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  • ISSN: 2333-6641
    Volume 6, Issue 2
    Review Article
    Laura Tyler Perryman*
    Background: Spinal cord stimulation (SCS) has been a time tested and cost-effective treatment to manage intractable chronic pain syndromes following spinal surgery, peripheral neuropathy, complex regional pain syndromes and others. However, the surgically implantable nature of all the components of SCS not only increases the surgical complications but the costs associated with the device also. Recent advancements in wireless technology appear to reduce these collateral burdens since the wireless device does not require an implantable pulse generator (IPG) or its connection cables.
    Material and results: A review of the available literature on traditional SCS (TSCS) and costs incurred, revealed that cost of a nonrechargeable battery was USD 13,150 (CSD 10,591; UK £ 7,243) in 2006 while a rechargeable battery had cost USD 20,858. Maintenance costs for the SCS equipment included a battery change every 4 years, on an average costing USD 3,539. IPG replacement involved expenses of CAD 5.071. A wireless device (Stimwave) is devoid of IPG costs and required 3-year maintenance costs of 1500 Euros only.
    Additionally, the wireless SCS (WSCS) is effective and without the complications of IPG which include pocket area pain, hematoma (in nearly 10% patients) and infection that accounts for 50% of infections following SCS implantation. Bench data had shown that a gluteal IPG location could produce nearly 9 cm of a thoracic lead displacement following spine motion in flexion, extension and rotation. Management of IPG complications costs additional health care budget, while with wireless SCS, this could be an avoidable expenditure. WSCS has been reported to be as effective as TSCS in patients with chronic pain following back surgery, herpes infection and complex regional pain syndrome in case illustrations.
    Conclusions: SCS has been an effective tool in chronic pain management. Traditional equipment includes an IPG cost between 13,000 and 20,000USD with a maintenance expense of 3,539 USD over 4 years (for battery change). On the other hand, wireless SCS had been reported to have nearly half of this maintenance cost for SCS therapy and without IPG costs and complications. Further clinical studies might indicate IPG expenditure as a redundant and unnecessary cost.
    Daniel Rodriguez*, Lady Alzate, Juan Camilo Gomez S, Federico Ocampo, and Alexander Trujillo
    Background: The optimal multimodal strategy for the management of postoperative pain in the pediatric population is still unknown; the use of regional blocks such as transverses abdominis block (TAP) in patients undergoing open appendectomy may reduce morphine requirements and increase the interval between boluses when using PCA.
    Objectives: To assess the effectiveness of TAP for the management of postoperative pain in the pediatric population who undergo open or laparoscopic appendectomy by comparing it to the use of placebo, exclusive systemic analgesia or wound infiltration. The secondary outcomes we asses were degree of patient satisfaction, nausea and postoperative and duration of hospitalization
    Selection Criteria: Randomized controlled clinical trials in patients younger than 18 years undergoing an open or urgent laparoscopic appendectomy under general anesthesia. The use of transversus abdominis plane block of the abdomen is compared to placebo, exclusive management with systemic analgesia or only wound infiltration.
    Data collection and analysis: Three reviewers independently assessed the trials to determine eligibility and risk of bias, then, data extraction was done.
    Main Results: Twenty-nine studies conducted until July 2017 was identified. Three of them were included and there were a total of 177 participants. Although not all included studies used the same measure for each outcome, the combination of the results of the three studies suggested that TAP blocks provide effective analgesia after appendectomy in the first two postoperative hours. In addition, when the surgical technique is open, the benefit extends up to 18 hours compared to standard opioid-based postoperative regimens, the consumption of opioids decreases and the time for the first dose increases.
    Research Article
    Ji Young Min, Jeong Rim Lee, Hye Mi Lee, Hyun Il Kim, and Hyo-Jin Byon*
    Objective: The dose of thiopental sodium for pediatric sedation has been determined mainly based on the patient’s weight. However, children’s demographic characteristics other than the weight can affect the sedative effect of thiopental sodium. The purpose of this study was to determine the demographic characteristics that affect the induction dose of thiopental sodium for pediatric sedation.
    Methods: We performed a retrospective chart review of children (<18 years of age) who underwent computed tomography/magnetic resonance imaging between January 2011 and August 2016 at a single tertiary medical center. We collected data on the demographics and the thiopental dose in children in whom sedation was successfully induced, without complications related to thiopental sodium. Regression analysis was performed to evaluate the relationship between the dose of thiopental sodium and the demographics.
    Ashraf S, Hassan Y*, Salmani UG, Ahmad GB, and Saleem B
    Introduction: Inhalational anaesthesia is the preferred technique of induction in the pediatric age group. Halothane with its negligible pungency and minimal effects on airway reactivity has been the cornerstone of pediatric inhalational induction despite its propensity to cause bradycardia, hypotension and arrhythmias. Sevoflurane with low blood gas solubility allows rapid induction and early emergence. Due to its pleasant odor, it is non-irritant to the airway which makes it an attractive alternative for inhalational induction in children.
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