Erector spinae plane block for rescue analgesia following caesarean delivery.

Pain after caesarean section is still a common and important source of patient dissatisfaction in many obstetric centres. With intrathecal morphine combined with multimodal analgesia, approximately 5­10% of patients experience severe breakthrough pain after caesarean delivery that is difficult to manage [1]. Planned erector spinae plane (ESP) block can result in excellent postoperative analgesia associated with high patient satisfaction after caesarean delivery [2, 3]. However, the role of this block for rescue analgesia following caesarean section has never been described. We present a case in which bilateral ESP block was used as rescue analgesia in a woman who had severe postoperative pain following elective caesarean delivery under spinal anaesthesia combined with multimodal analgesia. The patient described in this case gave written consent for publication of this observation.

Analysis of prognostic factors affecting mortality in Fournier's gangrene: A study of 72 cases.

INTRODUCTION: Fournier's gangrene is a rapidly progressing necrotizing fasciitis of the perineum and genital area associated with a high mortality rate. We presented our experience in managing this entity and identified prognostic factors affecting mortality. METHODS: We carried out a retrospective study of 72 patients treated for Fournier's gangrene at our institution between January 2005 and December 2014. Patients were divided into survivors and non-survivors and potential prognostic factors were analyzed. RESULTS: Of the 72 patients, 64 were males (89%) and 8 females (11%), with a mean age of 51 years. The most common predisposing factor was diabetes mellitus (38%). The mortality rate was 17% (12 patients died). Statistically significant differences were not found in age, gender, and predisposing factors, except in heart disease (p = 0.038). Individual laboratory parameters significantly correlating with mortality included hemoglobin (p = 0.023), hematocrit (p = 0.019), serum urea (p = 0.009), creatinine (p = 0.042), and potassium (p = 0.026). Severe sepsis on admission and the extent of affected surface area also predicted higher mortality. Others factors, such as duration of symptoms before admission, number of surgical debridement, diverting colostomy and length of hospital stay, did not show significant differences. The median Fournier's Gangrene Severity Index (FGSI) was significantly higher in non-survivors (p = 0.002). CONCLUSION: Fournier's gangrene is a severe surgical emergency requiring early diagnosis and aggressive therapy. Identification of prognostic factors is essential to establish an optimal treatment and to improve outcome. The FGSI is a simple and valid method for predicting disease severity and patient survival.