An extensive experience with postoperative pain relief using postoperative fentanyl infusion.

From October 1, 1987 through December 31, 1989, 517 patients who were undergoing both thoracic and abdominal surgical procedures were treated for postoperative pain with epidural fentanyl citrate infusion under the direction of an anesthesia pain service. Infusion rates of 4 micrograms/mL of solution were essentially the same for all subjects. Sixty-five percent of patients experienced superior pain control without the use of adjunctive analgesia. Twenty-eight percent of subjects achieved satisfactory pain control but required additional low-dose analgesics. Only 7% of patients remained uncomfortable despite additional intravenous narcotic administration. There were no deaths or respiratory arrests. Six percent of patients experienced nausea, and 0.8% of the cohort required catheterization for urinary retention. This technique of postoperative pain control was safe and provided excellent results. Catheter position was a major determinant of the efficacy of the method.

Recreational injuries in children: incidence and prevention.

Participation in eight common types of recreational activities leads annually to more than 2 million medically treated musculoskeletal injuries in children aged 5 to 14 years. Many of these injuries could have been prevented if current safety guidelines and protective equipment had been used. Studies have demonstrated the value of safety education programs in preventing injuries. Parents consider their child's physician an important source of safety education, and orthopaedic surgeons have a unique opportunity to provide injury prevention counseling. The American Academy of Orthopaedic Surgeons recognizes the importance of injury prevention and has developed advocacy programs that are readily available to physicians and the public. Individual orthopaedists should be involved in injury prevention through patient education, research, community programs, and regulatory efforts that promote safe play for children.