Acceptable Pain Relief Research Articles

Cryohypophysectomy for the Relief of Pain in Malignant Disease

Fifty consecutive patients with metastatic carcinoma who underwent cryohypophysectomy were studied. Of these, 26 had breast cancer, 19 had prostatic cancer, one had malignant melanoma, one had cancer of the kidney, and three had metastatic adenocarcinoma from an unknown primary tumour. After cryohypophysectomy, excellent pain relief was obtained in 48% of patients, good or acceptable pain relief was obtained in 40%, and poor or no relief in 12%. Two patients died: one of aspiration pneumonia and one of an unknown cerebral cause. Sixteen patients developed diabetes insipidus, of whom three required therapy with vasopressin; eight patients developed a cerebrospinal fluid leak, two of whom required surgical repair; and four patients developed meningitis, which resolved in three after antibiotic therapy. Results are compared with those from other published reports. Pain relief from cryohypophysectomy is surmised to be due to the production of endorphins, but no proof of this is available.

Cryohypophysectomy for the relief of pain in malignant disease.

Fifty consecutive patients with metastatic carcinoma who underwent cryohypophysectomy were studied. Of these, 26 had breast cancer, 19 had prostatic cancer, one had malignant melanoma, one had cancer of the kidney, and three had metastatic adenocarcinoma from an unknown primary tumour. After cryohypophysectomy, excellent pain relief was obtained in 48% of patients, good or acceptable pain relief was obtained in 40%, and poor or no relief in 12%. Two patients died: one of aspiration pneumonia and one of an unknown cerebral cause. Sixteen patients developed diabetes insipidus, of whom three required therapy with vasopressin; eight patients developed a cerebrospinal fluid leak, two of whom required surgical repair; and four patients developed meningitis, which resolved in three after antibiotic therapy. Results are compared with those from other published reports. Pain relief from cryohypophysectomy is surmised to be due to the production of endorphins, but no proof of this is available.

ICLH Replacement of the Knee

Investigations which began in 1968 have culminated in a knee arthroplasty which can now be confidently used to treat most patients with arthritic knee deformities. Our earlier studies showed that a prosthetic knee arthroplasty must be reliably aligned and stabilized in extension, that patellar pain and polyethelene wear were significant potential problems and that loosening and sinkage of the tibial component must be avoided. Our present knee prosthesis and instrumentation if properly used should avoid these pitfalls. Beginning in January 1977 we performed 84 knee arthroplasties utilizing the present design. A series of 79 knees has been available for our computer-assisted review; 46 patients had a diagnosis of inflammatory arthritis and 29 had primary osteoarthrosis: 22 knees had been previously operated upon. Although all femoral components were fixed with polymethylmethacrylate, the tibial components were completely cemented in 21 knees, partially cemented in 20, and no cement was used in 38 cases. In these latter knees special pegs provided a mechanical interlock with the tibia for fixation. Thirty-six patellae were replaced, of which 11 were fixed with a similar interlocking peg. The arthroplasties failed in 8 patients. Of the remainder, 90% of knees had acceptable pain relief and all but 4 patients were able to walk outdoors. Flexion to 90 degrees or more was achieved in 85% of the knees. Only 2 patients had unacceptable alignment. To date we feel that with the use of this improved prosthesis, in conjunction with the instruments which allow proper placement of the prosthesis, the majority of arthritic knees can be successfully corrected. However, further careful long-term follow-up studies must continue.

AN ASSESSMENT OF THE ANALGESIC EFFECT IN LABOUR OF PETHIDINE AND 50 PER CENT NITROUS OXIDE IN OXYGEN (ENTONOX)

Summary The effectiveness in clinical practice of conventional analgesia, with pethidine and 50 per cent nitrous oxide in oxygen (Entonox) has been studied in 663 consecutive patients. More than 75 per cent of mothers stated that they had obtained little or no pain relief from pethidine in the manner in which it was administered. In comparison, nearly half the patients who received Entonox had satisfactory analgesia and the incidence of acceptable pain relief with both agents was unrelated to parity. The number of patients receiving satisfactory analgesia was disturbingly low.