Analgesic requirements and postoperative recovery after scheduled compared to unplanned cesarean delivery: a retrospective chart review.

BACKGROUND: Studies examining the effects of various analgesics and anesthetics on postoperative pain following cesarean delivery conventionally use the scheduled cesarean population. This study compares postoperative analgesic requirements and recovery profiles in women undergoing scheduled cesarean compared to unplanned cesarean delivery following labor. We postulated that unplanned cesarean deliveries may increase postoperative analgesic requirements. METHODS: We conducted a retrospective chart review of 200 cesarean deliveries at Lucile Packard Children's Hospital, California. We examined the records of 100 patients who underwent scheduled cesarean delivery under spinal anesthesia (hyperbaric bupivacaine 12 mg with intrathecal fentanyl 10 microg and morphine 200 microg) and 100 patients that following a trail of labor required unplanned cesarean under epidural anesthesia (10-25 mL 2% lidocaine top-up with epidural morphine 4 mg after clamping of the umbilical cord). We recorded pain scores, analgesic consumption, time to first analgesic request, side effects, and length of hospital stay. RESULTS: We found no differences in postoperative pain scores and analgesic consumption between scheduled and unplanned cesarean deliveries for up to five days postoperatively. There were no differences in treatment of side effects such as nausea, vomiting, or pruritus (P>0.05). CONCLUSION: The results indicate that women experience similar pain and analgesic requirements after scheduled compared to unplanned cesarean delivery. This suggests that the non-scheduled cesarean population may be a suitable pain model to study pain management strategies; and that alterations in pain management are not necessary for the unplanned cesarean delivery population.

Tuberculous pancreatic abscess in an HIV antibody-negative patient: case report and review.

Tuberculosis (TB) is most commonly diagnosed as a pulmonary disease; however, haematogenous spread of the organism can cause disease in any organ system. We report the case of a 30-y-old woman, Human Immunodeficiency Virus (HIV) antibody-negative, who was diagnosed as having a pancreatic mass on computed tomographic (CT) scans. She underwent a laparotomy and the fluid drained from the mass was culture-positive for Mycobacterium tuberculosis. We review the clinical details of 37 similar cases of pancreatic TB in the literature, where each patient's HIV antibody status is negative or unknown. In this series 3 patients died (1 of these had commenced anti-TB therapy, the others had not) but the remaining 34 responded well to radiological-guided drainage and/or surgical intervention and anti-TB therapy. TB should be considered in the differential diagnosis of a pancreatic mass, especially when associated with epigastric pain or discomfort and weight loss.

A case of acute hepatitis E in Victoria.

OBJECTIVE: To report a case of acute hepatitis E in Victoria, confirmed by laboratory investigations. CLINICAL FEATURES: A 10-year-old boy presented for medical attention with a seven-day history of anorexia and jaundice, 17 days after arriving from Pakistan. The diagnosis of acute hepatitis E was suspected after exclusion of the known causes of viral hepatitis, and was further established by specific antibody testing and identification of hepatitis E virus-like particles in a faecal sample collected three weeks after the onset of illness. INTERVENTION AND OUTCOME: The patient was managed at home, treated symptomatically and made a complete recovery. CONCLUSION: In patients who arrive from countries where hepatitis E is endemic, and who develop non-A, non-B, non-C viral hepatitis, hepatitis E should be considered as a possible diagnosis.