International journal of clinical practice
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In a previous report the effectiveness of intraperitoneal bupivacaine in reducing pain following laparoscopic cholecystectomy was demonstrated. Other methods of pain relief are commonly used but none has been compared following laparoscopic cholecystectomy. In two further studies we have compared the analgesic effect of intraperitoneal bupivacaine against wound infiltration with bupivacaine, and against intraperitoneal bupivacaine with the addition of a non-steroidal anti-inflammatory drug (NSAID) in patients undergoing laparoscopic cholecystectomy. ⋯ There was no difference in pain scores in the two groups in either study. Intraperitoneal bupivacaine is as effective as wound infiltration. The addition of an NSAID makes no difference in the reduction of postoperative pain following laparoscopic cholecystectomy.
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An anonymous questionnaire-based study was devised to examine the role of preoperative assessment of patients by pre-registration surgical house officers. One hundred and eight patients awaiting elective surgery were entered into the study. ⋯ More than 25% of patients who stated that the benefits of their operation had been explained cited the PAC as the source; 45% of patients who believed the risks of their surgery had been provided felt the PAC had been the only source of this explanation. It was concluded that preoperative assessment clinics are an efficient and effective means of providing patients with valuable information about their operation.
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Int. J. Clin. Pract. · Jul 1997
Case ReportsSuicide attempt due to metoclopramide-induced akathisia.
Akathisia as a side-effect of metoclopramide has received increasing attention in consultation-liaison psychiatry in recent years. A case of metoclopramide-induced akathisia resulting in a suicide attempt is reported in order to highlight the suffering of such patients and the factors that lead to misdiagnosis.
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Int. J. Clin. Pract. · Jul 1997
The impact of pre-clerking clinics on surgical operation cancellations: a prospective audit.
Pre-clerking of all patients undergoing elective general surgical operations was introduced at our hospital in an attempt to reduce an unacceptably high operation cancellation rate. A prospective audit has been performed on the effect of this policy on the cancellation rate. Before the introduction of pre-clerking there was a marked seasonal variation in the number of patients who failed to attend for surgery, which could be explained by absence on holiday. This seasonal variation disappeared after the start of pre-clerking clinics, but there has been no reduction in the number of cancellations for medical reasons.