopy pain can increase recovery time and delay patient discharge. While previous studies have focused on the problems of nausea and vomiting, the purpose of this study was to assess the effect of diclofenac (a non-steroidal antiinflammatory drug) in the treatment of post-laparoscopy pain. Diclofenac (50 mg) or placebo was administered pr randomly and double-blind, prior to induction of anaesthesia, to 46 women. Pain intensity was assessed by the patient using a visual analogue scale 1, 12 and 24 hr after surgery. Postoperative analgesic requirements and side effects were also studied. Diclofenac resulted in better pain relief at 24 hr (1.0 vs 2.5, P < 0.05) and reduced the number of patients who needed additional postoperative analgesics (7 vs 15, P < 0.05). There was no difference in the incidence of side effects. These data suggest that diclofenac reduces post-laparoscopy pain and postoperative analgesic requirements.     

Continuous Intracisternal and High Cervical Intrathecal Bupivacaine Analgesia in Refractory Head and Neck Pain

Background: The upper cervical component of the spinomesencephalic tract and cranial nerves V, VII (nervus intermedius), IX, and X are involved in mechanisms of acute and chronic pain from head and neck structures. To date there is no reliable method for relief of refractory pain (i.e., pain that cannot be relieved by conventional pharmacologic therapies) from these structures. Therefore, we explored continuous intracisternal infusion of bupivacaine for the treatment of refractory pain of the head and neck.

Methods: Intracisternal catheters were inserted in 13 adults with refractory nonmalignant (n = 4) and malignant (n = 9) pain from the head, face, mouth, neck, and upper extremities; 0.5% plain bupivacaine was infused continuously at rates of 1-7 (median 1.5) mg/h with optional bolus doses of 0.5-2.0 mg 4-2 times/h. The efficacy was assessed from pain relief (daily VASmax, VASmin, and VASmean scores 0-10), daily doses of intracisternal bupivacaine and total opioid (expressed as mg parenteral morphine-eq), amount of nocturnal sleep, and rates of adverse effects.

Results: The 13 patients were treated for 3-182 days (median 37, total 712 days), 3 patients being treated at home for 10-112 days (median 88, total 210 days). In one patient, the efficacy of the treatment could not be estimated because of advanced senility. Eleven of the remaining 12 patients obtained acceptable pain relief with daily doses of intracisternal bupivacaine ranging from 20 to 118 mg (median 37 mg): VAS sub mean scores decreased from 7 to 2, mean pain relief increased from 30% to 80%, total opioid daily dose decreased from 53 to 36 mg parenteral morphine-eq, and nocturnal sleep increased from 2 to > 6 h (all figures are median values). Speech, eating, walking, and natural functions were generally not affected. Side effects such as tiredness and malaise, somnolence and sleep, feeling of coldness in the neck and skull base, transient post-spinal puncture headache, paresthesias, hoarseness, dysphagia, transient paresis of the upper/lower extremities, episodic miosis and conjunctival hyperemia, and transient orthostatic arterial hypotension were each observed in one or two patients. No patient presented clinical evidence of phrenic nerve paralysis. There was no nausea or vomiting. No persistent neurologic deficit or death could be attributed to the intracisternal pain treatment.     

Plasma exudation in the skin measured by external detection of conversion electrons

A novel technique for measurement of plasma exudation in the skin is described. Transferrin labelled in vivo with indium-113m is used as a plasma tracer. The conversion electrons from^113mIn are detected with a polystyrene crystal mounted on a photomultiplier tube. Owing to the short range of the electrons in tissue, background radiation from tracer circulating in underlying tissue will be very small, allowing plasma exudation in the skin to be detected with a high signal to noise ratio. The characteristics of the detector system are described in model experiments using sheets of mylar to simulate soft tissue. The acute inflammatory response to histamine provocation was studied in guinea pig skin. A dose-related increase in count rate representing vasodilatation and plasma exudation was detected over the skin after histamine provocation. The electron radiation system appears suitable for detection of low levels of superficial radioactivity and for pathophysiological studies of the skin.     

Prospective Randomized Open Blinded End-point (PROBE) Study. A novel design for intervention trials

A novel design for intervention studies is presented, the so called PROBE study (Prospective Randomized Open, Blinded End-point). This design is compared to the classical double-blind design. Among the advantages of the PROBE design are lower cost and greater similarity to standard clinical practice, which should make the results more easily applicable in routine medical care. Since end-points are evaluated by a blinded end-point committee it is obvious that there should be no difference between the two types of trials in this regard.     

Embolization of Spinal Metastases Reduces Peroperative Blood Loss: 21 Patients Operated on for Renal Cell Carcinoma

We evaluated the peroperative blood loss in 21 patients who were treated with 29 operative procedures for thoracolumbar spinal renal cell carcinoma metastases. Embolization was undertaken prior to 11 operations. At posterior surgery the average blood loss was one third after embolization compared with when embolization had not been performed. The blood loss was also lower during anterior surgery, although this difference was smaller. We recommend that preoperative embolization should precede surgical treatment of spinal metastases of renal cell carcinoma where it can be anticipated that the operation will extend into the pathological tissue.     

Effect on fertilization of intra-peritoneal exposure of oocytes to carbon dioxide

Follicular aspiration is generally performed via laparoscopyafter creating a pneumoperitoneum with carbon dioxide (CO₂)Adverse effects on embryo development may occur following exposureto CO₂, which is known to cause a decrease in follicular fluidpH. Such a reduction in pH may affect fertilization and earlyembryonic development and this study was carried out to studythese effects. Oocytes obtained by laparoscopy were comparedwith those obtained under ultrasonic guidance to determine whetherCO₂ exposure had any adverse effect. The results suggest thatCO₂ may affect fertilization, but once this has occurred, thereis no effect of CO₂ on the rate of cleavage of the embryos.