Evaluation of the effect of intra-operative intravenous fluid on post-operative pain and pulmonary function: a randomized trial comparing 10 and 30 ml kg(-1) of crystalloid.

BACKGROUND: Existing evidence suggests that administration of intravenous fluids has been shown to improve outcomes including pain in gynecological laparoscopic surgery but the optimum fluid dose has not been determined. AIMS: To determine the effect of administration of intravenous fluids on post-operative pain and pulmonary function after gynecological laparoscopy. METHODS: In a prospective randomized double-blinded study 100 ASA 1 and 2 elective patients undergoing gynecological laparoscopy were randomized to receive intravenous compound sodium lactate 10 ml kg(-1) (CSL10-restrictive) or 30 ml kg(-1) (CSL30-liberal) administered intra-operatively. The primary outcome measure was the post-operative pain score at 24, 48 and 72 h, assessed by 0-10 verbal rating scale (VRS). Pulmonary function (FEV1, FVC, PEFR) and oxygen saturation were also measured. RESULTS: Patients who received CSL 30 had lower post-operative pain scores than CSL 10 (ANCOVA-mean difference = 0.47, 95 % CI 0.11-0.83, P = 0.01). Post-operative pain VRS was lower in CSL30 than CSL10 at 48 h (mean difference 0.56, 95 % CI 0.04-1.09, P = 0.036). Patients in CSL30 reported shoulder tip pain less frequently than those in CSL10 (30.4 vs. 43.9 % of assessments, P = 0.03, OR 0.58) but reported wound pain more frequently 39.0 vs. 24.2 %, P = 0.01, OR 2.0). Indices of pulmonary function did not differ between groups at any time. CONCLUSIONS: Liberal compared to restrictive administration of i.v. crystalloid is associated with a clinical modest reduction in pain. Pulmonary dysfunction was not increased with liberal fluid administration.

Anaesthetic management of a patient with Liddle's syndrome for emergency caesarean hysterectomy.

We describe the anaesthetic management of a patient with Liddle's syndrome during caesarean section and emergency hysterectomy for placenta accreta associated with significant intrapartum haemorrhage. Liddle's syndrome is a rare autosomal dominant disorder characterised by early onset arterial hypertension and hypokalaemic metabolic alkalosis. Additional issues were the presence of short stature, limb hypertonicity and preeclampsia. Initial management with a low-dose combined spinal-epidural technique was subsequently converted to general anaesthesia due to patient discomfort. The management of Liddle's syndrome in the setting of neuraxial and general anaesthesia in a patient undergoing caesarean section is discussed.

Self-reported post-discharge symptoms following obstetric neuraxial blockade.

BACKGROUND: Economic pressures are leading to earlier hospital discharge following delivery, before complications of obstetric neuraxial block may become apparent. Our aim was to estimate the incidence of symptoms presenting post-discharge at a single tertiary obstetric centre. METHODS: From June 2004 to June 2007, a prospective observational study of all women receiving neuraxial block for labour and delivery in our hospital was conducted. Patients were reviewed in hospital by the acute pain team and provided with a discharge advice form to take home to identify potential block-related complications. We collected data on those contacting us with new-onset symptoms after hospital discharge. RESULTS: Ninety-eight patients (1.4%) made contact post-discharge following neuraxial block. The time range overall for presentation of symptoms was 2-260 days, with headache reported significantly earlier than backache. Many symptoms were self-limiting. Headache was the commonest primary complaint in 43 patients (44%) with four receiving an epidural blood patch. Sensorimotor symptoms of pain, paraesthesia or weakness was the primary complaint in 33 patients (34%), and backache in 21 (21%). Sixteen percent of patients with headache, 24% with sensorimotor symptoms and 14% with backache were referred to neurologists. There was a late self-report of obstetric palsy (1:15,033). CONCLUSIONS: New post-discharge symptoms were self-reported by 1.4% of patients following neuraxial blockade. These were not detected during hospital stay despite routine directed post-block review. Only 4% of these symptoms could be directly attributable to neuraxial block.