Relief of postoperative pain after arthroscopic knee surgery is important to promote early rehabilitation of patients. This study was aimed to compare the analgesic effects of bupivacaine and morphine injected into the knee after arthroscopic surgery. In a double-blind, randomized trial, we studied 60 patients who received one of three injections at the end of surgery. The patients were randomly divided into three groups; group 1 received 25ml of 0.25% bupivacaine, group 2 received 5mg of morphine mixed with 25ml of 0.9% normal saline and group 3 received a mixture of 25ml of 0.25% bupivacaine and Smg of morphine. Postoperative pain was assessed using a 100-mm visual analog scale(VAS). We recorded the total number of injections of supplemental analgesics, and the occurrence of side effects of bupivacaine and morphine were monitored. In group 1, VAS was significantly lower than group 2 at one and two hours after injection, but it was higher than the other two groups after four hours. In group 2, VAS was significantly lower than group 1 after four hours and later, but it was higher than the other two groups at one and two hours after injection. In group 3, VAS was maintained low during early and late postoperative period. No side effect was found in all patients. We conclude that intra-articular bupivacaine decreases early postoperative pain, morphine decreases late postoperative pain, and the mixture of bupivacaine and morphine is the most effective in controlling the postoperative pain during early and late period.
Analgesics ; Arthroscopy ; Bupivacaine* ; Humans ; Injections, Intra-Articular ; Knee* ; Morphine* ; Pain, Postoperative ; Postoperative Period ; Rehabilitation

A 55-year-old man with an implantable intrathecal drug delivery system (IDDS) implant removal surgery was performed to control a suspected implant infection. Clear discharge from a lumbar wound was detected after IDDS removal, but transcutaneous cerebral spinal fluid (CSF) leakage was not suspected because the patient did not suffer from a postural headache. Finally, a suspected CSF leakage was resolved with a single epidural blood patch.
Blood Patch, Epidural ; Drug Delivery Systems ; Headache ; Humans ; Middle Aged ; Neuralgia, Postherpetic ; Wounds and Injuries

Background: An airway assessment is usually best performed before an elective operation. But in an emergency operation, proper airway assessment can often be difficult. Fiberoptic intubation is a powerful and safe technique to deal with airway difficulty, but it requires a lot of training to be able to perform correctly. There are various specialized oral airways for fiberoptic intubation, but none of them have perfect functionality.CaseA 75-year-old male (body weight 71.6 kg, height 159.3 cm, body mass index 28.22 kg/m2) was diagnosed with acute appendicitis, and it was decided to do a laparoscopic appendectomy. After the induction of general anesthesia, it was impossible to insert the direct laryngoscope deep enough for vocal cord visualization without damaging the teeth because of limited mouth opening. We successfully performed fiberoptic intubation with a newly modified Guedel airway via a longitudinal channel on the convex side and a distal opened lingual end. Conclusions Our modified Guedel airway can be useful in assisting fiberoptic intubation in unexpectedly difficult airway situations.