Prevention and treatment of cardiovascular instability during spinal anaesthesia for caesarean section

Spinal anaesthesia is the method of choice for caesarean section. There is however a significant associated morbidity and mortality in South Africa, particularly in inexperienced hands. This review provides recommendations for safe practice for anaesthetists at all levels of expertise, with particular reference to the management of haemodynamic instability.

Neural blockade in chronic and cancer pain

Neural blockade can provide significant pain relief to patients with chronic and cancer pain but must be used in the correct manner and only on selected patients. The hazards of performing neurolytic treatments have become apparent with time and demonstrate the need to examine the long-term outcomes of these procedures. The present challenge is to identify with controlled trials those patients with chronic pain who would benefit from neural blockade.

Subcutaneous cannulae for morphine boluses in children: assessment of a technique

Indwelling subcutaneous cannula for the administration of intermittent morphine boluses postoperatively have been used in several centers as an alternative to intramuscular (IM) injections. We introduced this technique to our hospital, assessed it for complications in 220 children, and conducted a survey to see if nursing staff preferred it to IM injections. The injections through the subcutaneous cannulae caused minimal distress to the children. There were no major complications, 95% of the nursing staff preferred this technique, and 74% would give morphine more readily to a child with a subcutaneous cannula in situ.

Techniques to reduce the discomfort of paediatric laceration repair

The wide variety of techniques now available to provide analgesia and sedation in children undergoing laceration repair include needle-free techniques of wound repair, alternative methods of local anaesthetic infiltration, and non-pharmacological interventions. Knowledge and use of these options will help the practitioner limit a child's distress.