To compare the effect of intraoperative red cell salvage on blood transfusion and cost in patients undergoing idiopathic scoliosis surgery.

Retrospective

37 patients (36 females, 1 male) underwent scoliosis surgery from February 2007 to October 2008. Intraoperative red cell salvage (Group 1) was used. They were compared with 28 patients (23 females, 5 males) operated from January 2005 to December 2006 without the use of cell salvage (Group 2). 36 patients in group 1 had posterior surgery and 1 had anterior surgery. In Group 2, 20 patients had posterior surgery, 7 anterior and 1 patient had anterior and posterior surgery. Both groups were comparable for age, number of levels fused, preoperative haemoglobin and haematocrit values.

Amount of perioperative blood transfusion, costs

14 patients (50%) in group 2 had blood transfusion whereas only 6 (16%) were transfused blood in group 1. Average blood loss in group 1 was 1076 mls (range 315-3000) and 1626mls (419-4275) in group 2. An average of 2 units of packed red blood cells per patient was processed by the cell salvage system. Postoperative haemoglobin, haematocrit and hospital stay were comparable in both groups. Cost analysis shows the use of cell salvage is cost beneficial by £116.60 per case.

The use of red blood cell salvage reduces the amount of blood transfusion and is cost beneficial.

The aim of the study is to compare the postoperative pain relief provided by continuous perfusion of wound by bupivacaine and fentanyl with that of patient controlled analgesia using morphine in elective shoulder surgery. This retrospective case control study included 76 consecutive patients who had elective shoulder surgery. 39 patients had patient controlled analgesic system (PCA) with morphine and 37 patients had a continuous wound perfusion(intra bursal) with bupivacaine and fentanyl via a disposable Silicone Balloon Infuser. Patients were also given additional oral NSAIDs or morphine if needed. The pain score measured postoperatively based on a 10 point Visual Analogue Scale (VAS) at 1, 2, 3 and 18 hours was noted. The use of antiemetics and additional painkillers was recorded. The complications of both methods were also noted.

We found that the analgesia provided by continuous perfusion of wound by bupivacaine and fentanyl was constant and comparable to that provided by the patient controlled analgesic system using morphine. PCA with morphine was associated with significantly high incidence of nausea and vomiting (p < 0.001).We conclude that continuous perfusion of the wound by bupivacaine and fentanyl appears to be a simple, effective and safe method of providing analgesia following elective shoulder surgery.