Trial of three methods of intraoperative bupivacaine analgesia for pain after paediatric groin surgeryPurpose: To evaluate the relative effectiveness of three techniques of resional anaesthesia in the provision of postoperative analgesia in children. M~d~o~: Random assignment was made of 183 children scheduled for ~in surgery to one of three groups. Bupivacaine 0.5% plain (2 mg.kg -I) was injected by the surgeon a~er skin indsion. Group A received wound infilt~-tion. Group B had r~ional nerve blcx:kade. Group C had a combination of ~ ~. Postoperatively, pain was assessed using the CHEOPS behaviouraJ scale at half hourly intervals until dischar~ home. Satisfactory pain control was arbitrarily defined as a CHEOPS score of ~six. Potential differences among the groups were sought using graphical representation of mean pain scores, the frequendes of maximum pain scores, and the incidence of postoperative vomiting and oral analgesic consumption. ]R~ulll~: Rfteen patients had to be exduded from analysis. This let~ 61 patients in Group/k 55 in Group B, and 52 in Group C. There were no demographic differences among the groups. No differences were demonstrated amc~ the groups either in CHEOPS pain scores at any observation point (P = >0.8), or in the incidence of vomiting or need for postoperative analgesi~ (P = 0.52 and P = 0.41 respectively). Overall, 8096 of the observations made (I 135/I 425) met our definition of satisfactory pain control. A post hoc calculation of the power of the study confirmed suf~dent power to detect a 5% difference among groups. Conclusion: All three methods achieved anaJgesia with 80% of the pain scores meeting our defin~on of sal~sfactory pain control. None of the techniques enjoyed any apparent advantage.Objectif : l~valuer l'eflicacit6 relative de trois techniques d'anesth&ie rvagionales administr~ en vue de procurer l'analg6sie postol~ratoire ~ des enfants. ML'~odes : Cent quatm-vingt-trois enfants programn~ pour une chiru~e inguinale ont ~ assign& ~ un de trois groupes. Tous les enfants ont re~u de la bupivac.~'ne 0,5% simple (2 rng.kg -l) injec~ par le chirurgien apr~s l'indsion de la peau. Dans le 8roupe A, on infiltrait la plaie, dans le groupe B, on administrait un bloc nerveux, et dans le 8roupe C, on assodait les deux techniques. Apr~s l'interverfdon, la douleur ~Uiait &,aluL, e sur l'~elle CHEOPS. Le score 6 consid&~ comme r~lateur d'un soulagement satisfaisarr Les dif~rences inte~oupes potentielles ont L, t6 recherch~ ~ l'aide d'une projection ~aphique du score de douleur moyen, de la fr~uence des scores de douleur maximaJe et de l'incidence des vomissements postop&atoires et de la prise orale d'anaJg~ique. ]Rbmltal~ : Quinze patients ont ~t~ exdus de I'analyse. Ce qui laissait 61 patients au groupe ~ 55 au gYoupe Bet 52 au groupe C. Les groupes ne dif~raient pas sous I'aspect d~mographique. On n'a pas d&non~ de differences entre les groupes que ce soit sur I'&~helle CHEOPS ,~ tousles moments d'observa~on (P = 0,8) ou sur I'inddence des vomissements et les besoins d'analg&ie posto...

Summaryobjective To identify risk factors for urinary tract stones in Trinidad and Tobago. methods A consecutive series of patients presenting to institutions in Trinidad for the management of proven urinary tract calculi was interviewed by questionnaires designed to obtain data on age, gender, ethnicity, occupation, stone location, a family history of stone disease, a past history of certain medical diseases and a semiquantitative estimate of the magnesium intake in food, Ôover the counterÕ drugs and drinking water. An equivalent number of patients attending the same institutions for follow-up and verified from hospital records as having a previous radiological diagnosis of urinary tract stones, as well as a group of asymptomatic members of the community working in the same area, underwent the same interview. Chi-square, anova and Kruskal-Wallis tests were used to examine differences between the groups. Multiple logistic regression analysis was used to determine persistence of the significance of these differences after controlling for confounding variables.results Data sufficient for analysis were obtained for 122 previous and 102 prospective patients and 102 controls. The mean age of the patients was 32 years. The ratio of males to females was 0.9-1.8:1 for the affected groups, but significantly more males than females had calculi in the lower urinary tract (19% vs. 6%; P ¼ 0.004). More patients (30%) than controls (7%) gave a positive family history of urinary tract stone disease (P < 0.001). Affected persons had a lower dietary magnesium intake (P ¼ 0.003), which accounted for a significantly lower total magnesium intake (P ¼ 0.02). Logistic regression analysis of the variables studied indicated that independent predictors of the disease were a positive family history (P ¼ 0.001), total magnesium intake (P ¼ 0.001) and age (P < 0.001).conclusion A low magnesium intake and a positive family history are highly predictive of urinary tract calculi in this population.keywords urinary calculi, risk factors, magnesium, Trinidad and Tobago

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