LEVEL OF PAIN AND ANALGESICS TAKEN AFTER CESAREAN SECTION AND DIFFERENCES ACCORDING TO TYPE OF ANESTHESIA AND DEMOGRAPHIC FACTORS.

The aim of this study was to investigate the level of pain and analgesic consumption in puerperas after cesarean section according to the type of anesthesia administered. This was a prospective study conducted at the Department of Obstetrics and Gynecology, Mostar University Hospital, in the period from September 2015 to June 2016. The study included 111 puerperas. Experimental group included 54 puerperas operated on under spinal anesthesia, while comparative group included 57 puerperas operated on under general anesthesia. Primary endpoints of the study were pain score and dose number of analgesics used. Input parameters of the study were age, gestational age, education, and place of residence. To determine the level of pain, visual analog scale for pain was used. Results showed that puerperas operated on under spinal anesthesia had significantly lower pain sensation (p=0.031) and less need for analgesic consumption in the postoperative period as compared to those operated on under general anesthesia (p=0.024). Increased age was associated with lower pain sensation (p=0.014) and need for analgesics (p<0.05). Higher level of education was associated with greater need for analgesics (p=0.016). Living in urban area was associated with greater pain sensation (p=0.023) and less need for analgesics (p<0.17). Spinal anesthesia for cesarean section resulted in less pain and less need for analgesics in the postoperative period compared to general anesthesia.

Effects of midazolam co-induction to general anesthesia: A randomized clinical trial.

BACKGROUND: This study aimed to determine the potential advantages of midazolam co-induction with general anesthesia (GA) over the use of propofol alone. METHODS: We conducted a randomized, placebo-controlled, single-blinded clinical trial of 102 patients, aged 18 to 65, American Society of Anesthesiologists II and III, who underwent elective laparoscopic gallbladder surgery. Patients were randomly divided into 3 groups: the placebo group (C) received 1 mL of 0.9% saline intravenously and the test groups received intravenous midazolam at doses of 0.03 mg/kg (M1) or 0.06 mg/kg (M2) before induction of GA. We assessed effects of midazolam co-induction on arterial pressure and heart rate (HR) in the early stage of GA prior to surgical incision and effects on perioperative and postoperative glycemia and cortisol levels. Systolic/mean/diastolic (SAP/MAP/DAP) arterial pressure and HR were measured 4 times (preoperative, on the third, sixth and ninth minute after atracurium administration). Cortisol was measured on 3 occasions (preoperatively, 60 minutes after surgical incision, and the following morning) and glucose on 4 occasions (preoperatively, 15 and 60 minutes after incision, and the following morning). We also assessed the incidence of postoperative anxiety, postoperative nausea and vomiting (PONV), and propofol requirement for induction. RESULTS: SAP/MAP/DAP were significantly higher in M2 immediately after induction compared to the other study groups (P = .002/.004/.013). Midazolam co-induction led to a significant reduction in postoperative anxiety (P = .03), reduced cortisol concentration 60 minutes after surgical incision (P < .001) and propofol requirements (P < .001). CONCLUSION SUBSECTIONS: Midazolam co-induction prevented a marked decline in SAP/MAP/DAP immediately after induction of GA, led to reduced postoperative anxiety and cortisol response to surgery, and reduced propofol requirements for induction.