The British journal of surgery
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Randomized Controlled Trial Comparative Study Clinical Trial
Postoperative pain and pulmonary complications: comparison of three analgesic regimens.
In a prospective study, patients undergoing cholecystectomy were randomly allocated to receive (a) intermittent intramuscular morphine (n = 25), (b) continuous intravenous morphine infusion (n = 25) or (c) epidural bupivacaine (n = 25) for postoperative pain relief. Morphine by intravenous infusion provided comparable pain relief to intermittent intramuscular morphine; there was no significant difference in the incidence of postoperative pulmonary complications. ⋯ Arterial oxygen tensions were also significantly higher in the epidural group for the first three postoperative days (P less than 0.05). Epidural analgesia was associated with a significant reduction in the incidence of pulmonary complications (P less than 0.01) and chest infection (P less than 0.05).
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Meckel's diverticula were removed from 49 adult patients during a 15 year period. In 24 (49 per cent) of the patients the diverticulum was the cause of symptoms while in the remaining 25 it was an incidental finding at laparotomy. ⋯ Heterotopic tissue was noted histologically in six Meckel's diverticula, all of which produced symptoms. The importance of considering a diagnosis of Meckel's diverticulum in the young adult presenting with acute small bowel obstruction or rectal bleeding is emphasized.