The aim of this study was to examine the effectiveness of ropivacaine administered by a simple intraperitoneal technique in relieving pain following laparoscopic application of Filshie clips. Nineteen patients were randomised to receive either ropivacaine (200 mg) or normal saline through the umbilical port following clip application. Using a visual analogue scale women receiving ropivacaine had significantly lower pain scores 2 hours post operatively (0.97 vs 2.03 p < 0.05). The mean total postoperative fentanyl use was also significantly lower on the ropivacaine group (40 microg vs 104 microg p < 0.02). Only 10% (1/10) of the women in the ropivacaine group complained of nausea compared with 44% (4/9) in the control group. Furthermore, 80% (8/10) of women in the ropivacaine group were either very or totally satisfied with their pain relief. Only 56% (5/9) of the women in the control group were very or totally satisfied with their pain relief. Ropivacaine administered by a simple intraperitoneal technique following laparoscopic sterilisation significantly reduces postoperative pain and parenteral analgesic requirements. It would be reasonable to consider this method as standard practice following laparoscopic tubal ligation.

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Our study confirms that students are able to identify QA issues and propose solutions. We recommend that students have a formally recognized place in day surgery QA programmes, to close the QA loop and to adequately prepare them for medical practice in the 21st century.

This North American book is one of The Requisites in Anesthesiology series and it covers all topics on ambulatory anaesthesia. Each chapter is written by a different combination of authors. I found it an upto-date and easy-to-read book with a good scientific basis. There are many well-organised summary boxes and diagrams. Controversies and clinical guidelines are clearly outlined. Case studies add to the appeal. Some issues, particularly in the administration sections, relate to North American practice. The standard topics such as patient selection, postoperative nausea and vomiting and discharge criteria are covered well. Pharmacology and regional anaesthesia are also summarised. Throughout the book, current issues such as obstructive sleep apnoea, herbal medications, implantable defibrillators and neurologic monitoring are discussed. Geriatric anesthesia is detailed. The chapter on dentistry and office-based surgery definitely has a North American perspective, but the safety principles are emphasised. There is a comprehensive list of references and suggested readings at the end of each chapter. The older standard references are complemented by recent ones. This book would complement any existing medical library. It would be of value to a wide range of health professionals involved in Day Care Anaesthesia. In this regard it is good value for money. R. LIMB

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