Paediatric surgical research and publications in a developing country setting

Background: Research and publications are important in advancing quality of care as well as improving knowledge. Paediatric surgical research and publications in sub Saharan Africa have not been given much focused attention. Materials and Methods: A retrospective review of published work in paediatric surgery from a major paediatric surgical centre in Nigeria from 1969 - 2005. All published work were reviewed for nature of research; organ/system and disease condition studied; nature of publication; volume of publication in relation to staffing as well as journal of publication. Results: During the period there were 153 publications consisting of 86 (56.2) original researches (77 of which were of retrospective study designs and 9 prospective); 56 (36.6) case reports; 8 (5.2) letters and 4 (2.6) review articles. None of the studies and publications was funded. More publications were made when the department of surgery was better staffed. Congenital anomalies (57; 37.3) and surgical infections (28; 18.3) were more frequently studied and in 82 (53.4) publications the gastrointestinal tract was the focus. Most publications were in general medical journals (58; 37.9) and general paediatric journals (54; 35.3) but publications in paediatric surgical journals has continued to increase over the years and reached 25.9by 2005. Some of the difficulties and challenges faced included lack of funding; poor staffing and inadequate facilities for laboratory research. Conclusion: Paediatric surgical research and publication in Nigeria is increasing but faces important limitations. Advocacy efforts are needed to improve funding. Networking as well as collaboration is necessary to improve the quality and spectrum of research

Comparative study between caudal ropivacaine and bupivacaine with and without neostigmine in pediatric surgery

In a randomized, double-blinded study we examined the analgesic efficacy of caudal nesostigmine-ropivacaine mixture and caudal neostigmine-bupivacaine mixture in 75 pediatric patients schedulled for various surgical procedures such as lower abdominal, urologic and lower limb operations-After induction of general anaesthesia patients were allocated randomly into [5] equal group [n=15] to receive caudal analgesia. [I] Bupivacaine group 0.25% 1 mL/kg [2] Ropivacaine group 0.25% 1 mL/kg [3] Neostigmine group 2 micro g/kg [4] Bupivacaine 0.25% 1 mL/Kg +/- Neostiginine 2 micro g/Kg group [5] Ropivacaine .0.25% 1 mL/Kg+Neostigmine 2 micro g/Kg Group. There were no differences between the groups in demographic and haemodynamic data. Intraoperatively, children receiving caudal mixture of bupivacaine-neostigmine and ropivacaine-Neostigmine maintained haemodynaniiic stability and required less inhaled anaesthelics and had a short recovery time compared with the other groups. Postoperatively the caudal ropivacaine neostigmine mixtures resulted in superior analgesia and less motor blocks compared with the caudal bupivacaine-neostigmine mixtures. Recovery to first rescue analgesic times were [mean +/- SD] 384.33 +/- 302 min, 508 +/- 87.44 min, 266 +/- 58.7 and, 893.67 +/- 429.46 min and 1325 +/- 207.11 mm in the bupivacaine group, ropivacaine group, neostigmine group, bupivacaine neostigmine mixture group and ropivacaine-neostigmine mixture group respectively [P<0.001]. In addition, "ropivacaine-neostigmine" mixture group received the least number of paracetamol suppositories followed by "bupivacaine-neostigmine" mixture group then ropivacaine-group" followed by "bupivacaine group" and lastly "neostigmine group" which received the biggest number of paracetamol-suppositories to maintain adequate analgesia in the first 24 h postoperatively. Postoperative vomiting occurred in [2] patients [13.3] in both of caudal "bupivacaine-neostigmine and ropivacaine-neostigmine group. And in [4] patients [26.6%] in the neostigmine group otherwise, no patient in any of the other [2] groups had emetic side-effects. We conclude that caudal ropivacaine-neostigmine mixture resulted in superior analgesia and less motor blocks in the postoperative period compared with the caudal bupivacaine-neostigmine mixture