RESUMO
PURPOSE: The purpose of this study was to evaluate the effectiveness of intrathecal morphine following selective dorsal rhizotomy in pediatric patients previously diagnosed with cerebral palsy. METHODS: This was a retrospective, cohort analysis over the course of four years. The analysis consisted of a treatment group which received intrathecal morphine (5 mcg/kg) injection and a control group that did not receive the injection prior to dural closure. All patients underwent multilevel laminectomies for selective dorsal rhizotomy at Akron Children's Hospital. The effectiveness of the treatment was measured by total dose of hydromorphone administered on patient-controlled analgesia (PCA), number of days on oral narcotics, and cumulative dose of oral narcotic. RESULTS: Of the analyzed 15 pediatric patients, seven patients received intrathecal morphine injection while the other eight did not receive the treatment prior to dural closure. There was a difference of 1135 mcg in total PCA dose between the study group (3243âmcg) and the control group (4378âmcg). The total PCA dose based on weight was lower in the study group (163âmcg/kg) than in the control group (171âmcg/kg). CONCLUSION: Based on these findings, the administration of intrathecal morphine clinically reduces the opiate need in the first 96 hours post-operatively.
Assuntos
Morfina , Rizotomia , Humanos , Criança , Morfina/uso terapêutico , Analgésicos Opioides/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Estudos RetrospectivosRESUMO
This article describes a patient whose intracerebral MRSA may have been caused by a spider bite to the thigh 2 months earlier. The patient's headache, nausea, and vomiting initially were thought to be caused by a high-grade glioma. Most brain abscesses have otogenic sources and are not from distant hematogenous spread. Although systemic antibiotics help with symptomatology, surgical eradication (when feasible) followed by IV antibiotics, provides definitive treatment.