Postoperative pain relief and functional outcome following total knee arthroplasty - a prospective comparative audit of three analgesic regimes.

Pain control plays a key role in joint-replacement -surgery. As a surgeon the challenge is to reduce pain to an acceptable level in the post-operative period. The aim of the study was to assess the efficacy of bolus -local anaesthesia, infusion in to the surgical site and nerve blocks with femoral nerve catheter and its functional outcome. A prospective audit of 114 patients undergoing total knee arthroplasty were carried out.The patients were divided in to three groups : Group 1 (n = 27) received a bolus injection of 20 ml 0.25% levobupivacaine + 10 ml 0.25%bupivacaine + adrenaline + 30 ml saline. Group 2 (n = 39) received a bolus injection as on group 1 with 240 ml 0.25% bupivacaine infusion and 5 ml/hour using a Pain Buster pump. Group 3 (n = 48) received 30 ml 0.125% levobupivacaine to femoral (3-in-1) block with 30 ml 0.25% levobupivacaine to -sciatic nerve and introduction of a femoral nerve catheter. All patients were prescribed paracetamol 1 g QDS, Oxycontin 20 mg BD and Ibuprofen post -operatively. Pain was assessed with a Visual Analog Scale (VAS). The incidence of PONV was measured by PONY intensity score. The mean post-op VAS score for Group 3 was 4. The demand of oxynorm and NSAID were minimal in Group 3. The mean in patient stay for Group 3 was 3.1 days. The PONV intensity score was > 50 for 9 (36%) in Group 1, 15 (40%) in Group 2 and 9 (20%) in Group 3. There was loss of 20-30 degrees of flexion movements in Group 3 in the first 4 to 6 days post-op. Our study demonstrated that Regime 3 with the use of nerve blocks and femoral nerve catheter has given the maximum pain relief and good functional outcome following total knee replacement.

Witnessing wills.

Nurses are often asked to witness documents. Acting as a witness to someone's signature, however, must be carefully thought out, as shown by the fictitious scenario described below and follow-up discussion.

Glomerulonefritis idiopatica por deposito mensagial de inmunoglobulina A: presentacion de dos casos clinicos de enfermedad de Berger. / Idiopathic glomerulonephritis due to mesangial deposition of inmunoglobulin A: presentation of 2 cases of Berger's disease

Se presentan dos casos de enfermedad de Berger, glomerulonefritis caracterizada por depositos mesangiales de IgA. La patogenia del cuadro no se conoce bien, sin embargo, se ha planteado que se debe a complejos inmunes. Clinicamente se caracteriza por hematurias que se presentan a raiz de infecciones del tracto respiratorio superior. Un 25% de los casos evoluciona hacia la insuficiencia renal. Actualmente no hay un tratamiento eficaz que sea capaz de prevenir o detener esta evolucion desfavorable

Blood pressure levels in urban school-age population in Chile.

Two blood pressure (BP) measurements separated by 3 months were performed according to international guidelines on 2976 students (11 to 19 years) of different economic levels. Obesity was defined based upon height and weight. With the first measurements, 59th and 95th percentile value distribution curves were defined. Systolic hypertension (SH) was found in 9.5%; 10.2% were males and 8.9% females. The sample showed that 8.1% were obese (240 cases); among them the incidence of SH increased to 28.8% (69 cases) (p less than 0.01). In the entire sample, diastolic hypertension (DH) was 4.3%; males, 2.7%, and females, 5.5% (p less than 0.01). Among obese students, DH increased to 8.3% (20 cases) (p less than 0.01), and showed prevalence figures of 5.8% for obese males and 10.3% (14 cases) for obese females. After a second measurement, DH for the sample decreased to 1.8%. Salt intake and familial antecedents of high BP showed differences between hypertensive and normal populations.

Cifras tensionales en poblacion escolar chilena urbana. II. Parte. Distribucion por percentiles. / Blood pressure in Chilean urban school children. II. part.Percentile distribution

Con una determinacion individual de presion arterial obtenida de 3.442 escolares chilenos urbanos entre 6 y 19 anos se construyeron curvas de distribucion por percentiles para cada edad y sexo. Las mediciones se efectuaron durante 1979 y 1980 siguiendo las recomendaciones de la American Task Force on Blood Pressure Control in Children de EE.UU.Solo en 34.5% de los estudiantes tenian determinaciones previas de presion arterial.Los valores nacionales se comparan con los de EE.UU. y se destacan las diferencias. Al mismo tiempo se discute la confiabilidad de la cifra 140/90 mm Hg. como valor limite de la normotension. Este primer intento nacional para establecer los limites normales de la presion arterial se ofrece para su prueba en la practica pediatrica cotidiana y para facilitar la interpretacion de los valores obtenidos