Nickel dermatitis hazards from prostheses

This report reviews data relating to the nickel hazard from implanted prostheses. It is shown that nickel is released from stainless steel prostheses by the action of sweat, blood and physiological saline solution. In laboratory animals, solubilized nickel isn the tissue near the implant.     

Multimodal analgesia before thoracic surgery does not reduce postoperative paint

Several reports have suggested that preoperative nociceptiveblock may reduce postoperative pain, analgesic requirements,or both, beyond the anticipated duration of action of the analgesicagents. We have investigated, in a double-blind, placebo-controlledstudy, pre-emptive analgesia and the respiratory effects ofpreoperative administration of a multimodal antinociceptiveregimen. Thirty patients undergoing thoracotomy were allocatedrandomly to two groups. Before surgery, the treatment group(n = 15) received morphine 0.15 mg kg^–1 i.m. with perphenazine0.03mg kg^–1 i.m. and a rectal suppository of indomethacin100 mg, while the placebo group (n = 15) received midazolam0.05mg kg^–1 i.m. and a placebo rectal suppository. Afterinduction of anaesthesia, the treatment group received intercostalnerve block with 0.5% bupivacaine and adrenaline 1:200000 (3ml) in the interspace of the incision and in the two spacesabove and two spaces below. The placebo group received identicalinjections but with normal saline only. The treatment groupconsumed significantly less morphine by patient-controlled analgesiain the first 6 h after operation, but the total dose of morphineconsumed on days 2 and 3 after surgery was significantly greaterin the treatment group. There were no differences between thegroups in postoperative VAS scores (at rest or after movement),Pa_co2 values or postoperative spirometry. However, pain thresholdsto pressure applied at the side of the chest contralateral tothe site of incision decreased significantly from preoperativevalues on days 1 and 2 after surgery in both groups. The resultsof this study do not support the preoperative use of this combinedregimen for post-thoracotomy pain.