Meckel's Diverticulum with Small Bowel Obstruction Presenting as Appendicitis in a Pediatric Patient

The authors suggest that the small bowel be assessed in all appendectomy cases for a pathological Meckel's diverticulum

Preemptive Analgesia for Pediatric Peritoneoscopy, Comparing Caudal Block and Acetaminophen

Background and Purpose: Although caudal block and acetaminophen have shown efficacy in postoperative pediatric pain management, they have not been compared in efficacy following peritoneoscopy. Patients and Methods: The study population were ASA I or II children from 55 weeks postconceptual age to 10 years of age having peritoneoscopy. They were randomly assigned to preoperative caudal block using bupivacaine 0.6 mL/kg or preoperative rectal acetaminophen 30 mg/kg, with each group receiving acetaminophen 20 mg/kg per 6 hours for four doses. A blinded observer using the Objective Pain Scale assessed the children on awakening, in the PACU, and at discharge. A phone survey of satisfaction occurred on day 1. Acetaminophen was used in 18 patients, and 14 had a caudal block. Results: The initial PACU score was 4.1 ± 3.1 for acetaminophen and 2.3 ± 3.0 for caudal block (P = 0.03). Fifty-six percent of the acetaminophen group needed added narcotic, whereas only 22% of those with caudal block did (P = 0.02). Forty three percent of the acetaminophen group had nausea compared with 11% of the caudal block group (P = 0.023). There was no difference in satisfaction or in parental perception of pain control at home. Conclusion: Our results suggest that pediatric patients undergoing inguinal procedures received better pain control from caudal blocks and experienced less nausea than from high-dose acetaminophen suppositories. Our results support the use of a caudal block for postoperative pain control for pediatric inguinal operations with peritoneoscopy.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63289/1/10926410252832384.pd