Patients due to have a major orthopaedic operation should be assessed in advance, in order to be fully prepared for the operation the scheduled day the without cancellations and be cost-effective. We studied 208 patients the last 2 years scheduled for hip and knee replacement. Mean Age 68.7. F=150, M=58. The patients were formally admitted in the assessment stay unit where a fully orthopaedic and anaesthetic examination was done and appropriate lab tests were carried out. The whole procedure lasted 4 hours and was charged 88 Euros.

Only 37 patients have no medical problems. 98 suffered from hypertension and 10 of them needed further adjustment of their treatment. Out of 27 patients who had coronary artery disease, 12 referred to a cardiologist. All of the 12 patients with various heart problems needed further assessment. Readjustment of their treatment needed 3 out 15 diabetic patients. 1 out of the 8 patients with rheumatoid arthritis 1 needed reevaluation and 1 out 19 who suffered from various diseases 1 needed reassessment (Renal failure). Statistically 39 out of 208 had problems p< 0.001.

The anaesthetic assessment contributes to 1.Reduction of cancellations due to medical reasons. 2. Effective use of the theatre time. 3. Reduction of cost.

Aim: There are more than 50 methods for the treatment of Reflex Sympathetic Dystrophy Our aim is to test how effective is the treatment of patients with Reflex Sympathetic Dystrophy with guanethidine

Method: 15 patients (F=12, M=3, Mean age 59.9) were seen in the chronic pain clinic with Reflex Sympathetic Dystrophy. 13 patients had sustained a Colles fracture and 11 of them had a closed reduction and application of POP and 2 had an external fixation. 1 had an operation for release of median nerve and 1 amputation of 3 fingers due to trauma. There were first seen in the Pain Clinic 12–16 weeks after the initial injury. Main symptoms were pain and stiffness. On examination all of them had oedema of the hand, stiffness and discoloration. Allodynia was present in 8. Patsy osteoporosis was evident on the x-rays. Palmar elytritis with atrophy in 6. The treatment was intravenous sympathetic block with 20 mg guanethidine plus 2ml 2% lignocaine and N/Saline up to 20 ml. The second block was repeated after 3 days and the following depending on the response to pain. Physiotherapy session followed each block.

Results: 2 patients needed 5 blocks, 7 patients 4 blocks, 5 patients 3 blocks and 1 patient 2 blocks. In the end there was complete regression of the pain, oedema and restoration of the movement.

Conclusion: The sympathetic block with I.V. administration of guanethidine in combination with physiotherapy seems to be a safe and simple treatment of choice, well tolerated and with good results.