[USING A VISUAL ANALOGUE SCALE FOR ASSESSING THE SEVERITY OF PAIN SYNDROME AFTER CESAREAN SECTION, DEPENDING ON THE METHOD OF ANESTHESIA.]

THE AIM: To compare efficiency of various techniques of anesthesia after Cesarean section on degree ofpain expression in randomized clinical trial. MATERIALS AND METHODS: 120 puerperas aged from 21 till 33 years who were undergone to Caesarean section were studied. Patients were divided into four equal groups by number of observations. In groups 1st and 2nd patients were performed local anesthesia with continuous and bolus anesthetic. In group 3rd were performed bilateral blockade of the cross-space belly. In the 4th groups was used multimodal analgesia system. Each patient during the postoperative period was estimated the severity ofpain on a visual analog scale at rest and movement at 3, 6, 12, 24 and 48 hours. RESULTS: Intensity ofpain after surgery in patients of all groups decreased and reached lows of 48 hours after a Cesarean section. At the same time the 2nd group ofpatients (6,1 ? 1,4) had pain significantly less than that ofpuerperas from the 3rd and the 4th groups (13,2 J 2,4 and 18,0 ? 2,7). Meanwhile, indices offemale patients pain severity from the 1st and 2nd groups of the study were not statistically different. When studying distribution ofpatients on degree ofpostoperative pain it is established that atpuerperas of the 1st and 2nd group pains prevailed weak (47% and 67%) and moderately expressed (50% and 33%). In the 3rd group expression of a pain syndrome in all cases was moderate. In the fourth group the pain syndrome was considerably more expressed (the moderated - 53%; the strong - 4 7%). CONCLUSION: Pain syndrome after Cesarean section using the localanalgesia with continuous or bolus is reduced by 28-35%, which was significantly more than the blockade of the cross-space stomach and systemic analgesia.

[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.

Infusion of methylene blue in human septic shock: a pilot, randomized, controlled study.

OBJECTIVE: To evaluate the effects of continuous infusion of methylene blue (MB), an inhibitor of the nitric oxide pathway, on hemodynamics and organ functions in human septic shock. DESIGN: Prospective, randomized, controlled, open-label, pilot study. SETTING: Multidisciplinary intensive care unit of a university hospital. PATIENTS: Twenty patients with septic shock diagnosed <24 hrs before randomization. INTERVENTIONS: Patients were randomized 1:1 to receive either MB (MB group, n = 10) or isotonic saline (control group, n = 10), adjunctive to conventional treatment. MB was administered as an intravenous bolus injection (2 mg/kg), followed 2 hrs later by infusion at stepwise increasing rates of 0.25, 0.5, 1, and 2 mg/kg/hr that were maintained for 1 hr each. During infusion, mean arterial pressure was maintained between 70 and 90 mm Hg, while attempting to reduce concurrent adrenergic support. MEASUREMENTS AND MAIN RESULTS: Hemodynamics and organ function variables were assessed over a 24-hr period, and the survival rate at day 28 was noted. Infusion of MB prevented the stroke volume and the left-ventricular stroke work indexes from falling and increased mean arterial pressure. Compared with the control group, MB reduced the requirement for norepinephrine, epinephrine, and dopamine by as much as 87%, 81%, and 40%, respectively. Oxygen delivery remained unchanged in the MB group and decreased in the control group. MB also reduced the body temperature and the plasma concentration of nitrates/nitrites. Leukocytes and organ function variables such as bilirubin, alanine aminotransferase, urea, and creatinine were not significantly affected. Platelet count decreased in both groups. Five patients treated with MB survived vs. three patients receiving conventional treatment. CONCLUSIONS: In human septic shock, continuously infused MB counteracts myocardial depression, maintains oxygen transport, and reduces concurrent adrenergic support. Infusion of MB appears to have no significant adverse effects on the selected organ function variables.