Intraarticular fentanyl compared with morphine for pain relief following arthroscopic knee surgeryPurpose: To compare the analgesia produced by comparable doses of intra-articular (IA) morphine and fentanyl. Methods: Sixty-nine healthy patients undergoing arthroscopic surgery received a standardized general anesthetic of 4 mg'kg -I thiopental and 2/dg-kg -I fentanyl followed by 2 mg'kg -I succinylcholine prior to tracheal intubation and controlled ventilation. Maintenance of anesthesia was achieved with N20/O 2 and isoflurane.. At the conclusion of surgery intra-articular injection was: Group I (n =23) 50/~g fentanyl in 20 ml saline; Group II (n= 24) 3 mg morphine in 20 ml saline; Group III (n=22) 20 ml saline. Pain scores at rest using a visual analogue scale were recorded by a separate blinded observer at one, two, four, and eight hours postoperatively. Results: Pain scores at one, two, four, and eight hours were 36, 26.3, 20.9, and 12.8 vs 35.8, 33.8, 28.8, and 21.9 vs 70.5, 57.7, 58.4, and 53.6 for the IA4entanyl, IA-morphine, and control groups respectively. Pain scores were greater at all times for Group III. Pain scores for Groups I and II were similar at one hour, but thereafter were less (P < 0.001) for the IA-fentanyl group. Conclusion: Better postoperative analgesia was achieved with 50 Hg intraarticular fentanyl than with 3 mg intraarticular morphine.Objectif: Comparer I'analg&ie produite par des doses comparables de morphine et de fentanyl intra-articulaires (IA).M&hode : Soixante-neuf patients en sant~ devant subir une intervention arthroscopique ont re~u une anesth~sie g~n~rale standard avec 4 mg.kg-' de thiopental et 2/~g.kg-~de fentanyl suivis de 2 mg'kg-' de succinylcholine avant I'intubation endotrach~ale et la ventilation contr61~e. On a maintenu I'anesth&ie avec N20/O 2 et de I'isoflurane. /~ la fin de I'op&ation, rinjection intra-articulaire comprenait : Groupe I (n =23), 50 Hg de fentanyl dans 20 ml de solution sal&; Groupe II (n=24) 3 mg de morphine dans 20 ml de solution salve: Groupe III (n=22) 20 ml de solution sal6e. Les scores de douleur ont ~t~ not& au repos au moyen d'une &helle visuelle analogue par un observateur impartial distinct ~ une, deux, quatre et huit heures apt& I'op&ation. l~sultats : Les scores ont ~t~ ~ une, deux, quatre et huit heures de 36 -26,3 -20,9 -12,8 vs 35,8 -33,8 -28,8 -21,9 vs 70,5 -57,7 -58,4 -53,6 pour les patients qui ont re~u du fentanyl IA, de la morphine IA et la solution salve, respectivement. Les scores de douleur ont ~t~ plus grands, en tout temps, chez les patients du Groupe III. Les scores de douleur ont ~t6 similaires chez les patients des Groupes Iet II ~ une heure, mais moindres par la suite (P < 0,001 ) pour les patients qui ont regu du fentanyl IA. Conclusion : Une analg~sie plus efficace a &~ obtenue avec I'injection intra-articulaire de 50 Mg de fentanyl plut6t que 3 mg de morphine.

Dextran 70 (Hyskon) solution, as many other substances, is in current use as distension medium during hysteroscopy. The advantages of Hyskon solution are its nonconductivity and immiscibility with blood, allowing good visibility during operative hysteroscopy. Adverse reactions to Hyskon are mainly attributable to the drug’s antigenic properties and include severe anaphylactic reactions and fatalities. We report a case of anaphylactic shock during hysteroscopy using Hyskon solution as the distension medium, review the adverse reactions of Hyskon and summarize the treatment modalities used to decrease the incidence of the rare but serious adverse reactions with its use.

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