Vol 11, No 3 (2017)

Women have an intense pain in the labor. Amount of pain varies greatly and it depends on the emotional, mental, physical status of women and environmental factors. The pain is caused by various physiological factors and triggers a cascade of biochemical reactions in the woman’s body. Intense pain brings suffering to women and can do damage to the fetus. Effective and safe anesthesia delivery is extremely important task for modern medicine. The article describes the essence of the most popular methods of pain relief during labor, discussed their positive and negative properties. Search literature for the review of various special medical and general Internet search engines. There are medication and non-medication methods of pain relief in labor. Non-medication method is non-invasive and healthier for a maternity patient and a child but their effectiveness is disputable. Medication methods of pain relief are presented injection of opioid analgesics and non-opioid analgesics, inhalation and neuroaxial anesthesia methods. Every method has advantages and disadvantages. Opioid analgesics reduce the pain for a few hours however cause a large number of undesirable effects such as nauseaand sleepiness of maternity patient, respiratory distress and depression of consciousness of newborn. Study of non-opioid analgesics showed a high analgesic activity but it was not study enough to use for pain relief in labor. Today the most common method is neuroaxial analgesia. It relieves the pain effectively and has no effect on the fetus but it has some disadvantages.The question of the influence of the neuroaxial methods of anesthesia on the duration of the labor is controversial. Promising is the use of inhaled anesthetics in particular xenon. But these methods are not study enough. All currently used labor pain relief methods are not ideal as far as each method has its own characteristics and bad effects. In each particular case the method of labor pain relief must be selected individually, it’s necessary to take into consideration the psychological and physical condition of the woman and obstetric situation.

This review of the literature is devoted to the current state of the problem of management of headache in patients with non-traumatic subarachnoid hemorrhage (NSAH). This pathology is associated with severe and prolonged headache. Despite the huge amount of references on subarachnoid hemorrhage, a little attention is paid to headache in this pathology, so it remains largely unexplored. The article presents data on the epidemiology of the syndrome, possible mechanisms of occurrence, diagnostic methods. Details of the advantages and disadvantages of drugs for anesthesia, available in the arsenal of the clinician at the moment. The results of many previously published studies are diametrically opposed, which does not facilitate the choice of tactics for effective treatment and prevention of complications. The article also identifies the problems, the solution of which, possibly, will lead to an improvement in the results of treatment of SAH and further the quality of life of the patients. The lack of evidance data on the subject suggests that the research is relevant.

This paper will be concerned with the results of a prospective controlled longitudinal study which has involved 132 secundiparae (among them 69 patients are with the uterine scar after cesarean section). The parturient women have been divided into 3 groups. Group “A” includes 38 women with the uterine scar after cesarean section, in this group epidural analgesia was administered during vaginal delivery. Group “B” includes 32 secundiparae without uterine scar, in this group epidural analgesia was administered during vaginal delivery. Group “C” - 31 women with the uterine scar, no epidural analgesia was administered during vaginal delivery. Based on a comparative assessment of the pain syndrome intensity in labor according to the visual analogue scale, the research has proved that delivery at the women with the uterine scar is accompanied by statistically more significant pain than at the women without uterine scar. The necessity of analgesia during vaginal delivery at the women with the uterine scar has been proved. The effectiveness and safety of epidural analgesia at patients with the uterine scar have been analyzed. It has been proved that epidural analgesia provides anesthesia during vaginal delivery at the women with the uterine scar, while it does not affect the total duration and course of labor, maternal and perinatal outcomes, and does not mask the clinical picture of the uterine rupture threat.

Background: As diabetes takes on pandemic proportions more than 500000 aged (over 50 years) patients undergo pedis amputation yearly. Anemia is very often accompanied diabetes mostly in aged patients. Anemia may influence somehow the pain severity in postoperative period. Objective: To investigate the possible anemia influence on severity of post surgery pain in aged diabetes patients with anemia. Design: A retrospective medical documentation analysis. Setting: Federal scientific centre. Patients: 58 diabetes patients aged from 50 to 75 with and without anemia after elective pedis surgery. Intervention. Patients were allocated to one of four groups: - 16 patients with anemia who received naropin combined with lidocaine for peripheral nerve blockades (I group), 14 patients with anemia who received only naropin (II group), 11 patients without anemia who received naropin combined with lidocaine (III group) and 17 11 patients without anemia who received only naropin. Main outcome measures: Levels of mean arterial pressure, oxygen delivery index, glycaemia and VAS scores were evaluated on four time points: 24 hours before surgery, in operating room, 12 and 24 hours after surgery respectively. Results. VAS scores and levels of mean pressure was higher in anemia groups postoperativly - 3,3±1,50 vs 0,6±0,82 and 101,7±7,81 mm Hg vs 87,9±12,08 mm Hg respectively. Glycaemia levels had no statistically significant differences neither in time points nor in groups. Oxygen delivery index levels also had no differences in time points but levels were significantly different between groups. Conclusion: Taking in account the results of the analysis it is obvious that anemia contributes to the severity of pain in postoperative period in aged diabetes patients somehow. More clinical investigations must be done to evaluate exact portion of anemia contribution.