A prospective, randomized study was performed to detail clinical experience with both patient-controlled epidural analgesia (PCEA) and midwife-administered intermittent bolus (I B) epidural analgesia during labour, under the conditions pertaining in a busy obstetric delivery unit. Both methods used 0.125% bupivacaine plus fen tanyl, and similar rescue supplementation, although management decisions related to epidural analgesia were made principally by attending midwives. One hundred and ninety-eight women were recruited and data analysed from 167 (PCEA n =82, IB n =85). The groups were demographically similar. Median hourly pain scores, ratings of analgesia and satisfaction did not differ. Maximum pain scores were significantly higher in those receiving IB epidural analgesia (P< 0.05). The PCEA group had a significantly higher rate of supplementation and bupivacaine use (P< 0.01), and a longer duration of the second stage of labour (P < 0.03). The relative risk of instrumental delivery with PCEA versus the IB method was 1.57 (Cl 1.07-2.38). Experience within our unit with PCEA is contrasted with that of IB epidural analgesia, the method most commonly used; and with that of controlled trials comparing these two methods.

A prospective randomised controlled trial comparing rectal indomethacin with placebo was performed in children. Thirty children aged seven years and over undergoing open appendicectomy were given suppositories of either indomethacin 2 mglkg or placebo. Suppositories were given at the conclusion of surgery and again 12 and 24 hours later. All children were given morphine by a patient-controlled analgesia pump. After 36 hours, children given indomethacin had used 0.51 (SD 0.34) mglkg, and children given placebo 0.91 (SD 0.46) mglkg (P< 0.02). Pain scores measured with a visual analogue scale, sedation scores and the incidence of vomiting were similar in both groups. Children given indomethacin suppositories used 44% less morphine than children given placebo, and at the same time obtained similar postoperative analgesia.

Results from this short-term sterility study represent an initial step in the evaluation of multiple doses of surfactant from a single-use vial. The data suggest that 1-2 re-entries into a vial of calfactant, within 24 hours after the initial breach, can be a safe and economical method of providing more than a single dose of surfactant to infants weighing <1 kg. We encourage each institution to reproduce these findings before applying this concept to their patients.