A randomized, double-blind comparison between parecoxib sodium and propacetamol for parenteral postoperative analgesia after inguinal hernia repair in adult patients.

The newly injectable cyclooxygenase-2 selective nonsteroidal antiinflammatory drug, parecoxib, has never been compared with propacetamol, a parenteral formulation of acetaminophen. In this prospective, randomized, double-blind, double-dummy study, we randomly assigned 182 patients scheduled for initial inguinal hernia repair under general anesthesia to receive a single injection of 40 mg parecoxib or 2 injections of 2 g propacetamol within the first 12 h after surgery. The study variables were morphine consumption, pain at rest and while coughing, and patient satisfaction throughout the first 12 h postoperatively. For statistical analysis, we used the Student's t-test, chi(2), and covariance analysis. Total morphine consumption did not differ between the two groups. Pain was less intense in the parecoxib group at rest (P = 0.035) but did not differ for pain while coughing. The incidence of side effects was similar. Significantly more patients in the parecoxib group rated their pain management as good or excellent (87% versus 70% in the propacetamol group, P = 0.001). Within the first 12 h after inguinal hernia repair in adult patients, a single injection of parecoxib 40 mg compares favorably with 2 injections of propacetamol 2 g.

[A program of quality improvement in transfusion safety. Experience at Saint-Camille Hospital]. / Programme d'amélioration de la qualité en sécurité transfusionnelle. L'expérience de l'hôpital Saint-Camille.

A program of quality improvement of blood transfusion safety was carried out in St Camille Hospital after a call for tenders had been jointly issued by the French Ministry of Health and the French Agency for Medical Evaluation (ANDEM). The blood transfusion process was analysed and a diagnosis of the situation was performed. Improvement actions were then undertaken to control the blood transfusion process. They consisted in education programs, elaboration of procedures and documents such as a transfusion record and a transfusion manual. The effectiveness of the actions was measured using indicators. Such a quality improvement approach revealed to be a good method to manage the blood transfusion process and to improve safety. However, it requires people's involvement in the project, and rigorous project management.

[Cephalic cancer pain controlled by intraventricular administration of morphine and clonidine]. / Douleurs céphaliques néoplasiques contrôlées par administration intraventriculaire de morphine et de clonidine.

A 47-year-old woman suffered from a pharyngeal cancer causing pain only poorly relieved by high doses of oral morphine. Oral administration was switched to the intracerebroventricular (ICV) route but pain relief was only transient despite a daily dosage up to 1.5 mg of morphine. Finally an effective pain relief was achieved with increasing doses of clonidine (5 to 30 micrograms) in combination with morphine (1.5 mg) by ICV route. Neither arterial hypotension nor sedation occurred and the patient recovered transiently a better quality of life.

Clonidine-induced analgesia in postoperative patients: epidural versus intramuscular administration.

To compare the analgesic efficacy and plasma concentration of intramuscular (IM) versus epidural (EP) clonidine, 20 patients recovering from orthopedic or perineal surgery were randomly divided into two groups of ten. Clonidine (2 micrograms/kg) was administered epidurally in group 1 and intramuscularly in group 2. Analgesia was assessed using a visual analog scale (VAS) over a period of 6 h following clonidine administration. Venous blood samples were obtained at specific intervals for radioimmunoassay determination of plasma clonidine concentrations. The maximum reduction in VAS pain score was 78.5 +/- 20.6% in the EP group and 68.1 +/- 31.5% in the IM group (NS). Onset of analgesia was similar (within 15 min of injection), but duration tended to be longer after epidural than intramuscular administration (208 +/- 87 min vs. 168 +/- 95 min, mean +/- SD, P greater than 0.05). The peak plasma clonidine concentration after EP injection was 0.82 +/- 0.22 ng/ml and 1.02 +/- 0.76 ng/ml after IM injection. Hypotension, bradycardia, and drowsiness occurred with both methods of administration. None of these effects required treatment. Thus, in postoperative patients clonidine produces similar analgesia and side effects after parenteral or EP administration.

Postoperative analgesia with extradural clonidine.

The analgesic effect of extradural clonidine was evaluated in a double-blind study. In the recovery room, following orthopaedic or perineal surgery 20 ASA I and II patients were allocated randomly to two groups. The extradural clonidine (EC) group received clonidine 2 micrograms kg-1 in isotonic saline solution 15 micrograms ml-1. The extradural saline (ES) group received the equivalent volume of plain isotonic saline solution. Pain was evaluated by a visual analogue scale (VAS) at 15-min intervals for the first 2 h and subsequently at 30-min intervals for the following 4 h. Morphine 5 mg was given s.c. when patients complained of pain after extradural saline or clonidine. In the EC group, the mean (SD) maximum pain relief was 68.2 (24.1)% of the initial VAS score, but it was only 14.7 (25.2)% in the ES group. The mean duration of analgesia, before injection of morphine, was significantly longer in the EC group (210 (87) min) compared with the ES group (45 (27) min) (P less than 0.001). Drowsiness and moderate hypotension were observed in the EC group.

Evaluation of Doppler examination for diagnosis of catheter-related deep vein thrombosis.

The accuracy of Doppler examination was evaluated for the diagnosis of catheter-related venous thrombosis in 40 postoperative patients. Deep vein thrombosis was detected by venography in 15 patients and confirmed by the Doppler technique in a double blind study. Only one false-positive and one false-negative result were obtained with the Doppler technique. This technique appears to be valuable for the early diagnosis of catheter-related vein thrombosis, even in asymptomatic patients.

Post-operative rigidity after fentanyl administration.

A case of thoraco-abdominal rigidity leading to respiratory failure is described in the post-operative period in an elderly patient who received a moderate dose of fentanyl. This was successfully reversed by naloxone. The mechanisms possibly implicated in this accident are discussed.