Comparison of postoperative pain relief by intercostal block between pre-rib harvest and post-rib harvest groups

To compare intercostal nerve block before and after rib harvest in terms of mean postoperative pain score and mean postoperative tramadol usage. Randomized controlled trial. Department of Plastic Surgery, Mayo Hospital, KEMU, Lahore, from January 2011 to July 2012. Patients [n = 120] of either gender with ASA class-I and II requiring autogenous costal cartilage graft were inducted. Patients having history of local anaesthetic hypersensitivity and age < 15 years or > 60 years were excluded. Subjects were randomly assigned to pre-rib harvest [group-1] and post-rib harvest [group-2]. Local anaesthetic mixture was prepared by adding 10 milliliters 2% lidocaine to 10 milliliters 0.5% bupivacaine to obtain a total 20 ml solution. Group-1 received local anaesthetic infiltration along the proposed incision lines and intercostals block before the rib harvest. Group-2 received the infiltration and block after rib harvest. Postoperative consumption of tramadol and pain scores were measured at 6 and 12 hours postoperatively using VAS. Mean age was 31.43 A +/- 10.78 years. The mean pain scores at 6 hours postoperatively were 1.033 A +/- 0.609 and 2.4667 A +/- 0.812 in pre-rib harvest and post-rib harvest groups respectively [p < 0.0001]. The mean pain scores at 12 hours postoperatively were 1.45 A +/- 0.565 and 3.65 A +/- 0.633 in pre-rib harvest and post-rib harvest groups respectively [p < 0.0001]. The mean tramadol used postoperatively in first 24 hours was 169 A +/- 29.24 mg and 255 A +/- 17.70 mg in prerib harvest and post-rib harvest groups respectively [p < 0.0001]. Intercostal block administered before rib harvest as preemptive strategy result in decreased postoperative pain scores and narcotic use

Factors associated with postpiercing auricular cartilage keloids

To determine the factors responsible for postpiercing auricular cartilage keloids. Observational study. Department of Plastic Surgery, King Edward Medical University [KEMU], Lahore, from March 2007 to July 2010. Fifty patients of post-earpiercing keloids affecting the cartilaginous portion were included in the study. Patients with keloids at any other site, positive family history of keloids and recurrent keloids were excluded. Information regarding age at piercing, site of piercing, use of gun or home sewing needle for piercing, use of jewellery other than gold postpiercing, itching or redness with use of jewellery, tight fitting of jewellery in the piercing hole and postpiercing infection was collected. Fisher exact and Wilcoxon rank sum tests were used to analyse the data. All the patients had low lobule piercing at a mean age of 4.52 +/- 1.15 years and cartilage piercing at an average age of 22.32 +/- 3.74 years [p < 0.001]. Eleven patients [22%] had also simultaneous high piercing in the lobule. Only cartilage piercing sites developed the keloids. Postpiercing infection was present in all the 50 patients of cartilage piercing whereas only 3 out of 11 high lobule piercing sites got infected [p < 0.001]. Cartilage bearing portion of the ear is more likely to form keloids due to its piercing in or after adolescence and prolonged wound healing caused by infection

Comparison of traditional two injections dorsal digital block with volar block

To compare the traditional two injections dorsal digital block with volar block in terms of effectiveness of anaesthesia and pain of initial pinprick. Study Design: Quasi-experimental. Place and Duration of Study: AVH and casualty operation theatres, Mayo Hospital, KEMU, Lahore, from January to June 2007. Thirty patients requiring surgical procedure distal to proximal phalanx crease on two fingers of same or one finger of both hands were included. Cases with allergy to lignocaine, previous vascular insufficiency, previous digital replantation or peripheral neuropathy were excluded. One finger of every patient received two injection dorsal block whereas the other finger received single subcutaneous injection in the midline of the phalanx with lignocaine and epinephrine [volar block]. Patient looked away during the performance of block and wrote the severity of initial pinprick on a visual analogue scale. Effectiveness of anaesthesia was made measurable by the absence of pain during the surgical procedure. Total duration of the anaesthesia and any undesirable numbness of adjacent finger were noted. The t-test was used to compare the means and p-value less than 0.05 was considered significant. The mean pain scale score were 4.27+0.87 and 5.27+1.05 for volar and dorsal techniques respectively [p < 0.05]. Volar blocks were 100% effective whereas in dorsal blocks success rate was 80% [p < 0.05]. Single subcutaneous injection in the midline of phalanx with lignocaine and epinephrine [volar block] was significantly less painful to administer, is effective and safe technique to achieve digital anaesthesia, compared to the dorsal technique

Primary repair verses colostomy for colonic injuries

Objective: The objectives of this study are to: evaluate the role of primary repair with or without defunctioning colostomy in the management of colonic injury. identify the factors contributing to the outcome in management of colonic injuries

Study Design: Prospective Observational

Setting: Surgical Unit IV, DHQ Hospital PMC Faisalabad

Duration: November 2001 to November 2003

Subjects and Methods: The patients of colonic injury presenting at one emergency day were included in primary repair group [n=20] and patient of colonic injury at next emergency day were included in colostomy group [n=20]. All patients were aggressively resuscitated and investigated. Colonic injury was suspected on clinical grounds and managed according to standard protocol [vide infra]. Associated injures were managed accordingly. Colostomy was closed after three months and all patients were followed for six months complete record was maintained on preformed proforma

Results: Most patients were males and average age in both groups was 28.5 years. Fire arm injury was the top most cause of colonic injury in both groups. In both groups left colon was injured in majority of cases. Maximum time interval between injury and treatment in both groups was within 24 hours. Majority of patients in both groups had associated injuries and commonest injured viscera was small gut. The average hospital stay in primary repair group was half of that in colostomy group. Two patients [10%] in primary repair group who developed complications had right colonic injuries with moderate fecal contamination. In colostomy group ten patients [50%] developed complications majority having left colonic injury with moderate contamination. In majority of the patients who developed complications in both groups the delay was more than 6 hours. There was no mortality in either of the groups

Conclusion: Primary repair of colonic injuries has less morbidity and is less expensive as compared to colostomy and is ideal method of management for colonic injury in patients aggressively resuscitated with no pre existing medical illness