Intraperitoneal bupivacaine or lidocaine does not provide analgesia after total abdominal hysterectomy.

We have compared pain scores at rest and on standardized movement, and morphine consumption using patient-controlled analgesia in 60 patients who had undergone total abdominal hysterectomy. Patients were allocated randomly to one of three groups: in the saline group, 0.9% sodium chloride 50 ml was administered into the pelvic cavity before closure of the peritoneum; in the second group, the solution administered was 20 ml of 0.5% bupivacaine solution with epinephrine 1:200,000 diluted with saline to a final volume of 50 ml; in the third group, the solution used was 20 ml [corrected] of 2% lidocaine with epinephrine 1:200,000 diluted with saline to a final volume of 50 ml. We found that there was no significant difference between the three groups in visual analogue pain scores at 8, 12, 36 or 48 h after operation at rest or on movement, and no significant difference in sedation or dose of antiemetic administered. Mean morphine consumption in the first 24 h was 54.6 (SEM 5.9) mg in the saline group, 55.5 (6.4) mg in the bupivacaine group and 52.5 (5.3) mg in the lidocaine group. In the second 24 h, morphine consumption was 34.9 (6.6) mg, 28.1 (3.5) mg and 28.0 (3.5) mg in the three groups, respectively. We conclude that i.p. administration of local anaesthetic solution into the pelvic cavity did not confer appreciable analgesia in patients undergoing abdominal hysterectomy.

Cardiac rupture during electroconvulsive therapy.

A 57-year-old man with recurrent depression, resistant to drug therapy, was scheduled for a course of eight electroconvulsive therapy treatments. The patient had undergone seven treatments without incident over the previous 3 weeks. Immediately following the final treatment, the patient suffered cardiovascular collapse, culminating in cardiac arrest with electromechanical dissociation. Despite resuscitative measures, the patient died. Post-mortem examination found the cause of death to be cardiac tamponade, secondary to cardiac rupture.

The effect of syntocinon on blood loss during first trimester suction curettage.

We have studied 64 pregnant women (9 weeks gestation and greater undergoing elective vaginal termination of pregnancy). They were allocated randomly to one of two groups to receive either 1 ml (10 units) of syntocinon or 1 ml of saline (placebo) after cervical dilatation. Anaesthesia was standardised and surgery was performed by a single blinded gynaecologist, who assessed the size of the uterus and graded uterine contractility. All patients received a Cervagem vaginal suppository 70-270 min before surgery. The volume of blood loss was calculated colorimetrically and found to be less than 100 ml in all patients. The median blood loss in the syntocinon group (n = 30) was 17.6 ml, (range 6.1-72.7) and was significantly less than that in the placebo group (n = 34), median blood loss 24.5 ml, (range 6.7-94.3) (p = 0.02). Six patients in the saline group had unsatisfactory uterine contraction compared with none in the syntocinon group (p = 0.025).

Metoclopramide and prochlorperazine do not decrease propofol hypnotic requirements.

One hundred patients scheduled for minor surgery were given either saline, metoclopramide 0.1 mg.kg-1 or 0.2 mg.kg-1, or prochlorperazine 0.1 mg.kg-1 or 0.2 mg.kg-1 before induction of anaesthesia with a fixed rate infusion of propofol. Neither metoclopramide nor prochlorperazine reduced the induction dose of propofol. The possibility that these agents increased the induction dose could not be excluded.