Rare complications of caudal block with review of literature

Caudal block has been used for many decades. [3] The purpose of using this technique has been either for anesthetic use or for managing the low back ache especially when there is adhesions or compression on the nerve roots. Complications of this technique are well-documented, they include:[5] perforation of the rectum, hydrocele, infection, bleeding, loss of consciousness, cardiac arrhythmias, arrest, intravascular or intraosseous injection, urinary retention, subcutaneous injection, haematoma and absent or patchy block. We studied the case of a 36-year-old female who was found after her birth to be suffering from poliomyelitis at the right side. During her growth she was suffering from mild tolerable low back ache. Then, when she became 30 years old, her back ache got intolerable. MRI-scan and X-rays showed ascoliotic change at her lumbar area accompanied by epidural adhesions of the lumbar area, which caused her pain. A surgical consultation revealed no necessity for surgery at the time being. Therefore, conservative treatment was planned including caudal block by using a mixture of pupivacaine and steroids. During performing the caudal block, the patient was lying in aprone position, we started to inject 1.5 ml's of lignocaine [1%] in order to anesthetise the area which includes the subcutaneous tissue and sacro coxygeal ligament. After injecting 1 ml of lignocaine, patient lost her consciousness for about 15 minutes. All her hymodynamics and cardiac observations were normal. After gaining her conscious again, the procedure was carried out safely

Triple-target regimen for treatment of chronic pain following post herpic neuralgia [CPPHN]: a prospective trial at Jordan university hospital [JUH] pain unit

Chronic pain post herpic neuralgia [CPPHN] is one of the most difficult chronic pain problems. It has been recognized that CPPHN has three components: central, emotional and peripheral. Several studies have addressed the management of these components individually1-3. The purpose of this study was to determine the effect of manging these three components together in the same patient. A prospective study. Jordan University hospital, Department of Anaesthesia, Pain Unit. Prospective evaluation of 50 patients with chronic [CPPHN] from March 1990-June 1997. All patients had pain for more than 6 months upon entry to the study. All patients were given Tramadol, amitryptaline and steroids for 6 months. Subcostal block using Ethanol and Lignocaine was used once on day 5. Pain assessment was performed according to visual analogue sequar [VAS]. Complete cure was achieved in 70% of the patients at the end of 6 months therapy, mild tolerable pain continued in 10%, moderate to severe untolerable in 20%. Combined management for the three components of [CPPHN] by using drugs and local block appear to improve the outcome of these patients

Near drowning: a report of 4 cases and review of literature

Four near drowning patients were admitted to intensive care unit [ICU] at Jordan University Hospital [JUH] during the last 3 years [1986-1989]. Their ages ranged between 1-17 years [mean 9 years], 3 were males and one was a female. They were managed in the ICU by hyperventilation, PEEP, muscle paralysis, thiopentone coma and steroids, with monitoring of arterial blood gases and central venous pressure. All recovered completely except one who had neurological deficit. None of the victims had received medical resuscitation at the site of the accident prior to admission, they all arrived by public transport, first aid was performed at the emergency room at our hospital. We believe that first aid at the site of drowning is vital for avoiding the effects of hypoxia