Gastrointestinal symptoms secondary to implanted spinal cord stimulators.

IMPLICATIONS: We report severe gastrointestinal symptoms in two patients who had implanted spinal cord stimulators. These side effects were severe enough to require cessation of the stimulation, even though the patients reported significantly improved analgesia. It is important for clinicians caring for patients with these devices to be aware of these potentially severe side effects.

An evaluation of the safety and efficacy of administering rofecoxib for postoperative pain management.

UNLABELLED: The goal of our study was to evaluate the analgesic efficacy and safety of administering rofecoxib (1 mg/kg), a cyclo-oxygenase (COX)-2 selective nonsteroidal antiinflammatory drug, before pediatric tonsillectomy. Sixty-six patients, aged 3-11 yr, scheduled to undergo tonsillectomy received either placebo or rofecoxib (1 mg/kg). There were no significant differences between the two study groups with respect to demographics and blood loss. We found that the pain scores were significantly lower in the rofecoxib group compared with the control group at 2 h (P < 0.05) and 24 h (P < 0.006). The incidence of nausea (P < 0.03) and vomiting (P < 0.004) at home was more frequent in the control group than in the rofecoxib group. We conclude that a single preoperative dose of rofecoxib resulted in less vomiting and lower 24-h pain scores in pediatric patients undergoing an elective tonsillectomy. IMPLICATIONS: In children undergoing tonsillectomy, a single preoperative dose of rofecoxib decreases 2- and 24-h pain and decreases nausea and vomiting at home.

The addition of hydromorphone to epidural fentanyl does not affect analgesia in early labour.

PURPOSE: Epidural fentanyl after a lidocaine and epinephrine test dose, provides adequate analgesia and allows for ambulation during early labour. The current study was designed to determine the influence of hydromorphone added to an epidural fentanyl bolus (e.g., whether there is an increase in duration of analgesia). METHODS: Forty-four labouring primigravid women, at less than 5 cm cervical dilation, who requested epidural analgesia were enrolled in this randomized, double-blind study. After a 3 mL test dose of lidocaine with epinephrine, patients received fentanyl 100 microgram (in 10 mL volume). They randomly received the fentanyl with either saline or hydromorphone (300 microgram). After administration of the initial analgesic, pain scores and side effects were recorded for each patient at ten, 20, and 30 min, and every 30 min thereafter, by an observer blinded to the technique used. RESULTS: The patients were taller in the hydromorphone group (P < 0.04). There were no other demographic differences between the two groups. The mean duration prior to re-dose was not significantly different in the group that received hydromorphone (135 +/- 52 min) compared to the control group (145 +/- 46 min). Side effects were similar between the two groups. No patient in either group experienced any detectable motor block. CONCLUSION: In early labouring patients, the addition of hydromorphone (300 microgram) to epidural fentanyl (100 microgram after a lidocaine and epinephrine test dose) neither prolongs the duration of analgesia nor affects the ability to ambulate, and cannot be recommended according to the current study.