Annals of the Royal College of Surgeons of England
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Ann R Coll Surg Engl · Sep 1994
Clinical Trial Controlled Clinical TrialPrevention of phantom pain after major lower limb amputation by epidural infusion of diamorphine, clonidine and bupivacaine.
Phantom limb pain may appear in up to 85% of patients after amputation. There is no effective treatment. Perioperative epidural infusion of morphine and bupivacaine, alone or in combination, is effective in preventing phantom limb pain in patients with pre-existing limb pain. ⋯ At 1 year follow-up, one patient in the study group and eight patients in the control group had phantom pain (P < 0.002) and two patients in the study group versus eight patients in the control group had phantom limb sensation (P < 0.05). There was no significant improvement in stump pain. We conclude that perioperative epidural infusion of diamorphine, clonidine and bupivacaine is safe and effective in reducing the incidence of phantom pain after amputation.
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Ann R Coll Surg Engl · Sep 1994
The acute surgical admission: is mortality predictable in the elderly?
Most scoring systems used to predict mortality are complex. A simple preoperative assessment, the Sickness Assessment (SA), was evaluated as a predictor of mortality in elderly patients admitted as surgical emergencies. The three parameters comprising the SA are: hypotension on admission, the presence of severe chronic disease, whether the patient was independent and self-caring. ⋯ The predictive ability of the APACHE II score was not superior to SA. The SA is a simple preoperative assessment which identifies a high-risk group. It should be used in emergency surgical practice to improve outcome and avoid inappropriate surgery.
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A prospective study of the effectiveness of local anaesthesia in arthroscopy of the knee was performed in 212 consecutive patients. Arthroscopic surgery was undertaken successfully in 121 cases (57%), including meniscectomy and drilling of osteochondral defects. Dynamic evaluation of the patellofemoral joint articulation was possible and demonstration of pathological abnormalities was felt to be beneficial by some patients. ⋯ Only ten patients complained of moderate pain, none had severe pain. Local anaesthesia is contraindicated in cases with ipsilateral osteoarthritis of the hip or with significant synovitis of the knee. This technique is particularly suited to day case surgery.
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Ann R Coll Surg Engl · Sep 1994
Reduction in junior doctors' hours in an otolaryngology unit: effects on the 'out of hours' working patterns of all grades.
This study aimed to assess the effects of recent controls on juniors' duty hours (the 'New Deal') on the work performed by all grades of ENT medical staff 'out of hours'. For 100 days in 1993 the out of hours duties of all grades of doctor in the Otolaryngology Unit were monitored using daily logs. Three patterns of cover were run in parallel and subjected to comparison: Light: Senior House Officer (SHO)--Consultant (CON); Traditional: SHO-Intermediate (Registrar or Senior Registrar)--Consultant; Cross-cover--Pre-Registration House Officer (PRHO)--Intermediate-Consultant. ⋯ Reduction in on-call hours of junior staff resulted in a need for cross-cover and also in the frequent removal of an intermediate tier of staff. This has been shown to have a considerable effect on working patterns for intermediate and senior grades in an ENT unit of average size. Further reductions would be expected to have major effects on the working patterns of the consultant grade and considerably dilute the emergency experience of trainees.