Postoperative analgesic effect of intrathecal dexmedetomidine on bupivacaine subarachnoid block for open reduction and internal fixation of femoral fractures.

BACKGROUND: One of the drawbacks of subarachnoid block is the short duration of analgesia particularly when adjuvants are not added to local anesthetics agent used. However, dexmedetomidine an α2-adrenergic agent has been found to possess analgesic effect. AIMS: This study seeks to determine the analgesic efficacy of intrathecal 7.5 µg of dexmedetomidine and its side effects when used for open reduction and internal fixation (ORIF) of femoral fractures. METHODOLOGY: It is a prospective randomized, double-blinded study that was carried out in a Nnamdi Azikiwe University Teaching Hospital, Nnewi in Nigeria. Seventy American Society of Anesthesiologists I or II patients were randomized into two groups of 35 each to receive 3 ml of 0.5% hyperbaric bupivacaine combined with either 7.5 µg of dexmedetomidine in 0.3 ml of normal saline (Group D) or 0.3 ml of normal saline alone (Group S). Patient's outcome measures noted (time to first request of analgesia, proportion of patients with pain score <4 postoperatively using numerical rating scale [NRS], and total analgesic consumed in 24 h.). RESULTS: The patients in Group D had a longer time to first request of analgesia, larger proportion of patients with pain score <4 using NRS in the 2nd h postoperatively and lower amount of total analgesic consumed compared to those in Group S. These differences between the two groups were all statistically significant. Furthermore, there was no difference in the incidences of side effects between the two groups (P > 0.05). However, the patient satisfaction was better in Group D. CONCLUSION: The addition of 7.5 µg of dexmedetomidine to bupivacaine for subarachnoid block in the management of femoral fractures using ORIF provided better anesthetic profile, particularly prolonged duration of postoperative analgesia without significant side effects.

Scorpion sting pain: which way to treat?

The objective of reporting this case is to highlight the clinical usefulness of chloroquine in the management of scorpion sting pain with the hope of stimulating interest and research, especially in areas where local anesthetic agents may not be available. In this case reported here, lidocaine failed to provide sustained analgesia for pain relief following scorpion sting. Two milliliters of parenteral chloroquine was injected intradermally around the bite site. Chloroquine provided immediate pain relief within 3 minutes of injection. The pain relief was sustained beyond 24 hours. The use of local anesthetic agents should be continued while other agents such as chloroquine, which may also have relevant clinical usefulness, should be considered.

Experience with civilian vascular injuries in eastern Nigeria.

Accidents and trauma are the most common causes of death in the young Nigerian male. Due to inadequate facilities for recovering the injured, patients with major vascular injuries fail to reach the hospital alive. The incidence of vascular injury in the Nigerian population should be higher than is reflected in this study. Late presentation to the hospital results in the greater number of patients with traumatic aneurysms. Improvement in ambulance and hospital services for the injured will facilitate earlier detection and treatment of vascular injuries, improve the mortality rate, and limit the late sequelae of vascular injuries.

A clinical evaluation of clavulanate-potentiated amoxycillin in the management of moderate to severe respiratory tract infections.

This study investigated the effects of clavulanate-potentiated amoxycillin in the management of moderate to severe respiratory tract infections. A total of 34 patients aged 10-70 years were studied to establish the clinical and bacterial efficacy of treatment and screened for unwanted effects and abnormal laboratory findings. Clavulanate-potentiated amoxycillin was given in dosages of 375 or 750 mg twice daily, orally, for a mean of 13 days (range 3-30 days). Patients were assessed at the end of 2 weeks and again on discharge from hospital (if later) for up to 6 months. Overall diminution in the number of symptoms was recorded at the end of the study; 78% of symptoms had disappeared after 2 weeks. The treatment proved highly effective in controlling respiratory tract infections in 94% of patients. The necessity for multiple drug therapy and parenteral administration was also avoided.

Ear acupuncture using semi-permanent needles: acceptability, prospects and problems in Nigeria.

Ear acupuncture performed with indwelling auricular semi-permanent (ASP) needles, was used for the treatment of musculoskeletal pain and stiffness in 55 Nigerians. The male patients were initially reluctant to have an ASP needle stuck in their auricle, because they feared that the needle would attract embarrassing comments. No female objected to the use of these needles. The longest time an ASP needle remained in situ was 28 days (in a male), while the shortest time was 2 days. There was no associated ear lobe infection or scarification. All seventeen patients with acute torticollis had significant relief of pain and stiffness within 24 hours, scoring less than 25% (residual pain) on the visual analogue scale (VAS). Contrary to speculation auriculo acutherapy using the indwelling needles is acceptable to the Nigerian (male and female). The tropical weather does not necessarily predispose to infection at the site of needle, insertion, provided the area is kept dry. The technique is useful for the relief of musculoskeletal pain and stiffness, and permits the patient to continue self acutherapy at home without the need to return to the clinic. However, these needles are disposable and have to be imported. There is therefore the problem of availability.

Initial experience in a special pain clinic in Nigeria.

The first 100 patients seen in a Pain Clinic in Nigeria are analyzed and presented. There were 53 males and 45 females aged between 11 and 65 years (means 41.3 years). A variety of ailments brought the patients to the clinic, but arthritis, back pain and spasmodic torticollis were the commonest. Methods of treatment which included acupuncture, transcutaneous nerve stimulation and trigger point injections, depended on the facilities available, the level of intelligence and economic status of the patient, particularly with regard to the use of the transcutaneous nerve stimulator.

Sacral acupuncture for pain relief in labour: initial clinical experience in Nigerian women.

Sacral acupuncture was used for pain relief during labour in 30 pregnant Nigerian women. It produced clinically adequate analgesia in 19 women (63.3%). 6 women in this group (31.6%) reported that they had experienced no pain whatsoever throughout the period of labour and delivery (average duration - 8 hours). 11 women (36.7%) had no pain relief and required pethidine injection when sacral acupuncture proved ineffective. 24 women (80%), including 5 who did not obtain relief, indicated their wish to have sacral acupuncture during their next confinement. 2 women (6.7%) objected to needling, 3 considered acupuncture useless while another 2 did not believe in it. The patients' cardio-respiratory functions and uterine contractions were not adversely affected. There were no untoward effects on the mothers or their neonates. The procedure was technically simple, the equipment light and cheap. The needles did not interfere with nursing or obstetric manouvres. The procedure was however time consuming. The results were inconsistent and unpredictable. Despite these limitations, the simplicity, cheapness and absence of physiological complications associated with the procedure, make it a worthwhile medical armament for pain relief in the Nigerian environment, with limited resources and specialized manpower.

Anaesthetic management of congenital heart block and persistent ductus arteriosus in an infant.

Ketamine hydrochloride, pancuronium bromide and 100% oxygen were used during general anaesthesia for a left antero-lateral thoracotomy, insertion of a permanent cardiac pace-maker and ligation of a persistent ductus arteriosus in a three-month-old female infant, who was also in congestive cardiac failure. To the best of our knowledge, this is the first reported case of successful anaesthetic management for insertion of cardiac pace-maker and ligation of persistent ductus arteriosus under general anaesthesia in a Nigerian infant. The successful out-come of our anaesthetic technique encourages us to recommend the procedure for the anaesthetic management of similar complex cardiac abnormalities.

Ventilatory pulmonary function study in healthy young Nigerian adults.

Ventilatory pulmonary function was studied in 108 healthy young Nigerian adults using an electronic spirometer, with a view to determining the normal values of function for healthy Nigerians. The measured values of forced vital capacity, forced expiratory volume in 1 sec, maximum voluntary ventilation, and peak flow rate were compared with those obtained from similar studies on Nigerians and the predicted values for Caucasians. Higher values of function were obtained in Nigerian males than in the females. Nigerian males, however, showed lower values when compared with Caucasians of similar anthropometric measurements; there was no difference between the females in this study and their Caucasian counterparts. There were also some similarities and differences between the values obtained in this study and those of similar studies in Nigerians of different socio-ethnic backgrounds. The results emphasize the necessity for a ventilatory normogram for each socio-economic or ethnic grouping of individuals.

General anesthesia for cataract surgery: Experience at King Fahd Hospital of the University, Al-Khobar.

Although cataract surgery is increasingly being performed under local anesthesia in many centers, general anesthesia is preferred for cataract surgery at the King Fahd Hospital of the University (KFHU), Al-Khobar. Ninety two patients who had cataract extraction under general anesthesia at KFHU between October 1988 and April 1990 are presented. Of these, 57 patients (61.9%), had pre-existing medical ailments (mainly cardiovascular and metabolic). Perianesthetic problems (dysrhythmia, hypotension), were encountered in ten patients (10.8%). All responded to treatment. Surgical conditions were ideal. There was no mortality. It would appear that modern general anesthesia, with appropriate monitoring, can effectively be applied to planned cataract surgery, with good results, provided the patients are in optimal physical health.

Initial clinical experience with fazadinium bromide during anaesthesia in Nigerians.

Fazadinium Bromide (Fazadon, AH 8165), a non depolarising muscle relaxant, was injected into one hundred unpremedicated Nigerian patients requiring endotracheal intubation and prolonged skeletal muscle relaxation. The dose of Fazadon used was 1.5 mg per kg. body weight. Endotracheal intubation was possible in all the patients within thirty seconds of the intravenous injection of Fazadon. The initial single dose of the drug provided muscle relaxation for an average of forty minutes without the addition of any volatile anaesthetic agent. Arterial blood pressure was well maintained, but there was a mean increase in pulse rate of 20 beats per minute. Return of skeletal muscle activity was observed within one minute of the injection of neostigmine, in all but one patient.

Pericarditis: a persisting surgical problem.

A study of pericarditis treated surgically over a period of 14.5 years was conducted to evaluate the current pattern and management of this disease in a tropical environment. The series comprised 86 patients (58 males and 28 females) aged from 5 months to 60 years (mean 21.1 years). Pericarditis was effusive in 41 patients, calcific in 33 and fibrous in 12. Aetiological or associated factors were non-specific, pyogenic infection, rheumatic heart disease, endomyocardial fibrosis, tuberculosis and amoebiasis in 36, 21, eight, eight, six and four patients, respectively. All the patients were in New York Heart Association (NYHA) functional class III or IV. Operative treatment involved pericardiotomy with tube drainage in 32 patients, pericardiectomy in 49, and pericardiotomy with subsequent pericardiectomy in five. The total hospital mortality rate was 8.0%, and was largely a result of severe pre-operative cardiac decompensation and multiple organ failure. Of the 79 early survivors, 91% reverted to NYHA functional class I or II. Surgical treatment remains the most effective management of chronic pericarditis which still constitutes a major clinical problem in some countries.

Management of traumatic rupture of the diaphragm.

Traumatic rupture of the diaphragm is a potentially serious injury which presents in different forms depending on the mechanism of the causative trauma. Over a 7 year period, 20 patients (17 male and 3 female) with traumatic rupture of the diaphragm were seen in our unit; their mean age was 25.6 years. Automobile accidents caused the diaphragmatic injuries in 65 per cent of cases while falls from trees were the cause of injury in 10 per cent. Ten patients (50 per cent) were seen within 7 days of the injury and 95 per cent within 3 months. The left hemidiaphragm was ruptured in 85 per cent and the right in 15 per cent of cases. Fifty ribs were fractured in fourteen patients (70 per cent) but there were no pelvic fractures. Fourteen patients (70 per cent) had gastrointestinal visceral herniation into the thorax, the stomach, omentum, colon and spleen being the commonest herniating organs. Successful surgical repair was achieved in 18 patients, 4 of whom also had splenectomy; 2 patients were treated conservatively. A high index of suspicion and early surgical treatment are the mainstay of successful management of traumatic rupture of the diaphragm with or without herniation of abdominal organs.