We conducted a prospective, randomized, doubleblind study to compare analgesia obtained by wound infiltration using 29 ml of 0.25% bupivacaine alone, or with the addition of clonidine hydrochloride 150 g. A third group received bupivacaine wound infiltration with clonidine 150 g i.m. to control for the systemic effects caused by absorption of clonidine. We studied 46 adults undergoing elective inguinal hernia repair. The general anaesthetic technique, postoperative analgesia and wound infiltration technique were standardized. There was no difference in time to first analgesic request or to total analgesic consumption between the three groups during the 24-h study. Visual analogue scores (VAS) at rest and after coughing were noted over a 24-h period. The only difference was higher VAS scores at rest at 24 h in the control group who received i.m. clonidine. We conclude that for elective inguinal hernia repair, postoperative analgesia obtained by bupivacaine wound infiltration was not improved by the addition of clonidine 150 g. (Br.

A transoesophageal Doppler cardiac output monitor was used to study the cardiovascular changes occurring during laparoscopic cholecystectomy in patients without (group A) or with (group B) a history of cardiovascular disease, i.e. hypertension, ischaemic heart disease or heart failure. Insufflation of the abdomen with carbon dioxide caused significant (P < 0.01) falls in mean cardiac index (17.9% in group A, 25.1% in group B) and mean stroke volume index (15.3% in group A, 21.2% in group B). Simultaneously, there was a significant (P < 0.05) increase in mean systolic blood pressure (19.4%) in group A. There were no other differences in the cardiovascular responses of the two groups. There was no correlation between systolic blood pressure and either cardiac index or stroke volume index. No significant complications or morbidity were associated with the use of the transoesophageal Doppler monitor. We conclude that the cardiovascular changes associated with insufflation are neither predictable by clinical assessment nor adequately determined by routine monitoring. We recommend the transoesophageal Doppler monitor for use in this situation.

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