RESUMEN
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
RESUMEN
We review our thirteen year's experience [1997 and 2009] with surgical treatment of vesicoureteric reflux [VUR] at King Hussein medical center, pediatric surgery section. All files of patients who underwent intravesical cross-trigonal uretric reimplantation for VUR, between January 1997 and December2009 in our hospital were reviewed. Demographic details, reflux grade, bilaterality, radiological investigations, surgical approach and outcome were analyzed. 334 patients with VUR [grade II to V] underwent uretric reimplantation during the study period. 47.6% of the patients were males and 52.4% were female. The patients were between two and a half months to fourteen years of age. 11.7% were less than one year of age and 61% < 5years. 294 [88%] of the patients were classified as primary VUR and 40[12%] as secondary. The duration of follow up was from 8 months to 13 years. Persistent VUR requiring re-do ureteral reimplantation in 18 [5.4%] cases, and nephrectomy due to end- stage renal disease [ESRD] were performed in 33 [9.8%] patients. Successful rate was achieved in 90.2% of cases. The most frequent clinical abnormality leading to the diagnosis of VUR is UTI; the ultimate objective of treatment of VUR is to prevent infection, to allow normal growth and to prevent permanent renal parenchyma damage