Intra-articular analgesia following arthroscopic surgery of the shoulder.

Shoulder surgery is very often followed by severe postoperative pain. Loco-regional anaesthesia has greatly contributed as a solution of this problem. Nevertheless most of surgery is still performed under general anaesthesia. In this case many different methods have been proposed in order to mitigate postoperative pain. Intra-articular administration of local anaesthetics after shoulder surgery is not yet in routinely clinical practice. In this study efficacy of intra-articular administration of Ropivacaine versus Bupivacaine has been evaluated. Analysis of results showed both drugs to share the same effectiveness within four hours postoperatively. In subsequent period (6-24 hours) Ropivacaine demonstrated to provide a statistically significant better postoperative pain relief. Furthermore Ropivacaine group patients needed postoperative analgesics to a lesser extent than Bupivacaine group. The long-losting satisfactory level of analgesia, particularly with Ropivacaine, could recommend the use of intra-articular analgesia even for day-hospital or one-day surgery procedures.

Spectrum of methyldopa liver injury.

The administration of alpha methyldopa resulted in serious liver injury to seven patients, requiring hospitalization. All patients presented with symptoms indistinguishable from viral hepatitis. Histological changes ranged from those compatible with acute hepatitis to chronic active hepatitis and subacute hepatic necrosis. One patient with subacute hepatic necrosis rapidly progressed to hepatic failure and died; autopsy revealed postnecrotic cirrhosis. Inadvertent rechallenge after recovery resulted in dramatic recurrence of symptoms in one patient, confirming the fact that a hypersensitivity phenomenon is involved. A high state of awareness among physicians of this unpredictable toxic effect of the drug may reduce its unrecognized perpetuation.