[Epidural analgesia for painless delivery. Our experience]. / Analgesia epidurale per il parto indolore. Nostra esperienza.

BACKGROUND: We know that a stress condition causes hormonal responses (cortisol, prolactin, TSH, ACTH, catecholamines, beta-endorphines). This hormonal "storm" causes metabolic and haemodynamic changes that can get worse postoperative outcome as well as birth. Analgesia for labour is an anesthesiological procedure which spreading in Italy resulted very difficult, for instance, especially in southern Italy, "old popular believes" (such as paralysis risk after lumbar puncture, Post-Dural Puncture Headache (PDPH) and the confusion between epidural and subdural anesthesia). METHODS: In front of these problems we report our experience in this field. Experimental plan: in our retrospective study we examined painless labour cases and we compared them with natural labour cases without analgesia. ENVIRONMENT: women of this study were pregnant admitted in obstetrics department of our hospital at the end of pregnancy. PATIENTS: pregnant women who wanted epidural analgesia were 50 (group A); data group A were compared with data of 50 pregnant women who refused analgesia (group B). TECHNIQUE: beginning labour, when cervical dilatation was 3 cm and foetal head was going down we performed epidural puncture and positioned, catheter in epidural space giving opiate and local anesthetic drugs using "top-up" method. DATA: we compared APGAR-score after birth and the judgement expressed by women of the two groups. RESULTS AND CONCLUSIONS: APGAR-score in new-borns with epidural analgesia in higher than new-born without epidural analgesia; furthermore, patients who choose painless labour expressed a better judgement than women who refused epidural analgesia.

[Sciatic, femoral and cutaneous nerve block for arthroscopic meniscectomy in a patient with Eisenmerger's syndrome. Case report]. / Blocco dei nervi sciatico, femorale e cutaneo laterale della coscia per meniscectomia in artroscopia in un paziente affetto da sindrome di Eisenmerger. Caso clinico.

The principal complication to prevent in Eisenmerger disease with left-right shunt during surgery decreasing of systemic pressure with reduction of pulmonary perfusion and break-down of central oxigenation. A 32 ys old male patient (ASA risk 3) to undergo an extirpation of meniscus by arthroscopic surgery, suffering from Eisenmerger's syndrome with left-type only ventricle, diagnosed when he was 3 ys old and but no repaired by any operation. We performed a sciatic, femoral and lateral cutaneous of thigh nerves block with ropivacaine, that consents a prolonged antalgic effect in postoperative period with minimizing of systemic and pulmonary hypotension risk compared to general, epidural or spinal anaesthesia. Basing on our experience and literature references we think that the anaesthesiological technique with the lowest risk for lower limb surgery in Eisenmerger's syndrome is truncular block.