To establish whether caudal with ketamine or penile block provide superior postoperative analgesia for paediatric circumcision.

This was a single centre, prospective, randomized, controlled, double-blind trial. Forty males (aged between 18 months and 16 yr) were randomized to receive either a penile block using 0.25 mL kg−1 0.5% bupivacaine (Group P), or a caudal block using 0.5 mL kg−1 0.25% bupivacaine with 0.5 mg kg−1 ketamine (Group C). All of them were given a standard anaesthetic and rectal paracetamol 40 mg kg−1 and diclofenac 1–1.5 mg kg−1. Postoperative pain scores were assessed in recovery and the time to first analgesia, micturition and walking were recorded.

There were no failures in either group. The time to first analgesia was longer in Group C (C median = 459 min, interquartile range 374–553 min; P median = 374 min, interquartile range 224–507 min; P < 0.05). There was a delay in time to walking in Group C (C median = 162 min, interquartile range 119–208 min; P median = 120 min, interquartile range 92–132 min; P < 0.05). There was no difference between the groups in time to waking or micturition, or the incidence of vomiting, abnormal behaviour or bleeding.

Caudal bupivacaine with ketamine and penile block both provide effective postoperative analgesia for circumcision when given with non-steroidal anti-inflammatory drugs. This study shows that caudal bupivacaine with ketamine provides a longer duration of analgesia than penile block, but also causes delay in walking.

To investigate whether preemptive administered lornoxicam changes perioperative platelet function during thoracic surgery.

A total of 20 patients scheduled for elective thoracic surgery were randomly assigned to receive either lornoxicam (16 mg, i.v.; n = 10) or placebo (n = 10) preoperatively. All patients underwent treatment of solitary lung metastasis and denied any antiplatelet medication within the past 2 weeks. Blood samples were drawn via an arterial catheter directly into silicone-coated Vacutainer tubes containing 0.5 mL of 0.129 M buffered sodium citrate 3.8% before, 15 min, 4 h and 8 h after the study medication was administered. Platelet aggregation curves were obtained by whole blood electrical impedance aggregometry (Chrono Log®).

Platelet aggregation was significantly reduced 15 min, 4 h and 8 h after lornoxicam administration compared to placebo (P < 0.05) for collagen, adenosine diphosphate and arachidonic acid as trigger substances. Adenosine diphosphate-induced platelet aggregation decreased by 85% 15 min after lornoxicam administration, and remained impaired for 8 h.

Platelet aggregation assays are impaired for at least 8 h after lornoxicam application. Therefore perioperative analgesia by use of lornoxicam should be carefully administered under consideration of subsequent platelet dysfunction.