The efficacy of epidurally administered tramadol hydrochloride, a weak centrally acting analgesic, was studied for the relief of postoperative pain. Sixty patients undergoing abdominal surgery were randomly allocated to three treatment groups to be given the following agents by the epidural route: group 1 tramadol 50 mg; group 2 tramadol 100 mg; group 3 10 ml of bupivacaine 0.25%. The drugs were administered at the patients' request with each patient being allowed four doses in the first 24 h following surgery. Blood pressure, pulse rate, respiratory rate, arterial blood gas analyses, pain scores, the interval between doses and the occurrence of any side effects were recorded. Pain scores (assessed using a visual analogue scale) were significantly less (p < 0.05) at 3, 12, and 24 h in patients receiving tramadol 100 mg than in those receiving tramadol 50 mg or bupivacaine. The mean interval between doses for groups 1, 2 and 3 was 7.40 h, 9.36 h and 5.98 h respectively. The mean interval in group 2 was significantly longer than in group 3 (p < 0.05). The incidence of nausea and vomiting in group 2 was significantly higher than in group 3 (p < 0.05).

Clinica I for1111 I 56 1 vision; the extent of any oedema and its position can then be seen and infected material can be easily removed by suction from the oro-pharynx, where it tends to pool in a patient in the Trendelenburg position. There is a theoretical risk that a nasal tube on its way through the pharynx might rupture the abscess. Some anaesthetists have used oral tubes to obviate this risk, but it does not seem to be a problem in practice and the risk can be reduced if the nostril on the opposite side from the quinsy is used for the naso-tracheal tube when possible.Suxamethonium may be used with safety to faciliatate intubation if it is first ascertained that it is possible to inflate the patient manually.There are degrees of severity of quinsies and the individual anaesthetist must decide which is the most suitable method of induction for a particular patient in his hands but, in spite of the fact that forty-three patients were induced with a barbiturate and suxamethonium for intubation without complication in the present series, this should not be regarded as the method of choice. SutntnaryA review is presented of 114 cases of quinsy tonsillectomy. This shows that this advantageous operation has a low complication rate and is safe in skilled anaesthetic hands. AcknowledgmentsThe author wishes to thank Dr Derek Wylie for his constructive criticism and the surgeons of the Ear, Nose and Throat Department of St Thomas' Hospital for their co-operation. Re ferences

A prospective study of blocking T10‐L1 with local anaesthetic, bilaterally in 30 patients undergoing caesarean section under general anaesthesia has been shown to provide effective postoperative analgesia thus requiring significantly less narcotics (mean 66.6 mg of pethidine) compared to the 30 patients in the control group (mean 163 mg of pethidine). A cocktail of 0.5% of bupivacaine with adrenaline and xylocaine 1% produced analgesia for the duration ranging from 8 to 12 hours (mean 8.4 hours). Patients with abdominal field block were awake, alert and comfortable during the immediate postoperative period. They were pain‐free sufficiently to put the babies to the breast early and frequently.

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