BACKGROUND: Rubber band ligation of hemorrhoids causes less pain than excisional hemorrhoidectomy, but many patients still experience significant postprocedure discomfort. OBJECTIVE: This study aimed to determine whether topical lidocaine, with or without diltiazem, is more effective than placebo for analgesia after hemorrhoid banding. DESIGN: This is a prospective, randomized, double-blinded, placebo-controlled trial. Patients were randomly assigned to 2% lidocaine, 2% lidocaine with 2% diltiazem, or a placebo ointment. SETTINGS: This study was performed at 2 university public teaching hospitals and 2 private hospitals in Australia. PATIENTS: Consecutive patients aged >= 18 years undergoing hemorrhoid banding were selected. INTERVENTIONS: Topical ointments were applied postprocedure 3x daily for 5 days. MAIN OUTCOME MEASURES: Visual analog pain score, opiate analgesia usage, and patient satisfaction were the main outcome measures. RESULTS: Of 159 eligible patients, 99 were randomly assigned (33 in each group). Pain scores were reduced at 1 hour for the lidocaine (OR 4.15 [1.12-15.41]; p = 0.03) and lidocaine/diltiazem groups (OR 3.85 [1.05-14.11]; p = 0.04) compared with placebo. Patients in the lidocaine/diltiazem group had improved satisfaction (OR 3.82 [1.28-11.44]; p = 0.02) and were more likely to recommend the procedure to others (OR 9.33 [1.07-81.72]; p = 0.04). Patients in the lidocaine/diltiazem group required approximately 45% less total and in-hospital analgesia compared with the placebo. There was no difference in complications between any of the groups. LIMITATIONS: A cost/benefit analysis was not performed. Analgesic efficacy appeared to be short term and the procedures were performed only in the hospital/ nonambulatory setting. CONCLUSIONS: Topical lidocaine reduced short-term analgesia use, whereas combination lidocaine/diltiazem was associated with both improved analgesia and patient satisfaction after hemorrhoid banding.

ANZ Journal of SurgeryVolume 92, Issue 5 p. 1249-1250 IMAGES FOR SURGEONS Synchronous small bowel and colonic tumours in the absence of Lynch syndrome Allan M. F. Kwok MBBS, MS, FRACS, Allan M. F. Kwok MBBS, MS, FRACS orcid.org/0000-0002-8742-6236 Department of Colorectal Surgery, John Hunter Hospital, New Lambton Heights, New South Wales, Australia Contribution: Conceptualization, Supervision, Writing - original draft, Writing - review & editingSearch for more papers by this authorTangqi J. Ng BSc (Hons), MD, Tangqi J. Ng BSc (Hons), MD Department of Colorectal Surgery, John Hunter Hospital, New Lambton Heights, New South Wales, Australia Contribution: Writing - original draftSearch for more papers by this authorBrian Draganic BMed, FRACS, Brian Draganic BMed, FRACS Department of Colorectal Surgery, John Hunter Hospital, New Lambton Heights, New South Wales, Australia Contribution: Writing - review & editingSearch for more papers by this author Allan M. F. Kwok MBBS, MS, FRACS, Allan M. F. Kwok MBBS, MS, FRACS orcid.org/0000-0002-8742-6236 Department of Colorectal Surgery, John Hunter Hospital, New Lambton Heights, New South Wales, Australia Contribution: Conceptualization, Supervision, Writing - original draft, Writing - review & editingSearch for more papers by this authorTangqi J. Ng BSc (Hons), MD, Tangqi J. Ng BSc (Hons), MD Department of Colorectal Surgery, John Hunter Hospital, New Lambton Heights, New South Wales, Australia Contribution: Writing - original draftSearch for more papers by this authorBrian Draganic BMed, FRACS, Brian Draganic BMed, FRACS Department of Colorectal Surgery, John Hunter Hospital, New Lambton Heights, New South Wales, Australia Contribution: Writing - review & editingSearch for more papers by this author First published: 29 September 2021 https://doi.org/10.1111/ans.17244Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume92, Issue5May 2022Pages 1249-1250 RelatedInformation

BACKGROUND:There is a lack of information regarding the provision of parental leave for surgical careers. This survey study aims to evaluate the experience of maternity/paternity leave and views on work-life balance globally.METHODS:A 55-item online survey in 24 languages was distributed via social media as per CHERRIES guideline from February to March 2020. It explored parental leave entitlements, attitude towards leave taking, financial impact, time spent with children and compatibility of parenthood with surgical career.RESULTS:Of the 1393 (male : female, 514 : 829) respondents from 65 countries, there were 479 medical students, 349 surgical trainees and 513 consultants. Consultants had less than the recommended duration of maternity leave (43.8 versus 29.1 per cent), no paid maternity (8.3 versus 3.2 per cent) or paternity leave (19.3 versus 11.0 per cent) compared with trainees. Females were less likely to have children than males (36.8 versus 45.6 per cent, P = 0.010) and were more often told surgery is incompatible with parenthood (80.2 versus 59.5 per cent, P < 0.001). Males spent less than 20 per cent of their salary on childcare and fewer than 30 hours/week with their children. More than half (59.2 per cent) of medical students did not believe a surgical career allowed work-life balance.CONCLUSION:Surgeons across the globe had inadequate parental leave. Significant gender disparity was seen in multiple aspects.

Data sharing is not applicable to this article as no new data were created or analyzed in this study.

Complete mesocolic excision (CME) has been proposed for better local control of colon cancer and to improve cancer-specific survival (CSS). However, CME may be associated with increased morbidity from bleeding during central vascular ligation. This study aimed to investigate the outcome of conventional right hemicolectomy, a traditional anatomical dissection along anatomical planes with radical excision of the central lymph nodes at the level of the origin of colic artery but without exposure of superior mesenteric vein and artery (SMV/SMA). This was a retrospective review of a cohort of all elective right hemicolectomies performed at a specialist tertiary unit during a five-year period (2011–2015). Five-hundred-nineteen patients (271 female, a median age of 73.0 years (interquartile range (IQR) 65.0–80.0)) were included (Stage I disease: 2.7%, stage II: 53.2%, stage III: 33.3%, stage IV: 10.8%). At the latest follow-up (a median 47 months (IQR 29–67)), local recurrence occurred in 34 patients (6.6%). Three-year overall survival was 74.4% and 3-year CSS was 85.9%. Subgroup analysis for stage I–III showed local recurrence in 6.0%, sole distant recurrence in 7.6% while 19 patients (4.1%) suffered concomitant local and distant recurrence. The anastomotic leak rate was 1.0% and perioperative bleeding occurred in 1.2%. Oncological outcomes comparable to those of CME can be achieved by conventional surgery but with low rates of bleeding complications and anastomotic leakage. The proposed advantages of CME should be carefully considered and balanced against patients’ co-morbidities and potential complications.

Aim Fistula-in-ano (FIA) is associated with high treatment costs and has a deleterious impact on quality of life. A wide range of healing, incontinence and recurrence rates have been reported. This study aimed to identify operative, patient and disease factors that influence these outcomes after surgery for FIA. Method An observational cohort study of consecutive patients who were managed for FIA at a tertiary colorectal practice (1999-2019) was performed. Outcome measures included healing, impaired continence and the need to reoperate. Clinico-pathological variables, including patient comorbidities, fistula anatomy and operative approach, were assessed for their association with these outcomes. Results Some 411 procedures were performed on 263 patients [median age 41.8 years (range 17.8-79.7 years), 184 men (70.0%)]. Some 77.9% of patients achieved complete healing, 9.5% experienced some deterioration in continence postoperatively and 37.6% required reoperation at a median time of 19.0 weeks. Poorer healing was associated with Crohn's disease, high trans-sphincteric fistulas, extrasphincteric fistulas and steroid usage. Poorer continence was associated with female sex, age > 40 years, posterior location, suprasphincteric fistulas, seton insertion and having more than three subsequent procedures. The need to reoperate was associated with female sex, high trans-sphincteric fistulas, suprasphincteric fistulas, inflammatory bowel disease and previous operations for FIA. Conclusion Minimizing recurrence of FIA and preservation of continence can be competing management goals. More than one in three patients require reoperation, one in five fails to heal completely and one in ten suffers worsened continence following surgery. Awareness of the factors that contribute to these outcomes is important to the process of informed consent and managing patient expectations before surgery.

ANZ Journal of SurgeryVolume 90, Issue 9 p. 1814-1816 IMAGES FOR SURGEONS Locally advanced prostate cancer with peritoneal carcinomatosis causing large bowel obstruction Allan M. F. Kwok BSc, MBBS, FRACS, Allan M. F. Kwok BSc, MBBS, FRACS orcid.org/0000-0002-8742-6236 Department of Surgery, Wollongong Hospital, Wollongong, NSW, AustraliaSearch for more papers by this author Allan M. F. Kwok BSc, MBBS, FRACS, Allan M. F. Kwok BSc, MBBS, FRACS orcid.org/0000-0002-8742-6236 Department of Surgery, Wollongong Hospital, Wollongong, NSW, AustraliaSearch for more papers by this author First published: 14 January 2020 https://doi.org/10.1111/ans.15705Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume90, Issue9September 2020Pages 1814-1816 RelatedInformation

Diverticula of the appendix (DA) are infrequent and their clinical implications are often overlooked. Several studies have found a significantly increased prevalence of neoplasms in appendiceal specimens with diverticula. Despite the potential clinical implications, there is a paucity of literature. A systematic review and meta‐analysis was performed to evaluate the prevalence of DA and its association with neoplasia.

An external ventricular drain was inserted. The craniotomy bone flaps were replaced at the end of the operation. Exenteration of the left eye remnant was performed by Ophthalmologists. Though the patient had a stormy neurological recovery complicated by cerebral vasospasm, she did not require a ventriculoperitoneal shunt. After prolonged rehabilitation, she has significant preservation of neurological function being ambulatory, conversant, with a degree of cognitive impairment and inertia, as expected with the injury location. There is a severe spastic weakness of the left arm. The penetrating brain injury resulted from the deployment of a defective airbag. The projectile responsible for the penetrating brain injury (Fig. 3) was a component of the airbag explosive mechanism. Airbag related injuries are an important on-going public safety and trauma management issue which needs re-emphasis. Several factors determine the gravity of a penetrating brain injury, principal among which is the kinetic energy of the projectile (E = 1/2 mv). Whilst there are a number of prognostic factors, CT findings in this patient of bilateral brain damage, injuries to several lobes, intraventricular and sub-arachnoid bleeding, augur badly, though this patient has recovered well. For neurosurgeons, this confirms the imperative to provide, inter alia, a watertight closure and also the utility of the vascularized pericranial graft.

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BACKGROUND Hypoganglionosis is a rare condition that most often presents with abnormal gastrointestinal transit and usually arises in early childhood or adolescence. Two types have been described (Type I and Type II). The adult-onset form (acquired hypoganglionosis) is extremely uncommon and is thought to arise due to cellular remodelling as a result of chronic inflammation. It differs from Hirschprung’s disease in that there is a reduction in ganglion cells in the colonic neural plexuses as opposed to being completely absent. CASE SUMMARY A 31 year-old male presented to hospital with recurrent abdominal pain and vomiting over thirteen months. Abdominal computed tomography scans demonstrated thickening and stranding affecting the transverse, descending and sigmoid colon. Endoscopic appearances were non-specific but confirmed a mixed picture of mucosal inflammation and necrosis in various stages of healing. Numerous investigations were performed to elucidate an underlying aetiology but neither an infective nor ischaemic cause could be proven. Biopsy features were not typical of inflammatory bowel disease. Due to persistence of his symptoms and failure of medical management, a segmental colectomy was performed. Histological examination of the specimen revealed an unexpected finding of segmental hypoganglionosis. Complete surgical excision of the diseased segment of colon was curative and since his operation the patient has had no recurrence of symptoms requiring hospitalisation. CONCLUSION Our case serves to raise awareness of acquired hypoganglionosis as a rare condition that can result from chronic colitis.

ANZ Journal of SurgeryVolume 89, Issue 12 p. E564-E565 IMAGES FOR SURGEONS Terminal ileum within a Spigelian hernia: a rare presentation of small bowel obstruction Allan M. F. Kwok BSc, MBBS, Allan M. F. Kwok BSc, MBBS orcid.org/0000-0002-8742-6236 Department of Surgery, Wollongong Hospital, Wollongong, New South Wales, AustraliaSearch for more papers by this authorMina Sarofim BMed, MD, Mina Sarofim BMed, MD orcid.org/0000-0003-3808-0774 Department of Surgery, Wollongong Hospital, Wollongong, New South Wales, AustraliaSearch for more papers by this authorAndrew B. Still MBChB, FRACS, Andrew B. Still MBChB, FRACS orcid.org/0000-0003-1954-1854 Department of Surgery, Wollongong Hospital, Wollongong, New South Wales, AustraliaSearch for more papers by this author Allan M. F. Kwok BSc, MBBS, Allan M. F. Kwok BSc, MBBS orcid.org/0000-0002-8742-6236 Department of Surgery, Wollongong Hospital, Wollongong, New South Wales, AustraliaSearch for more papers by this authorMina Sarofim BMed, MD, Mina Sarofim BMed, MD orcid.org/0000-0003-3808-0774 Department of Surgery, Wollongong Hospital, Wollongong, New South Wales, AustraliaSearch for more papers by this authorAndrew B. Still MBChB, FRACS, Andrew B. Still MBChB, FRACS orcid.org/0000-0003-1954-1854 Department of Surgery, Wollongong Hospital, Wollongong, New South Wales, AustraliaSearch for more papers by this author First published: 28 January 2019 https://doi.org/10.1111/ans.14976Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume89, Issue12December 2019Pages E564-E565 RelatedInformation

ANZ Journal of SurgeryVolume 89, Issue 11 p. E542-E543 IMAGES FOR SURGEONS Unusual case of acute large bowel obstruction: endometriosis mimicking sigmoid malignancy Mina Sarofim BMed, MD, MS, Mina Sarofim BMed, MD, MS orcid.org/0000-0003-3808-0774 Department of Colorectal Surgery, Wollongong Hospital, Wollongong, New South Wales, Australia The University of New South Wales, Sydney, New South Wales, AustraliaSearch for more papers by this authorAbigail Attwell-Heap BSc (Biotech) (Hons), MBBS, Abigail Attwell-Heap BSc (Biotech) (Hons), MBBS Department of Colorectal Surgery, Wollongong Hospital, Wollongong, New South Wales, AustraliaSearch for more papers by this authorJodie Trautman MD, Jodie Trautman MD orcid.org/0000-0002-6680-3055 Department of Colorectal Surgery, Wollongong Hospital, Wollongong, New South Wales, AustraliaSearch for more papers by this authorAllan Kwok BSc, MBBS (Hons), Allan Kwok BSc, MBBS (Hons) orcid.org/0000-0002-8742-6236 Department of Colorectal Surgery, Wollongong Hospital, Wollongong, New South Wales, AustraliaSearch for more papers by this authorAndrew Still BHB, MBChB, FRACS, CSSANZ, Andrew Still BHB, MBChB, FRACS, CSSANZ orcid.org/0000-0003-1954-1854 Department of Colorectal Surgery, Wollongong Hospital, Wollongong, New South Wales, AustraliaSearch for more papers by this author Mina Sarofim BMed, MD, MS, Mina Sarofim BMed, MD, MS orcid.org/0000-0003-3808-0774 Department of Colorectal Surgery, Wollongong Hospital, Wollongong, New South Wales, Australia The University of New South Wales, Sydney, New South Wales, AustraliaSearch for more papers by this authorAbigail Attwell-Heap BSc (Biotech) (Hons), MBBS, Abigail Attwell-Heap BSc (Biotech) (Hons), MBBS Department of Colorectal Surgery, Wollongong Hospital, Wollongong, New South Wales, AustraliaSearch for more papers by this authorJodie Trautman MD, Jodie Trautman MD orcid.org/0000-0002-6680-3055 Department of Colorectal Surgery, Wollongong Hospital, Wollongong, New South Wales, AustraliaSearch for more papers by this authorAllan Kwok BSc, MBBS (Hons), Allan Kwok BSc, MBBS (Hons) orcid.org/0000-0002-8742-6236 Department of Colorectal Surgery, Wollongong Hospital, Wollongong, New South Wales, AustraliaSearch for more papers by this authorAndrew Still BHB, MBChB, FRACS, CSSANZ, Andrew Still BHB, MBChB, FRACS, CSSANZ orcid.org/0000-0003-1954-1854 Department of Colorectal Surgery, Wollongong Hospital, Wollongong, New South Wales, AustraliaSearch for more papers by this author First published: 02 October 2018 https://doi.org/10.1111/ans.14869Citations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume89, Issue11November 2019Pages E542-E543 RelatedInformation

We present the case of an 80-year old man taking rivaroxaban for atrial fibrillation who sustained massive intra-abdominal bleeding in the setting of acute cholecystitis. CT scan on admission revealed evidence of active bleeding into the gallbladder lumen and gallbladder perforation. Immediate resuscitation was commenced with intravenous fluids, antibiotics and blood products. Despite attempts to correct coagulopathy, the patient's haemodynamic status deteriorated and an emergency laparotomy was performed, with open cholecystectomy, washout and haemostasis. The patient had a largely uneventful recovery and was discharged on day 11 of admission. Patients with coagulopathies, whether pharmacological or due to underlying disease processes, are at very high risk of severe haemorrhagic complications and subsequent morbidity. As such, prompt recognition and operative management of haemorrhagic perforated cholecystitis is of crucial importance.

Background Traumatic diaphragmatic injuries from blunt or penetrating trauma are difficult to detect in the acute setting and, if missed, can result in significant morbidity and mortality in the future. We present a case demonstrating the natural progression of this resulting in faecopneumothorax, which is a rare but serious presentation. Case presentation A 22-year-old young man presented with left upper quadrant and chest pain, nausea, vomiting, and intermittent obstipation with a background of previous lower chest wall stabbings. Computed tomography demonstrated a diaphragmatic hernia containing the splenic flexure of the colon, but he declined treatment and self-discharged. He presented three more times with similar symptoms and self-discharged within a 2-week period and finally presented dyspnoeic and septic. Computed tomography demonstrated tension faecopneumothorax from the perforated colon. He was taken to theatres and found to have a 3-mm perforation at his splenic flexure and underwent a segmental resection of the affected colon, intrathoracic washout, and biological mesh repair of his diaphragmatic hernia. He remained alive and postoperative recovery was uneventful. Conclusions A review of the literature demonstrates the rarity of traumatic diaphragmatic injuries resulting in faecopneumothorax with only a few case reports in the last 50 years. We present a case demonstrating a natural progression of the condition and highlight the importance of having a high index of suspicion of diaphragmatic injuries in the trauma setting.

ANZ Journal of SurgeryVolume 89, Issue 11 p. E538-E539 IMAGES FOR SURGEONS Strangulated obturator hernia as an unusual cause of small bowel obstruction Allan M. F. Kwok BSc, MBBS, Allan M. F. Kwok BSc, MBBS orcid.org/0000-0002-8742-6236 Department of Surgery, Wollongong Hospital, Wollongong, New South Wales, AustraliaSearch for more papers by this authorMina Sarofim BMed, MD, Mina Sarofim BMed, MD orcid.org/0000-0003-3808-0774 Department of Surgery, Wollongong Hospital, Wollongong, New South Wales, AustraliaSearch for more papers by this author Allan M. F. Kwok BSc, MBBS, Allan M. F. Kwok BSc, MBBS orcid.org/0000-0002-8742-6236 Department of Surgery, Wollongong Hospital, Wollongong, New South Wales, AustraliaSearch for more papers by this authorMina Sarofim BMed, MD, Mina Sarofim BMed, MD orcid.org/0000-0003-3808-0774 Department of Surgery, Wollongong Hospital, Wollongong, New South Wales, AustraliaSearch for more papers by this author First published: 08 October 2018 https://doi.org/10.1111/ans.14868Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume89, Issue11November 2019Pages E538-E539 RelatedInformation

We read with interest the article by Sivakumar et al. describing a method to prevent slippage of spectacles during surgery. In the photograph demonstrating the method, the person is wearing a face shield that covers the nose and mouth but not the upper part of the face. We consider it timely to remind surgeons that spectacles alone do not provide effective protection from eye splashes during surgery, and that additional forms of eye protection should be used. The risk of receiving body fluid splashes to the eyes or periocular region during surgery is probably underestimated by many surgeons. The consequences of such splashes are potentially devastating, with transmission of human immunodeficiency virus to a health care worker following an eye splash incident having previously been reported. In one Australian study, in which eye shields were worn and then examined after surgery, 44% of eye shields tested positive for blood. Equally concerning, the surgeon was only aware of the spray episode in 8% of cases. A Japanese multicentre study reported similar findings. It is commonly believed that the wearing of spectacles during surgery provides good protection from splashes, with a New Zealand study finding that 68% of surgeons wear spectacles as their sole eye protection. The authors of this study took detailed measurements of the faces and spectacles of surgeons from a wide range of specialties, and generated a mathematical model to analyse adequacy of eye protection for each surgeon. They found that while all surgeons had adequate eye protection at the lateral aspects of their spectacles, only 78% had adequate protection at the inferior aspect, and alarmingly, none were adequately protected at the superior aspect. In light of these findings, we strongly advocate the wearing of safety goggles or visor masks by all surgeons, whether or not spectacles are worn underneath.

Objectives To determine if complications from blunt thoracic trauma are reduced with patient-controlled analgesia (PCA) compared with interval analgesic dosing given as needed. Secondary aims were to investigate the influence of PCA on hospital length of stay (LOS) and cost.Methods In this retrospective cohort study, patients were identified using the hospital trauma registry and clinical information department. Data on analgesic method, outcomes and confounders were obtained from the medical record. Costing data were obtained from the case-mix department. The analysis used logistic regression for the primary outcome and a generalised linear model for the secondary outcomes to adjust for potential confounders.Results 227 patients were included. In the PCA group, 17/52 (33%) patients had a complication compared with 26/175 (15%) in the interval dosing group. The adjusted odds for a complication in patients receiving PCA was not significantly different from the adjusted odds in those receiving interval dosing (OR=1.2, 95% CI 0.3 to 4.6, p=0.83). The median LOS was 8.9 days in the PCA group and 4.6 days in the interval dosing group. The adjusted LOS for patients receiving PCA was 10% shorter than those receiving interval dosing (relative difference 0.9, 95% CI 0.6 to 1.3, p=0.52). The median hospital cost was $A11 107 in the PCA group (IQR $A7520-$A15 744) and $A4511 (IQR $A2687-$A8248) in the interval dosing group. The adjusted total hospital costs for patients receiving PCA was 10% higher than for those receiving interval dosing (relative difference 1.1, 95% CI 0.8 to 1.5, p=0.44).Conclusions PCA did not reduce complications, hospital LOS or costs compared with interval analgesic dosing.