The similarities between phantom limb pain and preoperative limb pain have been noted, and this raises the possibility of modulating the pain by a preoperative blockade. The aim of this study was to investigate if it was possible to reduce postoperative phantom limb pain by giving lumbar epidural blockade (LEB) with bupivacaine and morphine for 72 h prior to the operation. 25 patients were interviewed about their limb pain before limb amputation, and about their phantom limb pain 7 days, 6 months and 1 year after limb loss. 11 patients, of mean age 77 years (52-93), received an LEB, so that they were pain-free for 3 days prior to operation. The control group, 14 patients of mean age 73.4 years (63.86), all had preoperative limb pain. Seven days after operation, 3 patients in the LEB group and 9 patients in the control group had phantom limb pain (P less than 0.10). After 6 months all patients in the LEB group were pain-free, whilst 5 patients in the control group had pain (P less than 0.05). After 1 year, all the patients in the LEB group were still pain-free, and 3 patients in the control group had phantom limb pain (P less than 0.20). Preoperative lumbar epidural blockade with bupivacaine and morphine reduces the incidence of phantom limb pain in the first year after operation.

No abstract

We studied 20 otherwise healthy women undergoing lower abdominal surgery. Immediately after wound closure, while still anaesthetized, they received either electroacupuncture (EA) or no further treatment. They were allowed pethidine for postoperative analgesia by patient-controlled infusion pump. Signs of postoperative distress (pain, nausea, drowsiness) were evaluated after 2 and 6 h by visual analogue scale scores. The group receiving EA consumed half the quantity of pethidine as that used used by the no treatment group. Two patients in the EA group had no postoperative analgesia in the first 2 h. There was no difference in the assessments of postoperative distress between groups. No patient was aware of having received EA or not.

Contents of metabolic energy stores and lactate in chronic reversibly dysfunctional myocardium were preserved. In contrast, energy stores were depleted in myocardium without functional recovery after revascularization.

In 18 patients scheduled for lower intraabdominal surgery (hysterectomy), changes in thyreotropin (TSH) thyroxine (T4), triiodothyronine (T3) binding of thyroid hormones to plasma proteins (T3-uptake) and glucose in serum were evaluated. In eight patients afferent neurogenic impulses from the surgical area were blocked (Th4-S5) with bupivacaine 0.5% infused continuously into the epidural space from the start of the operation until 6 h postoperatively. All patients received general anaesthesia with thiopentone, pethidine, pancuronium and nitrous-oxide plus oxygen. The patients receiving epidural analgesia had no increase in plasma-TSH, compared to the other group, which had a significant (P less than 0.05) increase peroperatively. The patients receiving epidural analgesia were pain-free and the normal stress-induced increase in plasma-glucose was abolished. Concerning T3 we found a significant decrease in both groups and a steady level of T4- and T3-uptake without significant fluctuations. Thus it can be concluded that the effects of surgical trauma on plasma-TSH concentration are markedly similar to the effects of other anterior pituitary hormones, i.e. HGH, prolactin and ACTH.

This study comprised 12 patients admitted for interpleural catheter treatment of chronic pancreatic pain. After the insertion of a left-sided interpleural catheter, 20 ml of bupivacaine 0.5% plain was given, followed by top-ups of 10-20 ml bupivacaine 0.5% as needed. Catheters were left in situ for 12-30 h. Immediate pain relief was achieved in all patients. Five patients had only a single blockade offering pain relief for a median of 33 days. One patient suffering from pancreatic carcinoma remained pain-free until death 45 days later. Seven patients returned for a second blockade after a median of 10 days. After this second blockade long-lasting pain relief was achieved in three patients for 70, 105 and 145 days. Two patients experienced pain relief lasting 11-14 days, while in two patients only a short-lived effect was observed, 3-8 days. Unimportant pneumothorax occurred in one patient. No cardiovascular or respiratory side-effects were recorded. We consider interpleural blockade an alternative worth further investigations in the future in the treatment of patients suffering from chronic pancreatic pain.

No abstract

A case of' premature labour induced by necrosis in a jbromjwma followed by laparotomy is described. Unsuccessful treatment with ritodrine was ,followed by successful treatment with epidural analgesia The possible role of' a sjwipathetic blockade i . 7 discussed Key wordsAnuesthesia; obstctric. Anarsthetir. techniques, regional; epidural.Intra-abdominal conditions that necessitate operation during prcgnancy are often complicated by fetal death or prcmature labour. * -4 The most widely used treatment to prcvcnt preterm delivery consists of bed rest, sedatives and possibly a [I-sympathomimetic drug such as r i t~d r i n e .~.~ In some cases this treatment has been unsuccessful. USC of epidural blockade for the treatment of threatcncd prctcrm labour or abortion does not seem to have been rcportcd previously. Case historyA prcviously healthy 26-year-old woman who was in the 18th week of a twin pregnancy, was admitted to hospital with intermittent pain in the lower abdomen. Utcrinc contractions could be felt at intervals of 3-5 minutes. A tender swelling was present on the right side of the uterus. There was no dilatation of the cervix. Ultrasonography of the abdomen showed two live fetuses and a tumour that measured 8 x 8 cm located in the anterior wall of the uterus. The patient was treated with bed rest, diazepam and pethidinc. Thc frequency and intensity of the contractions, as well as thc pain, increased during the first 24 hours of admission and the treatment was therefore supplemented with intravcnous ritodrine.The contractions continued during the following 2 weeks despite the administration of ritodrine at dose levels up to 125 ,ug/minute. Higher doses resulted in unacceptable tachycardia, with a pulse rate of more than 120 beats/ minute and tremor. An attempt was made on several occasions to reduce the dosage of ritodrine but resulted in an increase in the intensity and frequency of the uterine contractions. Nccrosis in a fibromyoma, leading to premature contractions, was suspected as the size and tendcrncss of the turnour increased.A laparotomy was carried o u t on the 15th day. Light general anacsthesia was supplementcd with epidural analgesia with bupivacaine 0.5% via an epidural catheter inserted into the L2-3 interspace. The operation revealed a fibromyoma with a diameter of 8 cm, situated mainly within the uterine wall. Enucleation was therefore impossible.Treatment with ritodrine I00 pg/minute was continued for thc following 48 hours and the epidural blockade was maintained by repeated injections of bupivacaine 0.5%, 1 0 ml every 2 hours: this led to a level of analgesia around L,-z. The patient still complained of severe pain and the contractions were accompanied by effacement and dilatation of the cervix. Treatment with ritodrine was discontinued at this timc and a continuous infusion of lignocaine 1.0% with adrenaline 5 pgiml, 20 ml/hour, commenced via the epidural catheter. This led to a level of analgesia around T8-g. The contractions ceased within I ? hours of the start of this treatment but ...