Comparison of the efficacy of eutectic mixture of local anesthetics (EMLA) and dorsal penile nerve block (DPNB) in neonatal circumcision.

BACKGROUND: Neonates feel pain. There is a concern among practitioners that pain of injecting analgesics to neonates prior to circumcision could as well be the same as the pain of the procedure. This has made many reluctant to offer effective analgesia for circumcision. If eutectic mixture of local anesthetics (EMLA) provides analgesia comparable to dorsal penile nerve block (DPNB), it will obviate needle prick and encourage analgesia use in neonatal circumcision. AIM: To determine how the analgesic efficacy of EMLA compares with that of DPNB in neonatal plastibell circumcision. METHODS: A prospective study of 110 male neonates for plastibell circumcision randomized into two groups: A and B, of 55 each, received EMLA or DPNB as analgesia prior to circumcision, respectively. The pulse rates and SpO2 were recorded with pulse oximeter pre-procedural and at four stages of the procedure (adhesiolysis, dorsal slit, tying, and excision) for each neonate. Also the modification of neonatal infant pain scale (NIPS) was recorded during the procedure. RESULTS: There were differential changes in SpO2 (lower absolute mean values) and pulse rate (higher absolute mean values) for neonates who received EMLA when compared with DPNB before the procedure. These differences were significant with SpO2 at adhesiolysis (91.0% and 95.0%), dorsal slitting (90.9% and 94.7%), and excision stages (93.4% and 95.3), respectively (P < 0.05). They were also significant with the pulse rates at adhesiolysis (167.9 and 158.6), dorsal slitting (174.3 and 161.7), and tying stages (182.2 and 169.0), respectively (P values = 0.013, 0.015, and 0.044, respectively). This shows DPNB is better than EMLA. However, the difference was not significant at the tying stage with SpO2 and at excision stage with PR (P > 0.05). CONCLUSION: EMLA produces analgesic effect. However, it does not provide effective analgesia for plastibell circumcision in neonates. DPNB provides a better analgesia than EMLA for neonatal plastibell circumcision.

Jejuno-ileal atresia: a 2-year preliminary study on presentation and outcome.

BACKGROUND/AIM: Intestinal atresia is a common cause of neonatal intestinal obstruction. Jejuno-ileum is the commonest site of intestinal atresia. Reports on Jejunoileal atresia in developing countries are still few. The purpose of this study is to determine the presentation and management outcomes of neonates with Jejunoileal atresia treated in our hospital. MATERIALS AND METHODS: Detailed data on all babies that presented and were treated within the study period (November2008-November, 2010) were kept and analyzed. A management protocol was put up and maintained. RESULT: A total of 9 babies (7males and 2 females) were treated. They were aged 2 hours to 13 days. Their weight ranged from 1.7kg to 3.3kg. Apart from one baby which presented within 2hrs with prenatal ultrasound diagnosis, others had bilious vomiting from the first day of birth, abdominal distension and delayed or absent passage of meconium. Even though symptoms developed on the first day of birth, presentation to the surgical unit was delayed 72hours and beyond in most patients.Type I atresia is commonest (no=4).There is associated gut malrotation in 2 babies. Five babies had complications which included surgical site infection, sepsis, prolonged vomiting post operatively, aspiration, rupture of dilated proximal segment after membrane excision, entero-cutaneous fistula and malnutrition. Three babies died giving a mortality of 33.3%. Mortality is commoner in types IIIb and IV. CONCLUSION: Mortality is higher in complex atresia which most times will require neonatal intensive care and parenteral nutrition facilities. These are still lacking in our institution. Providing these facilities will further improve outcome.

Use of prophylactic antibiotics in a paediatric day-case surgery at NAUTH, Nnewi, Nigeria: a randomized double-blinded study.

This was a randomized double-blinded study to assess the need for prophylactic antibiotics in paediatric day-case surgery, as well as the cost implication. Group A received preoperative intravenous ampiclox and vitamin B complex in doses appropriate for weight and age, while group B received only vitamin B complex as a placebo. The study was completed by 138 (95.2%) patients in group A, and by 140 (97.2%) patients in group B. Wound infection was seen in seven (5%) patients in group A and six (4.3%) patients in group B. The average cost of hernia repair in group A was US 43 dollars and US 31.1 dollars in group B.

Skin closure after groin hernia repair in children : a comparative study of three suture materials and two suture techniques

Objective The surgical scar is of great importance both to the patient and surgeon. For the patient an ugly scar may not only present a cosmetic problem but in some cases it may also impair function; and the surgeon is always confronted with the problem of possible litigation. This study was undertaken to evaluate the effect of different suture materials and skin suture techniques on surgical scars. Patients and Methods Three suture materials (chromic catgut 3/0; silk 3/0 and nylon 3/0) and two skin closure techniques (transcutaneous interrupted mattress and subcuticular continuous running sutures) were compared in a randomized partially blinded fashion using a groin skin crease incision. The resulting scars were graded after two years using a conceived three-level scale. Results Subcuticular nylon sutures gave the best cosmetic results followed by subcuticular chromic catgut. Transcutaneous interrupted mattress silk sutures left the worst scars followed by subcuticular continuous running silk sutures. Conclusion The use of suture materials for skin closure is still the norm in developing countries. We therefore suggest that for any particular suture material; the subcuticular continuous running technique should be used and whenever possible the suture material of choice should be nylon

Paediatric day-case surgery at NAUTH, Nnewi, Nigeria.

Day-care surgery is strongly advocated in well-selected paediatric cases when the complications are within acceptable limits because it is very cost effective.

Circumcision-related complications in the male : experience amongst the Igbo's of Southeast Nigeria

Objectives To evaluate male circumcision and the complications associated with it amongst the Igbo people of Southeast Nigeria. Patients and Methods This study was a prospective review of male circumcision and its complications amongst the Igbo's of Southeast Nigeria carried out over a period of six months. It was conducted in three centers (public; private and a mission hospital) in Anambra State (a core Igbo state) of Nigeria. Circumcision was done after birth at any convenient time; and the babies were followed up at the post natal clinic (six weeks after birth) for possible complications. A questionnaire is usually filled at the time of circumcision and completed at the post natal visit. Results A total of 141 circumcisions were performed during the study period. Most of the circumcisions (73.8) were done between 7 and 9 days after birth. The plastic bell method was used more extensively than the traditional method (68.1and 31.2; respectively). The method preferred by the mothers was not statistically different from the method used. The overall complication rate in this study was 24.1. A higher complication rate was recorded with the use of the traditional method compared to the plastic bell method (43.2vs. 15.6; P0.01); and when circumcision was performed by midwives instead of physicians (30.6vs. 14.5; P0.01). Conclusion Two factors were responsible for a high complication rate: the use of the traditional method of circumcision and the competence of the performer. It is therefore suggested that circumcision be done by the use of the plastic bell and only by qualified and trained personnel