ABSTRACT
The safety of epidural infusion for postoperative analgesia in pediatric spine surgery continues to be established. A continuous epidural infusion of morphine sulfate and bupivacaine was used for postoperative analgesia in 12 pediatric patients undergoing spinal surgery. The epidural was placed intraoperatively by the operating surgeon, while continuous infusion was managed postoperatively by a pediatric anesthesiology pain service team. In addition to the continuous infusion, 2 of the 12 also were provided on-demand patient-controlled boluses via epidural catheter for breakthrough pain. Patients experienced analgesia as documented by a comprehensive pain scale form. No catheters failed, while side effects were minimal and easily managed. These results provide confirmation of the safety and efficacy of continuous epidural infusion for postoperative analgesia following pediatric spine surgery and evidence that patient-controlled epidural analgesia is an option.
Subject(s)
Analgesia, Epidural/methods , Spinal Fusion , Adolescent , Analgesia, Patient-Controlled , Analgesics, Opioid/administration & dosage , Anesthetics, Local/administration & dosage , Bupivacaine/administration & dosage , Child , Female , Humans , Male , Morphine/administration & dosage , Pain, Postoperative/therapy , Spinal Curvatures/surgeryABSTRACT
The records of 97 patients with multiple hereditary osteochondromatosis were retrospectively reviewed. Seventy-eight patients had one or more osteochondroma(s) of one or both forearm(s). Fifty-three operations were performed, of which 41 were excisions of symptomatic osteochondromas or dislocated radial heads. All forearm, wrist, and elbow radiographs were reviewed. Four common radiographic parameters were measured: radial articular angle, carpal slip, relative ulnar shortening, and forearm-third metacarpal angle. Thirty-seven of these 78 patients were contacted by telephone questionnaire. The results indicated that skeletally mature patients do well on a functional basis and are comfortable with their appearance, despite deformity. Surgery can improve aesthetic appearance and provide pain relief when done before or after skeletal maturity. Because of these results, we are less aggressive in the early treatment of forearm deformities.
Subject(s)
Bone Diseases, Developmental/surgery , Exostoses, Multiple Hereditary/surgery , Forearm , Adolescent , Adult , Bone Diseases, Developmental/etiology , Child , Exostoses, Multiple Hereditary/complications , Exostoses, Multiple Hereditary/physiopathology , Female , Humans , Male , Radius/surgery , Range of Motion, Articular , Retrospective Studies , Treatment Outcome , Ulna/surgeryABSTRACT
We present a case that is unusual in two respects. To our knowledge, it is the first clearly documented instance in the literature of a post-traumatic, irreducible nondissociative volar intercalated carpal instability to result from a known wrist flexion force and a known dorsal capsuloligamentous tear. Second, the same wrist revealed a coalition at both intraosseous levels of the proximal carpal row: a synfibrosis at the scapholunate joint and a synostosis at the lunotriquetral joint. Treatment by open removal of an interposed capsuloligamentous flap from the radiocarpal joint, followed by alignment of carpal elements, temporary internal fixation, and repair of the damaged dorsal capsule and ligaments gave an excellent result.
