Biomedical subjects
Publications and source records attributed to K A Eggers.
We describe an obstetric patient who presented for removal of a retained placenta. After insertion of the spinal anaesthetic, she developed a severe headache, and a subarachnoid haemorrhage was diagnosed. We discuss the differential diagnosis of the headache, the occurrence of intracranial haemorrhages after dural puncture and the future management of this patient.
We have evaluated the effect of oral and i.v. tenoxicam on postoperative pain after unilateral total knee replacement in a double-blind, randomized, controlled study. Tenoxicam was administered to two groups of patients, either before (40 mg orally) or after (40 mg i.v.) surgery, then at 24 h after surgery (40 mg i.v.) and at the end of each day for 8 days (20 mg orally). A third group were given placebo at all times. All patients had access to PCA morphine for the first 48 h and then co-dydramol tablets for the duration of the study. We studied 101 patients, mean age 67 yr. There was no significant reduction in the requirement for PCA morphine for the duration of the study in either of the treatment groups, or for co-dydramol in the first 2 days, but tenoxicam significantly reduced the need for co-dydramol over the remaining 7 days. There were no significant differences in mobility between groups. There was a high incidence of adverse events reported, with a similar number in each of the three groups.
The analgesic effect of topical ibuprofen was investigated in ten volunteers. There were no significant differences in visual analogue scale pain scores for pinprick after 15 and 60 min of application of ibuprofen, placebo and EMLA cream. Comparison of visual analogue scale scores for venous cannulation after similar durations of ibuprofen and EMLA creams found significantly (p < 0.014) lower scores for EMLA at 60 min. We do not consider ibuprofen cream to be clinically useful for venous cannulation.
We describe a case of idiopathic postoperative brachial plexus neuropathy. A 68-yr-old man underwent elective total knee replacement under spinal anaesthesia. Two days after surgery, there was sensory loss and weakness in the right forearm and hand, which suggested an ulnar nerve neuropathy. Two weeks later the patient complained of a dull ache between the scapulae, followed by a burning sensation in the forearm and severe pain in the elbow. A diagnosis of brachial plexus neuropathy was made based on clinical examination and nerve conduction studies. The pain disappeared after a few months, although weakness of the right arm persisted 9 months later. The differential diagnosis between brachial plexus neuropathy and ulnar nerve neuropathy is important, as the prognosis of brachial plexus neuropathy is generally good.
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Three different concentrations of bupivacaine, 0.125%, 0.062% and 0.031%, all with diamorphine 0.0025%, were given as an epidural infusion at 10 ml.h-1 to 63 mothers in labour. When the three infusions were compared, significant differences were found in maternal requirements for top-ups and the degree of motor block, but there were no differences in the pain scores. The reduced motor block was not associated with a reduction in the instrumental delivery rate.
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