Congenital dislocation of the hip. Use of the Pavlik harness in the child during the first six months of life

To The Editor: I am writing in response to "Pain: Friend or Foe?" (2001;83-A:1424-5), an Orthopaedic Forum article by Dr. Whitesides. As an Acute Pain Clinical Nurse Specialist, I took great exception to his blanket condemnation of acute pain services. As a trained orthopaedic nurse, I began my practice as an Acute Pain Nurse at Sandwell NHS Trust. The orthopaedic consultants within the Trust were confident in my ability to recognize the complications of orthopaedic surgery. However, the general surgeons, similarly to Dr. Whitesides, did not trust the clinical judgment of a pain specialist. After four years, I have gained their trust, through my recognition of complications and my alerting them to situations such as anastomosis rupture and peritonitis, in which the chief symptoms were a sudden increase in pain. The risky clinical situations that are described in the article seem to be attributed to an overzealous use of analgesia in "overtherapeutic" doses. The dosages of epidural analgesia were not stated, but if low-dose local anesthesia is used in combination with low-dose opioids, then a "mobilizing epidural" may be achieved. In this state of medication, the patient is able to move his or her limbs easily, and any decrease in motor function will facilitate the discontinuation of the epidural to allow for evaluation of a true clinical picture. However, for patients with a tibial fracture treated with surgery, a patient-controlled intravenous system of analgesia that utilizes morphine may be more appropriate, as the vasodilating effects of the local anesthetic could aggravate any compartment syndrome formation. The …