The Australian and New Zealand journal of surgery
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Randomized Controlled Trial Clinical Trial
The effect of incisional infiltration of bupivacaine upon pain and respiratory function following open cholecystectomy.
A controlled, prospective, double-blind trial of wound infiltration with bupivacaine in elective open cholecystectomy was performed to determine if this was an effective method of pain relief and reduced respiratory complications. Additionally, dextran was added to the bupivacaine in an attempt to prolong the effect. The solutions used were, bupivacaine alone 0.25% (n = 14), bupivacaine 0.25% with dextran 70 (n = 16) and saline (n = 16) as a control. ⋯ Pain was assessed using a visual analogue scale and narcotic usage, and respiratory function was assessed by spirometry, chest X-rays and arterial blood gases. The study did not demonstrate any objective improvement in either pain relief or respiratory function. This may reflect inadequate infiltration by the surgeons in the study or that infiltration should have been performed prior to incision.
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Comparative Study
Helicopter retrieval of primary trauma patients by a paramedic helicopter service.
All trauma cases flown over a 3.5 year period by the Metropolitan Helicopter Ambulance (MHA) from the accident scene to the Alfred Hospital were analysed. The MHA carries paramedics trained in advanced life support and is not under direct medical control. There were 254 patients (226 males, 28 females, mean age 34 years) of whom 242 had sustained blunt trauma. ⋯ Review of paramedic management identified four cases where prehospital care could have been improved but it is unlikely the final outcome would have changed: delay in transport (1 case), inadequate i.v. fluid resuscitation (2 cases) and delay in intubation (1 case). There was 1 case of undiagnosed tension pneumothorax that contributed to the patient's death and 1 case of non-intubation where the outcome may have been altered. Overall there were 38 deaths (14% mortality), which was not significantly different from the predicted mortality of 17%.(ABSTRACT TRUNCATED AT 250 WORDS)
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This survey aimed to determine what type of information patients want about the risks of postoperative pain management and whether this corresponded to the information that doctors and nurses wished to provide. Seventy-four patients scheduled for elective surgery, 50 nurses and 48 doctors completed a questionnaire asking about perceived risks of analgesia, level of acceptable risk and information that should be provided to patients. Compared to doctors and nurses, patients underestimated the risks associated with postoperative pain relief, except for the risk of drug addiction, which they rated higher. ⋯ Doctors were willing to accept a greater risk of minor side effects to achieve excellent pain relief than were patients. In contrast, patients were willing to accept a greater risk of serious side effects. The results obtained in this survey will facilitate the preparation of guidelines for obtaining informed consent from patients to receive postoperative analgesia.
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A ten year review of penetrating thoracic and abdominal trauma examined pattern of injury, patient management and outcome. Ninety-six patients were included in the study, 55 with injury to the abdomen, 31 the thorax and 10 with injury to both areas. Fifty-eight cases were managed non-operatively; 5 combined abdominal and thoracic injuries, 26 thoracic and 27 abdominal. ⋯ Of the 28 abdominal cases, nine were found on laparotomy to have no significant visceral or vessel injury, one, however, was performed for omentum protruding through the wound. While a negative laparotomy was a relatively safe procedure, non-operative management had the advantages of a shorter hospital stay without wound-related morbidity. Selective non-operative management was found to be a relatively safe approach in this series.
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A total of 76 patients with traumatic extradural haematoma were treated within a period of 3 years. Four patients developed delayed extradural haematomas. These cases are reported in view of the unusual sequence and the importance of early diagnosis.