ABSTRACT
INTRODUCTION: The main objective of this study was to evaluate the feasibility of a laparotomy peritoneal dialysis insertion, under locoregional anesthesia, by transversus abdominis plane block anesthesia. METHODS: This was a retrospective study of the peritoneal dialysis catheter insertion under transversus abdominis plane block anesthesia in our center between the September 1, 2011 and July 31, 2013. The transversus abdominis plane block procedure was used as an alternative to general anesthesia. Patients who underwent a peritoneal dialysis catheter insertion under transversus abdominis plane block anesthesia were included in the study. The main criterion of the study was the pain expressed by the patient during the procedure. Postoperative complications were also evaluated. The catheter function was assessed by an infusion and drainage test just after surgical procedure, 10 days after the insertion and at dialysis initiation. RESULTS: Thirty-seven patients who had one catheter insertion were included in the study. Among those 37 patients, 28 (75.7%), 26 (70.3%) and 31 (83.8%) respectively did not express any pain during the procedure, two and four hours after the catheter insertion. Of the 37 patients, 5 had an early postoperative complication (hematoma: 11%, hemoperitoneum: 3%). The peritoneal dialysis catheter function was estimated to be good just after the insertion and 10 days after the surgery for 35/37 (95%) patients. Among these 36 patients, 29 (81%) had a catheter function peritoneal dialysis initiation. CONCLUSION: The transversus abdominis plane block anesthesia should be considered as an alternative to general anesthesia for the peritoneal dialysis insertion in comorbid end stage renal disease patient.
Subject(s)
Anesthesia/methods , Kidney Diseases/therapy , Peritoneal Dialysis , Abdominal Cavity/innervation , Humans , Laparotomy/methods , Pilot Projects , Retrospective StudiesABSTRACT
Morphological changes of skin in region of operative wound were investigated. There was established, that while application of fentanyl in high doses, using constant infusion for anesthesia in early postoperative period in children, operated for abdominal cavity tumors, the opioid-induced hyperalgesia occurrence is possible, what is accompanied by morphological changes in skin around operative wound, necrosis in centre of focus, pronounced perifocal reactive changes in a kind of significant inflammation and essential disorder of microcirculation with formation of small neural fibers on the 14th day. Pronounced fibrosis of derma, formation of big quantity of collagen fibers with edema, stratification.
Subject(s)
Abdominal Neoplasms/surgery , Analgesics, Opioid/adverse effects , Edema/pathology , Fentanyl/adverse effects , Hyperalgesia/pathology , Abdominal Cavity/innervation , Abdominal Cavity/pathology , Abdominal Cavity/surgery , Abdominal Neoplasms/pathology , Administration, Cutaneous , Adolescent , Child , Edema/chemically induced , Edema/physiopathology , Female , Humans , Hyperalgesia/chemically induced , Hyperalgesia/physiopathology , Male , Nerve Fibers/pathology , Postoperative Period , Skin/pathologyABSTRACT
Enteric nervous system (ENS) is a network made of neuronal cells and nervous fibers. There are two plexuses: myenteric of Auerbach and sub mucous of Meissner and Henle. Many substances are involved in neurotransmission at ENS level. ENS assures all gastrointestinal system functions: digestion, absorption, etc. Our study is made on 23 human fetal specimens at different ages of evolution with crown-rump lengths from 9 to 28 cm, and three new born human specimens. We used the Trichrome Masson stain technique and the argental impregnation Bielschowsky on block technique for microscopic evidence. Our study concerned the cavitary viscera allocated to the celiac plexus, involving all layers of each studied viscera.
