Preemptive caudal anaesthesia in children with bupivacaine-tramadol and levobupivacaine-tramadol: a randomized, double-blind, prospective study

Background and Aim: Caudal block is the regional anesthetic technique that is used most frequently in pediatric surgery and bupivacaine and levobupivacaine are widely utilized in this technique. Opioid drugs have been added to local anesthetic solutions to prolong duration of analgesia but ideal combination were not found. We compared the postoperative analgesic efficacy of equal concentrations of bupivacaine or levobupivacaine plus tramadol in pediatric patients. Objectives: Following objectives were monitored during study time of first analgesic requirement postoperatively, CHIPPS score for first 24 hrs, analgesic requirement in first 24 hrs, hemodynamic parameters and any side effects. Methodology:Sixty children aged 2 to 5 years who were undergoing inguinal herniorrhaphy or orchidopexy received bupivacaine 0.25% plus tramadol 2 mg/kg [1 ml/kg] [BT group] or levobupivacaine 0.25% plus tramadol 2 mg/kg [1 ml/kg] [LT group] by the caudal route after general anaesthesia. The primary outcome of the study was to compare the duration and quality of postoperative analgesia. The postoperative pain relief was evaluated by the Children and Infants Postoperative Pain Scale [CHIPPS] at 2, 4, 6, 12, and 24 h postoperatively. In addition, the time of first analgesic requirement was noted. Results: The CHIPPS scores were not statistically different between the groups. The duration of analgesiaandrequirements for rescue analgesia was similar. Urinary retention and motor blockade were observed more often in the BT group but statistically not significant. There were no significant differences between groups for arterial pressures and heart rate after caudal block and during the operation. Conclusion: Caudal bupivacaine plus tramadol and levobupivacaine plus tramadol have similar postoperative analgesic efficacy. Key Words: Bupivacaine; Levobupivacaine; Tramadol; Anesthesia; Caudal blockade

Massive subcutaneous emphysema and hypercarbia associated with laparoscopy

Laparoscopic surgical techniques have exp and ed tremendously within the last two decades and increasingly being used to treat intraperitoneal pathology. These minimally invasive techniques offer decreased operating time, decreased morbidity and decreased length of hospital stay. These procedures, however, are not completely safe and without potential morbidity. Massive and life threatening extraperitoneal pneumodissection after laparoscopic procedures is one of the uncommon complications associated with it. Here we describe a case of massive subcutaneous emphysema with prolonged hypercarbia