Randomised controlled trial of intramuscular tramadol versus transdermal buprenorphine patch for early postoperative surgical pain.

BACKGROUND: This study assesses the efficiency of the buprenorphine patch system compared to the routine use of tramadol intramuscular injections in the context of the South African public healthcare sector. METHODS: Patients were randomised into two groups, who received routine tramadol injections 100 mg every 8 hours intramuscular and buprenorphine patches 5 mcg every hour. The study assessed the first 48 hours postoperatively. A visual discrete pain scale was used to assess the level of postoperative pain as well as all complications associated with insufficient analgesic administration. RESULTS: The sample size included 75 patients in the tramadol group and 75 patients in the buprenorphine patch group. Nine patients (12%, p-value < 0.0001) who received the buprenorphine patch subsequently required additional analgesia. The pain score was found to be significantly less in the buprenorphine patch group on both day 1 and day 2, as were complications such as vomiting, nausea, nightmares, sweating and insomnia. The pain score in the buprenorphine group as significantly lower compared to the tramadol group. The use of the buprenorphine patch showed a slight increase in costs compared to the tramadol group (R7 800.75 vs R7 537.50; p-value 0.483) in the whole study. CONCLUSION: The study showed that the use of the buprenorphine patch is a reliable and effective method of postoperative analgesia, although it is slightly more expensive compared to the routine use of tramadol. The buprenorphine patch showed significantly better results in all assessed parameters; thus, it may be recommended for use at the Dr George Mukhari Academic Hospital (DGMAH).

Tumour reduction with a Cavitron Ultrasonic Surgical Aspirator® in the palliative care of anaplastic thyroid cancer.

A 54-year-old woman developed a fungating locally invasive anaplastic thyroid cancer with distant metastases, and was treated with aggressive tumour reduction, using a Cavitron® Ultrasonic Surgical Aspirator. This mode of treatment, applied for the first time in this context, proved to be effective, safe and improved her quality of life.

Laparoscopic cholecystectomy in black patients at Ga-Rankuwa Hospital: a feasibility study.

OBJECTIVE: To determine feasibility and outcome of laparoscopic cholecystectomy for Black patients in Ga-Rankuwa Hospital and to analyse the type of stones harvested. DESIGN: Cross sectional description study. SETTING: Ga-Rankuwa Hospital/Medunsa, South Africa. SUBJECTS: 79 patients who presented with cholelithiasis over a six year period. MAIN OUTCOME MEASURES: Successful performance of laparoscopic cholecystectomy on the subjects. RESULTS: 39 laparoscopic cholecystectomies were performed with seven conversions (18% conversion rate). Forty open cholecystectomies were also performed. Post operative stay after laparoscopic cholecystectomy averaged 3.5 days and that of the open converted group 6.9 days (p < 0.001). Two patients returned with persistence of symptoms following laparoscopic cholecystectomy. Twenty gall stones were analysed; 17 were of the cholesterol type and three of the black pigment type. CONCLUSIONS: Laparoscopic cholecystectomy is feasible in the Black populace of Ga-Rankuwa Hospital. The majority of gallstones are of the cholesterol type.

Sciatic artery aneurysm.

Sciatic artery aneurysm is a rare condition. We treated 4 patients. The clinical presentation in all 4 was as a result of aneurysm complications. The diagnosis was made on angiography in all of them. Surgical treatment was successful in 3 of the 4 patients.