Epidural Analgesia Decreases Narcotic Requirements in Low Level Spina Bifida Patients Undergoing Urologic Laparotomy for Neurogenic Bladder and Bowel

Purpose Concern of anatomical anomalies and worsening neurologic symptoms has prevented widespread use of epidural catheters in patients with low level spina bifida (LLSB). We hypothesize that thoracic epidural placement in the T9-T10 interspace is safe and decreases narcotic requirements in LLSB patients following major open lower urinary tract reconstruction (LUTR). Materials and Methods We reviewed consecutive LLSB patients who had LUTR and epidurals for post-operative pain control. Controls were LLSB patients who received single shot transversus abdominis plane (TAP) blocks with similar procedures. Complications from epidural placement, including changes in motor and sensory status were recorded. Opioid consumption was calculated utilizing equivalent IV morphine doses. Mean and maximum pain scores on post-operative day (POD) 0-3 were calculated. Results 10 LLSB patients who had lower urinary tract reconstruction and epidurals were matched to 10 LLSB patients who had lower urinary tract reconstruction and transverse abdominis plane blocks. Groups were demographically similar. All had full abdominal sensation and functional levels at or below L3. No epidural complications or changes in neurological status were noted. The epidural group had decreased opioid consumption on POD 0-3 (0.75 mg/kg vs. 1.29 mg/kg, p=0.04). Pain scores were similar or improved in the epidural group. Conclusions Thoracic epidural analgesia appears to be a safe and effective opioid sparing option to assist with post-operative pain management following lower urinary tract reconstruction in LLSB patients

Truck Route Access Evaluation: Paradise Power Plant, Muhlenberg County, Site #1113

The Freight Movement and Intermodal Access in Kentucky Study (SPR 98-189) is being conducted on behalf of the Kentucky Transportation Cabinet (KYTC). There are two major objectives of the study: evaluation of the access for trucks between intermodal or other truck generating sites and the National Highway System (NHS); and furthering the understanding of freight commodity flows throughout the state. This report summarizes the access evaluation for The Paradise Power Plant facility located in Muhlenberg County in the Pennyrile Area Development District (ADD) and KYTC Highway District # 2. The location of the site is shown in Figure 1. Work on other specific sites as well as the freight commodity flow task are on-going and are documented elsewhere. The sites to be evaluated were selected from two existing databases ( a truck facility survey from 1994 and the intermodal facility inventory) based on ADD and KYTC Highway District planner recommendations, geographic location, distance to the national highway system, and the number of trucks accessing the site. Consideration was also made for the freight type handled and transportation modes used. The Paradise Power Plant was recommended by Highway District #2. The site was visited two times for data collection and video recording as listed in Appendix A. The major facility in the area is the power plant. Reed Materials is located along KY 176 near Drakesboro. The surrounding area is generally rural. A phone survey of the facility manager was conducted early in the study process, and it showed about 120 trucks per day accessing the Paradise Power Plant. However, a 24-hour traffic count taken in August 1998 by KYTC recorded 437 trucks on KY 136 so this volume was used. The total traffic volume was 1,943 giving 22.5 percent trucks. The site trucks are generally semi tractor trailers which were five axle coal trucks with a 32-foot trailer. The largest trucks are six axle lowboys. The phone survey information can be found in Appendix B

Truck Route Access Evaluation: Edmonson County, From Western Kentucky Parkway to I-65

There are two main objectives of the Freight Movement and Intermodal Access in Kentucky Study (SPR 98-189) that is being undertaken by the Kentucky Transportation Center for the Kentucky Transportation Cabinet (KYTC): 1) evaluation of the access for trucks between intermodal or other truck generating sites and the National Highway System (NHS); and 2) furthering the understanding of freight commodity flows throughout the state. This report is slightly different from the others that summarize the access evaluation to a particular cluster of existing facilities. This route provides access to Edmonson county from the Western Kentucky Parkway (in Grayson county) and from I-65 (in Warren county) as shown on Figure 1. This route is not currently used by many trucks. Edmonson county was recommended for study by the Division of Transportation Planning of the KYTC due to the lack of 102 inch wide truck access. There is also a gross weight limit of 62,000 lbs on the entire route. The route is located in the Barren River Area Development District and is in KYTC Highway District #3. Work on other specific sites as well as the freight commodity flow task of SPR 98-189 are on-going and are documented elsewhere. Most of the sites to be evaluated in this project were selected from two existing databases (a truck facility survey from 1994 and the intermodal facility inventory) based on ADD and KYTC planner recommendations, geographic location, distance to the National Highway System, and the number of trucks accessing the site. Consideration was also made for the freight type handled and transportation modes used. As indicated above these issues were not considered here as the county was recommended for study based on the lack of truck access. The site was visited several times for data collection and video recording as listed in Appendix A. No facilities that might currently generate significant truck traffic were observed. Large numbers of trucks were noted near the interchange with I-65 due to truck stops. The access to these sites was deemed good. The area surrounding the route is generally rural although it travels through several small towns and also Brownsville which is a larger community. The phone survey which was conducted for other truck routes under evaluation was not conducted here due to the lack of current facilities. In the other cases studied during this project, the largest truck currently using the route was considered for evaluation of features such as off-tracking, grade, and turning radii. In this case, these trucks do not necessarily use this route, but access for a 48 foot tracker trailer was evaluated

Truck Route Access Evaluation: Madison County Industrial Park, Off US 25 South of Richmond, Site #2678

There are two main objectives of the Freight Movement and Intermodal Access in Kentucky Study (SPR 98-189) undertaken by the Kentucky Transportation Center for the Kentucky Transportation Cabinet: evaluation of the access for trucks between intermodal or other truck generating sites and the National Highway System (NHS); and furthering the understanding of freight commodity flows throughout the state. This report summarizes the access evaluation for one cluster of facilities located in Madison county in the Bluegrass Area Development District (ADD) and KYTC Highway District #7. The location of the site is shown in Figure 1. Work on other specific sites as well as the freight commodity flow task are on-going and are documented elsewhere. The sites to be evaluated were selected from two existing databases (a truck facility survey from 1994 and the intermodal facility inventory) based on ADD and KYTC Highway District planner recommendations, geographic location, distance to the national highway system, and the number of trucks accessing the site. Consideration was also made for the freight type handled and transportation modes used. This industrial park located along Duncannon Road in Madison county was recommended for study by the Bluegrass ADD planners. The site was visited several times for data collection and video recording as listed in Appendix A. The following facilities are located in the area: American Tape, Precision Tube, South Park Tool and Die, Mikron Industries, PK Tool, Ajax Magnathermic, and Concrete Materials Inc. Some of these facilities are located south off Duncannon Road, approximately 0.2 miles from US 25 on Industry Road, while others are located on Enterprise Drive 0.7 miles from US 25. Approximate locations are shown in Figure 2. The surrounding area is generally rural. The phone survey found approximately 208 trucks per day accessing these clustered sites, while KYTC data indicates only 389 trucks per day travel along US 25. The site trucks are generally semi tractor trailers with a maximum length of 53 feet. A phone survey with facility managers was conducted early in the study process (results are shown in Appendix B)

Truck Route Access Evaluation: Cook Family Foods, Grayson, Site #2663

This is a study undertaken on behalf of the Kentucky Transportation Cabinet (KYTC). There are two main objectives of the Freight Movement and Intermodal Access in Kentucky Study (SPR 98-189): evaluation of the access for trucks between intermodal or other truck generating sites and the National Highway System (NHS); and furthering the understanding of freight commodity flows throughout the state. This report summarizes the access evaluation for the Cook Family Foods facility located in Carter county in the FIVCO Area Development District (ADD) and KYTC Highway District #9. The location of the site is shown in Figure 1. Work on other specific sites as well as the freight commodity flow task are on-going and are documented elsewhere. The sites to be evaluated in .this study were selected from two existing databases (a truck facility survey from 1994 and the intermodal facility inventory) based on ADD and KYTC Highway District planner recommendations, geographic location, distance to the NHS, and the number of trucks accessing the site. Consideration was also made for the freight type handled and transportation modes used. The site was visited for video recording and data collection as listed in Appendix A. The facility is located at the end of CW Stevens Boulevard approximately 0.5 miles east of KY 1/KY 7, which is part of the National Highway System. The surrounding area is currently being developed. A phone survey was conducted with facility managers early in the study process. The phone survey found that approximately 50 trucks per day access the site. The trucks are generally semi tractor trailers with a maximum length of 53 feet. The freight handled at this facility is primarily meat products. The survey indicated that the traffic signal at the intersection of CW Stevens Boulevard and KY 1/KY 7 is slow, and that the exit ramp from I-64 eastbound does not have a traffic signal. The phone survey information can be found in Appendix B

Truck Route Access Evaluation: Bells Lane Cluster, Louisville, Site #7

This is a study undertaken on behalf of the Kentucky Transportation Cabinet (KYTC). There are two main objectives of the Freight Movement and Intermodal Access in Kentucky Study (SPR 98-189): evaluation of the access for trucks between intermodal or other truck generating sites and the National Highway System (NHS); and furthering the understanding of freight commodity flows throughout the state. This report summarizes the access evaluation for a cluster of facilities located along Bells Lane and Algonquin Parkway in Louisville in the KIPDA Area Development District (ADD) and KYTC Highway District #5. The location of the site is shown in Figure 1. Work on other specific sites as well as the freight commodity flow task are on-going and are documented elsewhere. The sites to be evaluated in this study were selected from two existing databases (a truck facility survey from 1994 and the intermodal facility inventory) based on ADD and KYTC Highway District planner recommendations, geographic location, distance to the NHS, and the number of trucks accessing the site. Consideration was also made for the freight type handled and transportation modes used. The site was visited for video recording and data collection as listed in Appendix A. The following facilities are located in the area: Ashland Petroleum, BP Oil, Carbide/Graphite Group Wharf, IT APCO Wharf, Thoroughbred Containers, Castro! Reprocessing, Miller Oil, BF Goodrich, Matlack, BASF, and Zeon Chemicals. Ashland Petroleum, BP Oil, and Thoroughbred Containers are on Algonquin Parkway, and the other facilities are located along Bells Lane as shown in Figure 1. All facilities are within one mile of I-264, which is part of the National Highway System. The surrounding area is generally urban with industrial and residential land uses. A phone survey was conducted with facility managers early in the study process. While the overall response from industries was very good, in some cases facility managers could not be contacted or did not want to assist with the survey. In order to stay within the resources available for the project not all smaller facilities with lower truck volumes could be contacted. The phone survey found that the number of trucks per day at specific sites varies from less than 10 to 125. The most common trucks indicted were semitrailer tankers, and the largest truck indicated had a length of 53 feet. Surveys with facilities on Algonquin Parkway indicated problems with rough railroad crossings and poor conditions on 41st Street. Problems at the interchange included a blind spot on the eastbound off ramp and limited sight distance on the westbound off ramp. It was also noted that the railroad crossings on Bells Lane were occasionally blocked for up to 30 minutes at a time. The phone survey information is found in Appendix B

Truck Route Access Evaluation: Hopkinsville Industrial Park, Off US 41 South of Hopkinsville, Site #41

The Freight Movement and Intermodal Access in Kentucky Study (SPR 98-189) is being conducted on behalf of the Kentucky Transportation Cabinet (KYTC). There are two major objectives of the study: evaluation of the access for trucks between intermodal or other truck generating sites and the National Highway System (NHS); and furthering the understanding of freight commodity flows throughout the state. This report summarizes the access evaluation for one cluster of facilities located in Christian County in the Pennyrile Area Development District (ADD) and KYTC Highway District# 2. The location of the site is shown in Figure I. Work on other specific sites and the freight commodity flow task are on-going and are reported elsewhere

Truck Route Access Evaluation: Bath County Industrial Site, Off of Kendall Springs Road Southwest of Owingsville, Site #26

The Freight Movement and Intermodal Access in Kentucky Study (SPR 98-189), undertaken by the Kentucky Transportation Center (KTC) on behalf of the Kentucky Transportation Cabinet (KYTC), has two main objectives. These objectives include 1) the evaluation of access for trucks between intermodal or other truck generating sites and the National Highway System (NHS) and 2) furthering the understanding of freight commodity flows throughout the state. This report summarizes the access evaluation for one cluster of facilities located in Bath County in the Gateway Area Development District (ADD) and KYTC Highway District #9. The location of the site is shown in Figure 1. Work on other specific sites as well as the freight commodity flow task are on-going and are documented elsewhere. The sites to be evaluated were selected from two existing databases (a truck facility survey from 1994 and the intermodal facility inventory) based on ADD and KYTC Highway District planner recommendations, geographic location, distance to the National Highway System, and the number of trucks accessing the site. Consideration was also made for the freight type handled and transportation modes used. The site was visited several times for data collection and video recordings as listed in Appendix A. The following facilities are located in the area: Donotech, Custom Foods, and Bath Manufacturing. All facilities are located off of Kendall Springs Road, on Donotech Drive, Darnell Drive, and Bath Mfg. Drive. Figures 2 and 3 show the relative location of the facilities found at this site (note that Bath Manufacturing was not yet completed). Phone surveys completed on the facilities indicate that only moderate truck traffic from these facilities travel on Kendall Springs Road. Approximately 15 trucks per day are placed on the route due to the operations of this site

Truck Route Access Evaluation: Campground Road Cluster, Louisville, Site #8

This is a study undertaken on behalf of the Kentucky Transportation Cabinet (KYTC). There are two main objectives of the Freight Movement and Intermodal Access in Kentucky Study (SPR 98-189): evaluation of the access for trucks between intermodal or other truck generating sites and the National Highway System (NHS); and furthering the understanding of freight commodity flows throughout the state. This report summarizes the access evaluation for a cluster of facilities located along Campground Road in Louisville in the KIPDA Area Development District (ADD) and KYTC Highway District #5. The location of the site is shown in Figure 1. Work on other specific sites as well as the freight commodity flow task are on-going and are documented elsewhere. The sites to be evaluated in this study were selected from two existing databases (a truck facility survey from 1994 and the intermodal facility inventory) based on ADD and KYTC Highway District planner recommendations, geographic location, distance to the NHS, and the number of trucks accessing the site. Consideration was also made for the freight type handled and transportation modes used. The site was visited for video recording and data collection as listed in Appendix A. The following facilities are located in the area: CITGO Petroleum, Marathon Petroleum, Borden Chemical Division, American Synthetic Rubber Corporation, Rohm & Hass, Clean Harbor, R&L Carriers and Dupont. The Clean Harbor facility is on Kramers Lane, and the others are located along Campground Road as shown in Figure 1. All facilities are less than three miles from Interstate 264, which is part of the National Highway System. The surrounding area is generally urban/suburban with a variety of land uses. A phone survey was conducted with facility managers early in the study process. The surveys were conducted only with industries in the pre-existing intermodal or truck databases or the major industries observed during the sites visits. While the overall response from industries was very good, in some cases facility managers could not be contacted or did not want to assist with the survey. In order to stay within the resources available for the project not all smaller facilities with lower truck volumes could be contacted. The surveys for this site were conducted with CITGO Petroleum and Marathon Petroleum. The number of trucks per day at specific sites varies from 25 to 200. The most common trucks indicted were 9,000 gallon tankers. Problems indicated along the route include potholes and inadequate turning radius from Kramers Lane onto Campground Road. The phone survey information can be found in Appendix B

Truck Route Access Evaluation: Central Kentucky Asphalt, Off of KY 1723, Site #2634

The Freight Movement and Intermodal Access in Kentucky Study (SPR 98-189), undertaken by the Kentucky Transportation Center (KTC) on behalf of the Kentucky Transportation Cabinet (KYTC), has two main objectives. These objectives include 1) the evaluation of access for trucks between intermodal or other truck generating sites and the National Highway System (NHS) and 2) furthering the understanding of freight commodity flows throughout the state. This report summarizes the access evaluation for one facility located in Fayette County in the Bluegrass Area Development District (ADD) and KYTC Highway District #7. The location of the site is shown in Figure 1. Work on other specific sites as well as the freight commodity flow task are on-going and are documented elsewhere. The sites to be evaluated were selected from two existing databases (a truck facility survey from 1994 and the intermodal facility inventory) based on ADD and KYTC planner recommendations, geographic location, distance to the NHS, and the number of trucks accessing the site. Consideration was also made for the freight type handled and transportation modes used. The site was visited several times for data collection and video recordings as listed in Appendix A. The facility for study was Central Kentucky Asphalt, and the initial trip to the site revealed that there were no other significant sources of truck traffic in the vicinity. Early into the study process, phone surveys were conducted so that facility managers could provide insight into potential access-limiting issues. The phone survey completed on the facility, which is located in Appendix B, found that approximately 60 trucks per day (120 one-way trips) are accessing the facility