Objective-To observe the effects of introducing an acute pain service to the general surgical wards of a large teaching hospital.

Once intraoperative epidural block has been established, colonic serosal red cell flux and inferior mesenteric artery flow are more closely associated with changes in mean arterial pressure than changes in cardiac output. The measured reduction in colonic flow does not respond to an increase in cardiac output with fluid resuscitation, but requires the use of a vasopressor to increase arterial pressure, before colonic blood flow is improved.

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SummaryA questionnaire designed to assess the knowledge of newly qualiJied house oficers about the management of postoperative pain, was sent to 203 preregistration house oficers in the South West region of England. The questionnaire sought information on the following: ( I ) the prescription of postoperative analgesia for four clinical cases, ( 2 ) the use of nonsteroidal anti-inflammatory drugs in patients with six medical conditions, and ( 3 ) the management of a patient who had an epidural infusion. The response rate was 26% (54 house oficers) and only 13% of those circulated answered all four clinical cases appropriately. The use of nonsteroidal anti-injammatory drugs was often inappropriate. The management of the patient with a postoperative epidural infusion was inadequate when compared with a minimum safe response protocol designed by the authors. The poor theoretical and practical knowledge demonstrated in this survey indicates that urgent changes are required in the undergraduate curriculum to take account of the recent revolution in the management of severe postoperative pain.