Journal of pediatric surgery
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Surgical separation of the fused liver is extremely risky and sometimes life-threatening in conjoined twins because of the potential risks of hypovolemia and hemorrhagic shock. ⋯ Cotton tourniquets temporally and securely blocked the local blood supply to the narrow gap dissecting interface with minimal interference with the remaining segments, in addition to orienting the transection of the fused liver and minimizing blood loss from the liver dissection.
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The purpose of this article was to report surgical and pain management outcomes of the initial Nuss procedure experience at the Children's Hospital of Wisconsin (Milwaukee) and to place this experience in the context of the published literature. ⋯ The institution of the Nuss procedure provides a highly desired result with significant complication rates. The ideal approach would deliver this result with lower risk. A pain service-driven epidural administration of morphine or hydromorphone with local anesthetic provides excellent analgesia for patients after Nuss procedure. The success of epidural analgesia is independent of catheter site and adjunctive medications. Ketorolac was an effective breakthrough medication.