Cancer pain in children: a two-step strategy

This review attempts to address the current pharmacological treatment strategies in children. Irrespective of the type of cancer Tain' is among the three most frequently reported symptoms and in 40% of children it is under treated. Cancer pain is a complex pain and various mechanisms are responsible for it. Self-reporting or behavioral observational scales are commonly used methods for pain assessment. In current practice, the two-step approach is considered an effective strategy for the pharmacological treatment of pain in children with cancer. For mild pain, paracetomol and ibuprofen are considered as first options in children older than 3 months. For moderate to severe pain, opioid analgesics should be considered and morphine is the drug of choice. It is strongly recommended that analgesics should be administered on a regular basis rather than on an [as required basis] via the most effective, simplest and least painful route. Authors highly recommend the most recent WHO guidelines for two-step strategy using common analgesics regimen in children for cancer pain

Use of pulsed radiofrequency in failed back surgery syndrome

Failed back surgery syndrome [FBSS] is a well-recognized complication of spinal surgery. Pulse radiofrequency of dorsal root ganglion has been recently described for such patients. In this report, pulsed radiofrequency was applied in 3 patients with failed back surgery syndrome, presenting with severe pain. Reasonable to good pain relief was achieved in 2 patients in 6 months follow-up, however, one patient got short-term pain relief. Based on this limited experience in FBSS where conventional and non-conventional treatments are not effective, pulsed radiofrequency may be considered a logical choice

Anaesthesia for caesarean section in patients with cardiac disease

This review contains material sourced from med-line and pub-med, search year 2002-2004. Material selected was pertaining to common cardiac ailments in pregnancy. Congenital cardiac problems i.e. Tetralogy of Fallot [TOF], Atrial Septal Defect [ASD], Ventricular Septal Defect [VSD], Eisenmengers syndrome, valvular heart disease, i.e. mitral stenosis, mitral regurgitation, aortic stensois and aortic regurgitation are discussed. Other cardiac conditions associated with pregnancy are pulmonary hypertension and peri-partum cardio-myopathy. Arrhythmias during pregnancy, vary from isolated premature to supra-ventricular and ventricular tachycardia, management is similar to non-pregnant patients. This review summarizes the current management of a parturient with cardiac disease requiring surgical delivery. Regional anaesthesia techniques are preferred as reflected in the current literature for patient with cardiac disease with minor alterations such as slow establishment of epidural for caesarean section or continuous spinal anaesthesia with very small incremental doses of local anaesthesia, maintaining the patient's SVR with vasopressors and fluid, monitoring of the fluid regimen with CVP and in some cardiac function with Swan Ganz catheter. Patients with Eisenmenger syndrome, pulmonary hypertension, should be advised to avoid pregnancy. In conclusion with vast advancements in obsterics care, improvements in cardiac surgery, many patients with cardiac disease can now be safely delivered surgically by skillful anaesthesiologists who are aware of the common potential intra-operative problems and the ability to respond to undesired events immediately

Knowledge, attitude and practice of parturients regarding epidural analgesia for Labour in a University Hospital in Karachi

To assess the knowledge, sources of knowledge, attitude [fears and misconceptions] regarding Epidural Analgesia [EA] and practices of parturients delivery at Aga Khan University hospital [AKUH]. A hospital based cross sectional study was conducted at the obstetric unit of AKUH, from November to December 2003. A questionnaire was filled through verbal interviews conducted on 448 parturients fulfilling the inclusion criteria. Seventy six% of the females were aware of epidural analgesia as a labor pain relieving method. However, only 19% availed EA. About 40% had heard about EA from their obstetricians and 64% from friends or relatives. Twenty even% believed that EA has detrimental effects on the baby while 9% stated that EA can prolong the duration of labour. Majority of the pregnant females delivering at Aga Khan University Hospital were aware of epidural analgesia for labour. However, only a small proportion are availing this service, due to fears and misconceptions