Gabapentin alleviates and/or prevents acute nociceptive and inflammatory pain both in animals and volunteers, especially when given before trauma. Gabapentin might also reduce postoperative pain. To test the hypothesis that gabapentin reduces the postoperative need for additional pain treatment (postoperative opioid sparing effect of gabapentin in humans), we gave 1200 mg of gabapentin or 15 mg of oxazepam (active placebo) 2.5 h prior to induction of anaesthesia to patients undergoing elective vaginal hysterectomy in an active placebo-controlled, double blind, randomised study. Gabapentin reduced the need for additional postoperative pain treatment (PCA boluses of 50 microg of fentanyl) by 40% during the first 20 postoperative hours. During the first 2 postoperative hours pain scores at rest and worst pain score (VAS 0-100 mm) were significantly higher in the active placebo group compared to the gabapentin-treated patients. Additionally, pretreatment with gabapentin reduced the degree of postoperative nausea and incidence of vomiting/retching possibly either due to the diminished need for postoperative pain treatment with opioids or because of an anti-emetic effect of gabapentin itself. No preoperative differences between the two groups were encountered with respect to the side effects of the premedication. However, 15 mg oxazepam was more effective in relieving preoperative anxiety than 1200 mg gabapentin.

We have studied the effect of a constant infusion of diclofenac 150 mg/24 h, ketoprofen 200 mg/24 h or placebo on postoperative pain after elective Caesarean section performed under spinal or extradural block in 90 patients in a prospective, randomized and double-blind study. During the first 24 h after operation, patients in the treatment groups were more comfortable than the placebo group (P < 0.005); the diclofenac group needed a mean of oxycodone 21.6 mg/24 h and the ketoprofen group 21.2 mg/24 h, compared with 38.3 mg/24 in the placebo group (P < 0.001); the mean time to the first injection of oxycodone was 270.5 min in the diclofenac group, 270.2 min in the ketoprofen group and 161.2 min in the placebo group (P < 0.001). During the first 24 h after operation, the temperature increased in the control group by 0.7 degrees C compared with 0.1 degrees C in the diclofenac group and 0.3 degrees C in the ketoprofen group. One patient in the diclofenac group was eliminated from the study because of uterine relaxation during the first 30 min after start of the drug infusion; this improved after cessation of diclofenac and infusion of sulprostone. There were no other serious side effects.

Women after caesarean section under a spinal block seem to suffer more often from TNSs than non-pregnant women. The conclusions are, however, uncertain since we had no control group operated on under other than spinal anaesthesia. The persisting neurologic symptoms in two patients might also be due to the obstetric procedure itself. To find out about the validity and possible underlying causes of our results, we need randomised studies with control groups receiving epidural or general anaesthesia.

Forty-nine patients with Achilles peritendinitis (APT) (11 bilateral) and 31 patients with retrocalcanear bursitis (RCB) (5 bilateral) were treated surgically (altogether 96 heels). There were 37 men and 12 women in the APT group, with a mean age of 38.4 years, and 26 men and 5 women in the RCB group, with a mean age of 32.3 years. Forty-five patients in the APT group and 30 patients in the RCB group were active in sports. All patients had been treated conservatively for at least 6 months (range 6 months to 13 years) without relief of symptoms. The operative method was bilateral longitudinal incision of fascia cruris and trimming of the adhesions to fascia and base of Kager's triangle in APT group, and ablation of the posterior upper corner of os calcaneus in RCB group. In order to assess the ability to return to sports, the healing results were evaluated by questionnaire in 42 patients (47 operations) in the APT group and 25 patients (28 operations) in the RCB group 2-11 years postoperatively. The results were excellent in 27, good in 11, fair in 7 and poor in 2 in the APT group, and excellent in 13, good in 10, fair in 2 and poor in 3 in the RCB group, respectively. Operative treatment of APT and RCB in patients whose symptoms persist after conservative treatment seems to give favourable results in the majority of cases.

Follow-up of postoperative pain scores during mobilization and fatigue levels might be an easy tool for the evaluation of postoperative recovery. Using an identical anaesthetic technique, the neuroendocrine response was of the same magnitude after both types of surgery.