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1 The intensity of postoperative pain is influenced by many factors, for example, individual variation, site of incision and type of operation, anaesthetic technique, and the interval from the end of operation to the appearance of pain. 2 These factors affect the efficacy of analgesics. 3 Mild analgesics provide adequate pain relief in half of our patients in the immediate postoperative phase when the pain is slight to moderate. 4 The maximum effect of mild analgesics corresponds to that produced by morphine 6-10 mg. Adequate analgesia may not therefore be provided for the treatment of severe postoperative pain unless narcotic analgesics have been used peroperatively. 5 When mild analgesics are combined with narcotics synergism is achieved. 6 As postoperative pain decreases with time, mild analgesics usually provide adequate pain relief on the first and following postoperative days. [ABSTRACT FROM AUTHOR]

Breakthrough pain (BKP) is a transitory flare of pain that occurs on a background of relatively well controlled baseline pain. Previous surveys have found that BKP is highly prevalent among patients with cancer pain and predicts more severe pain, pain-related distress and functional impairment, and relatively poor quality of life. An international group of investigators assembled by a task force of the International Association for the Study of Pain (IASP) evaluated the prevalence and characteristics of BKP as part of a prospective, cross-sectional survey of cancer pain. Fifty-eight clinicians in 24 countries evaluated a total of 1095 patients with cancer pain using patient-rated items from the Brief Pain Inventory (BPI) and observer-rated measures. The observer-rated information included demographic and tumor-related data, the occurrence of BKP, and responses on checklists of pain syndromes and pathophysiologies. The clinicians reported BKP in 64.8% of patients. Physicians from English-speaking countries were significantly more likely to report BKP than other physicians. BKP was associated with higher pain scores and functional interference on the BPI. Multivariate analysis showed an independent association of BKP with the presence of more than one pain, a vertebral pain syndrome, pain due to plexopathy, and English-speaking country. These data confirm the high prevalence of BKP, its association with more severe pain and functional impairment, and its relationship to specific cancer pain syndromes. Further studies are needed to characterize subtypes of BKP. The uneven distribution of BKP reporting across pain specialists from different countries suggests that more standardized methods for diagnosing BKP are needed.

The authors quantitated the enflurane-sparing effect of alfentanil during N2O/O2 anaesthesia in 50 patients undergoing body surface surgery and in 50 patients undergoing upper abdominal surgery. Patients were assigned to one of five treatment regimens (10 patients each group, double-blind administration) as follows: placebo bolus followed by placebo infusion (group I); or alfentanil bolus (30 micrograms kg-1) followed by infusion of placebo (group II) or alfentanil, at the rate of 10 (group III), 20 (group IV), or 40 (group V) micrograms kg-1 h-1. Anaesthesia was induced with thiopentone and vecuronium, and neuromuscular block was kept at 85-90% by continuous infusion of vecuronium. Increases in spontaneous electromyographic activity of neck muscles (NEMG) and in systolic blood pressure (SBP) served as criteria of inadequate anaesthesia. When such increases occurred, enflurane was given in 0.2% steps (end-tidal concentration) of 5 min each, until the increases were suppressed. The relationship between increases in NEMG and increases in SBP was inconsistent: only 10% of the increases occurred simultaneously. With alfentanil, the consumption of enflurane decreased by as much as 70% (P < 0.001) during superficial surgery and 50% (P < 0.05) during abdominal surgery.

Objective: To study over a period of one and a half years the effect of spiritual healing on patients with idiopathic pain syndrome using several psychological and medical parameters., Design: Randomized clinical trial., Setting: Outpatient pain clinic., Patients: Twenty-four patients with idiopathic chronic pain who had passed a pretreatment psychological interview were allocated randomly to receive spiritual healing or no active treatment., Main Outcome Measures: Medical interview (Visual Analog Scale and Pain Clinic Investigation Formula); International Association for the Study of Pain (IASP) Data Base Outline; psychological interview (Hopkin's Symptom Checklist, Middlesex Hospital Questionnaire, Beck's Depression Inventory, Coping Strategy Questionnaire, Health Locus of Control scale). Patients were evaluated at baseline and at 2 weeks posttreatment. Final assessment at 1 year posttreatment was done with a modified form of IASP Data Base Outline., Results: There was a minor decrease in analgesic drug intake and an improvement in sleep patterns in patients treated by the healer. Generally, clinical variables remained unchanged. Attitudes toward spiritual healing improved. There was a decrease in the feeling of hopelessness (p < 0.05) and an increased acceptance of psychological factors as reasons for pain (p < 0.05). Other scores of the psychological tests were unaffected by the healing. However, half (n = 6) of the treated patients felt that spiritual healing gave them some relief., Conclusion: Spiritual healing appears harmless and was subjectively helpful to some patients suffering from idiopathic chronic pain syndrome.

A new method of cholangiomanometry developed on the basis of operative needle cholangiography is described. The pressure of the common bile duct is recorded during continuous infusion using two different speeds. The procedure is complemented by pressure controlled injections of a contrast medium and by fentanyl test to study the function of the sphincter of Oddi.

Lumbar epidural blocks produced by 17 ml of etidocaine 1% or bupivacaine 0.5%, both with adrenaline (5 mug/ml), have been compared in a double-blind trial in 40 patients, all scheduled for elective urological surgery. The onset time and segmental spread of analgesia, tested by pinprick and thermal pain, seemed to be slightly shorter with etidocaine (not statistically significant). The duration of analgesia and the blood-pressure changes were comparable with both drugs. The incidence and intensity of motor block were higher with etidocaine.

Intracholedochal passage pressures (ICPP) were measured during halothane, enflurane and isoflurane anaesthesia as well as during anaesthesia without any volatile agent and in patients with a postoperative T-tube. There were no statistically significant differences in the mean ICPP between the study groups (altogether 49 patients). After i.v. fentanyl 0.1 mg a similar pressure increase (mean 0.5 kPa) was recorded in all anaesthetized groups as compared to a threefold increase (mean 1.6 kPa) in the postoperative group (p less than 0.001) with maximum at about 7 min in all groups. Intraoperative fentanyl did not cause surgically adverse effects i.e. false obstruction due to spasm in the operative cholangiography. It is concluded that all inhalation anaesthetics attenuate the ICPP response to fentanyl.