The Journal of craniofacial surgery
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Randomized Controlled Trial Clinical Trial
Postoperative pain management using intravenous patient-controlled analgesia for pediatric patients.
Pain control is an important consideration after any surgical procedures. Especially in children, more attention and care are needed during the period of postoperative pain control, which must be both sufficiently safe and effective. In this respect, intravenous patient-controlled analgesia provides improved titration of analgesic drugs, thereby maintaining optimal analgesic status with few side effects. ⋯ The degree of analgesia was assessed every 4 hours until the second postoperative day. The intravenous patient-controlled analgesia group had significantly lower pain scores and took less time until they were able to walk to the bathroom, but as many side effects as the control group. We concluded that intravenous patient-controlled analgesia is safe and effective for pediatric patients who have moderate to severe pain after operations such as rib cartilage graft, iliac bone graft, and large flap surgeries.
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Bone grafting to augment skeletal healing has become one of the most common techniques in surgical practice. However, the morbidity and limited availability associated with autografts, and the potential for disease transmission, immunogenic response, and variable quality associated with allografts, have engendered a plethora of alternative materials. ⋯ This article reviews the structure and function of calcium sulfate as a synthetic bone void filler and speculates on its future surgical role. It is anticipated that this foundation will also help assist in the understanding of how other bone graft alternatives may operate.
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Comparative Study
The value of transcranial Doppler ultrasonography in craniosynostosis.
Some children with craniosynostosis demonstrate raised intracranial pressure (ICP), requiring surgical decompression. Conventional methods of measuring ICP in such children are invasive, expensive, and require expertise. Transcranial Doppler ultrasonography (TCD) is an alternative, useful means of assessing ICP qualitatively, and is noninvasive, inexpensive, and safe. ⋯ TCD evaluations were performed before and after surgery to determine the pulsatility index (PI), which is known to show close correlation with ICP. The three modalities--TCD, ICP, and CT--showed poor correlation with each other. However, the fall in the PI value after surgery, as determined by TCD, was shown to be clinically useful, with a rise in the PI value after surgery being an ominous sign.