Tramadol's unique mechanism of action suggests efficacy as a local anesthetic adjunct for peripheral plexus blockade. Our study demonstrates that tramadol, added to mepivacaine for brachial plexus anesthesia, extends the duration and improves the quality of postoperative analgesia in a dose dependent fashion with acceptable side effects.

Post-mastectomy pain syndrome (PMPS) is experienced by 20-65% of patients who undergo breast surgery for cancer. The etiology of this chronic neuropathic pain syndrome is unclear and most likely multi-factorial. Symptoms may be mild, not requiring treatment, or severe, considerably restricting quality of life. The effectiveness of available pharmacological and pain management therapies is unknown. Certainly, some women remain under-treated with poor pain control. We report three women undergoing wide local excision for cancer of the breast and block dissection of axillary lymph nodes who subsequently developed severe PMPS. In these cases the symptoms were completely relieved by the aspiration or formal drainage of an encapsulated haematoma in the axilla. The removal of a minimal amount of blood brought instant improvement suggesting that pressure within the haematoma could be an etiological factor. An axillary haematoma, which may not be clinically obvious, should be considered as a possible cause of PMPS.

Objectives Healthcare staff can be prone to high levels of stress and research investigating mindfulness-based courses for this population is showing promise. Given the demands of healthcare work, shortened mindfulness courses may be more appropriate. The aim of the study was to evaluate the utility of a workplace-adapted mindfulness course (MBOE) in a hospital setting, including research on workplace-specific outcomes beyond stress reduction and data relating to home practice with a mobile app. Method The effects of assignment to a workplace-adapted, 6-week mindfulness course or a waitlist control condition on dispositional mindfulness, perceived stress and fulfilment of basic psychological needs at work were examined in a sample of 65 hospital staff. Results Compared with waitlist, staff taking the course showed significant increases in mindfulness and psychological need fulfilment and reductions in perceived stress. Mean levels of perceived stress reduced from a high level to within published norms. Reductions in stress and increases in mindfulness, autonomy and competence remained stable at follow-up. Increased mindfulness mediated improvements in need fulfilment and reductions in stress. Attendance and use of a mobile app for home practice were associated with positive outcomes. Social factors (relatedness) associated with the delivery and outcome of the course were also explored. ConclusionsThe results indicate that a workplace-adapted, short-format mindfulness course can achieve positive results in line with mindfulness courses for other contexts. Questions were raised regarding which distinct elements may improve outcomes, e.g. home practice and dispositional mindfulness vs. learning environment on more general improvements.

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