Continuous Epidural Analgesia Versus Continuous Peripheral Nerve Block in Unilateral Lower Extremity Pediatric Orthopedic Surgery: A Matched Case Comparison Study.

Introduction Continuous epidural analgesia (CEA) provides effective postoperative pain relief but includes a substantial side effect profile. Continuous peripheral nerve blocks (CPNBs) have fewer side effects and may quicken ambulation. The purpose of this study was to compare the morphine milligram equivalents (MMEs), need for analgesic rescue, visual analog scale (VAS) pain scores, time to ambulation, postoperative blood pressures, length of stay (LOS), and adverse event rates. Methods This was a matched case comparison study of pediatric patients (ages 8-17) undergoing unilateral lower limb surgery (41 CEA and 36 CPNB). Patients with a history of chronic pain, previous lower extremity surgery, and developmental delay were excluded. The Chi-square test and Student's t-test were used, and p-values < 0.05 were considered significant. Results There were no statistically significant differences in demographics or the American Society of Anesthesiologists (ASA) grade. There were no significant differences in postoperative MMEs, the need for analgesic rescue, or VAS scores on any postoperative day. The CEA group had a longer time to ambulation (2.56 ± 0.93 days versus 1.89 ± 0.69 days, p = 0.004). The CEA group demonstrated a higher number of days of systolic hypotension (0.61 ± 0.97 mmHg versus 0.06 ± 0.23 mmHg, p = 0.0009) and diastolic hypotension (1.90 ± 1.24 mmHg versus 1.00 ± 0.93 mmHg, p = 0.0006). There were no significant differences in the length of stay between the CEA and CPNB groups (5.08 versus 4.24, p = 0.28). There was no statistically significant difference between the rates of pruritus, light-headedness, and altered mental status. The CEA group demonstrated higher rates of nausea (51.2% versus 13.9%, p = 0.001), constipation (36.6% versus 8.3%, p = 0.004), urinary retention (9.8% versus 0%, p = 0.006), and average number of minor adverse events per patient (1.02 versus 0.25, p = 0.002). Conclusions CPNBs and CEAs demonstrate equivalent postoperative opioid use after unilateral lower extremity surgery in the pediatric population. In our population, a low complication rate and a decreased time to ambulation were seen in the CPNB group. There may be certain select scenarios priorly managed with a CEA that can be appropriately managed with a CPNB. A prospective multicenter study incorporating patient satisfaction data could further facilitate the incorporation of CPNB in pediatric pain management protocols after orthopedic surgery.

Ovicidal, immunotoxic and endocrine disrupting effects of saponin on Bulinus truncatus snails with special emphasize on the oxidative stress parameters, genotoxicological, and histopathological alterations.

Bulinus truncatus snail is one of the most medically important snails. The goal of this study was to evaluate the molluscicidal effect of saponin on these snails and study how it affects their biological functions. The present results showed that saponin had a molluscicidal activity against adult B. truncatus snails after 24h and 72h with LC50 (57.5 and 27.1 ppm, respectively) and had ovicidal acivity on the snails' embryos. By studying the effect of the sublethal concentrations (LC10 48.63 ppm or LC25 52.83 ppm) exposure on B. truncatus snails, they resulted in significant decreases in the survivorship, egg-laying, and the reproductive rate compared to untreated snails. Both concentrations caused morphological changes to the snails' hemocytes, where, after the exposure, granulocytes and hyalinocytes had irregular outer cell membrane and some cell formed pseudopodia. Granulocytes had large number of granules, vacuoles, while hyalinocytes' nucleus was shrunken. Also, these concentrations resulted in significant increases in sex hormone levels (17ß-estradiol and testosterone) in tissue homogenate of B. truncatus snails. It resulted in significant decrease in total antioxidant (TAO) activity, while, significantly increased lipid peroxidase (LPO) level, superoxide dismutase (SOD), nitrogen oxide (NO), and glutathione-S-transferase (GST) as compared to control group. Histopathological and genotoxicological damages occurred in snails' tissue after exposure to these concentrations. Conclusion, saponin has a molluscicidal effect on B. truncatus snails and might be used for the control of schistosomiasis haematobium. Besides, these snails could be used as invertebrate models to reflect the toxic effects of saponin in the aquatic ecosystem.

Biochemical and molecular alterations in freshwater mollusks as biomarkers for petroleum product, domestic heating oil.

To investigate the effect one of the oil products, domestic heating oil (DHO), on freshwater mollusks, Unio tigridis and Viviparous bengalensis were exposed to three DHO concentrations for each species (5.8, 8.7, and 17.4 ml L-1 for mussels; 6.5, 9.7, and 19.5 mlL-1 for snails, respectively). Antioxidant enzymes (superoxide dismutase, catalase), malondialdehyde, acetylcholinesterase and DNA damage in both species tissues were monitored over 21 days. The results showed that both antioxidant enzymes concentration (SOD and CAT) increased in the lowest DHO concentrations (5.8, and 8.7 ml L-1), and then decreased in the highest concentration (17.4 ml L-1) as the same pattern for Unio tigridis, but this not occurred for Viviparous bengalensis. MDA values recorded significantly increased compared to control. No reduction was observed in AChE concentrations in soft tissues of both mollusks may due to that DHO was a non-neurotoxicant to Unio tigridis and Viviparous bengalensis. The results of DNA damage parameters were showed significant differences (p≤ 0.05) between control and DHO concentrations except lowest concentration for each parameter measured in digestive gland of Unio tigridis. As well as, these significant differences were recorded between control and three concentrations of DHO exposure for comet length, and tail length parameters, and between control and highest oil concentration for tail moment in Viviparous bengalensis. DHO has the ability to prevent the reproduction of Viviparous bengalensis snail relation to control, that is what we considered strong evidence of the toxicity properties of DHO on the reproductive status of this species of snails. SOD, CAT, and MDA were useful biomarkers for evaluating the toxicity of DHO in mussel and snails, and comet assay was a good tool to assess the potential genotoxicity of DHO.