Vol 7, No 3 (2013)

Inadequate analgesia after operation is one of the reasons of complications in the early postoperative period. In obstetrics this problem gains also social character: early activation for care and feeding newborn is very important for woman. The goal of the study was to assess adequacy of pain management in women after Cesarean Section. The study included 139 patients. All of them were undergone the operation under spinal anesthesia. Two methods of analgesia were compared in early postoperative period and the patients were randomized into two groups for this purpose. The first group received combination of ketoprofene with the transversus abdominal plane block (TAP) and the other group received standard options of analgesia (ketoprofene+promedol). The study results showed that efficiency of analgesia in TAB-block group was higher that was confirmed by assessment made with rating verbal scales of pain. Opioid and non-steroid drugs consumption was much higher In standard analgesia group. The level of a cortisol and prolactinum was lower in patients from TAB-block group. Early activation was also registered in patients of this group. Hence, combination of the TAB-block with non-steroid agents provides high level of an analgesia, increases patient's comfort, and allows providing full care of babies starting from the first days after operation.

Multimodal combined anesthesia (MMCA) as a three-component thoracic epidural blocade with small doses of fentanil, ropivakain and adrenalin in combination with endotracheal anesthesia with sevofluran provides reliable anesthesiologic defence, early extubation and postoperation rehabilitation in patients undergone thoracic operations. This rationale gave grounds to apply this method in patients with lung cancer accompanied by COPD and severe impairment of ventilation reserves. We demonstrate successful experience of MMCA application in 13 patients including 8 patients undergone pneumonectomy. Baseline parameters of spirometry in all patients were lower than conventional limits of functional operability.

Clinical course of spinal block, intensity of its manifestation, quality of spinal anesthesia and occurrence of complications are mainly caused by level of local anesthetic distribution in subarachnoid space. Several factors responsible of this process and consequently neuraxial block are currently found out. The presented lecture considers the most clinically significant factors.