Ropivacaine 0.2% versus bupivacaine 0.25% in para-umbilical block in children

Para-umbilical block was an old block that regains a new interest. No study was available using Ropivacaine in this block. To compare quality of analgesia after using Ropivacaine 0.2% to Bupivacaine 0.25% in para-umbilical blocks. In a prospective randomized double blind study we included one to six years old children, scheduled for umbilical herniorrhaphy. The children were randomized in two groups to receive in para-umbilical block by side: Ropivacaine 0.2%: 0.2 ml.kg-1 [group GR] or Bupivacaine 0.25%: 0.2 ml.kg-1 [group GB]. The data of 75 children [GR= 38; GB= 37] were analyzed. The groups were comparable regarding the demographics' characters. The scores of Children's Hospital of Eastern Ontario Pain Scale in different postoperative times were comparable between the two groups. No difference was noted in the time of the first analgesic request. The two groups were comparable regarding the peroperative analgesia. No complication was recorded in this study. Ropivacaine 0.2% is equivalent to the Bupivacaine 0.25% concerning postoperative and peroperative analgesia in the para-umbilical block for umbilical herniorrhaphy

[Epidemiology of acute hematogenous osteomyelitis in children: a prospective study over a 32 months period]

To determine the demographic, clinical, biological and bacteriological profile of acute community acquired hematogenous osteomyelitis [AHO] in children. Prospective study including children admitted for AHO. We noted the demographic parameters of patients and the clinical, biological and radiological characteristics of the infection. Blood cultures and local specimen in operated children were systematically performed. 70 patients were included. The mean age was 7.7 years. The mean time between onset of symptoms and admission was 3.2 days. Distal tibia was the most frequent localization [18.66%]. Fever higher than 38[degree sign] on admission was found in 92.8% of patients. Creactive protein [CRP] was superior to 20 mg / L in 95.8% and ESR superior to 20 mm in the first hour in 92% of cases. A deep venous thrombosis was found in 7 patients and a pleuropulmonary Staphylococcus infection in 4 patients. Amicroorganism was isolated in 64.7% of cases. Staphylococcus aureus methicillin susceptible [SAMS] was the predominant germ. Staphylococcus aureus methicillin resistant [SAMR] accounted for 15.7% of staphylococcus aureus infections. The importance of CRP on admission and time to resolution of fever after the start of treatment were significantly higher in SAMR infections. The existence of deep venous thrombosis and a pleuropulmonary Staphylococcus infection and the need for surgical drainage were significantly more frequent in SAMR infections. The existence of a severe form of AHO should lead to a high suspicion of SAMR infection and prompt the prescription of an appropriate antibiotiotherapy

Bilateral stress fractures of the femoral neck with no risk factor: a case report

Stress fractures of the femoral neck are uncommon. They are caused by either excessive stress or bone fragility. To report a case of bilateral stress fracture of the femoral neck in a 15-year-old girl without any risk factors. We report a case of bilateral stress fracture of the femoral neck in a 15-year-old girl in whom no risk factors were found. One of the fractures was displaced at first diagnosis and was successfully treated by closed reduction and valgus subtrochanteric osteotomy. The other fracture was initially undisplaced but displacement occurred later despite internal fixation with a dynamic hip screw. A high index of suspicion of stress fractures of the femoral neck must be kept in mind even without risk factors. Delays in diagnosis and displacement should therefore be avoided

Time to extubation in infants undergoing pyloromyotomy, isoflurane inhalation vs remifentanil infusion

Infantile hypertrophic pyloric stenosis [IHPS] associated with metabolic alkalosis, could induce late anesthesia recovery, especially when opioids are used. The aim of this study was to compare the time of extubation and the quality of perioperative analgesia in infants scheduled for pyloromyotomy, receiving either isoflurane inhalation or remifentanil infusion. Thirty full-term infants scheduled for pyloromyotomy were prospectively studied. A standardized anesthetic induction was performed. For maintenance of anesthesia, infants were randomly allocated to receive either isoflurane 0.75% of inspired concentration [GI n = 15], or remifentanil as a continuous infusion of 0.4 microg.kg[-1].mn[-1] [GR n = 15]. At the beginning of skin closure, the anesthetic was discontinued and 15 mg.kg-1 of paracetamol administered. Non parametric tests were used in statistical analysis. The time to extubation was similar in both groups. The intraoperative heart rate was significantly lower in the GR group. Remifentanil provided better intraoperative analgesia than isoflurane in infants undergoing pyloromyotomy without increasing time to extubation