Preemptive Use of Ketamine on Post Operative Pain of Appendectomy

BACKGROUND: Although early reviews of clinical findings were mostly negative, there is still a widespread belief for the efficacy of preemptive analgesia among clinicians. In this study, we evaluated whether the preemptive use of ketamine decreases post operative pain in patients undergoing appendectomy. METHODS: In double-blind, randomized clinical trials, 80 adult male patients undergoing an operation for acute appendicitis were studied. Patients were randomly assigned to two groups. In the operating room, patients in the ketamine group received 0.5 mg/kg of ketamine IV 10 minutes before the surgical incision. In the control group, 0.5 mg/kg of normal saline was injected. The pain intensity was assessed at time 0 (immediately after arousal) and 4, 12, and 24 hours postoperatively using the 10 points visual analogue scale (VAS). RESULTS: Eighty patients (40 for both groups) were enrolled in this study. For all of the evaluated times, the VAS score was significantly lower in the ketamine group compared to the control. The interval time for the first analgesic request was 23.1 +/- 6.7 minutes for the case group and 18.1 +/- 7.3 minutes for the control (P = 0.02). The total number of pethidine injections in the first 24 hours postoperatively was 0.6 +/- 0.6 for the case group and 2.0 +/- 0.8 for the controls (P = 0.032). There were no drug side effects for the case group. CONCLUSIONS: A low dose of intravenously administered ketamine had a preemptive effect in reducing pain after appendectomy.

Torsion and gangrene of the gallbladder in a child

Torsion of the gallbladder with gangrene is a rare condition which is generally due to an abnormal anatomical variation of the organ; i.e., loss of fixation of the organ to the inferior margin of the liver and the presence of a long mesocyst. The case considered is a seven year old boy who presented with acute abdominal pain. He underwent laparotomy 36 hours after having sustained blunt abdominal trauma. Operation was limited to cholecystectomy and removal of a gangrenous gallbladder which had undergone torsion. The postoperative course was uneventful

Reconstruction of penile skin defect by cutaneous flap from the inner aspects of the thigh

Two patients with penile skin loss who were operated in 1991 are reviewed retrospectively. In both of them skin grafting was mandatory [due to large skin defects on the penile shaft]. Causative factors were localized infection in one case and verrucae accuminata in another. In both cases arandom flap from the skin of the inner surface of the thigh was applied. The pedicle flap was later transected