Pain after vasectomy

We studied the influence of the timing of injection of bupivacaine into the vas deferens on the intensity and duration of scrotal pain following vasectomy. Forty-two patients undergoing vasectomy under general anaesthesia were randomly allocated to have the operation performed on either the left or the right side first. On the first side to be operated upon, 5 ml bupivacaine 0.5% was infiltrated along the line of the scrotal incision. The vas deferens was identified and 1 ml bupivacaine 0.5% was injected into its lumen, with 0.5 ml directed proximally and 0.5 ml directed distally. After completion of the procedure on that side, the operation continued on the other side. On this occasion, the same dose of bupivacaine was injected into the vas deferens after division and ligation, and subcutaneously along the scrotal incision after skin closure. Median [interquartile range] visual analogue pain scores on the first side to be operated upon were significantly lower than on the second side on day 1 (7 [1.5–19] vs. 11 [2.5–47]) (p < 0.01) and day 7 (0 [0–8.5] vs. 0 [0–18.8]) (p < 0.05) postoperatively. The median [interquartile range] duration of postoperative discomfort was less on the first side operated upon than on the second (3 [1–7] vs. 6 [2–7]) (p < 0.01). Although statistically significant differences occurred between the treatment groups, the actual differences were small and may not be clinically significant.     

Economics of low-flow anaesthesia in children

We have measured the consumption of isoflurane and fresh gas flows in 77 infants and children during 20 all-day operating sessions using either the enclosed Mapleson A or the circle absorber mode of the Garden'Ventmasta'ventilator. The average consumption (SD) of isoflurane in 37 patients anaesthetised using the A mode of the Garden system with a mean fresh gas flow of 2.6l.min⁻¹ was 11.1 (4.2)g.h⁻¹, while that in 40 patients anaesthetised using the circle absorber mode with a mean fresh gas flow of 1.21.min⁻¹ was 4.7 (1.0)g.h⁻¹. These figures represent an overall saving of 58% in the use of isoflurane (p < 0.0001) and a mean reduction in fresh gas flow of 54% (p < 0.0001) as a result of using low-flow anaesthesia. With the addition of small bore breathing hoses the adult circle absorber system was practical to use in both infants and children. These findings should stimulate interest in the use of low-flow techniques in children.     

Recurrent respiratory depression after total intravenous anaesthesia with propofol and alfentanil

Since first commented upon by Lamarche in 1984, several cases of recurrent respiratory arrest after alfentanil infusions have been reported. In all these cases the alfentanil infusions have been used to supplement conventional anaesthetic techniques with nitrous oxide and/or inhalational agents and in most cases rather high total alfentanil doses have been administered. We have seen two cases of severe recurrent respiratory depression in healthy patients after relatively minor procedures performed under total intravenous anaesthesia with propofol–alfentanil infusions, air–oxygen ventilation and muscle relaxation, where the alfentanil doses administered were quite small. These cases are presented in detail and compared within a tabulated presentation with the earlier published cases of alfentanil-related recurrent respiratory depression.     

Peribulbar anaesthesia using a mixture of local anaesthetic and vecuronium

The aim of this double-blind, randomised study was to assess the effects of the addition of 0.5 mg of vecuronium bromide to a standard local anaesthetic mixture used for peribulbar anaesthesia. We studied 60 patients undergoing regional anaesthesia for intra-ocular surgery and were primarily interested in the quality of globe and lid akinesia. All received a mixture of 5 ml 2% lignocaine with 1:200 000 adrenaline, 5 ml 0.75% bupivacaine and 150 IU hyaluronidase with either 0.9% saline 0.25 ml (group A, n  = 30) or vecuronium bromide 0.25 ml (0.5 mg) (group B, n  = 30). Eye movements assessed at both 5 and 10 min were significantly reduced in the vecuronium group (group B) (p < 0.05). We conclude that the addition of vecuronium at a dose of 0.5 mg to the standard local anaesthetic mixture improves the quality of globe and lid akinesia.