Efficiency Evaluation of the Peridural Analgesia Methods After Hemorrhoidectomy

This article presents the results of a comparative assessment of the effectiveness of epidural anesthesia with a combination of local anesthetic and morphine with an automatic syringe, the technique of epidural analgesia in the bolus mode at specified time intervals and at the patient's request, and analgesia in the form of a continuous epidural infusion of 0.5% bipuvicaine solution in combination with a narcotic drug in patients after hemorrhoidectomy. Based on the results of the analysis, it can be concluded that the method of prolonged epidural analgesia in the postoperative period allows achieving good results with the least complications.

GROSSESSE ET ACCOUCHEMENT CHEZ LA FEMME OBESE

The obesity, factor of the morbimortalite, is considered as a real health public problem. In gynecology, its consequences on the fertility and the contraception are sever. Obesity during pregnancy increases the risk of complications for both the mother (gestational hypertension, diabetes mellitus) and the newborn (malformations and macrosomia). Deliveries are also more difficult with more c-section and failure in peridural analgesia. Our practices have to take into account these complications by assuring an adapted and premature care to improve the maternal and neonatal outcomes.

Comparison of early postoperative pain after partial tumour nephrectomy by flank, transabdominal or laparoscopic access

Aim: To explore whether the total pain experience differs after (partial) kidney tumour nephrectomies via flank, transabdominal or laparoscopic access. Materials and methods: We analyzed retrospectively 107 patients with flank, 12 with transabdominal and 21 with laparoscopic interventions. For pain treatment, conventional analgesics (A) or intravenous patient-controlled analgesia (PCIA) or thoracic peridural analgesia (tPDA) were used. Self-reported pain was measured with a Visual Analogue Scale three times daily. The area under the curve (AUC) at rest (R) and during a standardized body movement (M) were calculated from the intervention till the end of the second T(0–2) and seventh postoperative day T(0–7), respectively. Results: The median AUC for T(0–2) at R was more intense for laparoscopy (13) than for flank incision (A, 9) and approximately the same during M. For flank incisions (A), the median AUC at R rises from 9 for T(0–2) to 22 for T(0–7) and at M the median AUC increases from 18 to 37. In contrast, laparoscopy did not cause further pain after the second postoperative day. Furthermore, with flank incision for T(0–2), at R, tPDA was superior to A (median AUC: 5 versus 9, p = 0.02) and at M again tPDA (median AUC: 12) had a better pain-control as A (18) or even as PCIA (19, p = 0.005). Conclusion: Laparoscopic nephrectomies cause a relatively intense mean cumulative pain for T(0–2) and a subsequent absence of pain. However, flank incisions went on to increased pain levels until the seventh postoperative day with tPDA as most effective therapy.