Intravenous paracetamol is as effective as morphine in knee arthroscopic day surgery procedures

To conduct a prospective randomized study comparing the analgesic effect of Intravenous Paracetamol with Intravenous Morphine in postoperative pain control of patients undergoing knee arthroscopic surgery as day cases. Eighty four patients were randomised into two groups on the basis of the last digit of their medical number. Odd numbers were given Paracetamol [Group-I] and even Morphine [Group-II]. All patients underwent Examination under Anaesthesia [E.U.A] and knee arthroscopy +/- a partial menisectomy as day cases and had to stay of a minimum of 4 hours post surgery. A standardize General Anaesthesia was given to both groups. An intra-articular injection of 20mls of 0.5% Marcaine was given to all patients. Postoperative pain was assessed up to 4 hours using the Verbal Rating Scale [V.R.S.]. The adverse effects of the drugs were also observed. Of 84 patients, 76 were males and 8 females. The age range was from 18 to 69 years, weighing from 55 to 90kg. Paracetamol [Group-I] had 43 patients and there were 41 patients in the Morphine [Group-II] Group. The results according to VRS, from 0 to 4 hours showed no difference in the analgesic effect of the two groups, but much less adverse effect were noted in Group-I. In our study both intravenous Paracetamol and Intravenous Morphine seems to have the same analgesic effect. However, side effects with Intravenous Paracetamol were much less

Radiation to patients during dynamic HIP screw surgery

The aim of this study was two fold. To determine the diagnostic reference level [D.R.L.] dose of radiation during dynamic hip screw [D.H.S.] fixation and, to audit the orthopaedic department against this standard. A retrospective analysis of 112 consecutive patients between 31[st] December 2002 and the 6[th] July 2003, at Darenth Valley Hospital, Dartford, under going dynamic hip screw fixation for proximal femur fractures was carried out. The data was collected from the Radiographers log. The screening time and Dose Area Product [DAP] for each event was analyzed in conjunction with the Radiation Protection Department at Kings College, London. Taking the 75[th] percentile from the existing data, the DAP was set at 1.05cGy/cm[2]. The screening time for the procedure was set at 64.2 seconds. An audit to access the performance of the orthopaedic department against these standards was carried out. All grades of surgeons performing this procedure were included in the audit. In the total of 112 patients, there were 32 males and 80 females. The age range was from 27 to 99 years with a mean of 83.96 years. Sixty fractures were on the right side and 52 on the left. The total screening time for the procedures was 78.25 minutes with an average of 0.877 of a minute [i.e.] 52.62 seconds. The total Dose Area Product [DAP] was 96.42cGy/cm[2] with an average of 0.860cGy/cm[2]. At present there are no DRL for orthopedic procedures locally or nationally in the United Kingdom, despite this being a legal requirement since May 2000. The authors have determined a local DRL for DHS fixation which can be used as a guideline for this procedure. We recommend that DRL be set for other orthopedic procedures done under Fluoroscopic guidance, especially procedure involving younger patient