Pediatric cancer pain management at a regional cancer center: implementation of who analgesic ladder

collect data on the prevalence of various types of cancer pain in a sample of children with cancer, and to implement the WHO Analgesic Ladder in the management of pain in pediatric cancer. Eighty four pediatric patients suffering of cancer pain were studied during the period 2001-2006. Patients were requested to rate their global intensity of pain on 0-100 mm visual analogue scale [VAS 0 = no pain 100 = maximum pain]. Pain management was performed in accordance with the WHO Analgesic Ladder for cancer pain. Patients were followed up weekly for three weeks. Of the 84 pediatric children with cancer, pain was nociceptive in 26 [31%], neuropathic in 12 [14.3%] and mixed in 46 [54.8%]. Almost 7 [8.3%] of patients were on WHO step 3 at baseline. Thereafter the WHO step 3 increased; first week visit 36 [43%] patients; second week visit 58[69%], and third week 69 [82.1%]. At baseline, 40 [47.6%] patients took NSAID only, 2 [2.4%] patients took adjuvant, while 38 [45.2%] patients took combination of NSAID and adjuvant treatment. There was statistically significant [p = 0.000] reduction in VAS as time progressed. Cancer pain in pediatric age group can be well managed in accordance with the WHO Analgesic Ladder. Aggressive symptoms and control of treatment of related side effect are also needed to ensure successful implementation and the WHO Analgesic Ladder

rate dependent bundle branch block -transition from left bundle branch block to intraoperative normal sinus rhythm

A chronic hypertensive patient with electrocardiogram [ECG] showing left bundle branch block [LBBB] was given general anesthesia for right modified radical mastectomy. Her ECG reverted to normal sinus rhythm intermittently during peri-operative period. This intermittent ratedependent LBBB is a rare entity. Though hypertension is one significant co-morbid condition, the risk evalution of LBBB during anesthesia only on an ECG finding, is not justifiable. Rather patient should be investigated further for any cardiac risk