Comparison of caudal bupivacaine alone with bupivacaine plus two doses of dexmedetomidine for postoperative analgesia in pediatric patients undergoing infra-umbilical surgery: a randomized controlled double-blinded study.

BACKGROUND: Data are still insufficient about the effects of different concentrations of caudal dexmedetomidine when used to prolong postoperative analgesia in children. The aim of this study was to assess the analgesic efficacy and side effects of two doses of caudal dexmedetomidine (1 and 2 µg·kg(-1)) co-administered with bupivacaine in terms of postoperative pain scores and requirement of postoperative analgesia over 24 h in children undergoing infra-umbilical surgery. METHODS: Ninety-one children, aged 1-6 years, undergoing infra-umbilical surgery were included and randomly allocated into three groups of caudal block. Group B received 0.25% bupivacaine 2 mg·kg(-1) (0.8 ml·kg(-1)). Groups BD1 and BD2 received dexmedetomidine 1 and 2 µg·kg(-1), respectively along with bupivacaine 2 mg·kg(-1) in a total volume of 0.8 ml·kg(-1). Anesthesia was induced and maintained with sevoflurane in 100% oxygen. Hemodynamic and other routine intraoperative monitoring was carried out in addition to endtidal sevoflurane concentration. Time to spontaneous eye opening and postoperative pain and sedation scores were recorded in addition to time to first analgesia, paracetamol analgesic requirements, and any side effects during the first 24 postoperative hours. RESULTS: Time to first analgesia requirement was significantly longer in BD1 and BD2 groups compared to B group with mean values (95% CI) of 809 min (652-965), 880 (733-1026), and 396 (343-448), respectively, P < 0.001. Postoperative paracetamol analgesic requirements over 24 h were higher in group B compared to BD1 and BD2 groups (Mean (95% CI): 3.2 (2.9-3.5) doses, 1.9 (1.5-2.3), and 1.6 (1.3-1.9), respectively), P < 0.001. The dexmedetomidine groups had significantly higher postoperative sedation scores compared to plain bupivacaine group that were dose dependent and for longer time in BD2 group. Two patients in BD2 group developed bradycardia and hypotension, and one developed urine retention compared to none in other groups. CONCLUSION: A 1 µg·kg(-1) dose of caudal dexmedetomidine achieved comparable prolongation of postoperative analgesia to 2 µg·kg(-1) dose, with shorter duration of postoperative sedation and lower incidence of other side effects.

Comparison of ilioinguinal/iliohypogastric nerve blocks and intravenous morphine for control of post-orchidopexy pain in pediatric ambulatory surgery.

BACKGROUND: The present study is a prospective randomized double-blinded study that designed to evaluate and compare the effectiveness of postoperative pain control and incidence of complications between ilioinguinal/iliohypogastric nerve block and intravenous morphine in paediatric patients undergoing unilateral orchidopexy in day surgery unit. METHODS: Seventy patients aged 2-12 years were randomly allocated to two groups of thirty five. One group received intravenous morphine 100 microgram/kg before skin incision and the other group had ilioinguinal/iliohypogastric nerve block with 0.25 ml/kg bupivacaine 0.5% also before skin incision. All patients have received standardized anaesthesia. Postoperative pain was assessed using 0 - 10 scale at 0, 1, 2, 3 and 4 postoperative hours, also the intraoperative fentanyl requirements, time to first postoperative analgesia, the total number of paracetamol doses and any extra analgesic requirements were recorded, side effects like respiratory depression, vomiting, itching, inguinal hematoma and lower limb weakness were assessed during the first 24 hours. RESULTS: Pain scores were significantly lower in the morphine group compared to the block group on admission and one hour after admission to the postanaesthesia care unit, no significant difference in pain score on 2nd, 3rd and 4th postoperative hours. The total number of intraoperative fentanyl doses was significantly higher in the block group compared to morphine group, there was no significant difference in the duration of analgesia, number of total paracetamol doses, need for extra analgesics in both groups over the 24 postoperative hours. None of the seventy patients experienced postoperative respiratory depression, inguinal hematoma or lower limb weakness, but significantly more patients in morphine group experienced vomiting and itching compared to the block group. CONCLUSION: Ilioinguinal/iliohypogastric nerve block and intravenous morphine administered following general anaesthesia for unilateral orchidopexy in day surgery unit are safe and effective in controlling postoperative pain, morphine analgesia had a higher incidence of postoperative vomiting and itching.

Benign pneumoperitoneum in newborns: which abdomen to open and which one to observe?

Benign pneumoperitoneum in newborns is not a rare condition that should be managed conservatively. Neonatologists and surgical teams should work together to avoid unnecessary and potentially risky procedures.

Recurrent maturing perineal lipoblastoma.

Lipoblastoma is a rare benign neoplasm of fetal adipose tissue that we see mostly in infants and young children less than 3 years of age. Most lipoblastomas occur on the extremities, trunk, head and neck, and various other organs have been described. We report a case of a recurrent perineal lipoblastoma in a 2.5-year-old boy, which showed maturation of the lipoblasts as compared to the primary tumor.

Upper airway obstruction by a fragmented tracheostomy tube: Case report and review of the literature.

INTRODUCTION: Many objects were described in the literature as causes of upper airway obstruction including seeds, nuts and household particles but fragmented tracheostomy tube is a rarely reported cause of airway obstruction. We report a case of foreign body aspiration in the tracheobronchial tree due to a fragmented and migrated tracheostomy tube. PRESENTATION OF CASE: We report a 4.5 year old female patient who had upper airway obstruction due to a fragmented and migrated tracheostomy tube. She was diagnosed by chest X-ray and the tube was removed by rigid bronchoscopy. DISCUSSION: Several factors contribute to fragmentation of the tracheostomy tube including repeated removal and reinsertion, cleaning, boiling or chemicals. Early breakage is most often due to manufacturing defects. The occurrence of a fractured tracheostomy tube in children is rare. Nevertheless, tracheobronchial foreign bodies in children can be life threatening and pose a dire emergency. CONCLUSION: Based on our experience, the doctors and other staff should check for any manufacturing defects before the first use of a tracheostomy tube, which should reduce the occurrence of this rare, but life threatening.