CITATION: Smit, B. J. 1994. Morphine for cancer pain. South African Medical Journal, 84(11):788.The original publication is available at http://www.samj.org.za[No abstract available]Publisher’s versio

Smit, B. J.

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On 23 June 1994 interns from Groote Schuur andTygerberg hospitals, together with Peter Brewer of theMASA, met Dr Sutcliffe, deputy Director-General, Hospitaland Health Services, CPA. After lengthy negotiation aproposal was put to the interns which was accepted. Theproposal outlined a plan for a commuted overtimeallowance, paid in a fixed monthly amount in recognition ofinterns' long working hours. The proposal was accepted bythe MEC for Health, Mr Ebrahim Rasool. With the CPA nolonger responsible for the old Cape Province, this proposalonly covered interns in the Western Cape.Subsequent to this meeting, the OFS agreed to a fixedovertime allowance for interns. In an about-turn, negotiationswith the TPA for a commuted overtime allowance was alsoaccepted. JUDASA has also secured the same benefits forinterns in the Northern and Eastern Cape. An agreementwith the Natal administration is nearing completion.Jonny TaitzVice-Chairperson, JUDASA,Chairperson, Groote Schuur Interns I CommitteeJunior Doctors Association of South Africa428 Kin9'S HighwayLynnwoodPretoriaMorphine for cancer painTo the Editor: The reason for inadequate pain managementis a pavlOVian conditioned reflex.The law and associated bodies instil fear" in medicalstudents - the dreaded 'schedule 7'. Then this is reinforcedby the stigma of heroin, drug trafficking, addiction andconviction.Yet control of pain in a cancer patient at the end of thetherapeutic road is simple. Start with paracetamol andquickly work the way up the pyramid to opioids andtranquillisers.We need a clear signal from the lawmakers and the SouthAfrican Medical and Dental Council that will tell all cancerpatients that they and their doctors have their unconditionalblessing, and th.at for the purpose of controlling cancer painmorphine is a gift from the gods.Not to be forgotten is the important role the radiationoncologist can play in relieving both localised and diffusepain due to metastatic disease with localised and wide-fieldradiotherapy, or newly developed bone-seeking agents like153-Sm and possibly 117m-Sn.B. J. SmitDepartment of RadiotherapyUniversity of StellenboschTygerberg. W. CapeHeadache and backache after epiduralblock for postpartum sterilisationTo the Editor: Epidural block performed by obstetricians forpain relief in labour has long been established at PaarlHospital.' Since 1990 this technique has been extended touse in postpartum sterilisation!. Anaesthetists have bothcondoned3 and criticiSed' this approach. Contributions(except for one from Durban") on epidural block in the SouthAfrican literature are few.When one of Paarl's maternity sisters returned to PaarlMaternity Hospital in January 1994, she remarked that theloss-of-air-resistance technique had been abandoned atGroote Schuur and Mowbray hospitals. This prompted us toput a prospective questionnaire to 105 consecutive patientsupon whom an epidural block was performed forpostpartum sterilisation. The procedures were performed bymedical officers from the beginning of April to the end ofJuly 1994.After the epidural space was located with the loss-of-air-resistance technique (20 ml air injected under pressure),20 ml bupivacaine 0,5% (100 mg) was injected as a bolusat T12-L1 or one level higher or lower. The sterilisation wasthen performed, and 'on the following day the patients wereasked four questions. Eleven of the 105 (10,5%) had foundthe procedure unpleasant or painful, and 4 (3,8%) had had aheadache afterwards. Most of the patients (102; 97,14%)would advise their acquaintances to have an epidural block.This study seems to indicate that the loss-of-air-resistancetechnique is generally acceptable to obstetric patients andshould not be abandoned at Paarl Hospital.S. E. DowningD. J. SchneiderV. P. de Vi/tiersDepartment of Obstetrics and GynaecologyPaarl HospitalPaarl, W. Cape,. De Villiers VP. Epidural block as pain relief in labour. S Afr Med J 1973; 47: 1319-1320.2. De Villiers VP. Epidural block for postpartum sterilisation. S Afr Med J 1994; 84: 60.3. Jones CS. Epidural block for postpartum sterilisation (Letter). S Atr Med J 1994; 84:290.4. Rout CC, Rocke DA. Epidural block for postpartum sterilisation (Letter). S Afr Med J1994; 84: 290-292.5. Rocke OAt Rout CC. Russel HO. Singh S. The labour ward analgesic service at KingEdward VIII Hospital, Durban. S Atr Med J 1993; 83: 32-33.Johan se raadAan die Redakteur: David' is heeltemal verkeerd omspontane nagkrampe by die hoofbrekende toestande teklassifiseer. Inteendeel, difis nodig om net 'n klein bietjie tedink 'Voor voorgeskryf of raat gegee word. Min of meer soosvolg:Eerste gedagte: Neem hierdie pasient iets wat riagkrampekan veroorsaak - deur my of 'n kollega voorgeskryf of dalkvan 'n ander pasient geleen of selfmedikasie (onthouopelyfmiddels)?Tweede gedagte: Is die nagtelike fleksor krampe?Derde gedagte: As die pasient elke aand met slaaptyd diekuitspiere stadig rek sal medikasie dalk nie nodig wees nie.Passief, indfen nie moontlik om aktief te oefen nie. Vyf-en-negentig persent opgelos.Bedien dan die jenewer met lemmetjiesap.Johan du ToitPosbus 2805George, W. Kaap1. Pretorius O. Oavid se raat (Brief). S Afr Med J 1994; 84: 450.Volume 84 No.11 November 1994 SAMJ

Morphine for cancer pain

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Morphine for cancer pain

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