No abstract

The management of postoperative pain with continuous epidural fentanyl infusion was compared with continuous intravenous fentanyl infusion. In a randomized, doubleblind protocol we prospectively studied 20 patients undergoing repair of the anterior cruciate ligament of the knee. The quality of analgesia and the incidence of side effects were documented. Compared with patients receiving continuous intravenous fentanyl infusion, at 18 h postoperatively patients given continuous epidural fentanyl infusion reported similar pain scores both at rest (22 +/- 25 vs 27 +/- 21, P = 0.52) and with ambulation (59 +/- 18 vs 56 +/- 22, P = 0.82). Plasma fentanyl levels were 1.8 +/- 0.4 and 1.7 +/- 0.4 ng/mL (P = 0.91) for the intravenous and epidural groups, respectively. There were no significant differences in the incidence of nausea, pruritus, or urinary retention. There was no respiratory depression in either group. We conclude that when compared with continuous intravenous fentanyl infusion, continuous epidural fentanyl infusion offers no clinical advantages for the management of postoperative pain after knee surgery.

No abstract

Recent widespread abuse of cocaine has resulted in an alarming increase in emergency department admissions for acute treatment of this toxic drug. Highly publicized cocaine-associated deaths of prominent athletes have awakened both the medical community and the general public to the possible devastating effects of this so-called 'champagne of drugs'. A potent central nervous system stimulant, cocaine produces symptoms that include changes in activity, mood, blood pressure, cardiac rhythm, respiration and body temperature. The adverse effects of cocaine, which may progress rapidly to death, include cerebrovascular accidents, myocardial infarction, sudden cardiac arrhythmias, pneumomediastinum, rhabdomyolysis with myoglobinuric renal failure and intestinal ischaemia. In addition, cocaine has been implicated in obstetric and neonatal complications. Because of the exceedingly rapid progression of the 'cocaine reaction' to a fatal outcome, it is imperative that clinicians know how to recognise and manage the symptoms of cocaine overdose.