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SummaryWe have investigated the addition of adrenaline to pethidine for patient-controlled epidural analgesia after elective Caesarean section. In a randomised, double-blind study, patients received patient-controlled epidural analgesia for 24 h using pethidine 5 mg.ml -1 with adrenaline 5 mg.ml(adrenaline group, n 40) or pethidine 5 mg.ml -1 without adrenaline (plain group, n 38). Visual analogue scale pain scores at rest and on coughing measured 2 h, 6 h and 24 h after surgery were similar between the two groups. There was a trend towards lower mean total consumption of pethidine in the adrenaline group (231.5 mg; SD 140.5 mg) compared with the plain group (289.5 mg; SD 139.5 mg; p 0.071). Patients in the adrenaline group had higher visual analogue scale scores for nausea at 2 h and 24 h and higher scores for pruritus at 2 h compared with the plain group. Addition of adrenaline to pethidine for patient-controlled epidural analgesia does not appear to have significant clinical advantages.

Spirometry was performed before operation, soon after recovery ("early") and the day after ("late") general anaesthesia for elective surgery in 20 children with asthma and 20 matched children without asthma. Pulse oximetry was recorded on the first postoperative night. The mean early peak expiratory flow rate (PEFR) decreased in the asthmatics by 19.91 (95% confidence intervals (CI) 10.84-28.97)% and in the controls by 19.25 (10.70-27.80)%. The mean early FEV1 decreased in the asthmatics by 16.02 (9.29-22.75)% and in the controls by 11.03 (2.86-19.19)%. The mean late decrease from baseline PEFR for the asthmatics was 18.55 (11.23-25.87)% but only 14.93 (7.89-21.97)% for the controls. The mean late FEV1 was 8.2 (0.83-15.56)% below baseline in the asthmatics but only 6.82 (-0.79 to 14.42)% in the controls. There were no differences in overnight pulse oximetry. We conclude that healthy children exhibited a decrease in FEV1 and PEFR after general anaesthesia for elective surgery, but this decline did not appear to be any greater in well controlled asthmatic children compared with children who did not have asthma.

AimsThe incidence of persistent post-operative pain (PPP) is 30–85% in lower limb amputee (LLA) patients and identification of preoperative risk factors are warranted. Preoperative levels of anxiety, depression, pain catastrophizing, neuropathic pain and severe preoperative pain have previously been linked with PPP but such screening tools are not used in the clinical hospital setting. The aim of this study was to assess feasibility of using questionnaires for anxiety, depression, pain catastrophizing, neuropathic pain and preoperative pain levels in a clinical preoperative setting.MethodsPatients scheduled for non-traumatic amputation of the lower leg or femur were recruited from three Danish hospitals. Exclusion criteria were surgery 4-weeks prior to LLA, same leg re-amputation, or inability to participate. Pre-operative values of anxiety, depression and catastrophizing were assessed using the Hospital Anxiety (A) and Depression(D) Scale (HADS) (cutoff: 8) and Pain Catastrophizing Scale (PCS) (cutoff =32). Neuropathic pain was assessed preoperatively using Pain-Detect-Questionnaire (PD-Q) (cutoff: 19). The maximum preoperative pain intensity was assessed using the Numeric Rating Scale (NRS; 0: no pain and 10: worst imaginable pain). Scores are presented as median values with interquartile range (Q1–Q3).ResultsEight of 18 patients (5 females) completed this pilot study: median age 71 (range 56–83), 6 femur and two lower leg amputees. Nine of ten excluded patients were unable to complete the questionnaires and one patient was operated acutely. Median pre-operative HADS-D and -A scores were 7 (3–9, 50% ≥ cutoff) and 4 (1–8, 25% ≥ cutoff), pre-operative PCS score was 24 (18–28, 13% ≥ cutoff), pre-operative PD-Q score was 16 (8–22, 50% ≥ cutoff) and NRS score was 9.5 (8–10).ConclusionsThis study indicates that it is possible to implement preoperative questionnaires in a clinical setting. However, more than 50% of the patients are unable to complete the questionnaires.