The Australian and New Zealand journal of surgery
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Randomized Controlled Trial Comparative Study Clinical Trial
A double-blind comparison of the relative efficacy, side effects and cost of buprenorphine and morphine in patients after cardiac surgery.
The analgesic efficacy, side effects and cost of administration of regimens of intravenous buprenorphine and intravenous morphine were compared in a randomized double-blind trial performed during the first 24 h after cardiac surgery. Seven patients received buprenorphine by intermittent intravenous injection and six received morphine by continuous infusion. Both these regimens provided good analgesia for the entire 24 h period, with only mild pain at rest and moderate pain on vigorous coughing. ⋯ Buprenorphine had no narcotic code restriction and could be given by intermittent intravenous injection, whereas morphine required checking and handling as a restricted drug and administration by continuous intravenous infusion. When labour and material costs were computed, over the first 24 postoperative hours, it cost $19.76 per patient to administer morphine, but only $3.16 to administer buprenorphine. Thus the use of buprenorphine injections for the first 24 h after cardiac surgery produced pain relief and respiratory depression comparable to that produced by a morphine infusion, but with a significant cost saving in terms of labour and materials.
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Randomized Controlled Trial Clinical Trial
The effect of incisional infiltration of bupivacaine upon pain and respiratory function following open cholecystectomy.
A controlled, prospective, double-blind trial of wound infiltration with bupivacaine in elective open cholecystectomy was performed to determine if this was an effective method of pain relief and reduced respiratory complications. Additionally, dextran was added to the bupivacaine in an attempt to prolong the effect. The solutions used were, bupivacaine alone 0.25% (n = 14), bupivacaine 0.25% with dextran 70 (n = 16) and saline (n = 16) as a control. ⋯ Pain was assessed using a visual analogue scale and narcotic usage, and respiratory function was assessed by spirometry, chest X-rays and arterial blood gases. The study did not demonstrate any objective improvement in either pain relief or respiratory function. This may reflect inadequate infiltration by the surgeons in the study or that infiltration should have been performed prior to incision.
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Endovascular repair of abdominal aortic aneurysms (AAA) is a new minimally invasive method of aneurysm exclusion that has been adopted with increasing enthusiasm, and with acceptable clinical results. It is important, however, to assess new health-care technologies in terms of their economic as well as their clinical impact. The aim of the present study was to compare the total treatment costs for endovascular (EVR) and open surgical repair (OSR) for AAA. ⋯ Treatment costs for endovascular repair are higher than conventional surgical repair due to the cost of the vascular prosthesis and the greater requirement for radiological imaging studies.
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Two letters written by James Y. Simpson are included among a bound collection of 25 of his pamphlets held in the Gordon Craig Collection of the Library of the Royal Australasian College of Surgeons. Both letters are written in pamphlets relating to Simpson's championing of chloroform. ⋯ This very rare pamphlet was posted to Dr Fleetwood Churchill, a Dublin obstetrician, on 13 November 1847, 9 days after the 'dining room experiment' in Simpson' s home, when the anaesthetic properties of chloroform were dramatically demonstrated. The second letter is written 10 months later and is also addressed to Dr Fleetwood Churchill. The content of both letters is discussed, as is also the rarity of the proof copies of the first printed document describing the use of chloroform.
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Randomized Controlled Trial Comparative Study Clinical Trial
Intertrochanteric fractures of the femur: a randomized prospective comparison of the Gamma nail and the Ambi hip screw.
The Gamma nail has been introduced as an advance over the Ambi hip screw in intertrochanteric femoral fractures. Its efficacy in an Australasian setting has not been documented. ⋯ The Gamma nail proved technically more demanding with higher intra-operative complications and inferior return of mobility.