EFFICIENCY AND SAFETY OF BILATERAL ULTRASOUND RECTUS SHEATH BLOCK IN URGENT LAPAROTOMY.

58 patients who underwent urgent laparotomy were included in this randomized controlled study. The efficacy and safety of bilateral ultrasound rectus sheath block of ropivacaine with systemic analgesia in comparison with only systemic analgesia were assessed. Rectus sheath block reduces the pain intensity and the consumption of opioids and declines the incidence of the adverse effects, therefore improving the quality of analgesia and postoperative comfort ofpatient.

[COMPARISON OF THE EFFECTIVENESS OF ILIOINGUINAL-ILIOHYPOGASTRIC BLOCKADE AND TRANSVERSUS ABDOMINIS PLANE BLOCK FOR ANALGESIA AFTER CESAREAN SECTION].

In this prospective randomized study we compared the analgesic efficacy of the ilioinguinal-iliohypogastric nerves block and transversus abdominis plane block for analgesia after caesarean delivery performed by suprapubic laparotomy. The study includes 164 healthy women with ASA status I-II class, undergoing elective surgery under spinal anaesthesia. During the first postoperative hour patients in the "block's" groups received ultrasound-guided blocks of the anterior abdominal wall with ropivacaine 100 mg both. For the TAP-block we used 20 ml 0.25% solution, for the ilioinguinal-iliohypogastric block--10 ml 0.5% from each side. Patients were monitored for visual analogue scale (VAS) scores at rest and during movement (at 3, 6, 9, 12 and 24 hours after surgery), concentration of the cortisol and glucose were measured, and consumption of the tramadol and its adverse effects were controlled. We concluded that both blocks improve postoperative analgesia after caesarean delivery. The Ilioinguinal-iliohypogastric block showed greater efficacy than the transversus abdominis plane block.

[Epidural analgesia in the first stage of labor--is there an alternative?].

OBJECTIVE: To evaluate the influence of epidural analgesia and lumbar paravertebral block on the structure of the delivery, the fetus and newborn, and the quality and duration of analgesia. MATERIALS AND METHODS: Patients were randomized into three groups, 30 patients in each group. In the group-1 patients received epidural analgesia (EA), in the group-2--paravertebral block (PVB), in the group-3 patients refused pain relief in labor. Pain was assessed by VAS. Length of the first and second stage of labor the impact on the CTG and fetal blood gases from the umbilical cord of newborns in the first minute of life were fixed. Data were analyzed by Mann-Whitney U test and presented as median (25th-75th percentiles). RESULTS: In both groups of patients in pain reduction was significant adjustment contractions and after 1 hour was 94.5% in EA, and PVB group--78.7% of the initial values. Under EA opening cervix was statistically significantly greater than in the PVB (192.5 (145, 302) vs 172.5 (112, 210) min) p < 0.05. Second stage of labor was also shorter in the PVB than in the EA (30.4 (10.2, 46.5) vs 59.8 (40.2, 81.5) min), in the control group it was--40.6 (21.3, 55.4) min, p < 0.05. PVB was observed in the group of more stable hemodynamics than in the EA for the entire period of observation. There were no adverse effects on the fetus and the newborn in the arms of the study. CONCLUSION: The proposed lumbar paravertebral block is simple to perform, is effective in reducing pain in the first stage of labor does not require continuous hemodynamic monitoring may be used for the treatment of birth dystocia and is a good alternative when the use of epidural analgesia during labor is limited.

[Effect of early multimodal rehabilitation on postoperative recovery after abdominal hysterectomy].

UNLABELLED: Purpose of the study was to evaluate the impact of the use of enhanced recovery after surgery for the postoperative period, and the inflammatory response after hysterectomy. INTRODUCTION: Methods Prospectively, 50 patients ASA 1-2 aged 42-72 years were randomized into two groups: the ERAS group (n = 25) and the control group (CG) with traditional perioperative management (n = 25). combined spinal and epidural anesthesia technique was used in all patients. Patient-controlled epidural analgesia in the ERAS group and multimodal analgesia with combination of paracetamol, tramadol and ketoprofen in the control group were used postoperatively. We measured plasma concentrations of interleukin-6 (IL-6), interleuki-nIL-1beta (IL-1beta) and C-reactive protein (CRP) preoperatively and at 24 hours and 7 days after surgery. Data were analyzed by Mann-Whitney U test and presented as median (25th- 75th percentiles). RESULTS: There was no statistically significant differences in the IL-6 and IL-1beta concentrations throughout the study. At 6 and 24 hours the pain severity of according to VAS was higher in the control group at rest and on coughing during all study stages. We found no correlation between the level of pain and plasma concentrations of IL-1beta and IL-6. The plasma concentration of CRP in the control group was higher at 24 hours and at 7 days after surgery: (P < 0.01). Level of CRP in the control group tended to increase during the observation period. CONCLUSIONS: In our study, the serum concentration of IL-6 and IL-1beta did not depend on the method of postoperative pain management. Using the ERAS protocol reduced postoperative plasma concentration of CRP. The increased level of CRP in the control group may be related with autoimmune reaction in wound due to delayed mobilization of patients.

[Intralesional administration of local anaesthetics after abdominal hysterectomy: is another technique of analgesia needed?].

The efficacy and safety of continuous wound infiltration with Ropivacaine in combination with systemic anaesthesia were assessed in randomized controlled trial in 60 patients after open hysterectomy. In the trial wound administration of Ropivacaine reduced the postoperative consumption of opioids and the intensity of pain syndrome and reduced the frequency of side effects of narcotic analgesics.

[Abdominal cross section space blockade as a component of the multimodal postoperative analgesia in patients after cesarean section: blockade efficiency analysis].

UNLABELLED: RESEARCH PURPOSE: To compare postoperative analgesia after Cesarean section with abdominal cross section space (ACSB) blockade in a combination with non-opioid analgesics versus conventional system anaesthesia. MATERIALS AND METHODS: 62 patients (2 groups of 31), after planned Cesarean section were included in this randomized research. In main group ACSB was used for postoperative analgesia, in control--a system anaesthesia. Research included pain assessment with visual-analogue scale (VAS) during rest and cough after spinal block regression and 12 and 24 hrs postoperatively. Additionally vital capacity of lungs changes was measured. RESULTS: In the main group VAS data in rest and at cough at stages 12 and 24 of h. after operation were significantly lower, than in control group. Vital capacity of lungs in this group was reliably higher at a stage of 24 h. CONCLUSION: ACSB in a combination with non-opioid analgesics provides high analgesia level without narcotic analgesics application, increases postoperative patients comfort after Cesarean section.

[Realization of Fast track surgery principles during cesarean section].

The aim of the study was to evaluate the efficiency of Fast Track Surgery (FTS) program application and determine the role of the anesthesiologist in its realization during planned Cesarean section. There were 2 randomized groups formed (basic and control), which contained 22 patients each. The groups were identical by all anthropometrical indicators. The FTS was applied in the basic group while the control group was led in traditional postoperative mode. The level of postoperative pain was estimated by Visual Analogue Scale (VAS) in rest and during cough 6, 12 and 24 hours after surgery, cortisol and glucose level dynamics, Baevskiy index, nausea and vomiting frequency, defecation and urination delay, presence of anxiety and weakness were assessed. The VAS and Baevskiy index were lower in the basic group during 12th and 24th hour of investigation, p < 0.05. There was no difference in dynamic cortisol levels in both groups. The values of cortisol levels didn't exceed those of presurgical levels. The tendency of hypoglycemia in control group that testified the prevalence of ketabolic proccesses was accompanied by weakness and orthostatic reactions. In both groups urination delay, nausea and vomiting were present. The obtained data proved the efficacy and safety of FTS during Cesarean section. The study shows that the decision of FTS has to be made by the anesthesiologist. It can improve perioperative conduction of patients and result in the promt stabilization of mother's condition after surgical intervention and result to the optimized contact with the child as well as reduce the period of hospital stay and decrease the expenses.

[Effect of adrenaline on the quality of postoperative epidural analgesia].

The aim of the study was to assess the efficacy and safety of patent controlled analgesia (PCEA) combining opioid-local anesthetic mixture and adrenaline administered after thoracotomy and laparotomy. 164 adult patients after major thoracic and abdominal surgery were enrolled in prospective randomized study. All patients were given PCEA using 0.125% bupivacaine and fentanyl (2 mcg/ml) eithr without (BF group, n = 73) or with adrenaline (2 mcg/ml) (ABF group, n = 91). Pain scores were assessed in rest and coughing by 100-point visual analog scale (VAS) at 3, 6, 12 and 24 hours after ICU admission. In addition, the consumption of medication and the incidence of adverse effects (pruritis, urine retention, and nausea/vomiting) were recorded. Data were compared by the means of Student's t-test and chi2 test. p < 0.05 was regarded as statistically significant. VAS in coughing was significantly lower in the ABF group at 3rd 6th 12th, 18th and 24th hour after ICU admission. The consumption of medication requested for the adequate analgesia (VAS < 3) decreased in the ABF group compare to the BF group. The number of incidence of side effects was lower in the ABF group. The outcome of the study shows that use of PCEA with bupivacaine--fentanyl mixture with adrenaline after major surgery reduces the consumption of both bupivacaine and fentanyl and lowers the incidence of adverse effects, therefore improving the quality of analgesia.