Efficacy of combined local anesthetic wound infiltration and paracetamol suppositories in relieving postoperative pain in children

To evaluate the efficacy of combined incisional infiltration with Bupivacine and Paracetamol suppositories with Paracetamol suppositories alone in relieving the postoperative pain associated with surgery of inguinal pathologies. Prospectively, on hundred and ten children whom underwent groin surgery at Prince Rashed Ben Al-Hassan hospital form April 1, 2008 to December 1, 2008 were included in the study. Their ages ranged from six months to 13 years. Surgery was performed under general anesthesia. Patients were randomized into two groups; group A [55 patients] received Paracetamol rectally 30 mg/kg immediately preoperatively, while group B [55 patients] had Paracetamol rectally 30mg/kg and incisional wound infiltration with Bupivacaine 1 mg/kg. Post operative pain was managed by giving Paracetamol. The duration of the postoperative analgesia was estimated based on the time when rescue analgesia was first given. Assessment of the quality of postoperative analgesia was based on the children's behavior. In our study, both parents and older children were willing to cooperate. None of the children in the study groups suffered from local anesthetic toxicity such as arrhythmias, seizures, allergy and hematoma or tissue edema. In group A, 15 children suffered pain in the recovery room and received further analgesia in the form of Paracetamol suppositories, 18 had pain and received analgesia at home within four to six hours after discharge. The remaining 22 suffered pain during the next five days after surgery. In group B, two patients had pain in the recovery room, eight had pain with early mobilization at home and had their first analgesic dose after five to eight hours. The other 45 children had no significant post-operative pain. Group B showed an increased duration of postoperative analgesia with early mobilization. Rescue mean time at which children had their first post-operative dose of analgesia was two to four hours in group A and it was five to eight hours in group B. No patient in group B needed analgesia after day three post-operatively. Wound infiltration with Bupivacaine 1mg.kg combined with rectal Paracetamol 20 mg/kg has a better and valuable efficacy compared to the rectal Paracetamol 30mg/kg alone with respect to providing pain relief following inguinal herniotomy, hydrocelectomy and orchidopexy in children, with a longer duration of pain relief and earlier mobilization

Anesthetic techniques used for cesarean section at the royal medical services hospitals in 2007

To describe the different anesthetic techniques used for cesarean section at the Royal Medical Services Hospitals. We retrospectively reviewed the anesthetic techniques used for Cesarean sections performed between 1[st] of January to the 31[st] of December 2007 at Royal Medical Services Hospitals. Data collection aimed at anesthetic techniques used for scheduled and non-scheduled Cesarean sections. Out of a total of 5,314 Cesarean sections performed in the year 2007 at our institution, 81.6% were performed under general anesthesia, 18.3% under spinal anesthesia, and 0.1% under epidural anesthesia. General anesthesia still predominated in our hospitals, the percentage of general anesthesia performed by different hospitals varied from 41% to 96%. This review of anesthetic techniques used for Cesarean section shows an overuse of general anesthesia and low use of regional anesthesia. There is a need to adjust clinical practice at the Royal Medical Services Hospitals in accordance with recent scientific data

Anatomical factors of anticipated prolonged laryngoscopy

To evaluate the impact of some anatomical factors on the frequency of anticipated prolonged laryngoscopy. Our investigation included 504 adult patients of both sexes, aged 23-71 years, ASA I-II, scheduled for various elective surgical procedures at Prince Rashed military hospital during the period January 2008 till December 2008, under general endotracheal controlled anesthesia. Frequency of prolonged laryngoscopy was determined in relation to some anatomical factors. Total frequency of prolonged laryngoscopy [>15 seconds] was 13.3% [Group II, n=67 patients] .There were no significant discrepancies regarding demographic data in this group. Group I [n=437] included patients with decreased laryngoscopy time [<15 seconds]. p-value was more significant [<0.05] regarding the following anatomical risk factors: mouth opening less than 5 cm, thyromental distance less than 6.5 cm and sternomental distance less than 12.5 cm. The presence of at least three anatomical risk factors in the same patient could anticipate prolonged laryngoscopy and hence disturbance of ventilation

Management of childhood and adolescent varicocele: experience at Prince Rashid Bin Al-Hassan Hospital-Jordan

The aim of this retrospective study is to evaluate if the early repair of varicocele in children and adolescents can prevent testicular growth arrest and male infertility later on. During a three year period [2004- 2006], 70 children and adolescents with varicocele who were operated on at Prince Rashid Hospital were reviewed [mean age 15 years, 9-19 years]. All patients had been evaluated by a urologist or a pediatric surgeon. High ligation of the internal spermatic vein was carried out either by open retroperitoneal approach or transperitoneal laparoscopic approach. Of the 70 patients 39 had grade II varicocele and 31 had grade III varicocele. In 33 patients [49%], the disease was associated with ipsilateral testicular growth arrest. In seven patients [10%], the disease was associated with impaired seminal fluid analysis parameters, four patients had recurrence of varicocele, and three patients developed hydrocele. Of 33 patients with testicular growth arrest, 32 [97%] regained normal testicular volume post operatively, while six of the seven patients with impaired seminal fluid analysis achieved normal parameters after surgery. Varicocele can affect ipsilateral testicular growth and seminal fluid analysis parameters, which may adversely affect fertility. We recommend early recognition and treatment

Evaluation of peribulbar anesthesia for senile cataract surgery at Prince Rashid Hospital

To evaluate peribulbar local anesthesia for senile cataract surgery at Prince Rahsed Hospital.Materials and This was a prospective study of patients undergoing senile cataract surgery with peribulbar anesthesia between April, 2001 and April,2002 at Prince Rashed Hospital. One hundred and ninety senile cataract patients who were admitted for cataract surgery were evaluated for local anesthesia. One hundred and seventy two [88 males and 84 females] were found suitable for local anesthesia and were entered into the study. The remaining eighteen patients had surgery under general anesthesia and were excluded from the study.A change to general anesthesia was done in one case. Ninety% of cases had no complication. Complications such as scleral perforation or retrobulbar hemorrhage did not occur.Our study confirms the safety and applicability of cataract surgery performed with peribulbar anesthesia in our setting. Furthermore it solved the problem of those medically compromised patients whose operations were repeatedly delayed due to their unfitness for general anesthesia