Caudal levobupivacaine with and without fentanyl in pediatric surgery

Single dose caudal analgesia is one of the most useful and popular regional blocks used in modem pediatric anesthetic practice. Racemic bupivacaine is commonly used for caudal analgesia however, there have been reports of systemic toxicity. Levobupivacaine was found tobe less toxic than bupivacaine, and produces a block clinically similar to bupivacaine. This study was designed to evaluate the effects of two doses of caudal levobupivacaine with and without fentanyl in children. 90 children ASA 1-11 aged 1-5 yr, undergoing elective hypospedius, circumcision andhemia repair were studied. Anesthesia was induced and maintained with sevoflurane. Spontaneous ventilation was chosen using a laryngeal mask airway. After induction patients were turned to the left lateral position and a caudal block was performed. Patients were randomly divided into three groups to receive a volume of 1 ml.kg[-1] of: levobupivacaine 0.25% [group I], 0.125% [Group II] and 0.125% plus fentanyl 2micro g.mL[-1] [group III]. Successful blockade was defined by absence of gross movement or significant [>20%] change in HR, NIBP and/or RR on application of surgical stimulus which was allowed 10 mm after caudal injection. Postoperative analgesia was evaluated by the Children and Infants Postoperative Pain Scale [CHIPPS]. Duration of postoperative analgesia was recorded and CHIPPS and motor weakness were measured every 30 min for the first 6h and every 2h thereafter until the end of the study [24 h]. lntraoperative analgesia was adequate in 96.5%, 93.3% and 93.3% in group 1, 2 and 3, respectively. The duration of postoperative pain relief was significantly prolonged in group I [10.3h] compared with group 2 [6.1 h] and group 3 [6.8h] while no difference was found between group 2 and group 3. Motor blockade score of 1 was observed in 30% of patients in group I during the first postoperative hour and was not observed in any patients in the other two groups P<0.05. Caudal levobupivacaine 0.125% and 0.25% are safe and effective as adjuvant to general anesthesia in children and the higher concentration was associated with early mild motor blockade and longer postoperative analgesia. Fentanyl did not provide any additional benefit when combined with levobupivacaine 0.125%

Vaginoplasty for congenital absence of the vagina

In this work, several refinements of McIndoe technique were presented which are the dissection of a large pocket using an adjustable vaginal stent and the use of a meshed thick split thickness skin graft for lining the neovaginal pocket. This study included six cases of congenital vaginal agenesis [two patients had testicular feminization syndrome]. The volume of the reconstructed vaginal pockets ranged from 65 to 130 cc. After six-month follow-up period, the percentage of reduction in the size of the neovaginae from their original sizes ranged from 4.25 to 11.5%. These refinements proved to be of a value in improving the final outcome of the McIndoe technique for vaginal reconstruction

Long term follow-up of surgically reconstructed flexor tendon system of the hand in complicated cases associated with scarred tendon bed using tendon proshesis

This study aimed to evaluate the long-term functional results in surgically reconstructed flexor tendon system of the hand following complicated injuries associated with scarred tendon bed and loss of integrity of its sheath. The study presented the long-term functional results in 32 patients. Most of the injuries [24] had occurred at work. Cutting tools were the causative trauma in the majority of cases. Radiologically, all the operated digits were free from any bone or joint abnormalities. The cases were selected and the neurovascular bundle was, at least, intact at one side of the involved digit; in addition, many were associated with joint contracture of one or more of the digital joints and limited passive motions

cross - leg flap, is it still a viable option?

This work presented several examples of lower extremity defects, where the cross-leg flap was a viable option and was considered high in the reconstructive ladder among other procedures for the reconstruction of these defects. The study suggested that the cross-leg is still a viable option in the reconstruction of lower leg and foot, where local tissues are not available and is a safe alternative to free tissue transfer

use of island groin flap in the reconstruction of the lower abdomen and perineal region

In this study, an island groin flap was used for a satisfactory reconstruction of soft tissue defects of the lower abdomen and perineal region in eight patients. This flap had several advantages; simple operation, wide range of coverage, large rotation arc, direct closure of the donor site and no sacrifice of muscle in comparison with musculocutaneous flaps. It was of a great value in the reconstruction of lower abdominal wall soft tissue defects with intact underlying fascia or sufficient scarring to prevent herniation. It can be used in the reconstruction of almost all defects in perineal region

Refinements of the inferior dermal pedicle technique and a modified pattern suited for reduction of huge gigantomastia

In this study, several modifications in the original Wise's pattern used in the inferior dermal pedicle technique and several technique refinements were introduced. Thirty cases were randomly selected from individuals who have sought consultation and requested reduction mammoplasty. It was concluded that the inferior dermo-glandular pedicle technique with some modifications was an adaptable technique for the reduction of hugely enlarged breasts with safety as regards the viability of areola and nipple complex and with good esthetic results

role of MR imaging in the diagnosis of swollen lower extremities

In this study, MR imaging of swollen extremity was performed on 20 patients using T1 and T2-weighted spin-echo and short inversion time inversion recovery sequences. Thickness and signal intensity of the cutis, subcutis and subfascia were evaluated in the images. In all cases with lymphatic edema, trabecular structures suggesting dilated collateral lymphatic vessels were observed in the swollen subcutis. Regarding the non-lymphatic patients, one case of nephrotic syndrome showed similar findings. In four cases with venous edema, fatty intensity was found in the subfascia. In the remaining three cases, the subcutis exhibited only water intensity

functional repair of unilateral cleft lip

The goal in cleft lip repair is the restoration of the normal anatomy as far as possible. Most of the attempts and efforts in cleft lip repair had been directed toward the skin incision. In recent years the importance of the functional cleft lip repair with orbicularis oris muscle realignment and a sequential layered closure has been stressed. The aim of this paper was to present the clinical experience with accurate repair of the 2 different functional portions of the orbicularis oris muscle [the intrinsic and extrinsic bundles] in the correction of unilateral cleft lip in 10 cases

out come of primary nerve repair at the forearm

Eighteen injured peripheral nerves at the forearm level were repaired primarily either by immediate or by delayed primary repair according to the mechanism of injury, the presence of contamination and /or skin loss. Nine nerves were cut sharply and were immediately repaired of which four nerves achieved excellent results, three achieved good results and the results were poor in the remaining two nerves. In nine nerves, there were laceration, contamination and /or skin loss and they were repaired by delayed primary neuropathy after one week from the time of injury. Two nerves achieved excellent results, five nerves achieved good results and two nerves achieved poor results

Primary repair of lip nose deformities in bilateral complete cleft lip: one stage open tip rhinoplasty at the time of lip repair

This paper presented a preliminary report on one-stage reconstruction of lip nose deformities in complete bilateral cleft lip. The technique used is a modification of the principle of open tip rhinoplasty popularized by Gunter and Rohrich, 1987 with a modification of the principles of bilateral lip repair popularized by Millard, 1977. The technique used for 11 consecutive cases with bilateral complete cleft lip, admitted in Sayed Galal and El-Husain hospitals, Al-Azhar University in the period between October 1992 and December 1994. The steps of the technique, the results and the complications are discussed

Reversed pedicled adipofascial flap for coverage distal pretibial soft tissue defects

Reconstruction of the distal pretibial soft tissue defects continue to challenge the reconstructive surgeon. This study reviewed the possibility of the use of reversed pedicle Adipofascial flap based on the distal perforators of both the posterior tibial and peroneal arteries. Ten patients were selected for this study, 7 patients with traumatic defects with fracture tibia, and 3 patients with chronic osteomyelitis associated with chronic unstable scarring. The study also demonstrated the durability of the flap in the presence of these problems