Caudal bupivacaine-neostigmine effect on postoperative pain relief in children

To assess the effect of different neostigmine doses added to caudal bupivacaine on postoperative pain relief in assigned pediatric herniotomy surgery. Our randomized, double-blinded and prospective investigation included 134 patients, aged 7-14 years, classed I - II physical status class by the American Society of anesthesiologists [ASA], of both genders and scheduled for herniotomy. Children were randomly assigned into four groups to receive a caudal administration of 0.25% plain bupivacaine 0.5ml/kg [group I, n= 33]. For the following three groups, bupivacaine was mixed with neostigmine in the following manner: 1.5mcg/kg neostigmine [group II, n= 34], 3mcg/kg neostigmine [group III, n= 33] and 6mcg/kg neostigmine [group IV, n= 34], with a total caudal volume of 1 ml/kg administered in all groups after induction of general anesthesia. Postoperative use of rescue analgesics using paracetamol during the first postoperative 24 hours was recorded. Postoperative pain was evaluated using the numerical pain rating scale with a score from zero to 10. The Chi-square and Students t test were used to test statistical significance where P <0.05 was considered significant. Mean duration of postoperative analgesia was 4.7 hours, 16.35 hours, 16.8 hours and 16.65 hours in groups I, II, III and IV, respectively, [p<.05]. Mean postoperative paracetamol consumption was 41.9mg/kg in group I, 12.8mg/kg,14.1 mg/kg and 11.4mg/kg in groups II, III and IV, respectively [P<0.05], during the first 24 postoperative hours. Administration of caudal neostigmine combined with bupivacaine significantly prolongs the duration of postoperative pain relief with decreased requirement for rescue analgesics

reasons for cancellations of elective pediatric surgery cases at queen Rania Al-Abdullah children hospital

To investigate the rate and the reasons of cancellation of elective pediatric surgery in our hospital and to formulate possible suggestions to minimize it. This is a retrospective study conducted between 1[st] of July 2012 to the 30[th] of June 2013. The study population included all patient listed in the operating list in the day before surgery. Cancelled case we defined as a case listed on operating list and did not undergo surgery on scheduled time during the same period. Data collected from operating room data base and from incident report for cancellation of surgery for each cancelled case. The data collected was analyzed to define the reasons for cancellation in our hospital. During the study period 6061 patients were scheduled for elective surgery. More than 50% of them were scheduled by general pediatric division. Four hundreds and ninety cases were canceled on the day of surgery making the cancellation rate of 8%. The highest cancellation rate [16.7%] was reported by ophthalmology department while lowest rate [2.8%] was reported by ENT department. Patient related reasons were the commonest [69.8%]. the commonest reasons were non- attendance on the day of surgery, followed by the presence of acute illness. treating surgeon related reason counted for 23.8% of cancellation. incomplete work up, no need for surgery, and lack of time were the major reason for cancellation. hospital related reasons counted for 6.4% of cancellations. the most common reason was non availability of ICU or ward bed. This study clearly identifies that the reasons for elective surgery cancellation are multifactorial and complex, mostly non- attendance of patient is the major reason. Redesigning our work processes by involving the patient in the care plan such as selecting date of surgery, establishing pre-operative anesthesia clinic and optimum surgical list booking should reduce rate of cancellation in our hospital

Comparison of postoperative pain relief impact between caudal bupivacaine alone and caudal bupivacaine-dexamethasone mixture administration for pediatric local tube urethroplasty

To compare the postoperative analgesic influence between caudal bupivacaine only and caudal bupivacaine-dexamethasone combination administration in children undergoing local tube urethroplasty. This prospective, randomized and clinical trail investigation included 162 male pediatric patients, classed I by the American society of anesthesiologists, aged 11-14 years and assigned for local tube urethroplasty at Queen Rania Hospital, King Hussein Medical Center, Amman-Jordan, during the year of 2013. General anesthesia was induced using inhalational sevoflurane / oxygen anesthesia, after which a laryngeal mask airway was inserted and an intravenous line was secured. All subjects were repositioned to receive caudal sacral block using randomly either plain bupivacaine 0.25% mixed with normal saline 0.9% [Group I, n=80] or plain bupivacaine 0.25% mixed with dexamethasone 0.1mg/kg [Group II, n=82], not exceeding a total volume of 0.5ml/kg and not exceeding a maximum dose of 2mg/kg of bupivacaine in both groups, dividing the total volume in ¾ for bupivacaine and ¼ for dexamethasone, saline or both. Postoperatively, in the recovery room, rectal paracetamol 10 mg/kg was administered if the numerical rating scale was more or equal to four. Postoperative analgesia quality was assessed. Statistical discrepancies between the two groups were evaluated using Students t and Chisquare tests. Variance was used to assess inter-group differences in changes of pain scores. A value of P<0.05 was considered significant. Postoperative mean pain free period was significantly less in group I [186 min] than in group II [272 min] [P<0.05]. The mean time to first rectal paracetamol dose was 192 min. in group II and 125 min. in group I [P<0.05] The combination of caudal bupivacaine-dexamethasone significantly enhanced the postoperative analgesic profile compared to caudal bupivacaine-saline in children undergoing local tube urethroplasty under combined general-caudal anesthesia

Comparison of recovery characteristics of sevoflurane and halothane in children undergoing adenotonsillectomy

To compare recovery characteristics of sevoflurane and halothane anaesthesia in children. Patients and A total of 80 children aged 3-8 years presenting for elective adenotonsillectomy. Children divided into two groups: Group I: In which received sevoflurane anaesthesia. Group II: In which received halothane anaesthesia. The mean time of emergence and time of interaction after surgery was significantly shorter in group I than group II. The time taken to be ready for discharge from recovery room to the ward was also significantly shorter in group I than group II. Recovery is significantly faster with sevoflurane than with halothane anaesthesia

Retrograde facial nerve dissection in superficial parotidectomy versus standard approach: a comparative study

This study was conducted to determine whether the retrograde approach in parotidectomy is more efficient than standard anterograde parotidectomy without compromise of surgical effectiveness. A prospective analysis of 48 patients undergoing superficial parotidectomy was conducted. Cases were divided into those undergoing retrograde facial nerve dissection and those undergoing standard anterograde facial nerve dissection. The following had been monitored: surgical time, estimated blood loss, and incidence of either temporary or permanent facial nerve injury. Statistical comparisons were conducted for the two approaches comparing the three different mentioned variables. The average patient age was 48.5 years with a female preponderance [71%]. There were 23 standard superficial parotidectomies and 25 retrograde approaches. Compared to standard superficial parotidectomy, retrograde superficial parotidectomy consumed less operative time [1.80 versus 2.10 hours], decreased intraoperative blood loss [88.00 ml versus 50.00 ml]. No significant difference in incidence of either temporary or permanent facial nerve injury was observed. In appropriately selected cases, compared with standard anterograde parotidectomy, retrograde parotidectomy is more efficient in terms of lower operative time and less blood loss, with no added risk to facial nerve injury

Tubeless percutaneous nephrolithotomy: our experience at Queen Rania urology center

To assess the outcome and safety of tubeless percutaneous nephrolithotomy in managing renal and upper ureteric stones in selected patients. Between June 2003 and July 2006, 85 patients with mean age of 35 years [range 17-67], were selected by simple random sampling method where two patients were chosen on weekly basis [2 patients every week] for the whole study period at Queen Rania Urology Center to undergo tubeless percutaneous nephrolithotomy for renal and upper ureteric stones. Of 85 patients, 50 cases were on the left side and 35 cases were on the right side, stone size was less then 3 cm in all cases. Nephrostomy tubes were not used in any patient. The incidence of complications, transfusion requirement, stone free rate and length of hospital stay were obtained. From 85 patients, 63 [74%] patients had solitary renal stone, 18 [21%] patients had multiple stones and 4 [5%] patients had upper ureteric stones. Average hospital stay postoperatively was 2 days [1-3]. The mean duration of percutaneous nephrolithotomy was 60 minutes [45-110], complete stone clearance was achieved in 77 patients [91%], 8 patients [9%] had small residual stones [<5mm] from which 3 patients [3.5%] required Extra Corporeal Shock Wave. Lithotripsy, while other patients required no further management. Blood transfusion was required in one patient because of postoperative hematuria which subsided spontaneously. Tubeless percutaneous nephrolithotomy is a safe, effective procedure for renal and upper ureteric stones in selected patients

effects of triamcinolone/lignocaine peritonsillar infiltration on post-tonsillectomy pain

Tonsillectomy continues to be one of the most common surgical procedures performed worldwide. Despite advances in anesthetic and surgical techniques, post tonsillectomy morbidity remains a significant clinical problem. We conducted a placebo-controlled, single blind study to determine the efficacy of a local preoperative injection of a steroid/anesthetic combination in preventing post tonsillectomy pain