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Query: UMLS:C0027497 (nausea)
 23,468 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Intrathecal morphine in an average dose of 0.01 mg/kg was given to 33 patients between ages 11 and 16 years who had spinal arthrodesis for idiopathic scoliosis. The morphine was administered intrathecally as a 10 cc bolus at the conclusion of the arthrodesis, but before closure. The goal was to study safety in terms of respiratory depression and pain relief. Respirations occurred spontaneously in 30 of the 33 patients within 15 minutes of cessation of anesthesia. Respiratory depression occurred in five patients, four of whom had arterial blood pCO2 levels greater than 60 mm Hg. Thirty-one patients had relief of pain for 8 to greater than 40 hours, averaging 18 hours. Two patients had no noticeable pain relief. There appeared to be no relation between dose and pain relief in this limited dose range. We were unable to duplicate the long duration of pain relief reported elsewhere. We also were unable to decrease the side effects of respiratory depression and nausea to a level reported by others. It may be that the 10 cc bolus injected intrathecally circulates to the brain and ventricles faster than desired, or that factors relating to type of anesthesia or dose need to be considered. Low-dose intrathecal morphine does provide noticeable pain relief in younger patients undergoing spinal fusion. The side effects of nausea and respiratory depression can be managed safely with medication.
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PMID:Intrathecal morphine in younger patients for postoperative pain following spinal fusion. 192 2

Intrathecal morphine in an average dose of 0.01 mg/kg was given to 33 patients between ages 11 and 16 years who had spinal arthrodesis for idiopathic scoliosis. The morphine was administered intrathecally as a 10-cc bolus at the conclusion of the arthrodesis, but before closure. The goal was to study safety in terms of respiratory depression and pain relief. Respirations occurred spontaneously in 30 of the 33 patients within 15 minutes of cessation of anesthesia. Respiratory depression occurred in five patients, four of whom had arterial blood pCO2 levels greater than 60 mm Hg. Thirty-one patients had relief of pain for 8 to greater than 40 hours, averaging 18 hours. Two patients had no noticeable pain relief. There appeared to be no relation between dose and pain relief in this limited dose range. We were unable to duplicate the long duration of pain relief reported elsewhere. We also were unable to decrease the side effects of respiratory depression and nausea to a level reported by others. It may be that the 10 cc bolus injected intrathecally circulates to the brain and ventricles faster than desired, or that factors relating to type of anesthesia or dose need to be considered. Low-dose intrathecal morphine does provide noticeable pain relief in younger patients undergoing spinal fusion. The side effects of nausea and respiratory depression can be managed safely with medication.
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PMID:Intrathecal morphine: dosage and efficacy in younger patients for control of postoperative pain following spinal fusion. 206 32

The aim of this study was to assess the efficacy of epidural morphine plus bupivacaine for post-operative pain control following Harrington rod insertion. In 22 scoliotic patients, studied prospectively, the epidural catheter was positioned under direct vision, intra-operatively before wound closure. Post-operatively, the patients received 2 mg morphine in 4 ml of 0.25% bupivacaine through the epidural catheter whenever they complained of pain. The pain score was assessed before and after every injection, using the Visual Analogue Pain Scale, and side-effects were monitored. All patients had adequate pain relief following analgesic administration. The mean (+/- SD) pre-injection pain score decreased from 2.5 +/- 0.15 on the first post-operative day to 0.7 +/- 0.2 by the fourth day. The side-effects, including nausea, vomiting and pruritus, were minimal. It is concluded that morphine, in 0.25% bupivacaine administered through an intra-operatively placed epidural catheter, provides a safe and effective post-operative analgesia in patients undergoing Harrington rod insertion for idiopathic scoliosis.
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PMID:Epidural morphine plus bupivacaine for relief of post-operative pain following Harrington rod insertion for correction of idiopathic scoliosis. 764 46

Scoliosis is a common complication in children with cerebral palsy (CP). In these patients, surgical correction carries a high risk of complications. CP is also associated with gastrointestinal dysmotility such as delayed gastric emptying and gastro-oesophageal reflux. We describe 5 patients with CP in whom symptoms of gastric dysmotility clearly exacerbated after orthopaedic scoliosis surgery. They all showed persisting vomiting, nausea, bloating, weight loss, and anorexia necessitating total parental nutrition and/or jejunal feeding. This intensified nutritional support resulted in weight gain. Symptoms, however, persisted in half of the patients. The aetiology of these gastro-intestinal motility problems following scoliosis surgery remains unclear. Mechanical obstruction needs to be ruled out. Delayed gastric emptying may be due to postprandial antral hypomotility as a consequence of sympathic stimulation. Malnutrition could further aggravate gastrointestinal dysmotility. This complication should be taken into account when surgery for spinal deformities in CP patients is planned, especially in patients with pre-existing gastrointestinal motility problems.
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PMID:Gastric dysmotility following orthopaedic scoliosis surgery in patients with cerebral palsy: a case series. 2108 23

Corrective surgery for scoliosis is an extensive procedure with well-known problems of postoperative pain control. Additional problems with nausea, vomiting, ileus, and sedation can result in delayed mobilization and a prolonged inpatient hospital stay. At our institution, a multimodal approach to pain management has been used to successfully address these issues. The use of intravenous acetaminophen has been a helpful adjunct to our armamentarium of pain medication in this patient population. We present an illustrative case of our use of multimodal analgesia beginning intraoperatively and continuing during the acute inpatient postoperative period.
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PMID:Multimodal pain management after spinal surgery for adolescent idiopathic scoliosis. 2337 74

This article reports a study of adolescents' narrated experiences of undergoing scoliosis surgery. Six adolescents were interviewed. Open and semistructured questions were asked, and a qualitative content analysis of the text was performed. The results are presented in three main categories followed by subcategories. The three main categories of experience were emotional, physical, and social. The emotional aspects that emerged were fear, nightmares, nervousness, and helplessness. These had a great impact on adolescents' well-being before, during, and after the hospital visit. The physical aspects were mobilization, scars, different hip levels, pain, nausea, appetite, and urinary catheter. These aspects caused much discomfort, mostly during the hospital visit. The social aspects were friends, power, coaching and comfort, and sports. Some of the social aspects had a strong negative impact on the adolescents' well-being mostly after the hospital visit. This study suggests that both before and long after the surgery adolescents have strong emotions that they should be better prepared and helped to manage. To optimize perioperative care an interdisciplinary, a holistic approach must be taken that incorporates the complexity and whole of the adolescent's experiences. The findings of this study suggest that perioperative care of adolescents during scoliosis surgery needs to be optimized. To improve patients' psychologic preparation before surgery pediatric nurses should learn more about the individual patient and make care plans from a holistic perspective. Follow-up after discharge should address emotional, social, and physical aspects of the adolescent's health.
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PMID:Adolescents' experience with scoliosis surgery: a qualitative study. 2345 27

We present the case of a 12-year-old girl who underwent an uncomplicated posterior spinal fusion with instrumentation for scoliosis and who later developed nausea, emesis, and abdominal pain. We discuss the epidemiology, prevalence, anatomic findings, symptoms, diagnostic tests, and clinical management, including nonsurgical and surgical therapies, of superior mesenteric artery syndrome (SMAS), a rare condition. Over a 2-week period, the patient developed an uncommon type of bowel obstruction likely related to her initial thin body habitus, correction of her deformity, and weight loss after surgery. The patient returned to the operating room for placement of a Stamm gastrostomy feeding tube with insertion of a transgastric-jejunal (G-J) feeding tube. The patient had the G-J feeding tube in place for approximately 6 weeks to augment her enteral nutrition. As she gained weight, her duodenal emptying improved, and she gradually transitioned to normal oral intake. She has done well since the G-J feeding tube was removed. Posterior spinal fusion for adolescent idiopathic scoliosis is a relatively common procedure, and SMAS is a rare condition. However, in the case of an asthenic adolescent with postoperative weight loss, intestinal obstruction can develop. When planning operative spinal correction in scoliosis patients who have a low body mass index at the time of surgery and who have increased thoracic stiffness, be alert for signs and symptoms of SMAS. This rare complication can develop, and timely diagnosis and medical management will decrease morbidity and shorten the length of time needed for nutritional rehabilitation.
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PMID:A Rare Cause of Postoperative Abdominal Pain in a Spinal Fusion Patient. 2637 64

Droperidol is a D2 receptor antagonist currently used in Europe for preventing postoperative nausea and vomiting. It was used to perform neurolept anaesthesia in combination with fentanyl until a Food and Drug Administration (FDA) 'black box' warning restricted its use due to cardiovascular side effects in 2001. There is no literature regarding the effects of droperidol on transcranial motor evoked potentials (TcMEPs) elicited by electrical stimulation. Our aim was to report two cases of spine surgery in which TcMEPs were lost due to droperidol administration. We report the cases of a 4-year-old male with scoliosis undergoing correction and a 58-year-old woman with metastasis on the D8 vertebrae undergoing kyphosis correction. Intraoperative neurophysiological monitoring was achieved through TcMEPs and somatosensory evoked potentials (SEPs). Intraoperative neurophysiological monitoring (IONM) showed a temporal loss of TcMEPs without SEPs changes coinciding with the administration of droperidol. TcMEP stimulation parameters were changed to double train of pulses, with the aim to elicit them, obtaining responses. Five minutes after droperidol administration, TcMEPs were equal to those at baseline. Droperidol used as prophylaxis for postoperative nausea abolishes TcMEPs. Changing stimulation parameters to double train of pulses, it allows to bypass droperidol central action, achieving monitorable TcMEPs.
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PMID:What Can We Learn From Two Consecutive Cases? Droperidol May Abolish TcMEPs. 2837 41

Superior mesenteric artery (SMA) syndrome is a rare and potentially life-threatening complication of scoliosis surgery. The anatomical relationship of the duodenum and the superior mesenteric artery, the correction of angular deformity of the spine, and the normal adolescent growth spurt all contribute to the condition. We report the case of a 14-year-old boy who had a history of idiopathic scoliosis and presented with bilious vomiting that had persisted for 7 days after posterior T9-L4 fusion with instrumentation. After an unremarkable immediate postoperative course, on postoperative day 19 the patient presented to the emergency department with abdominal pain, nausea, and vomiting. Unrelenting brown vomitus, abdominal pain, and a 20-lb weight loss were noted. A series of upper gastrointestinal radiographs confirmed a diagnosis of SMA syndrome. A nasojejunal tube was placed, and nutritional rehabilitation was optimized. We highlight this case for its rarity and emphasize the importance of maintaining a high index of suspicion when evaluating a child who has had spinal deformity correction and presents with postoperative gastrointestinal complaints. Early recognition of the nonspecific symptoms of abdominal pain, abdominal distension, bilious or projectile vomiting, hypoactive bowel sounds, and anorexia plays a key role in post-scoliosis surgery and is crucial in preventing the severe morbidity and mortality associated with SMA syndrome.
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PMID:Superior Mesenteric Artery Syndrome as a Complication of Scoliosis Surgery. 2843 98

Appendicitis is a common cause of pediatric abdominal pain, largely occurring in the second decade of life. We present the case of a 14-year-old girl who underwent an uncomplicated posterior spinal fusion with instrumentation for scoliosis, who later developed abdominal pain, nausea, and emesis secondary to acute appendicitis. Her hospital course was significant for prolonged intravenous use of narcotics for pain control and subsequent constipation but negative for abdominal pain or tenderness during her admission. While gastrointestinal complications are a common cause of unplanned 30-day readmissions in the pediatric population, appendicitis has yet to be reported. To our knowledge, this is the first case report of acute appendicitis after posterior spinal fusion, likely resulting from postoperative pain management.
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PMID:Acute Appendicitis After Spine Fusion for Adolescent Idiopathic Scoliosis: A Case Report. 3064 57


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