Postoperative Visual Analogue Pain Scores Research Articles

Intrathecal hydromorphone added to hyperbaric bupivacaine for postoperative pain relief after knee arthroscopic surgery

Adding opioid to spinal anaesthetic provides additional analgesia during the postoperative period. The purpose of this study was to determine the dose of intrathecal hydromorphone necessary to achieve postoperative pain relief after arthroscopic knee surgery. In a prospective, double-blinded parallel, placebo-controlled manner, 60 patients who were undergoing unilateral knee arthroscopy randomly received unilateral spinal anaesthesia with 0.5% hyperbaric bupivacaine 6 mg combined with 0.0, 2.5, 5.0 or 10.0 μg per 0.05 ml hydromorphone. Fifteen patients were assigned to receive each dose. The visual analogue pain scores (VAPSs) were measured at 30 min and 2, 4, 6, 12 and 24 h postoperatively, and the side-effects of hydromorphone were recorded. The postoperative VAPSs at 4, 6 and 12 h for the 5 and 10 μg hydromorphone groups were significantly decreased, compared to the control group. The 2.5 μg hydromorphone group had lower VAPS only at 4 and 6 h postoperatively. Nausea was significantly increased in the 10 μg hydromorphone group (46.6%). The analgesic effects of 5 and 10 μg intrathecal hydromorphone provided satisfactory pain relief for 12 h postoperatively and nausea increased significantly in a dose-dependent manner.

Ultrasound-guided transversus abdominis plane block does not improve analgesia after elective caesarean section when intrathecal diamorphine is used-A randomised double-blind controlled trial

Context: Previous studies comparing transversus abdominis plane (TAP) block and opioids for postoperative analgesia for caesarean section under spinal anaesthesia have been performed in the absence of a long-acting intrathecal opioid or with intrathecal morphine. In our unit, we use spinal diamorphine for caesarean sections under spinal anaesthesia. We wished to establish whether the performance of ultrasound-guided TAP blocks should be introduced into routine practice. Materials and Methods: Following local ethics committee approval, 53 parturients presenting for elective caesarean section were recruited. All patients received a spinal anaesthetic with 0.5% heavy bupivacaine and 300 mcg diamorphine. The study was completed by 48 patients who were randomised to undergo postoperative TAP blocks with 20 mL to each side of either 0.25-0.5% bupivacaine (n = 23) or normal saline (n = 25). Standard postoperative analgesia comprised of regular diclofenac and paracetamol, and subcutaneous morphine on request via an indwelling subcutaneous cannula. A blinded investigator assessed each patient at 2, 6, and 24 h postoperatively. Results: There were no statistically significant differences in postoperative morphine requirements or visual analogue pain scores between the two groups. The incidence of side effects was similar. Conclusions: We conclude the ultrasound-guided TAP block does not improve analgesia following elective caesarean section under subarachnoid block with intrathecal diamorphine and its routine implementation during utilisation of a multimodal analgesic regimen may not be beneficial.

High tibial osteotomy in medial compartment osteoarthritis and varus deformity using the Taylor spatial frame: early results

We report the early results of high tibial osteotomy (HTO) in medial compartment osteoarthritis (OA) and varus deformity using the Taylor spatial frame (TSF). Between October 2005 and April 2007, 9 patients with medial compartment OA and varus deformity underwent TSF application and medial opening wedge HTO. Pre- and post-operative Oxford knee scores, SF-12 and visual analogue pain scores were recorded along with radiographic outcomes. Median follow-up was 19 months (range 15–35). Mean age at operation was 49 years (range 37–59). The median time spent in the frame was 18 weeks (range 12–37). The mean preoperative Oxford knee score was 28.7. This improved to a mean of 35.4 post-operatively (P = 0.0142). 6 (67%) patients had a documented pin-site infection. With TKR as an end point, the survival rate of HTOs was 88.9% at a median of 19 months follow-up. This study demonstrates that in selected patients the TSF provides a viable treatment option for performing HTO in medial compartment OA with varus deformity.

Intrathecal Morphine Analgesia in Idiopathic Scoliosis Surgery

We previously determined the intrathecal morphine optimal dose to maximize analgesia in patients undergoing idiopathic scoliosis surgery while minimizing adverse effects. Our purpose was to determine if this protocol was equally effective across sex and racial groups. We studied 287 patients given a moderate dose of intrathecal morphine of 9 to 19 μg/kg (mean 14 μg/kg): 240 female and 47 male patients and 224 White (W) and 63 African-American (AA) patients. Factors analyzed included postoperative visual analog pain scores (VAS), time to first opioid dose, total morphine over the first 48 hours, and postoperative complications of respiratory depression requiring pediatric intensive care unit (PICU) admission, nausea/vomiting and pruritis. For female and male patients, mean VAS pain scores in postanesthesia care unit (PACU) were 0.48 ± 1.14 and 0.56 ± 1.16, mean times to first opioid dose were 16.65 ± 4.38 and 16.72 ± 4.97 hours, and total morphine over the first 48 hours were 1.49 ± 0.53 and 1.49 ± 0.58 mg/kg, respectively. Respiratory depression and PICU admission occurred in 10 of 240 female (4.1%) and 3 of 47 male (6.4%) patients. Minor complications of nausea/vomiting and pruritis occurred in 78 of 240 female (31.7%) and 12 of 47 male (25.5%) patients. For W and AA patients, mean VAS pain scores in PACU were 0.48 ± 1.10 and 0.46 ± 1.13, mean times to first opioid dose were 16.53 ± 3.77 and 17.12 ± 6.05 hours, and total morphine over the first 48 hours were 1.54 ± 0.53 and 1.30 ± 0.53 mg/kg, respectively. Respiratory depression and PICU admission occurred in 9 of 224 W (4.0%) and 4 of 63 AA (6.3%) patients. Nausea/vomiting and pruritis occurred in 77 of 224 W (34.4%) and 11 of 63 AA (17.5%) patients, respectively. Intrathecal morphine results in safe and effective for postoperative pain relief in patients undergoing surgery for idiopathic scoliosis irregardless of sex or race. III, retrospective comparative study.

Distal Tibiofibular Syndesmosis Reconstruction Using a Free Hamstring Autograft

Chronic instability of the distal tibiofibular syndesmosis and its treatment is infrequently described in the literature. We report our results for treating this condition with a reconstruction based on restoration of near normal anatomy with a hamstring autograft. Eight patients, who had chronic distal tibiofibular syndesmosis instability diagnosed arthroscopically underwent reconstruction of the distal anterior tibiofibular ligament and the transverse interosseus ligament using a free semi-tendinosis hamstring autograft. A radiographic and clinical review of the patients was performed. The average followup was 39 (range, 9 to 86) months. The postoperative visual analogue pain score was 19 out of 100 compared to 73 out of 100 preoperatively. The postoperative mean AOFAS score was 85.4 (range, 49 to 100), the SF-36 score was 81 (range, 56 to 92) and the Maryland foot score was 89.3 (range, 63 to 100). Chronic instability of the distal tibiofibular syndesmosis is an infrequent problem but disabling when it occurs. Our results show an improved VAS score for pain, improved swelling and instability symptoms as well as SF-36, AOFAS and Maryland scores. We would recommend this method to reconstruct the anterior tibiofibular ligament and the transverse interosseus ligament which has failed to respond to debridement alone.

Indications and Outcomes for Surgical Treatment of Patients with Chronic Migraine Headaches Caused by Occipital Neuralgia

Occipital neuralgia is a headache syndrome characterized by paroxysmal headaches localizing to the posterior scalp. The critical diagnostic feature is symptomatic response to local anesthetic blockade of the greater or lesser occipital nerve. Further characterization is debated in the literature regarding the diagnosis and optimal management of this condition. The authors present the largest reported series of surgical neurolysis of the greater occipital nerve in the management of occipital neuralgia. A retrospective chart review was conducted to identify 206 consecutive patients undergoing neurolysis of the greater or, less commonly, excision of the greater and/or lesser occipital nerves. A detailed description of the procedure is presented, as is the algorithm for patient selection and timing of surgery. Preoperative and postoperative visual analogue pain scores and migraine headache indices were measured. Success was defined as a reduction in pain of 50 percent or greater. Of 206 patients, 190 underwent greater occipital nerve neurolysis (171 bilateral). Twelve patients underwent greater and lesser occipital nerve excision, whereas four underwent lesser occipital nerve excision alone. The authors found that 80.5 percent of patients experienced at least 50 percent pain relief and 43.4 percent of patients experienced complete relief of headache. Mean preoperative pain score was 7.9 +/- 1.4. Mean postoperative pain was 1.9 +/- 1.8. Minimum duration of follow-up was 12 months. There were two minor complications. Neurolysis of the greater occipital nerve appears to provide safe, durable pain relief in the majority of selected patients with chronic headaches caused by occipital neuralgia.

Prospective randomized double-blind placebo-controlled trial of postoperative elastomeric pain pump devices used after laparoscopic ventral hernia repair

The laparoscopic repair of ventral hernias can result in significant postoperative pain necessitating a prolonged hospital stay, increased narcotic use, and patient dissatisfaction. Elastomeric pain pump devices with local analgesics may significantly reduce postoperative discomfort after laparoscopic ventral hernia repair. This prospective randomized, double-blind, placebo-controlled study evaluated the effect of local anesthetic continuously infused with an elastomeric pain pump device to reduce postoperative pain. After institutional review board approval of the study, all patients undergoing laparoscopic ventral hernia repair consented to participate. Standardized technique included routine transfascial fixation sutures and titanium spiral tacks. Elastomeric pain pumps were placed percutaneously just above the mesh in the hernia sac. For 48 h postoperatively, 100 ml of continuous 0.5% Marcaine or normal saline was used at 2 ml/h. Postoperatively, the patients were evaluated every 8 h for the first 72 h, then after 2 weeks, 6 weeks, and 3 months for pain scores, narcotic usage (both oral and intravenous), return of flatus, length of hospital stay, and postoperative complications. Of the 73 patients enrolled in the study, 37 received 0.5% Marcaine, and 36 received placebo. Despite randomization, the control group had significantly more obese patients (mean body mass index [BMI], 39 vs. 33 kg/m(2); p = 0.005), and more recurrent hernias (40% vs. 19%; p = 0.05), and also tended to have more prior hernia repairs (0.8 vs. 0.3; p = 0.06). There were no significant differences between the two groups in terms of operative times (p = 0.7), hernia size (p = 0.9), mesh size (p = 0.6), number of transfascial fixation sutures (p = 0.4), or number of spiral tacks (p = 0.13). Postoperative visual analog pain scores, usage of oral or intravenous narcotics, and morphine equivalents were similar between the two groups at all study points (p > 0.05). There were no significant differences between the two groups based on return of bowel function, toleration of a regular diet, or length of hospital stay. No postoperative complications directly related to the catheter were observed. This prospective randomized double-blind, placebo-controlled trial showed no advantage of an elastomeric pain pump device in terms of providing a measurable reduction in postoperative pain scores, narcotic use, time to return of bowel function, or length of hospital stay after laparoscopic ventral hernia repair. Further studies are warranted to determine other alternatives for reducing postoperative pain after laparoscopic ventral hernia repair.

Dorsal Radiocarpal Ligament Capsulodesis for Chronic Dynamic Lunotriquetral Instability

Chronic lunotriquetral (LT) instability (persisting >3 months after injury) can be treated with a variety of surgical methods (LT fusion, ligament repair or reconstruction, or arthroscopic debridement), with varying degrees of success. We retrospectively evaluated the results of dorsal capsulodesis using the dorsal radiocarpal ligament in an attempt to reinforce the dorsal LT interosseous ligament in patients with chronic dynamic LT instability. A total of 11 patients (mean age, 37 years) with persistent posttraumatic wrist pain and weakness were diagnosed with dynamic LT instability (positive LT ballotment test, disruption of Gilula's lines or volar intercalated segment instability deformity on stress radiography, arthroscopic findings of Geissler grade 3, or 4 LT tears). They were treated consecutively with dorsal capsulodesis. We used subjective and functional outcome measures to evaluate the results. The mean follow-up period was 31 months (range, 12-65 months). The postoperative visual analog pain score and Mayo wrist score were significantly improved compared with their preoperative values. The average grip strength increased by 5 kg, and the average range of wrist flexion was reduced by 3 degrees . In this small series, in the short term, dorsal radiocarpal ligament capsulodesis reduced pain and instability and improved function in patients with chronic dynamic LT instability. Therapeutic IV.

Randomized Trial of Laparoscopic v Open Nephrectomy

Clayman and associates first described laparoscopic nephrectomy in 1990. This paper describes the first randomized controlled trial to compare laparoscopic with open surgery for simple and radical nephrectomy. Between 2001 and 2004, 45 patients requiring simple or radical nephrectomy (tumors as large as 8 cm) were randomized to either open surgery through a loin incision or laparoscopic nephrectomy (transperitoneal). Outcome measures included operative time, complications, hospital stay, pain scores, time to return to normal activities, and quality of life scores (EuroQol). The mean operative time was 105 minutes in the laparoscopic group and 93 minutes in the open-surgery group (P = 0.4). Blood loss, complications, and the mortality rate were similar in the two groups, as was the hospital stay at a median of 4 days in the laparoscopic group and 5 days in the open group (P = 0.9). Postoperative visual analog pain scores averaged 3.6 in the laparoscopic group compared with 5.4 in the open group (P = 0.02). There was no difference in pain scores at 3 months. Return to normal activities was faster in the laparoscopic group at 42 days v 62 days in the open group (P = 0.04). Laparoscopic nephrectomy is associated with less postoperative pain and a faster return to normal activities than open nephrectomy.

Limitations of Laparoscopy for Bilateral Nephrectomy for Autosomal Dominant Polycystic Kidney Disease

We retrospectively studied outcomes following bilateral hand assisted laparoscopic nephrectomy. We retrospectively reviewed the charts of 18 patients with symptomatic autosomal dominant polycystic kidney disease who underwent bilateral hand assisted laparoscopic nephrectomy. Preoperative radiographic imaging was reviewed retrospectively to determine kidney size based on an ellipsoid shape. A visual analog pain scale with scores of 0 to 10 to assess pain related to autosomal dominant polycystic kidney disease was measured preoperatively and postoperatively. Average patient age was 48.2 years (range 30 to 64). Of the patients 14 successfully underwent bilateral hand assisted laparoscopic nephrectomy, while 4 required open conversion. A total of 16 patients underwent nephrectomy for pain and 2 underwent surgery for frequent recurrent symptomatic urinary tract infections. All patients except 1 underwent renal transplantation before bilateral nephrectomy. There was a significant difference in the volume of the right and left kidneys between the hand assisted laparoscopic and open groups (mean +/- SD 1,043 +/- 672 and 1,058 +/- 603.8 vs 4,052 +/- 548 and 3,592 +/- 1,752 cm(3), p <0.001 and 0.06 respectively). There were 5 complications, including wound infection and protracted ileus in 2 patients each, and incisional hernia in 1. In addition, the difference in mean preoperative and postoperative visual analog pain scores was statistically significant (6.9, range 3 to 10 and 0.5, range 0 to 2, p <0.05). Bilateral laparoscopic hand assisted nephrectomy is a safe and reliable option in patients requiring removal of the 2 kidneys in a single setting. Rather than performing staged nephrectomies, hand assisted laparoscopic nephrectomy allows the single administration of general anesthesia and provides effective relief of bothersome symptoms in patients with symptomatic autosomal dominant polycystic kidney disease. This procedure is safe in patients with renal transplants. Patients with massive polycystic kidneys with a kidney volume of greater than 3,500 cc are at increased risk for open conversion and they may have improved outcomes if open nephrectomy is attempted from the outset.

Measured FEV1 in the first postoperative day, and not ppoFEV1, is the best predictor of cardio-respiratory morbidity after lung resection☆

There is a low correlation between predicted postoperative FEV1 (ppoFEV1) and FEV1 measured the days after pulmonary resection, when most complications are developed. The hypothesis of this investigation is that ppoFEV1 does not predict postoperative morbidity in patients undergoing lung resection when immediate postoperative FEV1 is considered in the predictive model. One hundred ninety-eight consecutive patients undergoing lobectomy or pneumonectomy were included in a prospective, multiinstitutional study. age, body mass index, ppoFEV1, surgical approach (VATS or muscle-sparing thoracotomy), type of analgesia (epidural or intraveous), postoperative visual analogue pain score and FEV1 measured the day after the operation. Target variable: occurrence of postoperative cardio-respiratory complications. Method of analysis: classification tree (CART) dividing the population at random in two subsets and developing a bootstrap set of 100 trees resampling training data. The relative importance of each variable and the accuracy of both initial and committee trees to predict the outcome were presented. One hundred seventy-seven lobectomies and 21 pneumonectomies were included. Overall cardio-respiratory morbidity was 22%. According to CART results, first day FEV1 was the most important variable to classify cases as primary splitter and as a surrogate of each primary splitter (100% importance). Patient age followed (51%) and ppoFEV1 was third (43%) with a score similar to postoperative pain score (42%) and type of analgesia (36%). Sensitivity and specificity of the initial tree were, respectively, 0.5 and 0.7; values for committee tree were 0.5 sensitivity and 0.7 specificity. Postoperative cardio-respiratory complications are more related to FEV1 measured in the first postoperative day than to ppoFEV1 value.

Does remifentanil-based anesthesia cause acute opioid tolerance?

INTRODUCTION: The development of acute opioid tolerance with potent short-acting opioids such as remifentanil is described in animal studies, but the results of clinical studies are controversial. Remifentanil-based anesthesia is commonly used at our hospital to facilitate neurophysiologic monitoring during scoliosis surgery. We compared postoperative morphine consumption and visual analogue pain scores in children receiving remifentanil/propofol or morphine/propofol anesthesia for scoliosis surgery.

The preoperative administration of ketoprofen improves analgesia after laparoscopic cholecystectomy in comparison with propacetamol or postoperative ketoprofen

Non-opioid analgesics, paracetamol and non-steroid anti-inflammatory drugs (NSAIDs) are proposed for pain relief after laparoscopy. We compared perioperative propacetamol (P) and ketoprofen (K) to provide analgesia after laparoscopic cholecystectomy. After ethical committee approval, we included 104 ASA I-II patients, without preoperative analgesic drugs, who were scheduled to undergo laparoscopic cholecystectomy. Anaesthesia was standardized using propofol, fentanyl, atracurium, isoflurane and N(2)O 50%. Ketoprofen 100 mg or propacetamol 2 g or a saline drip (a 100-ml unit of saline in 10 min) was infused blindly and randomly. Patients received either ketoprofen (group K1) or propacetamol (group P1) before induction of anaesthesia and saline after surgery, or saline before surgery and ketoprofen (group K2) or propacetamol (group P2) after surgery. Postoperative visual analogue pain scores (VAS 0-100 mm) were recorded during 24 h. If VAS was >30, a second dose (placebo, ketoprofen or propacetamol) was infused. Nalbuphine 0.2 mg kg(-1) i.v. was given as rescue analgesic if VAS was > or =50. Ninety-eight patients were studied The number of patients not requiring the second analgesic was greater in K1 (33.5%) than the others (K2 0%, P1 0%, P2 7.5%). VAS scores were significantly lower in K1 (P=0.001), with less nalbuphine consumption compared with P1. VAS and opioid request were similar in K2 and P2. Preoperative administration of ketoprofen improves postoperative analgesia after laparoscopic cholecystectomy compared with its postoperative administration and pre- and postoperative propacetamol.

The analgesic and sedative effects of intrathecal midazolam in perianal surgery

Our purpose was to evaluate the analgesic and sedative effects of intrathecal midazolam when added to spinal bupivacaine in patients undergoing perianal surgery under spinal anaesthesia. Forty-four patients were randomly allocated into two equal groups: Group I (B) received hyperbaric bupivacaine 0.5% 2 mL + saline 0.9% 1 mL in a total volume of 3 mL intrathecally; Group II (BM) received hyperbaric bupivacaine 0.5% 2 mL + 1 mL of 2mg preservative-free midazolam in a total volume of 3 mL intrathecally. In both groups, the onset and recovery times of sensory block, the degree and recovery times of motor block as well as the sedation and visual analogue pain scores were recorded, and statistically compared. In Group BM, the postoperative visual analogue pain scores were significantly lower at the first 4 h (P < 0.05), the average time until the first dose of additional analgesic requirement was significantly longer (P < 0.05), and sedation scales were significantly higher (P < 0.05), compared to Group B. There were no statistically significant differences in the onset and the full recovery times of sensory and motor blocks in the two groups. The use of intrathecal midazolam combined with intrathecal bupivacaine produces a more effective and longer analgesia with a mild sedative effect in perianal surgery.

Arthroscopic treatment of painful snapping of the scapula by using a new superior portal

Purpose: To evaluate the results of arthroscopic resection of the superomedial corner of the scapula, using a new superior portal, in patients with a snapping scapula problem. Type of Study: Case series. Methods: Ten patients with painful snapping of the scapula were treated arthroscopically using standard portals as well as a recently developed superior arthroscopic portal. There were 4 women and 6 men with a mean age of 26.9 years (range, 16 to 40 years). All patients were right-handed with a right side operation in 8 cases. There was a history of significant shoulder trauma in 6 patients. All patients had normal preoperative computed tomography scans and radiographs. The average duration of symptoms before surgery was 53.2 months (range, 12 to 154 months). At follow-up, the results were scored using the UCLA system. Results: All patients were followed-up at an average of 11.5 months (range, 3 to 23 months). There were no intraoperative or postoperative complications and, in particular, no neurologic lesions resulting from the introduction of arthroscopic instruments. The scapulothoracic crepitus resolved in 2 patients and decreased in 8 patients. There was reduction of pain in all cases, with a mean postoperative visual analog pain score of 2.6. Nine patients were able to return to their preoperative work and 6 could return to their previous sports activity. According to the UCLA scores, the results were 4 excellent, 5 good, and 1 fair. All patients reported that the procedure was worthwhile. Conclusions: Arthroscopic surgery is beneficial for patients with painful snapping of the scapula. The new superior portal is safe and has made the operation easier to perform.

Potential Beneficial Effects Of Intrathecal Opioids In Cardiac Surgical Patients

Background: Postoperative pain control plays an important role on prognosis of patients undergoing thoracic surgery. The length of stay in the intensive care units and hospital is correlated with the quality of pain management. We assessed the potential role of intrathecal opioid supplement for fast tracking cardiac surgery patients. Methods: This is a retrospective, chart review of 133 consecutive patients undergoing open-heart procedure at Buffalo VA Medical Center. They were studied with respect to time-to-extubation, the degree of pain relief, and postoperative parentral narcotic use. Sixty-four patients received supplemental intrathecal opioids and 69 patients received conventional opioid-based anesthesia. Postoperative visual analog pain scores and 24 h analgesic requirements were measured as indices of postoperative pain. Time to extubation, partial pressure of oxygen and carbon dioxide were measured as indices of respiratory function. Results: Patients receiving intrathecal opioids appeared to be more comfortable (VAS = 2 vs. 7) upon arrival at the surgical intensive care unit (SICU) and 24 h after surgery (VAS = 3 vs. 5). These patients also required less parentral morphine in the first 24 hours after surgery (11.4 ± 3.1-mg vs. 52.6 ± 6.2; p<0.05). The majority of patients receiving intrathecal opioids were extubated in the operating room following termination of surgery, suggesting a lower incidence of postoperative respiratory depression. This was associated with a lower need for reintubation that those receiving IV opioids. Conclusion: We believe that the addition of spinal opioids was beneficial in the early postoperative care of cardiac surgery patients with respect to pain management and ventilatory requirements.

Normal postoperative gastric emptying after orthopaedic surgery with spinal anaesthesia and i.m. ketorolac as the first postoperative analgesic

We have assessed the effect of i.m. ketorolac or morphine on early postoperative gastric emptying of liquids in patients undergoing orthopaedic surgery with spinal anaesthesia. Liquid gastric emptying was measured by absorption of paracetamol with patients acting as their own controls. There was no delay after ketorolac 30 mg, but morphine 10 mg resulted in marked delay. There was no difference in postoperative visual analogue pain scores between treatments.

Pain relief after arthroscopic surgery of the knee: A prospective, randomized, and blinded assessment of bupivacaine and bupivacaine with adrenaline

A prospective, randomized, and double-blind study was conducted to compare the influence on postoperative pain of equal volumes of saline, bupivacaine, or bupivacaine with adrenaline, injected both intraarticularly and into the wound puncture site, for 118 day case patients undergoing elective knee arthroscopy. Marginal analyses of postoperative visual analogue pain scores and postoperative fentanyl doses showed that the group given bupivacaine with adrenaline had less postoperative pain when compared with the saline group. However, when multifactor analyses were performed, preoperative visual analogue pain scores, operation type and length, and the sex of the patient were all shown to be significant predictors of postoperative pain, but the use of bupivacaine was not. We conclude that the observed differences in postoperative pain were due to differences between the groups in these predictive factors, especially preoperative pain scores, and that the use of bupivacaine was less important and not statistically significant in influencing postoperative pain.

DICLOFENAC FOR DAY-CARE ARTHROSCOPY SURGERY: COMPARISON WITH A STANDARD OPIOID THERAPY

Sixty unpremedicated patients presenting for day-care arthroscopy surgery were allocated randomly to receive diclofenac 1 mg kg-1 i.m., fentanyl 1 microgram kg-1 i.v. or no analgesic during the course of anaesthesia. Patients receiving fentanyl had slightly, although not significantly prolonged recovery times. Patients receiving diclofenac had significantly improved postoperative visual analogue pain scores compared with patients receiving placebo medication (P less than 0.05). With fentanyl, pain scores were reduced also, but the effect was not statistically significant. Both fentanyl and diclofenac produced significant reduction in postoperative analgesic requirements (P less than 0.05). We conclude that diclofenac 1 mg kg-1 i.m. was an effective analgesic for arthroscopic procedures on the knee and is a useful alternative to opioids for day-care patients.