Background: Perioperative haemodynamic changes are well recognised sequelae of adrenalectomy for phaeochromocytomas. The aim of this study was to compare haemodynamic changes in patients undergoing laparoscopic adrenalectomy (LA) for phaeochromocytomas and other adrenal tumours.Method: Patients were identified from a prospective database (Jan 1999-Feb 2008). All patients were managed by a multi-disciplinary team. Haemodynamic variables were: pulse, blood pressure and the requirement of antihypertensive or vasopressor therapies in the perioperative period.Results: Over the nine-year period, 34 consecutive patients underwent laparoscopic phaeo-chromocytoma resection (one patient had delayed contralateral LA) and 104 consecutive patients underwent LA for other tumours (two patients had delayed contralateral LA). 5 out of 35 resections in the phaeochromocytoma group experienced severe hypertension (systolic blood pressure (SBP) >200 mm Hg) compared to two out of 106 resections in the non phaeochromocytoma group (p=0.010). No patient in either group had a transient or persistent (>10 min) SBP >220 mm Hg. Intraoperative antihypertensive Use was significantly increased in the phaeochromocytoma group (p < 0.005). There were no significant differences between groups for persistent hypotension (SBP <80 mm Hg), heart rate > 120/min and recovery room haemodynamic parameters.Conclusion: LA for phaeochromocytoma can be accomplished with low perioperative haemodynamic complications when compared to LA for other adrenal tumours. (C) 2009 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

Objective To compare the analgesic efficacy and side effects of the synthetic cannabinoid nabilone with those of the weak opioid dihydrocodeine for chronic neuropathic pain. Design Randomised, double blind, crossover trial of 14 weeks’ duration comparing dihydrocodeine and nabilone. Setting Outpatient units of three hospitals in the United Kingdom. Participants 96 patients with chronic neuropathic pain, aged 23-84 years. Main outcome measures The primary outcome was difference between nabilone and dihydrocodeine in pain, as measured by the mean visual analogue score computed over the last 2 weeks of each treatment period. Secondary outcomes were changes in mood, quality of life, sleep, and psychometric function. Side effects were measured by a questionnaire. Intervention Patients received a maximum daily dose of 240 mg dihydrocodeine or 2 mg nabilone at the end of each escalating treatment period of 6 weeks. Treatment periods were separated by a 2 week washout period. Results Mean baseline visual analogue score was 69.6 mm (range 29.4-95.2) on a 0-100 mm scale. 73 patients were included in the available case analysis and 64 patients in the per protocol analysis. The mean score was 6.0 mm longer for nabilone than for dihydrocodeine (95% confidence interval 1.4 to 10.5) in the available case analysis and 5.6 mm (10.3 to 0.8) in the per protocol analysis. Side effects were more frequent with nabilone. Conclusion Dihydrocodeine provided better pain relief than the synthetic cannabinoid nabilone and had slightly fewer side effects, although no major adverse events occurred for either drug. Trial registration Current Controlled Trials ISRCTN15330757.

European Journal of PainVolume 10, Issue S1 p. S125-S125 470 A RANDOMISED CONTROLLED STUDY OF SATIVEX, A CANNABIS BASED MEDICINE, IN NEUROPATHIC PAIN CHARACTERIZED BY ALLODYNIA T.J. Nurmikko, T.J. Nurmikko Walton Centre for Neurology and Neurosurgery, LiverpoolSearch for more papers by this authorM.G. Serpell, M.G. Serpell Gartnavel General Hospital, GlasgowSearch for more papers by this authorB. Hoggart, B. Hoggart Solihull Hospital, BirminghamSearch for more papers by this authorP.J. Toomey, P.J. Toomey York District Hospital, York, UKSearch for more papers by this authorB.J. Morlion, B.J. Morlion University Hospital, Leuven, BelgiumSearch for more papers by this authorD. Haines, D. Haines Castle Hill Hospital, HillSearch for more papers by this authorN. Sarantis, N. Sarantis GW Pharma Ltd, Salisbury, UKSearch for more papers by this author T.J. Nurmikko, T.J. Nurmikko Walton Centre for Neurology and Neurosurgery, LiverpoolSearch for more papers by this authorM.G. Serpell, M.G. Serpell Gartnavel General Hospital, GlasgowSearch for more papers by this authorB. Hoggart, B. Hoggart Solihull Hospital, BirminghamSearch for more papers by this authorP.J. Toomey, P.J. Toomey York District Hospital, York, UKSearch for more papers by this authorB.J. Morlion, B.J. Morlion University Hospital, Leuven, BelgiumSearch for more papers by this authorD. Haines, D. Haines Castle Hill Hospital, HillSearch for more papers by this authorN. Sarantis, N. Sarantis GW Pharma Ltd, Salisbury, UKSearch for more papers by this author First published: 13 January 2012 https://doi.org/10.1016/S1090-3801(06)60473-4Read 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. Volume10, IssueS1September 2006Pages S125-S125 RelatedInformation

Use of intravenous fluids is an important part of perioperative management. The aim of this study was to compare outcome following administration of restricted or standard postoperative intravenous fluids and sodium in patients undergoing elective colorectal surgery.

Objective To compare patient outcome following repair of a primary groin hernia under local (LA) or general anesthesia (GA) in a randomized clinical trial.Summary Background Data LA hernia repair is thought to be safer for patients, causes less postoperative pain, cost less, and is associated with a more rapid recovery when compared with the same operation performed under GA.Methods All patients presenting to three surgeons during the study period with a primary groin hernia were considered eligible. Outcome parameters measured including tests of vigilance, divided attention, sustained attention, memory, cognitive function, pain, return to normal activity, and costs.Results Two hundred seventy-nine patients were randomized to LA or GA hernia repair; 276 of these had an operation, with 138 participants in each group. At 6, 24, and 72 hours postoperatively there were no differences in vigilance or divided attention between the groups. Similarly, memory, sustained attention, and cognitive function were not impaired in either group. Although physical activity was significantly impaired at 24 hours, this and return to usual social activities were similar in both groups. While patients in the LA group had significantly less pain on moving, at 6 hours they were less likely to recommend the same operation to someone else. GA hernia repair cost 4% more than the same operation under LA.Conclusions There are no major differences in patient recovery after LA or GA hernia repair. Patients should be offered a choice of anesthesia, LA or GA, for repair of their groin hernia.

A double-blind, randomised, placebo-controlled 8-week study was conducted to evaluate the efficacy and safety of gabapentin in the treatment of neuropathic pain, using doses up to 2400 mg/day. The study used a novel design that was symptom- rather than syndrome-based; an approach that aimed to reflect the realities of clinical practice. Participants had a wide range of neuropathic pain syndromes, with at least two of the following symptoms: allodynia, burning pain, shooting pain, or hyperalgesia. Patients were randomised to gabapentin (n=153) or placebo (n=152). Gabapentin was given in three divided doses, initially titrated to 900 mg/day over 3 days, followed by two further increases, to a maximum of 2400 mg/day if required by the end of week 5. The primary outcome measure was changed in average daily pain diary score (baseline versus final week). Over the 8 week study, this score decreased (i.e. improved) by 1.5 (21%) in gabapentin treated patients and by 1.0 (14%) in placebo treated patients (P=0.048, rank-based analysis of covariance). Significant differences were shown in favour of gabapentin (P<0.05) for the Clinician and Patient Global Impression of Change, and some domains of the Short Form-McGill Pain Questionnaire. Improvements were also shown in patient-reported outcomes in quality of life, as seen by significant differences in favour of gabapentin in several domains of the Short-Form-36 Health Survey. Gabapentin was well tolerated and the majority of patients completed the study (79 versus 73% for placebo). The most common adverse events were mild to moderate dizziness and somnolence, most of which were transient and occurred during the titration phase. This study shows that gabapentin reduces pain and improves some quality-of-life measures in patients with a wide range of neuropathic pain syndromes.

BACKGROUND:Chronic pain is the most serious long-term complication that can occur after repair of a groin hernia. The aim of this study was to assess the outcome of patients who report severe or very severe pain 3 months after groin hernia repair.METHODS:This was a population-based study of all patients who underwent repair of a groin hernia between April 1998 and March 1999 in Scotland. All received a postal questionnaire 3 months after hernia repair and those who reported severe or very severe pain at the operation site were asked to complete a further questionnaire 2.5 years later. The main outcome measure included the number of patients with persistent pain and the effect of pain on daily activities and quality of life.RESULTS:Of 5506 patients who underwent repair of a groin hernia, 4062 (74 per cent) returned the first questionnaire and 125 (3 per cent) reported severe or very severe pain. Eight-six (72 per cent) of 120 patients (five had died or could not be contacted at the original address) replied to the second questionnaire; 61 (71 per cent) still reported pain, which was severe or very severe pain in 22 (26 per cent) and mild or very mild in 39 (45 per cent). Twenty-nine (48 per cent) sought further medical help from their general practitioner or surgeon. Nine (15 per cent) attended a pain clinic while five (8 per cent) had further surgery. Chronic pain had significant effects (P < 0.001) on all daily activities including walking, work, sleep, relationships with other people, mood and general enjoyment of life.CONCLUSION:Chronic pain persists in most patients who report severe or very severe pain at 3 months after hernia repair, and has a significant effect on the patients' daily activities and quality of life.

Background: Local anaesthetic hernia repair is thought to be safer for patients, causes less postoperative pain, costs less and is associated with a more rapid recovery for patients when compared with the same operation performed under general anaesthetic. The aim of this study was to compare patient outcome following local (LA) or general anaesthetic (GA) repair of a primary groin hernia. Methods: A randomized trial comparing patient outcome following LA or GA hernia repair. Outcome parameters measured included tests of vigilance, divided attention, sustained attention, memory, cognitive function, pain, return to normal activity and costs. Results: Two hundred and seventy-nine patients were randomized to LA or GA hernia repair, 276 of whom had an operation with 138 participants in each group. At 6, 24 and 72 h postoperatively there were no differences in vigilance or divided attention between the groups. Similarly, memory-sustained attention or cognitive function was not impaired in either group. Although physical activity was significantly (P = 0.0001) impaired at 24 h, this and return to usual social activities, 10 (7–14) days for LA versus 11 (7–14.5) days for GA, P = 0.5841, were similar in both groups. While patients in the LA group had significantly less pain on moving (P = 0.04) at 6 h, they were less likely 84 per cent versus 95 per cent for GA (P = 0.011), to recommend the same operation to someone else. General anaesthetic hernia repair cost £30.54 more than the same operation under LA. Conclusions: This study indicates that patient recovery is similar after LA or GA hernia repair.