Oral oxycodone hydrochloride versus epidural anaesthesia for pain control after radical retropubic prostatectomy.

OBJECTIVE: To evaluate whether combined oral intake of paracetamol (4 x 1 g) + oxycodone hydrochloride (2x10 mg) is adequate and equivalent to epidural anaesthesia (EDA) with respect to postoperative pain control and postoperative mobilization after radical retropubic prostatectomy (RRP). MATERIAL AND METHODS: Forty consecutive patients scheduled for RRP were randomized to either: EDA with ropivacaine + paracetamol (4 x 1 g tablet) + injected or oral morphine on demand (EDA group); or infiltration of 25-40 ml of 0.25% bupivacaine into the wound + oxycodone hydrochloride (2 x 10 mg tablet) + paracetamol (4x1 g tablet) + injected or oral morphine on demand (OXY group). The groups were compared with respect to pain control determined by means of a visual analogue scale (VAS), time to free mobilization, hospital stay, complications, operation time and bleeding. RESULTS: Both analgesic regimens provided satisfactory analgesia, i.e. VAS scores remained significantly below 4 (p<0.0001). The EDA group experienced slightly less pain than the OXY group on the operation day but this was not significant: median VAS scores of 0.7 and 1.8, respectively (p=0.27). Median VAS scores during hospital stay were 1.7 in both treatment groups. VAS scores ranged from 0.1 to 3.3 and from 0.2 to 3.5 in the EDA and OXY groups, respectively. There was no significant difference in postoperative mobilization between the groups (p=0.06). The median duration of hospital stay was 3 nights in both groups. CONCLUSION: Postoperative pain control after RRP with oral oxycodone hydrochloride, paracetamol and extra morphine on demand is preferable to EDA when pain control as well as mobilization and costs are taken into account.

The terrorist bomb explosion in Bologna, Italy, 1980 : An analysis of the effects and injuries sustained

In August 1980 a terrorist bomb attack was made on the central railway station of Bologna, Italy. Altogether 291 persons were injuried, 73 of whom died at the scene. An analysis of the nature of the injuries and the mechanism by which they occurred showed that three types of bomb injuries could be distinguished: primary blast injuries (pulmonary injuries and flashburns), and secondary and tertiary injuries (concussions, lacerations, and fractures), the latter two types from flying debris set in motion by the blast wave or propulsion of the body. Chest X-ray should be included as a routine part of the examination of blast-injured patients on admission, since many of them develop respiratory insufficieney within 24 hours even when primary symptoms are mild. Because the secondary and tertiary effects of a bomb explosion often lead to multiple injuries, these patients require considerable therapeutic and medical care resources. By an evaluation of the degree of severity of the injuries with use of the AIS (Abbreviated Injury Scale) and ISS (Injury Severity Score) systems, the injurious effects of different types of disasters can be estimated and the findings can serve as a basis for future planning of disaster preparedness(AU)