Patients with higher anxiety and depression levels had higher postoperative pain and analgesic requirements in this study.

We distributed the Religion and Spirituality in Cancer Care Study via the Middle East Cancer Consortium to physicians and nurses caring for advanced cancer patients. Survey items included how often spiritual care should be provided, how often respondents themselves provide it, and perceived barriers to spiritual care provision.ResultWe had 770 respondents (40% physicians, 60% nurses) from 14 Middle Eastern countries. The results showed that 82% of respondents think staff should provide spiritual care at least occasionally, but 44% provide spiritual care less often than they think they should. In multivariable analysis of respondents who valued spiritual care yet did not themselves provide it to their most recent patients, predictors included low personal sense of being spiritual (p < 0.001) and not having received training (p = 0.02; only 22% received training). How "developed" a country is negatively predicted spiritual care provision (p < 0.001). Self-perceived barriers were quite similar across cultures.Significance of resultsDespite relatively high levels of spiritual care provision, we see a gap between desirability and actual provision. Seeing oneself as not spiritual or only slightly spiritual is a key factor demonstrably associated with not providing spiritual care. Efforts to increase spiritual care provision should target those in favor of spiritual care provision, promoting training that helps participants consider their own spirituality and the role that it plays in their personal and professional lives.

Acupressure at the P6 meridian point is an effective alternative for the prevention of nausea and vomiting in patients receiving patient-controlled analgesia with morphine after gynaecological surgery.

Purpose: To determine the et~cacy and safety of patient-controlled epidural analgesia of morphine or fentanyl in combination with bupivacaine for postoperative pain relief. Methods: Forty ASA I-II patients scheduled for major abdominal surgery were studied. After insertion of a lumbar epidural catheter, patients were given a non-opioid general anaesthetic. After surgery patients complaining of pain, received a loading dose of 2 mg morphine (Group I) or 50/Jg fentanyl (Group II). For continuing pain, I mg morphine in 4 ml bupivacaine 0. 125% (0.25 mg.ml-' morphine and I tug'm1-' bupivacaine, Group I) or 20/ag fentanyl in 4 ml bupivacaine 0.125% (5/lg-ml -~ fentanyl and I mg.ml -r bupivacaine Group II) were administered. Blood pressure, heart rate, respiratory rate and Sp02 were monitored. Assessments of pain (VAS), nausea-vomiting, motor block, pruritus and sedation were recorded for 24 hr. Results: No difference in pain or sedation was observed between groups. The 24 hr postoperative opioid consumption was 15.50 -+ 7.53 mg morphine and 555.10 _+ 183.85 ~ug fentanyl. Total bupivacaine 0.125% consumption was 58.00 + 30.14 ml in Group I and 101.05 + 36.77 ml in Group II. One patient in Group II complained of motor weakness in one leg. The incidence of nausea (Group 1 45%, Group II 10% P < 0.05) and pruritus (Group I 30%, Group II 5% P < 0.05) was less in patients receiving fentanyl. Conclusion: Both methods were effective in the prevention of pain but, because of fewer side effects, fentanyl may be preferable to morphine. Objectif : DEterminer I'efficacitE et la s&uritE d'emploi de I'analg&ie p&idurale, contr61& par le patient, ~ base de morphine ou de fentanyl en combinaison avec la bupivacaine pour le soulagement de douleurs postop&a-toires. M~thode : Quarante patients ASA I-II devant subir une chirurgie abdominale majeure ont &E &udi&. Apr& I'insertion d'un catheter pEridural Iombaire, les patients ont re~u un anesthEsique gEnEral sans opioide. Les patients qui ont ressenti des douleurs apr& I'intervention ont regu une dose d'attaque de 2 mg de morphine (Groupe I) ou de 50/~g de fentanyl (Groupe II). Pour soulager une douleur prolong&, I mg de morphine dans 4 ml de bupivacaine 0, 125 % (0,25 mg'ml l de morphine et I mg.mg" de bupivacaine, Groupe I) ou 20 ~g de fentanyl dans 4 ml de bupivacaine 0, 125 % (5/ag.ml-' de fentanyl et I mg'ml -~ de bupivaca,ne, Groupe II) ont EtE administr&. La tension art&ielle, la frEquence cardiaque, le rythme respiratoire et la Sp02 ont EtE enregistr&. Les Evaluations de la douleur (EVA), les naus&s et les vomissements, le blocage moteur, le prurit et la sedation ont EtE notes pendant 24 h. R~sultats : Aucune difference n'a EtE observ& entre les groupes concernant la douleur ou la sedation. La consommation d'opioide pendant 24 h aprEs I'opEration a EtE de 15,50 __-7,53 mg de morphine et 555, 10 _+ 183,85/ag de fentanyl. La consommation totale de bupivaca'ine 0,125 % a EtE de 58,00 ---30, 14 ml dans le Groupe Iet de 101,05 -+ 36,77 ml dans le Groupe II. Un patient du Groupe II s'est...

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