A prospective, randomized, double-blind, controlled study was conducted to assess the efficacy of intra-articular bupivacaine and diamorphine. Ninety-six day-case patients were allocated randomly to receive intra-articular injections of either 20 mL 0.9% saline (control, n = 35), 20 mL 0.5% plain bupivacaine (n = 31), or 20 mL 0.9% saline with 5 mg diamorphine (n = 30) prior to tourniquet release. Visual analogue scales (VAS) were completed at 1 h, 3 h (discharge) and 24 h, and supplementary analgesia noted. Intra-articular analgesics conferred a noticeable improvement in patient comfort. First, the quantity of supplementary analgesia required prior to discharge was significantly reduced (P = 0.016); second, patients reported a less disturbed night's sleep (P = 0.034).

A prospective survey was conducted among an aesthesiologists to determine their criteria for excluding a patient from autologous blood donation prior to total hip prosthesis. Information on patients operated on during a 5-week period was obtained using a questionnaire, consisting of a set of possible responses to simple questions, matched with some parametric values. Sixty-eight of the 99 patients included in the survey underwent surgery without donation. Age was the main cause for exclusion (34%). The age of patients excluded because of their age alone was 75 ± 11 years (standard deviation). The age of patients excluded from donation and who did not subsequently receive homologous blood was comparable with that of patients not autotransfused but who received homologous blood (68 ± 4 vs. 69 ± 6 years, respectively). Post-operative haemoglobin concentrations were similar whether transfusion was performed or not, and regardless of the origin of blood given. Since age is no longer taken into consideration at the time of transfusion, it is likely that exclusion of a patient from autologous blood donation because of age is an arbitrary choice.

Combined effects of prolonged prostaglandin E1 (PGE1)-induced hypotension and haemodilution on hepatic function were studied in 30 patients undergoing hip surgery. The patients were randomly allocated to one of three groups; those in group A (n = 10) were subjected to controlled hypotension alone, those in group B (n = 10) to haemodilution alone and those in group C (n = 10) to both controlled hypotension and haemodilution. Haemodilution in groups B and C was produced by withdrawing approximately 1000 mL of blood and replacing it with the same amount of dextran solution, and final haematocrit values were 21 or 22%. Controlled hypotension in groups A and C was induced with PGE1 to maintain mean arterial blood pressure at 55mmHg for 180 min. Measurements included arterial ketone body ratio (AKBR, aceto-acetate/3-hydroxybutyrate) and clinical hepatic function parameters. AKBR and biological hepatic function tests showed no change throughout the time course in groups A and B. In group C, AKBR showed a significant decrease at 120 min (−40%) and at 180 min (−49%) after the start of hypotension and at 60 min (−32%) after recovery of normotension, and SGOT, SGPT, LDH and total bilirubin showed significant increases after operation. The results suggest that a prolonged combination of more than 120 min of PGE1-induced hypotension and moderate haemodilution would cause impairment of hepatic function.