Acetaminophen versus acetaminophen with codeine after pediatric tonsillectomy.

OBJECTIVE: To compare the effectiveness of acetaminophen versus acetaminophen with codeine after pediatric tonsillectomy and adenoidectomy. STUDY DESIGN: Prospective, randomized, double-blind study. METHODS: Fifty-one children ages 3 to 12 years scheduled for outpatient tonsillectomy and adenoidectomy were studied. Patients were randomly assigned to receive acetaminophen or acetaminophen with codeine in unlabeled bottles for postoperative pain control. The Wong-Baker FACES pain rating scale was used to help children quantify their level of pain after surgery. The level of pain, quantity of pain medication required, presence of side effects, and the percentage of a normal diet consumed was recorded for 10 postoperative days. RESULTS: There was no difference (P > .05, all time points) in the level of postoperative pain reported by the parents and children in the two groups. The acetaminophen with codeine group tended to have increased problems with nausea, emesis, and constipation, but these differences did not reach statistical significance. Children in the acetaminophen group consumed a significantly higher percentage of a normal diet on the first 6 postoperative days (P < .05, all time points). CONCLUSION: There was no difference in the level of pain control provided by acetaminophen and acetaminophen with codeine as measured by the Wong-Baker FACES pain rating scale. Postoperative oral intake was significantly higher in children treated with acetaminophen alone.

Delayed repair of transected nerves: effect of brain-derived neurotrophic factor.

OBJECTIVE: To determine if administration of brain-derived neurotrophic factor (BDNF) after peripheral nerve transection can improve the functional outcome in situations where epineurial repair must be delayed. DESIGN: Randomized, blinded, controlled trial. SUBJECTS: Thirty-four Sprague-Dawley rats. INTERVENTION: Sciatic nerves were transected and, after a 2-week delay, repaired with epineurial sutures. Animals were assigned to receive daily administration of lactated Ringer solution (LR [control] group); BDNF delivered at the time of nerve transection through 2 weeks after nerve repair, for a total of 4 weeks (BDNF-early group); or BDNF delivered at the time of nerve repair through 2 weeks after repair (BDNF-late group). Outcome was assessed using sciatic functional indices (SFIs) and histomorphometric analysis. RESULTS: The SFI maximal recovery was superior in the BDNF groups, but this difference did not reach statistical significance (SFI, -90.1+/-9.6 [LR group], -85.7+/-7.6 [BDNF-early group], and -84.6+/-4.8 [BDNF-late group], where normal function is 0 and complete loss of function is -100; P = .27). The mean axon diameter tended to be greater in the BDNF groups compared with the LR group, i.e., 2.43+/-0.23 microm (LR group), 2.80+/-0.44 microm (BDNF-early group), and 2.83+/-0.38 microm (BDNF-late group) (P = .05). CONCLUSIONS: The local administration of BDNF to nerves that underwent transection and then repair after a delay resulted in an increase in axonal diameters and maximal SFIs, a difference that did not reach statistical significance. The timing of BDNF administration after nerve transection did not affect neuronal regeneration.

Peripheral nerve regeneration in CNTF knockout mice.

OBJECTIVES: To determine the role of ciliary neurotrophic factor (CNTF) in the regeneration of the mouse sciatic nerve following injury by studying the CNTF knockout mouse in a blinded, randomized and controlled evaluation. STUDY DESIGN: Fifty-eight wild-type and 57 CNTF knockout mice were randomly assigned to one of four treatment groups: sham surgery (sciatic nerve exposure), sciatic nerve crush, nerve transection without repair, and nerve transection followed by epineurial suture repair using 10-0 monofilament suture. Walking track analysis was performed before and after surgery at weekly intervals for 7 weeks, using a previously described formula. At the completion of walking track analysis, morphometric histological analysis of axon number and axon diameter in the distal sciatic nerves was performed. RESULTS: The wild-type and knockout mice that underwent only sham surgery had no change in their walking tracks during the study interval (P = .30 on postoperative day 49). The wild-type mice that underwent sciatic nerve crush showed complete functional recovery (P = .66 on postoperative day 28), but the CNTF knockout mice whose sciatic nerves were crushed did not fully recover (P = .05 on postoperative day 49). The CNTF knockout and wild-type mice showed similar levels of recovery after transection without repair (P = .78), and the rate of contracture formation was not significantly different (P = .40). The CNTF knockout and wild-type mice showed similar levels of recovery after epineurial repair (P>.31), however the rate of severe contractures was greater in the CNTF knockout mice (6 of 13) than in the wild-type mice (2 of 12) (P = .11). CONCLUSION: The absence of CNTF impairs the ability of mice to recover from a sciatic nerve crush injury. There is also a trend toward a greater rate of contracture formation after sciatic nerve transection and epineurial suture repair when CNTF is unavailable. These findings suggest that CNTF is important for recovery of neuronal function following crush and transection nerve injuries.

Autologous and heterologous blood transfusion in head and neck cancer surgery.

OBJECTIVE: To determine if the use of autologous blood ameliorates the increased risk for cancer recurrence that has been associated with perioperative blood transfusion. DESIGN: Retrospective medical record review. SETTING: Tertiary care hospital. PATIENTS: One hundred sixty-five consecutive patients with stages II to IV squamous cell carcinoma of the head and neck treated surgically at a university hospital from January 1, 1989, through December 31, 1994. MAIN OUTCOME MEASURES: We evaluated the impact of perioperative autologous and heterologous blood transfusion and 10 other variables on recurrence. Univariate and multivariate analyses were used. RESULTS: Heterologous blood recipients had a 59% recurrence rate, whereas those who had received autologous blood or no transfusion had recurrence rates of 33% and 35%, respectively. The following 4 variables had a statistically significant association with recurrence by multivariate analysis: previous treatment of current malignancy (P<.001); receipt of heterologous blood (P = .04); positive margin (P = .04); and nodal disease (P = .04). The receipt of heterologous blood was associated with a 40% increased risk for recurrence. CONCLUSION: Autologous blood products should be used during head and neck cancer surgery if possible when transfusion is necessary.