Evaluation of the effectiveness of the Quadratus Lumborum Block type I using ropivacaine in postoperative analgesia after a cesarean section — a controlled clinical study

Objectives: Quadratus Lumborum Block in contrast to Transversus Abdominis Plane Block contains a unique component which not only stops somatic pain but also inhibits visceral pain by spreading the local anesthetic to the paravertebral space. This study was designed to determine whether performing the Quadratus Lumborum Block type I in patients un­dergoing cesarean section would be associated with both decreased morphine consumption and decreased pain levels in the postoperative 48-hour period. Material and methods: Sixty patients undergoing caesarean section under spinal anesthesia were randomly and equally assigned to one or other of two groups: QLB I (who received Bilateral Quadratus Lumborum Block type I with the use of 24 mL 0.375% ropivacaine per side) or a Control group. In both groups, on-demand morphine analgesia was administered postoperatively within the first 48 hours. The following were measured: the morphine consumption; the time elapsed from the C-section until the first dose of morphine; and the levels of pain intensity among patients in rest (numeral pain rating scale). Results: There were no statistically significant demographic data differences between the QLB I and Control groups. The following significant differences were observed in the 48-hour postoperative period: morphine consumption was higher in the Control group (p = 0.000); the time elapsed from the C-section until the first dose of morphine was longer in QLB I group (p < 0.05); and the median of the pain numeric rating scale was higher in the Control group (p < 0.05). Conclusions: Quadratus Lumborum Block type I significantly reduces morphine consumption and pain levels up to 48 hours postoperatively

The influence of epidural analgesia on the course of labor

Summary Objective: The aim of the study was to analyze the influence of epidural analgesia (EA) on the course of labor. Material and methods: The study group consisted of 191 women with EA („walking anesthesia”). 209 women without EA were chosen for controls. All the patients delivered at the 1st Dept of Obstetrics and Gynecology, Medical University of Warsaw, Poland. T-test and chi2 test were used for statistical analysis and

Practical issues of nutrition during continuous renal replacement therapy

Continuous renal replacement therapy (CRRT) in critically ill patients has significant impact on one’s ability to provide efficient nutritional therapy. CRRT may help in the prevention of intestinal oedema and the maintenance of the proper function of the gastrointestinal tract by enabling strict control of the fluid balance. It facilitates early introduction of nutrition via the enteral route, as well as allowing for the composition of high-volume feeding mixtures. It is necessary to take into consideration that during CRRT, together with blood purification of toxic substances, nutritive elements are also eliminated to some extent (micro- and macronutrients). In this article, the authors discuss the impact of CRRT on nutritive elements loss, energetic balance and present the principles of adjusting feeding prescriptions to changes implied by CRRT.Continuous renal replacement therapy (CRRT) in critically ill patients has significant impact on one’s ability to provide efficient nutritional therapy. CRRT may help in the prevention of intestinal oedema and the maintenance of the proper function of the gastrointestinal tract by enabling strict control of the fluid balance. It facilitates early introduction of nutrition via the enteral route, as well as allowing for the composition of high-volume feeding mixtures. It is necessary to take into consideration that during CRRT, together with blood purification of toxic substances, nutritive elements are also eliminated to some extent (micro- and macronutrients). In this article, the authors discuss the impact of CRRT on nutritive elements loss, energetic balance and present the principles of adjusting feeding prescriptions to changes implied by CRRT

Zalecenia postępowania w bólu pooperacyjnym AD 2014

On the initiative of the Polish Association of the Study of Pain, Polish Society of Anesthesiology and Intensive Therapy and community of anesthesiologists, a multidisciplinary working group composed of representatives of the above entities reviewed the most recent literature reports regarding acute post-operative pain management in adults and children and prepared recommendations outlined below. The reason of the need for updating the 2011 guidelines was to introduce the newest pain treatment strategy, i.e. multimodal therapy with special emphasis on the use of new drug formulations, another approach to known and commonly used anesthetics and manner of their administration. An attempt was made to adjust the organization of perioperative pain management to the currently recommended trends in safety management within the framework of the unfolding program “Hospital without pain”. The group supported the model of prognostication of post-operative pain developed by specialists in many surgical disciplines, and each model was expanded to include methods of pain management that are to be systematically updated to keep up with scientific progress. The updated guidelines are more “cautious” than the former ones in recommending the extradural techniques of pain control in favor of regional anesthesia with peripheral nerve blockade or the multimodal analgesia. The current recommendations, like the former guidelines, contain references to recent evidence-based medicine resources. Some of them rely on clinical experience and expert opinions but result only from single reports and require further studies. These are only suggestions which are not reflected in characteristics of each individual medicinal product, thus, they are used off label.Z inicjatywy Polskiego Towarzystwa Badania Bólu, Polskiego Towarzystwa Anestezjologii i Intensywnej Terapii oraz środowiska anestezjologów, multidyscyplinarna grupa robocza w składzie jak wyżej, dokonała przeglądu najnowszego piśmiennictwa z zakresu postępowania w ostrym bólu pooperacyjnym w przypadku osób dorosłych i dzieci i przygotowała poniższe zalecenia. Powodem aktualizacji wytycznych z 2011 roku była konieczność przybliżenia nowoczesnej strategii terapii multimodalnej, w zakresie stosowania nowych postaci leków, innego podejścia do znanych i powszechnie stosowanych analgetyków oraz sposobu ich podawania. Dokonano próby dostosowania organizacji przeciwbólowej opieki okołooperacyjnej do obowiązujących trendów w zakresie zarządzania bezpieczeństwem w ramach wciąż rozwijającego się programu Szpital bez bólu. Podtrzymano wypracowaną strategię modelu prognostyki bólu pooperacyjnego, wypracowaną w gronie wielu specjalistów z dyscyplin zabiegowych, którym to modelom przypisane zostały metody postępowania przeciwbólowego, aktualizowane w miarę postępu wiedzy.Zaktualizowane wytyczne są „ostrożniejsze” niż poprzednie w zalecaniu uśmierzania bólu drogą zewnątrzoponową, na rzecz regionalnych blokad obwodowych, bądź też metody multimodalnej. Aktualne zalecenia, wzorem poprzednich, zawierają cytowania prac z ostatnich lat, uwzględniając założenia medycyny opartej na dowodach. Niektóre z zaleceń oparte są na doświadczeniu klinicznym i opiniach ekspertów, a wynikają z pojedynczych doniesień i wymagają dalszych badań. Są to jedynie sugestie, nie mające odzwierciedlenia w treści charakterystyki każdego z produktów leczniczych, zatem stosowane off label

Results of the severe sepsis registry in intensive care units in Poland from 2003−2009

 BACKGROUND: Severe sepsis remains the most common cause of death in intensive care units (ICUs) according to many epidemiological studies. There are no data in Poland on the extent of severe sepsis cases treated in ICUs. The aim of the study was to analyse the course and outcome of severe sepsis patients treated in Polish ICUs.METHODS: In 2003, the internet-based severe sepsis registry was created as a multicentre observational research project. An online questionnaire was made accessible to ICUs participating in the study. Questionnaires were completed after the discharge of patients and included demographic data, clinical and microbiological information about the cause, course, treatment and outcome of septic patients. All data were given voluntarily and anonymously.RESULTS: During the 7-year period (2003−2009), 4999 cases of severe sepsis were registered for analysis. The mean age of septic patients was 57 years, and the majority of the patients were men (58%). The mean length of stay in the ICU was 10 days. A significant decrease in the mortality rate was observed from 54% in 2003 and 56% in 2004 to 46% in 2009 (P < 0.05). Most of the patients were admitted to the ICU for surgical reasons (56%), and intra-abdominal infections predominated (49%). Severe sepsis patients were admitted to ICUs in critical condition, and the majority of them (89%) had 3 or more organs dysfunction. The APACHE II score on admission was 26 points. Community acquired infections were the most frequent cause of severe sepsis (53%). Most of the pathogens responsible for infection were Gram-negative bacteria (58%). Gram-positive bacteria were identified in 34% of patients and fungi in 16%. A positive blood culture was detected in 41% of patients. Vasopressors were administered to most of the patients (86%). There was a marked increase in the frequency of administering noradrenaline and a decrease in administering dopamine. Renal replacement therapy was applied in 22% of the patients, and there was a marked increase in this type of therapy in the last two years of the study period.CONCLUSIONS: Patients with severe sepsis involved in the 7-year registry were critically ill in half of the cases because of intra-abdominal infections, and the majority of them had multi-organ dysfunction. The mortality of registered patients was high, but it significantly decreased during the observation time. Based on the results obtained from this voluntary registry, the authors conclude that mandated sepsis registries should be established in Polish hospitals to improve the strategy of diagnosing and managing this syndrome. BACKGROUND: Severe sepsis remains the most common cause of death in intensive care units (ICUs) according to many epidemiological studies. There are no data in Poland on the extent of severe sepsis cases treated in ICUs. The aim of the study was to analyse the course and outcome of severe sepsis patients treated in Polish ICUs.METHODS: In 2003, the internet-based severe sepsis registry was created as a multicentre observational research project. An online questionnaire was made accessible to ICUs participating in the study. Questionnaires were completed after the discharge of patients and included demographic data, clinical and microbiological information about the cause, course, treatment and outcome of septic patients. All data were given voluntarily and anonymously.RESULTS: During the 7-year period (2003−2009), 4999 cases of severe sepsis were registered for analysis. The mean age of septic patients was 57 years, and the majority of the patients were men (58%). The mean length of stay in the ICU was 10 days. A significant decrease in the mortality rate was observed from 54% in 2003 and 56% in 2004 to 46% in 2009 (P < 0.05). Most of the patients were admitted to the ICU for surgical reasons (56%), and intra-abdominal infections predominated (49%). Severe sepsis patients were admitted to ICUs in critical condition, and the majority of them (89%) had 3 or more organs dysfunction. The APACHE II score on admission was 26 points. Community acquired infections were the most frequent cause of severe sepsis (53%). Most of the pathogens responsible for infection were Gram-negative bacteria (58%). Gram-positive bacteria were identified in 34% of patients and fungi in 16%. A positive blood culture was detected in 41% of patients. Vasopressors were administered to most of the patients (86%). There was a marked increase in the frequency of administering noradrenaline and a decrease in administering dopamine. Renal replacement therapy was applied in 22% of the patients, and there was a marked increase in this type of therapy in the last two years of the study period.CONCLUSIONS: Patients with severe sepsis involved in the 7-year registry were critically ill in half of the cases because of intra-abdominal infections, and the majority of them had multi-organ dysfunction. The mortality of registered patients was high, but it significantly decreased during the observation time. Based on the results obtained from this voluntary registry, the authors conclude that mandated sepsis registries should be established in Polish hospitals to improve the strategy of diagnosing and managing this syndrome