1
|
Sato M. Ultrasound-guided quadratus lumborum block compared to caudal ropivacaine/morphine in children undergoing surgery for vesicoureteric reflex. Paediatr Anaesth 2019; 29:738-743. [PMID: 31034730 DOI: 10.1111/pan.13650] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 04/15/2019] [Accepted: 04/19/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND Ultrasound-guided quadratus lumborum block is a regional anesthetic technique which can provide perioperative analgesia for all age groups, including pediatric patients undergoing abdominal surgery. We hypothesized that the quadratus lumborum block would be as efficacious as a caudal block, the gold standard of pediatric lower abdominal regional anesthesia, in providing pain control after ureteral reimplantation but also have a longer duration. METHODS Forty-seven pediatric patients between the ages of 1 and 17 years undergoing bilateral ureteral reimplantation surgery via a low transverse incision were enrolled and randomized into the quadratus lumborum block and caudal block groups. All blocks were performed preoperatively under general anesthesia. We analyzed the following outcomes: the requirement for narcotic analgesics, pain score, episodes of emesis, and complications at 0, 4, 24, and 48 hours postoperatively. RESULTS The study included 44 patients after excluding three who were ineligible. The fentanyl requirement for postoperative rescue analgesia during the first 24 hours was significantly lower in the quadratus lumborum block group than in the caudal block group (median [interquartile range]: 0 [0-1] vs 3 [0-5], P = 0.016, 95% confidence intervals: -4 to 0) but not at 30 minutes, 4, or 48 hours. No significant difference was observed in the pain scores or the incidence of interventions to treat nausea and vomiting during the entire period. No postoperative complication was observed. CONCLUSION The quadratus lumborum block was more effective in reducing the postoperative opioid requirement for rescue analgesia during the initial 24 hours than caudal ropivacaine/morphine.
Collapse
Affiliation(s)
- Makoto Sato
- Department of Anesthesiology, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan
| |
Collapse
|
2
|
Abstract
Vesicovaginal fistula (VVF) is an abnormal communication between the bladder and the vagina. Prompt diagnosis and timely repair are essential for successful management of these cases. As the clinical scenario is variable, it is difficult to frame uniform guidelines for the management of VVF. Hence, the management protocol is dependent on the treating surgeon and the available resources. Conservative methods should be used in carefully selected patients. Delayed repair is better than the early repair of VVF. Transvaginal route for repair is preferred as it has low morbidity, higher success rates, and minimal complications. Anticholinergics should be used in the postoperative period for better chance of bladder healing. When facilities are available, all the patients may be referred to a tertiary care center where expertise and advanced resources are available. Trained surgeons adapting the new trends should refine the art of VVF repair.
Collapse
Affiliation(s)
| | | | - Arabind Panda
- Department of Urology, KIMS Hospitals, Secunderabad, Telangana, India
| |
Collapse
|
3
|
Zhang C, Xiao Z, Zhang X, Guo L, Sun W, Tai C, Jiang Z, Liu Y. Transcutaneous electrical stimulation of somatic afferent nerves in the foot relieved symptoms related to postoperative bladder spasms. BMC Urol 2017; 17:58. [PMID: 28705210 PMCID: PMC5513144 DOI: 10.1186/s12894-017-0248-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 07/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bladder spasm is a common side effect of urological surgery. Main treatment modalities include opioids or anticholinergic medication; however, bladder spasms still occur even after these interventions. Recent studies indicate that transcutaneous stimulation of the foot can result in 50% increase in bladder capacity in healthy adults, and inhibit bladder detrusor overactivity in spinal cord injured patients. In this study, we examined the effects of transcutaneous electrical stimulation of the foot on bladder spasms related symptoms. METHODS Sixty-six male patients who underwent prostate or bladder surgeries due to benign prostatic hyperplasia or bladder diseases were randomly divided into two groups: the control group (n = 36) and the treatment group (n = 30). The control group received the routine postoperative care. The treatment group received daily transcutaneous electrical stimulation of the foot during 3 days after surgery; each time lasted for 60 min. All patients were evaluated by the Visual Analogue Scale for pain sensation, frequency of bladder spasm episodes, and a total score of bladder spasms symptoms. RESULTS In the control group, the patients with bladder surgery had a higher Visual Analogue Scale score than patients with prostate surgery (P = 0.024). In both treatment and control groups, the Visual Analogue Scale score, spasm frequency, and total score of bladder spasm symptoms decreased from day 1 to day 3 (P <0.001). The Visual Analogue Scale score at day 2, total score of bladder spasm symptoms at day 2 and day 3 were significantly lower in the treatment group than in the control group (P <0.05). CONCLUSION These results provided preliminary evidence suggesting beneficial effects of stimulating somatic afferent nerves in the foot on postoperative bladder spasms. TRIAL REGISTRATION The study was registered with Chinese Clinical Trial Registry on June 13 2016 ( http://www.chictr.org.cn/ ) (Identifier: ChiCTR-INR-16008635).
Collapse
Affiliation(s)
- Chanjuan Zhang
- Department of Urology, The Second Hospital of Shandong University, 247 Beiyuan Street, Jinan, 250033 China
| | - Zhiying Xiao
- Department of Urology, The Second Hospital of Shandong University, 247 Beiyuan Street, Jinan, 250033 China
| | - Xiulin Zhang
- Department of Urology, The Second Hospital of Shandong University, 247 Beiyuan Street, Jinan, 250033 China
| | - Liqiang Guo
- Department of Urology, The Second Hospital of Shandong University, 247 Beiyuan Street, Jinan, 250033 China
| | - Wendong Sun
- Department of Urology, The Second Hospital of Shandong University, 247 Beiyuan Street, Jinan, 250033 China
| | - Changfeng Tai
- Department of Urology, University of Pittsburgh, Pittsburgh, PA USA
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA 15213 USA
| | - Zhaoqun Jiang
- Department of Urology, The Second Hospital of Shandong University, 247 Beiyuan Street, Jinan, 250033 China
| | - Yuqiang Liu
- Department of Urology, The Second Hospital of Shandong University, 247 Beiyuan Street, Jinan, 250033 China
| |
Collapse
|
4
|
Peng XF, Lv XG, Xie H, Sa YL, Xu YM, Feng C, Zhang XR. Effectiveness of Solifenacin for Managing of Bladder Spasms in Patients With Urethroplasty. Am J Mens Health 2017; 11:1580-1587. [PMID: 28669278 PMCID: PMC5675211 DOI: 10.1177/1557988317713634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
To evaluate the efficacy and safety of solifenacin in the treatment of bladder spasms after urethroplasty. Patients underwent urethroplasty were randomly assigned to the study group ( n = 165) and the control group ( n = 150). Patients in the study group were treated with solifenacin for 7 days. Patients in the control group were placebo. Each group was further divided into four subgroups: paracentetic suprapubic cystostomy subgroup, traditional suprapubic cystostomy subgroup, former suprapubic cystostomy subgroup, and urethral catheter subgroup. A visual analogue scale (VAS) was used to measure the severity of bladder spasms. The mean duration of spasms, the frequency of spasms, and the incidences of urine extravasation and radiating pain were recorded each day. There were no significant differences in the VAS scores and mean duration of bladder spasms between the study and control groups . However, there was a significantly lower VAS score in the patients taking solifenacin in the paracentetic suprapubic cystostomy subgroup ( p < .05). A similar tendency was noted in the mean duration of bladder spasms in this subgroup. In a comparison of the daily and nightly frequency of spasms within the four subgroups, a significant improvement was noted in the control group within 5 days. A similar difference was not noted within 6 days in the study group. The short-term therapy with solifenacin is an effective and safe method for decreasing the frequency of bladder spasms after urethroplasty. Patients undergoing paracentetic suprapubic cystostomy might be the only subset to benefit from this treatment.
Collapse
Affiliation(s)
- Xu Feng Peng
- 1 Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,2 Shanghai Eastern Urological Reconstruction and Repair Institute, Shanghai, China
| | - Xiang Guo Lv
- 1 Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,3 Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - Hong Xie
- 1 Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,2 Shanghai Eastern Urological Reconstruction and Repair Institute, Shanghai, China
| | - Ying Long Sa
- 1 Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,2 Shanghai Eastern Urological Reconstruction and Repair Institute, Shanghai, China
| | - Yue Min Xu
- 1 Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,2 Shanghai Eastern Urological Reconstruction and Repair Institute, Shanghai, China
| | - Chao Feng
- 1 Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,2 Shanghai Eastern Urological Reconstruction and Repair Institute, Shanghai, China
| | - Xin Ru Zhang
- 1 Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,2 Shanghai Eastern Urological Reconstruction and Repair Institute, Shanghai, China
| |
Collapse
|
5
|
Safavi M, Honarmand A, Atari M, Chehrodi S, Amoushahi M. An evaluation of the efficacy of different doses of ketamine for treatment of catheter-related bladder discomfort in patients underwent urologic surgery: A prospective, randomized, placebo-controlled, double-blind study. Urol Ann 2014; 6:51-6. [PMID: 24669123 PMCID: PMC3963344 DOI: 10.4103/0974-7796.127030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 12/09/2012] [Indexed: 11/16/2022] Open
Abstract
Background: Urinary catheterization might have catheter-related bladder discomfort (CRBD). We evaluated the efficacy of different doses of ketamine in comparison to placebo as a treatment of CRBD. Materials and Methods: One hundred twenty patients who were candidate for urological surgery requiring catheterization of the urinary bladder were randomly divided into four groups including 30 patients in each. Group I received normal saline, Group II received ketamine 150 μg/kg/iv, Group III received ketamine 200 μg/kg/iv, and Group IV received 250 μg/kg/iv in the equal volume of 2 mL. The patients were observed for each 15 min in the recovery room and in the 1 h, 2 h, 6 h, 12 h, and 24 h after discharging from it for severity of CRBD and pain, levels of sedation, and post-operative nausea and vomiting. Results: The severity of CRBD at the recovery room was significantly reduced in Group III and Group IV after 24 h compared with Group I and Group II (P < 0.05). There was no significant difference between Group III and Group IV in this respect. The median sedation level was significantly lower in 15 min and 30 min after arrival to the recovery in Group III and Group IV compared with Group I and Group II (P < 0.05). There was no significant difference between Group III and Group IV in this regard. Conclusions: Ketamine 200 μg/kg/iv had similar efficacy with ketamine 250 μg/kg/iv in reducing the severity of CRBD without occurring significant side effect.
Collapse
Affiliation(s)
- Mohammadreza Safavi
- Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azim Honarmand
- Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammadali Atari
- Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shirin Chehrodi
- Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahsa Amoushahi
- Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
6
|
Hubert KC, Kokorowski PJ, Huang L, Prasad MM, Rosoklija I, Retik AB, Nelson CP. Durability of antireflux effect of ureteral reimplantation for primary vesicoureteral reflux: findings on long-term cystography. Urology 2012; 79:675-9. [PMID: 22245304 DOI: 10.1016/j.urology.2011.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 11/03/2011] [Accepted: 11/07/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To evaluate the long-term durability of successful ureteral reimplantation (UR) for vesicoureteral reflux (VUR) through a review of late cystography (LC) findings. MATERIALS AND METHODS We performed a retrospective chart review of all children with primary VUR who underwent successful open UR (grade 0 VUR into the reimplanted ureter[s] on initial cystogram) at our institution from January 1990 to December 2002. We identified successful UR patients who underwent LC ≥ 1 year after UR and reviewed the results for the presence of recurrent VUR into the reimplanted ureter(s). RESULTS Seven-hundred ninety-four patients underwent successful open UR for primary VUR, of whom 60 (7.6%) had a subsequent LC. Preoperative VUR grade was ≤ II in 20 (34.5%) and ≥ III in 38 (65.5%). Median age at UR was 3.5 years (IQR 1.3-6.2 years); 51 (85%) were female. UR was intravesical in 45 (75%) and bilateral in 19 (32%). LC was performed at a median of 38.7 months after UR (IQR 19.6-66.1 months). Indication for LC was febrile urinary tract infection (UTI) in 16 (27%), nonfebrile UTIs in 15 (25%), follow-up of contralateral VUR in 16 (27%), and other clinical indications in 13 (21%). The recurrence rate was 0%; of the 79 reimplanted ureters, 100% (95% CI 95.4-100) had no VUR (grade 0). CONCLUSION Among children who underwent successful open UR for primary VUR, there was no VUR recurrence on extended follow-up. This suggests that the late durability of open antireflux surgery is excellent.
Collapse
Affiliation(s)
- Katherine C Hubert
- Department of Urology, Children's Hospital Boston, Boston, MA 02115, USA
| | | | | | | | | | | | | |
Collapse
|
7
|
Surgical Reimplantation for the Correction of Vesicoureteral Reflux following Failed Endoscopic Injection. Adv Urol 2011; 2011:352716. [PMID: 21274435 PMCID: PMC3025361 DOI: 10.1155/2011/352716] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Revised: 11/23/2010] [Accepted: 12/08/2010] [Indexed: 11/18/2022] Open
Abstract
Purpose. In recent years, endoscopic injection became the procedure of choice for the correction of vesicoureteral reflux in the majority of the centers. Unfortunately, endoscopic treatment is not always successful and sometimes requires more than one trial to achieve similar results to that of an open reimplantation surgery. Our aim of this study is to evaluate the feasibility and success rate of open ureteral reimplantation following failed endoscopic procedure. Patients and Methods. During 2004-2010, we evaluated 16 patients with persistent vesicoureteral reflux (grades II-IV) following failed endoscopic treatment. All patients underwent open ureteral reimplantation. All patients were followed with an ultrasound 6 weeks following surgery and every 6 months thereafter for an average of 22 months. Voiding cystography was performed at 3 months after surgery. Results. During unilateral open ureteral reimplantation, the implanted deposit from previous procedures was either excised, drained, or incorporated into the neotunnel with the ureter. Vesicoureteral reflux was resolved in all patients with 100% success rate. No new hydronephrosis or signs of obstruction developed in any of the patients. qDMSA renal scan was available in 8 patients showing improvement of function in 5 and stable function in 3, and no new scars were identified. Conclusions. Open ureteral reimplantation is an excellent choice for the correction of failed endoscopic treatment in children with vesicoureteral reflux.
Collapse
|
8
|
Abstract
The greatest advance in pediatric pain medicine is the recognition that untreated pain is a significant cause of morbidity and even mortality after surgical trauma. Accurate assessment of pain in different age groups and the effective treatment of postoperative pain is constantly being refined; with newer drugs being used alone or in combination with other drugs continues to be explored. Several advances in developmental neurobiology and pharmacology, knowledge of new analgesics and newer applications of old analgesics in the last two decades have helped the pediatric anesthesiologist in managing pain in children more efficiently. The latter include administering opioids via the skin and nasal mucosa and their addition into the neuraxial local anesthetics. Systemic opioids, nonsteroidal anti-inflammatory agents and regional analgesics alone or combined with additives are currently used to provide effective postoperative analgesia. These modalities are best utilized when combined as a multimodal approach to treat acute pain in the perioperative setting. The development of receptor specific drugs that can produce pain relief without the untoward side effects of respiratory depression will hasten the recovery and discharge of children after surgery. This review focuses on the overview of acute pain management in children, with an emphasis on pharmacological and regional anesthesia in achieving this goal.
Collapse
Affiliation(s)
- Susan T Verghese
- The George Washington University Medical Center, Division of Anesthesiology, Children’s National Medical Center, Washington, DC, USA
| | - Raafat S Hannallah
- The George Washington University Medical Center, Division of Anesthesiology, Children’s National Medical Center, Washington, DC, USA
| |
Collapse
|
9
|
Inoue M, Caldarone CA, Frndova H, Cox PN, Ito S, Taddio A, Guerguerian AM. Safety and efficacy of ketorolac in children after cardiac surgery. Intensive Care Med 2009; 35:1584-92. [PMID: 19562323 DOI: 10.1007/s00134-009-1541-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Accepted: 05/11/2009] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To evaluate the nephrotoxic and opioid-sparing effects of ketorolac in children after cardiac surgery. DESIGN A retrospective cohort study. SETTING A Cardiac Critical Care Unit in a university-affiliated children's hospital. SUBJECTS Children less than 18 years of age who underwent low-risk cardiac surgery from July 2002 to December 2005. RESULTS Among 248 children studied, 108 received ketorolac and 140 did not. The ketorolac group was older, included a larger proportion of atrial septum defect repairs and a smaller proportion of ventricular septum defect repairs compared to the control group. The median change in serum creatinine did not differ between the ketorolac group and the control group (% change [IQR]); 12% [1-25] increase versus 12% [-3 to 31] increase, P = 0.86. On postoperative day 0 or 1, the ketorolac group received less opioids than control group. There was no difference in duration of mechanical ventilation or in length of stay between groups. CONCLUSION Ketorolac started in the first 12 h after a low-risk cardiac surgery in children is not associated with a measurable difference in renal function. The data suggest that ketorolac may be effective in reducing the exposure to opioids. Further studies are required to define subsets of children after cardiac surgery who could safely benefit from ketorolac therapy to reduce pain.
Collapse
Affiliation(s)
- Miho Inoue
- Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | | | | | | | | | | | | |
Collapse
|
10
|
Collins C, Klausner AP, Herrick B, Koo HP, Miner AS, Henderson SC, Ratz PH. Potential for control of detrusor smooth muscle spontaneous rhythmic contraction by cyclooxygenase products released by interstitial cells of Cajal. J Cell Mol Med 2009; 13:3236-50. [PMID: 19243470 PMCID: PMC4516481 DOI: 10.1111/j.1582-4934.2009.00714.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Interstitial cells of Cajal (ICCs) have been identified as pacemaker cells in the upper urinary tract and urethra, but the role of ICCs in the bladder remains to be determined. We tested the hypotheses that ICCs express cyclooxygenase (COX), and that COX products (prostaglandins), are the cause of spontaneous rhythmic contraction (SRC) of isolated strips of rabbit bladder free of urothelium. SRC was abolished by 10 μM indomethacin and ibuprofen (non-selective COX inhibitors). SRC was concentration-dependently inhibited by selective COX-1 (SC-560 and FR-122047) and COX-2 inhibitors (NS-398 and LM-1685), and by SC-51089, a selective antagonist for the PGE-2 receptor (EP) and ICI-192,605 and SQ-29,548, selective antagonists for thromboxane receptors (TP). The partial agonist/antagonist of the PGF-2α receptor (FP), AL-8810, inhibited SRC by ∼50%. Maximum inhibition was ∼90% by SC-51089, ∼80–85% by the COX inhibitors and ∼70% by TP receptor antagonists. In the presence of ibuprofen to abolish SRC, PGE-2, sulprostone, misoprostol, PGF-2α and U-46619 (thromboxane mimetic) caused rhythmic contractions that mimicked SRC. Fluorescence immunohistochemistry coupled with confocal laser scanning microscopy revealed that c-Kit and vimentin co-localized to interstitial cells surrounding detrusor smooth muscle bundles, indicating the presence of extensive ICCs in rabbit bladder. Co-localization of COX-1 and vimentin, and COX-2 and vimentin by ICCs supports the hypothesis that ICCs were the predominant cell type in rabbit bladder expressing both COX isoforms. These data together suggest that ICCs appear to be an important source of prostaglandins that likely play a role in regulation of SRC. Additional studies on prostaglandin-dependent SRC may generate opportunities for the application of novel treatments for disorders leading to overactive bladder.
Collapse
Affiliation(s)
- Clinton Collins
- Department of Surgery, Urology Division, Virginia Commonwealth University School of Medicine, VA 23298-0614, USA
| | | | | | | | | | | | | |
Collapse
|
11
|
Abstract
OBJECTIVE Pain management following bladder surgery in children is often complicated by bladder spasm. The overall severity of spasm can be reduced with opioids, anticholinergic medication and sedatives, although breakthrough spasms often occur. At the Royal Children's Hospital, Melbourne, intravesical bupivacaine has been used to manage postoperative bladder spasm to good effect. The administration of intravesical bupivacaine is analysed in this prospective audit of locally applied intravesical anaesthetic and compared with other methods. METHOD From February to August 2003, histories of 58 patients who had intravesical bupivacaine were studied and compared with six other methods of management of postoperative bladder spasm. CONCLUSION Data showed that epidural anaesthesia was the most effective treatment of pain, with a pain score reduction of 6.6, compared with a reduction of 6.1 with intravesical bupivacaine, and 4.5 using intravenous morphine. However, intravesical bupivacaine was the most effective method for the relief of bladder spasm.
Collapse
Affiliation(s)
- D Chiang
- Paediatric Urology Unit, Sunshine Hospital, and Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | | | | | | |
Collapse
|
12
|
Affiliation(s)
- Brian J Anderson
- Department of Anaesthesiology, University of Auckland School of Medicine, Auckland, New Zealand.
| |
Collapse
|
13
|
Abstract
The primary aim of this study was to prospectively investigate whether there was an association between the duration of post-operative catheterisation and the incidence of bladder spasm in children following ureteric reimplantation surgery. A secondary aim was to investigate whether other surgical and post-operative factors had an effect on the incidence of bladder spasm.
Collapse
Affiliation(s)
- D Gillies
- School of Nursing, Family and Community Health, University of Western Sydney, Locked Bag 1797, NSW 1797, Penrith South DC, Australia.
| | | | | | | |
Collapse
|
14
|
Abstract
Pain is a common symptom after surgery in children, and the need for effective pain management is obvious. For example, after myringotomy, despite the brief nature of the procedure, at least one-half of children have significant pain. After more extended surgery, such as tonsillectomy, almost all children have considerable pain longer than 7 days. Nonsteroidal anti-inflammatory drugs (NSAIDs) are useful for postoperative pain management because surgery causes both pain and inflammation. Several pediatric studies indicate NSAIDs are effective analgesics in the management of mild and moderate pain. In the treatment of severe pain, NSAIDs should be given with acetaminophen (paracetamol) or opioids, and the use of an appropriate regional analgesic technique should be considered. NSAIDs are more effective in preventing pain than in the relief of established pain. Pain following surgery is best managed by providing medication on a regular basis, preventing the pain from recurring. This proactive approach should be implemented for any procedure where postoperative pain is the likely outcome. In children, the choice of formulation can be more important than the choice of drug. Intravenous administration is preferred for children with an intravenous line in place; thereafter mixtures and small tablets are feasible options. Children dislike suppositories, and intramuscular administration should not be used in nonsedated children. Ibuprofen, diclofenac, ketoprofen and ketorolac are the most extensively evaluated NSAIDs in children. Only a few trials have compared different NSAIDs, but no major differences in the analgesic action are expected when appropriate doses of each drug are used. Whether NSAIDs differ in the incidence and severity of adverse effects is open to discussion. Because NSAIDs prevent platelet aggregation they may increase bleeding. A few studies indicate that ketorolac may increase bleeding more so than other NSAIDs, but the evidence is conflicting. Severe adverse effects of NSAIDs in children are very rare, but it is important to know about adverse effects in order to recognize and treat them when they do occur. NSAIDs are contraindicated in patients in whom sensitivity reactions are precipitated by aspirin (acetylsalicylic acid) or other NSAIDs. They should be used with caution in children with liver dysfunction, impaired renal function, hypovolemia or hypotension, coagulation disorders, thrombocytopenia, or active bleeding from any cause. In contrast, it seems that most children with mild asthma may use NSAIDs.
Collapse
Affiliation(s)
- Hannu Kokki
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland.
| |
Collapse
|