Postoperative analgesic effect, of preoperatively administered dexamethasone, after operative fixation of fractured neck of femur: randomised, double blinded controlled study.

Background: Fractured neck of femur is a common cause of hospital admission in the elderly and usually requires operative fixation. In a variety of clinical settings, preoperative glucocorticoid administration has improved analgesia and decreased opioid consumption. Our objective was to define the postoperative analgesic efficacy of single dose of dexamethasone administered preoperatively in patients undergoing operative fixation of fractured neck of femur. Methods: Institutional ethical approval was granted and written informed consent was obtained from each patient. Patients awaiting for surgery at Cork University Hospital were recruited between July 2009 and August 2012. Participating patients, scheduled for surgery were randomly allocated to one of two groups (Dexamethasone or Placebo). Patients in the dexamethasone group received a single dose of intravenous dexamethasone 0.1 mg kg -1 immediately preoperatively. Patients in the placebo group received the same volume of normal saline. Patients underwent operative fixation of fractured neck of femur using standardised spinal anaesthesia and surgical techniques. The primary outcome was pain scores at rest 6 h after the surgery. Results: Thirty seven patients were recruited and data from thirty patients were analysed. The groups were similar in terms of patient characteristics. Pain scores at rest 6 h after the surgery (the principal outcome) were lesser in the dexamethasone group compared with the placebo group [0.8(1.3) vs. 3.9(2.9), mean(SD) p = 0.0004]. Cumulative morphine consumption 24 h after the surgery was also lesser in the dexamethasone group [7.7(8.3) vs. 15.1(9.4), mean(SD) mg, p = 0.04]. Conclusions: A single dose of intravenous dexamethasone 0.1 mg kg -1 administered before operative fixation of fractured neck of femur improve significantly the early postoperative analgesia. Trial registration: ClinicalTrials.gov identifier: NCT01550146, date of registration: 07/03/2012

Souterrain in Grallagh Lower Td. Co. Waterford

A souterrain was discovered here when the weight of a tractor passing overhead caused a collapse of the roof of Chamber I. It was surveyed in March 1976. The landowner, Mr. Thomas Curran of Ballylangdon has consented to keep the site open for future inspection. The site is not directly connected with any visible surface structure. A small uni-vallate ringfort is however situated c.I60m S.S.E. of the site. The bedrock is a slaty sandstone.

Optimizing perioperative analgesia for patients undergoing operative fixation of hip fractures

This PhD thesis describes work carried out on investigation of various interventions with the aim to optimise the anaesthetic management of patients scheduled to undergo operative fixation of hip fractures. We analysed the perioperative effects of continuous femoral nerve block, single preoperative dose of i.v. dexamethasone, the intention to deposit local anaesthetic in different locations around the femoral nerve during ultrasound guided femoral nerve block, continuous spinal anaesthesia and peri-surgical site infiltration with local anaesthetic after surgical fixation of hip fractures. Continuous femoral nerve block provided more effective preoperative analgesia six hours after the insertion of the perineural catheter compared to a standard opiate-based regimen in patients undergoing operative fixation of fractured hip. A single low dose of preoperative dexamethasone in the intervention group decreased pain scores by 75% six hours after the surgery. Both interventions had no major effect on the functional recovery in the first year after the surgical fixation of fractured hip. The results of the ultrasound guided femoral nerve block trial showed no clinical advantage of intending to deposit local anaesthetic circumferentially during performing femoral nerve block. Using the Dixon and Massey’s “up- and-down” method, we demonstrated that intrathecal 0.26 ml of 0.5% bupivacaine provided adequate surgical anaesthesia within 15 minutes in 50% of patients undergoing operative fixation of hip fracture. Finally, we demonstrated that local anaesthetic infiltration had no effect on pain scores 12 hours after the surgical fixation of fractured neck of femur. In addition to this original body of work, a review article was published on femoral nerve block highlighting the use of ultrasound guidance. In conclusion, the results of this thesis offer an insight into interventions aimed at optimising perioperative analgesia in patients scheduled to undergo operative fixation of hip fractures.

Echoes of existentialism in the works of Carlos Fuentes

In this thesis I have set out to trace the echoes of existentialism in the work of the Mexican novelist, Carlos Fuentes scrutinizing, in particular, La región más transparente, La muerte de Artemio Cruz and Cambio de piel. In the opening segment of the thesis I outline the essential tenets of existentialist thought and how it became the predominant philosophical and literary movement of the early part of the twentieth-century. Stemming from the work of Sören Kierkegaard in Denmark towards the end of the nineteenth-century, it challenged the arid philosophies of previous generations and provided a new way of looking at man and the human condition. In this opening chapter, I study the works of the more important philosophers in this regard such as Heidegger, Sartre, Jaspers, Marcel, Unamuno, and Ortega y Gasset and show how each in his own way contributed to the further development of the new philosophy. Chapter 2 is concerned with the spread of existentialism to the Latin American continent. In the early part of the twentieth-century, Mexico was emerging from a turbulent revolutionary period and seeking a solution to the fractured nature of its society. The Spanish philosopher, Ortega y Gasset, and the many Spanish intellectuals who sought refuge from Franco’s dictatorship in Mexico, helped to popularise the new philosophy and these lively debates about existentialism served to underpin ideas around mexicanidad or Mexican national identity. Carlos Fuentes was deeply immersed in the debate of his time, positioned as he was as a prominent public intellectual. In La muerte de Artemio Cruz he shows us how great wealth and power are a poor recompense for the loss of love and compassion and lead only to alienation and selfishness. In his other best known novel, La región más transparente, he explores the rise of modern Mexico and its society – an inauthentic society that is corrupted by a scramble for wealth and self-aggrandizement. The final chapter is devoted to the study of Cambio de piel which is concerned with violence and alienation as central pillars of existence. The violence depicted here precipitates a crisis in the human condition and an accompanying sense of alienation. The thesis seeks to establish that existentialism is central not only to Fuentes’s literary concerns but also forms a part of his ethics as an artist.