Journal Issue: No 3, Issue 11, JULY-SEPT, 2005
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Volume
Number
Issue Date
2005
Journal Title
Journal ISSN
1812-2027
Journal Volume
Articles
Analgesia after inguinal herniotomy in children: Combination of simplified (Single Puncture) ilioinguinal and iliohypogastric nerve blocks and wound infiltration vs. caudal block with 0.25% bupivacaine
(Kathmandu University, 2005) BK, Bhattarai; TR , Rahman; BP, Sah; UR, Tuladhar
Objective: To assess whether simplified ilioinguinal and iliohypogastric nerve block in combination with minimal
wound infiltration with local anaesthetic is better than caudal block with local anaesthetic alone in children
undergoing inguinal herniotomy for easy transition to safe oral analgesia. Subject and Methods: Sixty children of
both sexes undergoing herniotomy were allocated randomly to receive either simplified (single puncture)
ilioinguinal and iliohypogastric nerve block described by Dalens in combination with small volume wound
infiltration with 0.1ml/kg of 0.25% bupivacaine (Group I) or caudal block with 1 ml/kg of 0.25% bupivacaine
(Group II) at the end of surgery under general anaesthesia using halothane in oxygen and nitrous oxide mixture.
Duration of analgesia, complication associated, parents and children’s satisfaction were compared. Results: The
mean duration of analgesia was 253±102.6 minutes in group I as compared to 219.6±48.4 minutes in group II. Six
(20%) patients in group I and two (6.67%) patients in group II required parenteral analgesic. Complications and
parents and children’s satisfaction were comparable in both the groups. Conclusion: Simplified ilioinguinal and
iliohypogastric nerve blocks described by Dalens in combination with small volume local anaesthetic wound
infiltration with its longer mean duration of analgesia offers better safety margin to start oral analgesics than caudal
block with local anaesthetic alone in children undergoing herniotomy. Larger studies may further confirm the
findings.
Key words: Simplified ilioinguinal and iliohypogastric nerve blocks, wound infiltration, caudal block
Two faces of major lower limb amputations
(Kathmandu University, 2005) B, Paudel; BK, Shrestha; AK, Banskota
Objectives: To review the indications for major lower limb amputations in adults and children in our patient
population and to compare our experience in prosthetic rehabilitation with that of other published information.
Material and Methods: We retropectively reviewed charts of patients who underwent amputation between 1997
to 2004 at the Orthopaedic Department of B& B Hospital (BBH ) , Gwarko and Hospital and Rehabilitation center
for Disabled Children ( HRDC), Banepa. There were 113 patients at BBH & 89 patients at HRDC . Major
amputation was defined as any amputation at or proximal to wrist and ankle. Results: Major lower limb
amputations constituted 73.58 %(39/53) of all major amputations at BBH and 97.77% (44/45) at HRDC.Road traffic
accident was found to be number one cause for major lower limb amputations (74.29%) in adult population. In
children postburn contracture was the leading cause for amputation (29.54 %) folowed by Congenital limb
conditions (22.72%) ,Spina bifida with trophic ulcers ( 20.45 %), Tumor (13.63%), Chronic Osteomyelitis (6.81%),
Trauma (4.54%) and Arthrogryposis (2.27%). Prosthetic fitting and rehabilitation is as yet far from satisfactory in
the adult population but all the children who had amputation at HRDC were fitted with prosthesis. Conclusion:
Main causes of major lower limb amputation in both population is largely preventable by instituting safty measures
and conducting awareness program. There is a need for an effective prosthetic fitting center for adults.
Key Words: Major lower limb amputations, Prosthesis fitting
Variation of intraocular pressure in patients with leprosy
(Kathmandu University, 2005) SS, Javvadhi; H, Das; BP, Badhu; S, Agrawal
Introduction: There are various controversial reports on intraocular pressure (IOP) in patients with leprosy.
Purpose: The current study was undertaken to study the level of intraocular pressure in leprosy patients and its
association with the risk factors. Materials and methods: This was a prospective cross sectional comparative
study. An ophthalmologist and a dermatologist evaluated consecutive 93 patients with leprosy. The risk factors
studied were age, gender, bacillary index, clinical diagnosis, duration of disease and treatment; and ocular
complications. The IOP in these patients was compared with healthy age and sex matched controls. Results: A total
of 186 leprosy patients (93) and healthy controls (93) were studied. The mean applanation IOP for the right and left
eyes in leprosy patients was 12.87 ± 1.20 mm of Hg and 13.22±2.70 mm of Hg respectively. This was found to be
significantly lesser (p<0.001) than in the controls (RE=15.14±2.58 and LE=15.41±2.36mmHg). The untreated
leprosy patients had significantly lower IOP than those with treatment (p<0.001). None of the risk factors were
found to be independently associated with the decrease in IOP. The duration of treatment, however, showed a trend
towards having a significant association (p=0.057) with the lower level of IOP. Conclusion: The level of IOP is
lower in leprosy patients than in the healthy controls. Age, gender, bacillary index and presence of ocular
complications due to leprosy are not independently associated with the decrease in IOP. The untreated leprosy
patient tends to have a lower IOP. This finding can be used to monitor effectiveness of treatment of leprosy.
Key words: Leprosy and intraocular pressure