We studied a number of factors that may be associated with urinary retention, in particular the method of postoperative analgesia delivery, in 47 men and 69 women undergoing lower limb joint replacements. The following factors were studied: age, gender, height, weight, previous history of urinary retention, presence of symptoms suggestive of urinary tract obstruction, type of anaesthetic (general anaesthetic or spinal anaesthetic), type of postoperative analgesia (intramuscular or patient-controlled analgesia with morphine) and the total dose of morphine given. Urinary retention developed in 18.1% of patients. Stepwise logistic regression analysis was used to identify independent explanators of an increased probability of developing urinary retention. Three factors emerged - male gender, increasing age and the use of patient-controlled analgesia.

SummaryTransdermal hyoscine (Scopoderm TTS CIBA) was compared with placebo in 67 patients receiving postoperative analgesia via a patient-controlled analgesia system. AN patienrs underwent an abdominal hysterectomy and had a standard anaesthetic. They werefiillowed up in recovery and daily,for 3 days postoperatively. Fewer patients in the hyoscine group suffered emetic sequelae in recovery and on the third postoperative day ( p < 0.05). The hyoscine group received h a y the number of supplementary antiemetic doses compared to placebo. However, despite transdermal hyoscine there was still a high (78%) incidence of nausea and vomiting. The only SignjJcant ( p < 0.05) increase in side effects attributable to hyoscine was a higher reported incidence of visual disturbance on the second day. Key wordsComplications; nausea, vomiting. Antiemetic; transdermal hyoscine. Analgesia; patient controlled analgesia.Patient-controlled analgesia (PCA) is used frequently in our hospital but we have observed a high incidence of nausea and vomiting with this technique [I]. This may in part be due to a reluctance to administer intramuscular antiemetics. Antiemetics are not administered routinely with PCA, unlike when intramuscular opioids are used. Clearly an alternative to the intramuscular route of administration of antiemetics would be desirable. Transdermal hyoscine has been shown to be an effective antiemetic for motion sickness [2-41; however, its use for preventing postoperative nausea has not been so well demonstrated [5-71. These studies used intramuscular postoperative analgesic regimens which result in peaks and troughs of opioid blood concentration. Patients receiving PCA are prescribed small doses of analgesia which they are able to self-administer at frequent intervals and may be expected to have a more constant blood concentration. Transdermal drug delivery also offers a mechanism to achieve and maintain a relatively constant drug concentration [8]. This was the rationale for studying the effectiveness of transdermal hyoscine in patients receiving PCA. MethodPatients aged between 18 and 65 years and of ASA status 1 or 2 requiring general anaesthesia for abdominal hysterectomy were recruited into the trial. The study was approved by the Hospital Medical Ethics Committee and written informed consent was obtained. The patients were randomly allocated to receive either a hyoscine transdermal patch or a matching placebo patch. On the evening before surgery the use of PCA was explained and patients were informed that an intramuscular antiemetic would be available on request postoperatively.Oral temazepam 20 mg was given 2 h pre-operatively and the patch, or placebo, applied behind the ear. The placebo was a standard waterproof dressing (Johnson and Johnson) and each hyoscine patch was covered by a similar dressing, so that its identity could not be distinguished from placebo by patient or assessor. The patches were applied by a nurse who was not involved with subsequent assessment.A standard anaesthetic was given consisting ...

We present the results of a randomised, double-blind controlled trial to determine the effect of adding bupivacaine to intraperitoneal Hartmann's solution, used to reduce the incidence of postoperative adhesions, on postoperative pain and on analgesic consumption in patients presenting for major laparoscopic gynaecological procedures. Fifty-six women were studied and postoperative analgesic requirements and visual analogue scores were used to assess the pain experienced by the treatment group when compared with the control group. There was no statistical difference in the pain scores between the two groups at any time during the study period (Student's t-test; p = 0.29-0.74) nor was there any difference in analgesic consumption (Mann-Whitney U-test; p = 0.34-0.79).

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We studied a number of factors that may be associated with urinary retention, in particular the method of postoperative analgesia delivery, in 47 men and 69 women undergoing lower limb joint replacements. The following factors were studied: age, gender, height, weight, previous history of urinary retention, presence of symptoms suggestive of urinary tract obstruction, type of anaesthetic (general anaesthetic or spinal anaesthetic), type of postoperative analgesia (intramuscular or patient-controlled analgesia with morphine) and the total dose of morphine given. Urinary retention developed in 18.1% of patients.Stepwise logistic regression analysis was used to identify independent explanators of an increased probability of developing urinary retention. Three factors emerged ± male gender, increasing age and the use of patient-controlled analgesia.