Biomedical subjects
Publications and source records attributed to P G Nay.
IMPLICATIONS: Raynaud's disease is an episodic and debilitating disease of the circulation to the fingers and toes. This case report describes an acute exacerbation of Raynaud's disease in a patient undergoing surgery with epidural anesthesia. This potentially hazardous complication has not been previously reported.
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A study of 43 patients undergoing coronary artery bypass grafting was conducted in order to compare pre-operative expectation of pain severity and duration to actual postoperative experience. As judged by linear visual analogue scores, patients expected more pain than they experienced (p = 0.0359). For the majority of patients, pain duration was less than expected. Eighty-four per cent of patients reported that their pain was better or the same as expected. Ninety-five per cent of patients were satisfied or very satisfied with postoperative analgesia. The authors conclude that, although the standard of postoperative analgesia after coronary artery bypass grafting remains objectively poor (the median postoperative pain score was 4 on a 10 cm linear visual analogue pain score), patients are usually satisfied with their pain relief. The authors suggest that this may be related to patients' pre-operative overestimation of postoperative pain severity. The authors caution against giving patients unrealistic expectations of the quality of postoperative analgesia.
A 52-year-old woman with chronic back pain presented for lumbar extradural analgesia. The 'loss of resistance to air' technique was used to locate the extradural space. Prolonged paraesthesia and paresis of left leg occurred following the procedure. Urgent lumbar computed tomography scan revealed nerve root displacement due to extradural air.