Preemptive ilioinguinal-iliohypogastric nerve block versus morphine for unilateral varicocoelectomy

The surgical approach for varicocelectomy is similar to that of herniorraphy. Iliohypogastric-ilioinguinal [IHII] nerve block reduces postoperative pain after herniorrhaphy. The effect of preemptive intramuscular injection of 0.1 mg/kg of morphine was studied in ambulatory surgery for patients undergoing unilateral varicocoelectomy and the results were compared with those of IHII nerve block. This study was performed at Jordan University Hospital, Amman, Jordan, between August 2005 and December 2006. After obtaining the approval of the ethical committee, an informed consent was taken from 68 adult male patients in ASA [American Society of Anesthesiologist] who are I-II scheduled for unilateral varicocoelectomy. Those patients were included in a prospective, randomized, double blind study. 34 patients have received IHII nerve block 10 minutes before the incision with 20 mls of bupivacaine 0.5% [B group], and 34 patients received 0.1 mg/kg of morphine 10 minutes also before the incision [M group]. All patients have received standardized anesthesia, pain was assessed by 0-10 [VAS] Visual Analogue Score at 0, 30 minutes, 1, 2, 3, post operative hours. The incidences of nausea, vomiting, sedation, itching and additional analgesic requirement were assessed. P < 0.05 was considered significant. Iliohypogastric-ilioinguinal nerve block group reported lower postoperative pain scores at 30 minutes P=0.00255, 1 hour P=0.0001, 2 hours P=0.0103.No significant differences were present between the two groups at 3 and 4 hours postoperatively. The incidence of sedation, nausea, vomiting and itching was similar in both groups [p=NS]. Iliohypogastric-ilioinguinal nerve block for unilateral ambulatory varicocoelectomy can reduce pain more than morphine in the immediate postoperative period, but this reduction was not associated with a reduction in opioid related side effects

Anaphylactic reactions during intravenous urography

Out of 4261patients from the Jordan University Hospital and Al-Islamic Hospital, Amman Jordan, five patients developed serious anaphylactoid reactions after intravenous injection of iodinated radiographic contrast medium [RCM] within the past 18 months. Two patients were above 55 years of age with a history of ischemic heart disease, two others gave a history of allergy; one to fish and the other to RCM [urografin] [R] and the 5th patient was a young female without a previous history of allergy or significant illness. In this retrospective study, the present situation concerning the aetiology of RCM reactions, dangers, precautions and treatment are thoroughly discussed

Intravenous digital subtraction angiography in the preoperative evaluation of renal cell carcinoma

Intravenous digital subtraction angiography [IVDSA] was performed in 5 patients with renal cell carcinoma presenting with a solitary renal mass to assist in the preoperative evaluation to document the number of renal arteries present with the relative vascularity of the tumour, and to record tumour extension into the renal vein or inferior vena cava. The IDVSA findings were compared with computed tomography [CT] as well as the surgical and pathological results. IVDSA was found to be relatively non-invasive, safe and accurate. It offers unique information and is complementary to CT in the evaluation of a renal mass