Summary We assessed the effectiveness of intra‐articular solutions of morphine, bupivacaine with adrenaline and a combination of both, compared with placebo in facilitating mobilisation and reducing postoperative pain and analgesic requirements for 24 h after operation. Forty patients undergoing arthroscopic knee surgery were studied in a double‐blind, randomised, controlled trial. All treatments proved more effective than placebo in facilitating earlier mobilisation and in decreasing postoperative pain as measured by visual analogue scale. Morphine alone provided the best analgesia and significantly decreased analgesic consumption for 24 h after surgery. We conclude that 1 mg of intra‐articular morphine provides effective pain relief following arthroscopic knee surgery and that the addition of bupivacaine is of no benefit.

These findings support a reappraisal of current clinical interpretation of cardiorespiratory fitness highlighting the potential for incorrect fitness stratification when natural variation is not accounted for.

Laparoscopic cholecystectomy is feasible and can be recommended for symptomatic gallstone disease in grossly obese patients.

New Findings What is the central question of this study?To what extent cardiorespiratory fitness is impaired in patients with abdominal aortic aneurysmal (AAA) disease and corresponding implications for postoperative survival requires further investigation. What is the main finding and its importance?Cardiorespiratory fitness is impaired in patients with AAA disease. Patients with peak oxygen uptake of <13.1 ml O2 kg−1 min−1 and ventilatory equivalent for carbon dioxide at anaerobic threshold ≥34 are associated with increased risk of postoperative mortality at 2 years. These findings demonstrate that cardiorespiratory fitness can predict mid‐term postoperative survival in AAA patients, which may help to direct care provision. Abstract Preoperative cardiopulmonary exercise testing is a standard assessment of cardiorespiratory fitness (CRF) and risk stratification. However, to what extent CRF is impaired in patients undergoing surgical repair of abdominal aortic aneurysm (AAA) disease and the corresponding implications for postoperative outcome requires further investigation. We measured CRF during an incremental exercise test to exhaustion using online respiratory gas analysis in patients with AAA disease (n = 124, aged 72 ± 7 years) and healthy sedentary control subjects (n = 104, aged 70 ± 7 years). Postoperative survival was examined for association with CRF, and threshold values were calculated for independent predictors of mortality. Patients who underwent preoperative cardiopulmonary exercise testing before surgical repair had lower CRF [age‐adjusted mean difference of 12.5 ml O2 kg−1 min−1 for peak oxygen uptake (V̇O2 peak ), P < 0.001 versus control subjects]. After multivariable analysis, both V̇O2 peak and the ventilatory equivalent for carbon dioxide at anaerobic threshold (V̇E/V̇normalCO2− AT ) were independent predictors of mid‐term postoperative survival (2 years). Hazard ratios of 5.27 (95% confidence interval 1.62–17.14, P = 0.006) and 3.26 (95% confidence interval 1.00–10.59, P = 0.049) were observed for V̇O2 peak  < 13.1 ml O2 kg−1 min−1 and V̇E/V̇normalCO2− AT ≥ 34, respectively. Thus, CRF is lower in patients with AAA, and those with a V̇O2 peak  < 13.1 ml O2 kg−1 min−1 and V̇E/V̇normalCO2− AT ≥ 34 are associated with a markedly increased risk of postoperative mortality. Collectively, our findings demonstrate that CRF can predict mid‐term postoperative survival in AAA patients, which may help to direct care provision.

Surgery for radical treatment of esophageal cancer (EC) carries significant inherent risk. The objective identification of patients who are at high risk of complications is of importance. In this study the prognostic value of cardiopulmonary fitness variables (CPF) derived from cardiopulmonary exercise testing (CPET) was assessed in patients undergoing potentially curative surgery for EC within an enhanced recovery program. OC patients underwent preoperative CPET using automated breath‐by‐breath respiratory gas analysis, with measurements taken during a ramped exercise test on a bicycle. The prognostic value of , Anaerobic Threshold (AT) and VE/VCO 2 derived from CPET were studied in relation to post‐operative morbidity, which was collected prospectively, and overall survival. Consecutive 120 patients were included for analysis (median age 65 years, 100 male, 75 neoadjuvant therapy). Median AT in the cohort developing major morbidity (Clavien–Dindo classification >2) was 10.4 mL/kg/min compared with 11.3 mL/kg/min with no major morbidity ( P = 0.048). Median in the cohort developing major morbidity was 17.0 mL/kg/min compared with 18.7 mL/kg/min in the cohort ( P = 0.009). optimum cut‐off was 17.0 mL/kg/min (sensitivity 70%, specificity 53%) and for AT was 10.5 mL/kg/min (sensitivity 60%, specificity 44%). Multivariable analysis revealed to be the only independent factor to predict major morbidity (OR 0.85, 95% CI 0.75–0.97, P = 0.018). Cumulative survival was associated with operative morbidity severity (χ 2 = 4.892, df = 1, P = 0.027). These results indicate that as derived from CPET is a significant predictor of major morbidity after oesophagectomy highlighting the physiological importance of cardiopulmonary fitness.