To determine the efficacy and safety of caudal bupivacaine in combination with rectal diclofenac for postoperative analgesia in paediatric patients

To assess the efficacy and safety of combination of caudal bupivacaine anesthesia and diclofenac sodium suppository for postoperative analgesia in pediatric patients. Interventional study. Imam Clinic [a private hospital] North Nazimabad Karachi. from May 2004 to March 2007. All pediatric patient ASA physical one and two between the ages 6 months to 12years of either sex undergoing infra umbilical surgery received caudal block with bupivacaine 0.25% in a dose of 0.5ml/Kg and diclofenac sodium suppository 1mg/Kg rectally. Patients in whom caudal analgesia was contra indicated or failed were excluded from the study. Postoperative pain was assessed using observers' pain scale and self report of pain by child when he was greater than 2 years age. Postoperative complications were also recorded. During the study period, 99 patients undergoing different infra umbilical procedures [hernia, hypospadias repair, PPV ligation, circumcision, orchidopexy etc] received combination of caudal bupivacaine analgesia and rectally administered diclofenac sodium for post- operative analgesia. There were 94 male patients. In all patients caudal block remained successful. All patients were pain free and none of them required additional/rescue analgesia. Postoperative nausea and vomiting were reported in 3 patients. No other side effects like retention of urine, respiratory depression etc was observed postoperatively. Combination of single shot caudal block with bupivacine 0.25% in a dose of 0.5 ml/Kg and rectal diclofenac sodium for postoperative analgesia in pediatric patient is a simple, safe and effective procedure

Single dose dexamethasone as antiemetic following abdominal hysterectomy

The purpose of the study was to evaluate the prophylactic effect of single -dose dexamethasone [8 mg] on postoperative nausea and vomiting [PONV] in women undergoing abdominal hysterectomy. Metoclopramide and saline served as controls. One hundred twenty women [40 in each of the three groups] undergoing abdominal hysterectomy under general anesthesia were enrolled in this randomized, double-blinded, placebo-controlled study. After tracheal intubation, group I received IV dexamethasone 8 mg, whereas groups II and III received IV metoclopramide 10 mg and saline, respectively. Patients in-group I reported a lower incidence of PONV and requested less rescue antiemetics than those in group III during the first four postoperative hours [P <0.01]. Patients in group I reported a lower incidence of PONV than those in groups II [P <0.05] and III [P <0.01] during the 24-hr postoperative period. Groups II and III did not differ from each other in the incidence of PONV and the proportion of patients who requested rescue antiemetics. We thus conclude that prophylactic IV dexamethasone 8 mg significantly reduces the incidence of PONV in women undergoing abdominal hysterectomy. At this dose, dexamethasone is more effective than metoclopramide 10 mg or placebo