Journal of the Royal College of Surgeons of Edinburgh
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The severity of postoperative pain after thoracotomy means that total analgesia cannot be achieved with a single method or agent without significant side-effects. Recent advances in our understanding of the mechanism of pain generation and maintenance mean that measures prior to surgery greatly affect the requirement for postoperative analgesia. We review the methods available for post-thoracotomy analgesia in the light of our knowledge of peripheral and central mechanisms of neuronal hypersensitivity. The combination of opiate premedication, preoperative non-steroidal anti-inflammatory drugs (NSAIDs), preincisional regional block and postoperative continuous paravertebral block together with NSAIDs may be the ideal combination for near total analgesia following thoracotomy.
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J R Coll Surg Edinb · Apr 1993
Review Clinical TrialCombined predeposit and salvage autotransfusion in elective aortic aneurysm repair.
In this study assessing the safety and value of the routine use of autotransfusion in elective aortic aneurysm surgery, the first 16 patients (control group) received homologous transfusion only, while the subsequent 38 patients (autotransfusion group) received a combination of predeposit and salvage autotransfusion (Solcotrans device). Between 1 and 3 units of blood were venesected preoperatively, and a median of 0.80 (0.20-2.75) litres of unwashed shed blood was salvaged and re-infused (48% of the measured blood loss). ⋯ There were no haematological or biochemical complications. Predeposit and salvage autotransfusion is simple and safe, and reduces banked blood requirement in aortic aneurysm surgery.
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J R Coll Surg Edinb · Apr 1993
Removal of metal implants after fracture surgery--indications and complications.
In a study of 297 internal fixation operations for fractures or joint injuries performed during 1982, a second operation for implant removal was undertaken in 42% of cases. Significant complications occurred following the second procedure in 19%. Implants which were retained did not give rise to appreciable problems. It is suggested that implants should only be removed when there are clear clinical indications for doing so.