Effects of suppository acetaminophen, bupivacaine wound infiltration, and caudal block with bupivacaine on postoperative pain in pediatric inguinal herniorrhaphy

The control of postoperative pain is important in children, and poor pain control leads to organ dysfunction and behavioral problems. We compared the analgesic effects of suppository acetaminophen, bupivacaine wound infiltration, and caudal block with bupivacaine on postoperative pain in pediatric inguinal herniorrhaphy. In this double-blinded, randomized controlled clinical trial, 90 children of American Society of Anesthesiologists [ASA] grade I-II, aged between 3 months and 7 years, and scheduled for elective unilateral inguinal herniorrhaphy under general anesthesia were assigned to three equal groups. Patients in the first group received 20 mg/kg of suppository acetaminophen. In the second group, 2 mg/kg of 0.5% bupivacaine was infiltrated in the incisional site, and in the third group, a caudal block was performed with 0.75 mL/kg of 0.25% bupivacaine. The Face, Legs, Activity, Cry, Consolability [FLACC] pain scale was applied 30 minutes after operation. Thereafter, the FLACC score was obtained every hour during the next 6 hours. If the FLACC score was 4 or over, we administered 0.5 mg/kg of intravenous meperidine. The data was transferred to SPSS-10 software and analyzed statistically with chi-square and analysis of variance tests. P < 0.05 was considered significant. The mean analgesic duration in the acetaminophen, bupivacaine infiltration, and caudal block groups was 4.07, 5.40, and 5.37 hours, respectively. Significant differences were not observed between the bupivacaine infiltration and caudal block groups [P = 0.9], but the differences between the bupivacaine infiltration and acetaminophen groups [P = 0.034] and the caudal block and acetaminophen groups [P = 0.039] were significant. With regard to meperidine administration, significant differences were not observed between the bupivacaine infiltration and caudal block groups [P = 0.848], but significant differences were observed between these two groups and the acetaminophen group [P < 0.05]. Patients in the bupivacaine infiltration and caudal block groups had less postoperative pain than those in the acetaminophen group and received lower amount of meperidine. We concluded that in children, bupivacaine infiltration and caudal block with bupivacaine produce better analgesia than suppository acetaminophen. It seems that bupivacaine infiltration is better than caudal block because of its simplicity, lower incidence of complications, and failure rate

Comparison of the effects of spinal anesthesia between pre-eclamptic patients and normal pregnant women during cesarean section

To compare the effects of spinal anesthesia between pre-eclamptic patients and normal pregnant women during cesarean section. The participants of this hospital-based cohort study consisted of 60 women. Their age range was between 18-40. Thirty patients were pre-eclamptic and the others were normal pregnant women. Spinal anesthesia was administered with 2ml lidocaine 5%. Hemodynamic changes, dose of ephedrine requirement, incidence of nausea and Apgar score were compared between two groups. Data were transformed to the SPSS software. Then Chi-square, T-student and Fischer exact tests were performed for statistical analysis. There was no significant statistical difference of age and weight between two groups. In regard to basic, post spinal and post ephedrine systolic and diastolic blood pressure, significant statistical differences were noted. Similarly as regards the number of patients who developed hypotension and the dose of ephedrine injection, there were meaningful statistical differences between two groups. Development of hypotension and dosage of ephedrine injection in pre-eclamptic patients were less than healthy pregnant women during cesarean section under spinal anesthesia. As such spinal anesthesia is a safe method for cesarean section in pre-eclamptic patients

[ effects of single and repeated bouts of gymnastic training on salivary IgA and cortisol]

The purpose of this study was to investigate the effects of single and repeated bouts of gymnastic training on salivary IgA and cortisol, in elite boy's gymnasts. Twenty boys with mean age of 10 +/- 0.8 years, height 145 +/- 9 cm, weight 37 +/- 8 kg and body fat percent 14.2 +/- 6[meam +/- SE] in Ghaemshahr Club in 2007, performed the select and controlled gymnastic training in two bouts [single session, and double session], one week apart. The first bout, included one session a day, beginning at 6 to 8 P.M. and the second bout was performed in two sessions per day, beginning at 8.30 to 10.30 A.M and 6 to 8 P.M. Salivary samples [5 ml] to form un-stimulated were collected in pre-exercise, immediately after and 2 hours following gymnastic training. Levels of IgA and cortisol were measured by ELISA method. ANOVA test was performed for analysis of the obtained data. The IgA level indicated no significant change after two bouts of exercise within the same day [P>0.5], however, cortisol concentration increased [P<0.05]. No significant correlation was observed between IgA and cortisol concentrations. These findings suggest that two bouts of gymnastic training [120-minutes], at moderate intensity with a 7.30 hours rest in between, had no effect on IgA concentration, but caused an increased in cortisol concentration.