Results of Open Wound Technique in the Treatment of Post-Sequestrectomy Dead Space

BACKGROUND AND METHOD. Severe chronic osteomyelitis with variable outcomes is still common among children in developing nations. There has been no consensus on the optimal method of treatment. We therefore prospectively evaluated the rates of wound healing and recurrence following open wound treatment of post-sequestrectomy dead spaces in 30 patients with haematogenous chronic osteomyelitis of the tibial shaft at the King Orthopaedic Clinic; Ekpoma; Edo State; Nigeria; between January 2001 and December 2005. Thirty similar patients whose post-sequestrectomy dead spaces were treated by closed wound technique formed the control group. Both groups were subjected to standard methods of perioperative management. Saucerisation; sequestrectomy and curettage were the cornerstones of surgical therapy. The wounds were primarily either left open (study group) or closed (control group). The rates of wound healing and recurrence were used to assess the outcome of treatment. The chi-squaretest was used for statistical analysis. RESULT. The median age was 13 years; with a range of 6 - 60 years. Staphylococcus aureus was the organism most commonly associated with chronic osteomyelitis. Rates of wound healing and recurrence in the study group were significantly better than in the control group (p0.05); eventhough it took a relatively longer period to achieve healing with the open method of treatment. The follow-up period ranged from 1 to 5 years; with a median of 2 years.CONCLUSION. We observed that the results of the open method of treating post-sequestrectomy dead spaces were good; and we advocate its use in resource-poor settings

safety, benefits and effectiveness of different intravenous subanesthetic doses of ketamine when combined with small dose of midazolam before combined spinal epidural technique for orthopedic lower extremity surgery

In a double blind, randomized, and controlled study of 100 patients [aged 20-60 years], we compared the effect of intravenous [IV] coadministration of different small doses of ketamine [0.00, 0.15, 0.30, and 0.45 mg/kg] with midazolam 0.03 mg/kg in alleviating patient anxiety and pain during establishment of combined spinal epidural [CSE] technique. Patients received midazolam 0.03 mg/kg with placebo [Group C, n= 25] or ketamine 0.15 mg/kg IV [Group K1, n= 25], 0.30 mg/kg IV [Group K2, n= 25] or 0.45 mg/kg IV [Group K3, n= 25], 5 minutes before local analgesic infiltration at the site of SCE and 10 minutes before performing CSE. Scores for sedation, patient's behavior to CSE puncture, and ease of CSE establishment, the mean arterial blood pressure [MBP], heart rate [HR] and arterial oxygen saturation [SpO2] were recorded; the need for ephedrine, atropine and supplemental O2 inhalation was recorded. The incidence of adverse effects especially of unpleasant emergence reactions were recorded. Lastly, the quality of the CSE technique was assessed by the patient and a blind observer. Patients in Group K2 who received midazolam 0.03 mg/kg with ketamine 0.3 mg/kg IV showed ideal scores for sedation, behavior to CSE puncture, and ease of placement of CSE, and best hemodynamic compensation for the inhibitory cardiovascular effects of spinal anesthesia and also for maintenance of normal SpO2. In addition group K2 showed the best quality of anesthesia when assisted by the patient and the blind observer, without significant unpleasant emergence reactions. We conclude that addition of ketamine 0.3 mg/kg to midazolam 0.03 mg was safe, useful, and effective in alleviating patient's anxiety and pain during placement of CSE

Continuous spinal anaesthesia using a standard epidural set for lower limb orthopedic procedures in high risk elderly patients

We studied 60 elderly Patients undergoing lower limb orthopedic procedures classified as ASA III or IV. Lumbar continuous spinal anaesthesia [CSA] was performed using a 20 G epidural catheter through an 18 G Tuohy needle. Small local anaesthetic boluses of isobaric bupivacaine [0.5%] was injected to achieve the desired sensory level of anaesthesia. Demographic data, anaesthetic duration, local anaesthetic doses, sensory level to pinprick, Arterial blood pressure, heart rate, use of systemic sympathomimetics and complications were recorded. Sensory level was between TB-T12, maximal decrease in systolic, diastolic BP and heart rate was 30 +/- 12.5%, 16.8 +/- 9.5% and 15.6 +/- 5.8% respectively. IV ephedrine used in 25% of our patients. While postdural puncture headache [PDPH] occurred in 1,66% of cases. No postanaesthetic neurological deficit was recorded. We conclude that CSA using a standard epidural set and isobaric bupivacaine is feasible for L.L. surgery in high-risk elderly patients

Study of IV tenoxicam for analgesia after major orthopedic surgery

A controlled double blind study after major orthopedic surgery was done to compare a single I. V. dose of tenoxicam [20 mg] with placebo in 78 patients. It was associated with a reduction in consumption of morphine as assessed by patient-controlled analgesia. The consumption of morphine in tenoxicam group when compared with placebo was significantly reduced by 57% during the first 12 hour [P <0.002] and nonsignificantly reduced by 19.9% during the next 12-24 hour after operation [P >0.05]. When tenoxicam used as a single I.V. dose [20 mg], it has no significant effect on blood loss, bleeding tendency, or platelet functions. The possible adverse effects on hematological and renal functions are not recorded in their results