Persistent pain in patients following scoliosis surgery.

Chronic or persistent pain is increasingly recognised as a consequence of surgery in a number of different disciplines. The pain often exhibit qualities that differ from the acute post-operative pain and may represent changes in the central nervous system. There is lack of information regarding the incidence of persistent pain in patients following spinal surgery for scoliosis. This study aims to estimate the incidence of persistent pain following spinal surgery for scoliosis in a group of mainly adolescent patients. Questionnaires were distributed to consecutive patients attending the outpatient clinic of a hospital with specialist services in paediatric orthopaedics and spinal surgery. One hundred and five patients out of 122 eligible patients completed the survey. Fifty-two percent had ongoing pain upon hospital discharge either in the primary surgical site and/or in the iliac bone graft site. Approximately 10 and 7% of all patients had back and pelvic pain persisting beyond 12 months, respectively. A small proportion described elements of neuropathic pain. There was a trend suggesting that those who experienced more severe post-operative pain were more likely to develop persistent pain. These data are consistent with those reports that implicate surgery as the trigger for chronic pain.

Severe hypotension and hepatic dysfunction in a patient undergoing scoliosis surgery in the prone position.

Many patients with neuromuscular disorders develop progressive scoliosis and require corrective surgery. We present a patient with hereditary motor and sensory neuropathies who developed severe hypotension during corrective surgery for thoracolumbar scoliosis. The haemodynamic disturbance was probably secondary to thoracic hyperlordosis and the knee-chest position and was aggravated by surgical manipulation. This may be prevented by tailored preoperative evaluation of different patient prone position supports and frames in order to select that which causes least cardiovascular and respiratory disturbance. This patient also developed severely deranged liver function postoperatively and the possible aetiology is discussed.

An autologous blood donation program for paediatric scoliosis patients in Hong Kong.

A retrospective audit was conducted to determine the safety, efficacy and patient satisfaction related to a preoperative autologous blood donation program for children and teenagers undergoing corrective surgery for scoliosis. Forty-five of the 77 patients donated the requested amount of blood. These 45 compliant patients had been requested to donate fewer units of blood than noncompliant patients (mean 4.0 vs 4.6 respectively, P = 0.02). Twelve patients required allogeneic blood transfusion. Two patients had surgery delayed making the collected autologous blood unavailable. The extent of the operation was associated with the need for allogeneic blood transfusion. Six and a half percent of all donated units of blood were discarded. No major complications were reported. Overall, 93% of patients were satisfied with the program. With careful patient selection, good inter-departmental coordination and teamwork, preoperative autologous blood donation in paediatric patients undergoing extensive corrective surgery for scoliosis is safe and effective.

Incidence of diaphragmatic paralysis following supraclavicular brachial plexus block and its effect on pulmonary function.

Thirty unpremedicated ASA physical status 1-3 patients aged between 18 and 69 years, scheduled for upper limb surgery, received a conventional supraclavicular brachial plexus block using a nerve stimulator and bupivacaine 0.375% 0.5 ml.kg-1. Spirometric measurements of pulmonary function and ultrasonographic assessments of diaphragmatic function were made before the block and at 10-min intervals after injection until full motor block of the brachial plexus had developed. Complete paralysis of the ipsilateral hemidiaphragm occurred in 50% of patients. Seventeen per cent of patients had reduced diaphragmatic movement and the rest (33%) had no change in diaphragmatic movement. Those with complete paralysis all showed significant decreases in pulmonary function, whereas those with reduced or normal movement had minimal change. All patients remained asymptomatic throughout, with normal oxygen saturation on room air.

Maternal nutrition: a positive approach in family planning.

PIP: A strong argument for overall family limitation in less developed countries (LDC) may hinge on the ability of family planners to show parents how to have better babies who will not only survive but also develop to their full mental and physical potential. An adequate diet, especially with respect to protein, during both pregnancy and lactation will result in a better baby. This paper presents unpublished findings on survival rates and physical performances of offsprings whose mothers received different diets during pregnancy and lactation. Experiments on rats show that underfeeding them during pregnancy and lactation results in poor survival, permanent growth stunting, and delayed achievement in physical performance of the progeny. However, giving an adequate diet, especially in terms of protein, to mothers during both pregnancy and lactation results in offsprings with greater neonatal and infant survival rates, normal physical development, and complete physiological performance tasks at earlier ages. In addition, such offsprings are more efficient users of food throughout their life spans, require less food for growth and/or maintenance of body weight, and exhibit superior neuromotor and behavior development. These findings should be incorporated in family planning programs through the implementation of a systematic campaign to improve maternal nutrition. Mothers should be educated on the importance of adequate protein intake during pregnancy and lactation, and protein supplements should be provided to these mothers to ensure protein intake. These educational efforts should be applied particularly in areas where cultural patterns are such that pregnant and lactating mothers who need the most nutrients often get the least. Family planning programs which focus on the positive aspects of education and nutrition rather than the negative aspect of contraception may find greater support from organizations and governments. Family planning should come to mean "fewer babies--but better babies".^ieng