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Objectives: Uncontrolled pain after cesarean delivery is associated with women’s dissatisfaction and limited ability to take care of the neonate. Materials and methods:This prospective observational study included 173 women scheduled for elective cesarean delivery under spinal anesthesia. Postoperative analgesia included subcutaneous morphine 0.1 mg/kg in the post-anesthesia care unit, followed by intravenous paracetamol 1000 mg every eight hours and intravenous diclofenac 75 mg every 12 hours in the ward. Subcutaneous morphine was repeated on demand. Pain intensity at rest, pain intensity after movement and cumulative morphine consumption were recorded at 2, 4, 8, and 24 hours postoperatively. Acute pain intensity was assessed on a 100 mm visual analogue scale (VAS, score 0-100 mm). Three and six months postoperatively, women were interviewed by phone for the presence of persisting pain, abnormal sensation in the wound area and analgesic consumption. Results:Our results showed that 24 hours postoperatively the mean dose of morphine was 16±7.1 mg and VAS scores at rest and after movement were 23±17.3 mm and 40±20.9 mm, respectively. The mean VAS scores at rest remained below 31 mm at all times, while after movement they were over 40 mm at both four and eight hours postoperatively (45±23.8 mm and 43±23.2 mm, respectively). Three months postoperatively, 15% of women reported the presence of continuous or intermittent pain, 72% loss of sensation or numbness at the site of surgery and 32% occasional analgesic consumption at home. Six months after surgery, 5% of women reported pain, 44% loss of sensation or numbness in the wound area and none of them (0%) consumed analgesics due to persistent post-cesarean delivery pain. Conclusion:Based on the above-mentioned findings, we concluded that the amount of morphine consumed in the ward was low and possibly inadequate to alleviate early post-cesarean delivery pain. The overall incidence of persisting pain was low and consistent with previous studies.

Neurofibromatosis type 1 is a complex genetic disorder affecting multiple organ systems. Cardiovascular manifestations include hypertension, often associated with concomitant pheochromocytoma. We present a hypertensive crisis during induction of anesthesia in a patient with neurofibromatosis type 1, scheduled for abdominal myomectomy, which revealed an undiagnosed pheochromocytoma. The case highlights the importance of assessing all patients with neurofibromatosis type 1 for pheochromocytoma, because if it is left undiagnosed, it can be disastrous in the setting of anesthesia and surgery.

Aim:The main purpose of this work is to highlight the therapeutic tools used in physiotherapeutic clinical practice and their effect on a chronic rheumatic pain syndrome called fibromyalgia (FMS). Fibromyalgia is not caused by autoimmune, inflammatory, articularmuscular disorders and is accompanied by symptoms of extensive pain, fatigue, depression, cognitive disorder and sleep, but also general sensitivity. The present study therefore aimed to carry out a detailed examination of the literature on the modern techniques of conservative rehabilitation of fibromyalgia, including therapeutic exercise, electrotherapy through the effects of TENS andlaser, as well as alternative forms of treatment such as acupuncture. Methods:The present study followed the PRISMA guidelines. The PRISMA declaration is a protocol that guides the construction of systematic reviews in a transparent and consistent manner using a 27-item checklist and a 4-phase flowchart. keywords : fibromyalgia syndrome, physiotherapy, exercise, acupuncture, TENS

Background and aims Regional oxygen saturation (rSO2) monitoring of the brain by near-infrared spectroscopy (NIRS) has been mainly used during carotid endarterectomy. The present study was conducted in volunteers and investigates the rSO2 values of the brain, heart and liver tissue as assessed by NIRS in the supine and the sitting position. Methods After obtaining written informed consent from forty-nine healthy volunteers, rSO2 values were recorded in the heart and liver areas in the supine and the sitting position, while simultaneously the rSO2 values of the brain. Results The rSO2 brain values in the supine and the sitting position were 69 ± 6.0 and 66 ± 6.1 respectively (p = 0.0001). The rSO2 values in the supine and the sitting position were 76 ± 10.5 and 79 ± 6.7 for the heart (p > 0.05) and 85 ± 6.8 and 82 ± 7.2 for the liver, (p = 0.007). Heart rSO2 values were higher than the brain rSO2 values in both the supine (76 ± 10.4 versus 69 ± 6.6; p = 0.0001) and the sitting position (79 ± 6.7 versus 66 ± 6.1; p = 0.0001). The liver rSO2 values were also higher than the brain rSO2 values in the supine (85 ± 6.8 versus 69 ± 6.0; p = 0.0001) and in the sitting position (82 ± 7.2 versus 66 ± 5.7; p = 0.0001). Arterial blood pressure and arterial oxygen saturation (SpO2) did not differ between the two positions but the heart rate was higher in the sitting position (p = 0.030). Conclusions We conclude that brain and liver (but not heart) rSO2 values are higher in the supine than sitting position. Additionally, NIRS may be used to assess oxygenation of the heart and liver.

Local anesthetics combined with opioids are commonly used in labor epidural analgesic schemes. This study investigated if the addition of fentanyl to epidural ropivacaine can affect cervical dilation and progress of vaginal delivery.Sixty-two nulliparous parturients were randomized to receive epidurally 8 ml ropivacaine 0.2% combined with fentanyl 20 μg (F/R-group, n = 31) or with normal saline 0.4 ml (R-group, n = 31), every hour. Rescue doses of 5 ml ropivacaine 0.2% were also administered. Measurements were performed every 60 min until full cervical dilation. The primary end-point was the time to reach 10-cm cervical dilation. Secondary outcomes were Bishop scores, mode of delivery, total ropivacaine dose, pain, and satisfaction scores (numerical scale, 0-10).Data from 60 parturients (29 in the F/R and 31 in the R-group) were analyzed. The F/R-group had 26 vaginal deliveries (four instrumentally assisted), and three cesarean deliveries. The R-group had 27 vaginal deliveries (six instrumentally assisted) and 4 cesarean deliveries. Time to 10-cm cervical dilation did not differ between the groups (4 ± 2.4 h in the F/R-group vs 4.4 ± 2.1 h in the R-group, p = .341). The number of women remaining in the study every hour until full cervical dilation and Bishop scores for a 4-h period did not differ between the groups (p = .617). Total ropivacaine dose was comparable between the groups, but the F/R-group reported significantly lower pain (p = .01) and higher satisfaction scores (p = .001).The addition of fentanyl to ropivacaine 0.2% solution did not affect cervical dilation and progress of the first stage of labor, but improved both analgesia and satisfaction.

To investigate the effect of spinal anesthesia on cerebral rSO2 during elective cesarean delivery (CD).Thirty-four women scheduled for elective CD under spinal anesthesia were recruited. In the operating room rSO2 of the left and right frontal area and right thigh was recorded using three disposable sensors. A combination of 1.8-2.0 ml of 0.75% ropivacaine plus 10 μg of fentanyl were injected intrathecally. Systolic and diastolic blood pressure, heart rate, SpO2 as well as rSO2 of the left and right forehead areas and right thigh were recorded before, 5, 10, and 25 to 50 minutes after spinal injection, after uterine incision and placenta delivery, and analyzed with ANOVA repeated measures. The study was approved by the Aretaieio Hospital Institutional Review Board and registered with ClinicalTrials.gov (ID: NCT01669135).The rSO2 left and right frontal area values decreased significantly from baseline (p=0.0001 and p=0.0001 respectively), with most remarkable decreases 5 and 10 minutes after spinal injection, from 65 (SD 8.7)% to 56 (SD 9.3)% and 56 (SD 9.5)% (p=0.0001 and p=0.0001) for the left and from 63 (SD 7.7)% to 55 (SD 9.3)% and 56 (SD 8.9)% (p=0,0001 and p=0.0001) for the right frontal area respectively. The rSO2 right thigh values increased significantly during the study period (p=0.0001).Contribution of extracranial circulation to the rSO2, lack of PaCO2 and cardiac output measurements.Women undergoing CD under spinal anesthesia may present decreases in cerebral rSO2. The clinical impact of these results remains to be determined.

The occurrence of lipomas in the parotid gland is extremely rare, and impossible to differentiate clinically. A case of this bizarre entity is reported herein, which was treated successfully with superficial parotidectomy. A 57-year-old man with a well-circumscribed, rubbery mass, probably arising from the right parotid gland was investigated in our hospital initially with ultrasound scan, and finally with MRI-scan. Both imaging modalities implied a benign lipomatous tumor and the patient underwent an uneventful superficial parotidectomy. Although adipose tissue is a natural component of parotid glands, lipomas arising in the gland are very unusual. The entity'™s incidence is about 1% (0.6-4.4%) of parotid gland mass lesions and history of previous trauma in the area is the most common pathophysiological mechanism described. Tomographic imaging modalities are very accurate in preoperative diagnosis and cosmetic appearance is the usual indication for surgical intervention. Any particular symptoms jeopardize clinically the diagnosis of parotid lipoma. As always, surgical excision should respect the facial nerve and branches.

The antiepileptics gabapentin and pregabalin are used as adjuvants to control postoperative pain.The aim of the present study was to investigate the effect of perioperative administration of pregabalin on postoperative acute and chronic pain and analgesic requirements.Department of Anaesthesiology, Aretaieio University Hospital, Athens, Greece.Eighty patients scheduled for abdominal hysterectomy or myomectomy were randomly assigned to the pregabalin or to the control group.The pregabalin group received 150 mg of pregabalin 8-hourly, starting on the afternoon before surgery and continued until the fifth postoperative day. The control group was similarly treated, but received placebo capsules instead.Postoperative intravenous morphine and Lonalgal (30 mg codeine with 500 mg paracetamol) tablet consumption, visual analogue pain scores at rest and on coughing, sedation, anxiety, dizziness, ataxia, blurred vision and diplopia were recorded. One and 3 months postoperatively patients were interviewed for the presence of pain and analgesic needs due to surgery.The pregabalin-treated patients consumed less morphine during the first 48 h postoperatively (P = 0.0001). However, consumption of Lonalgal tablets and visual analogue scores for pain at rest and on coughing did not differ between the groups. No difference was found in sedation and anxiety scores between the patients who received placebo or pregabalin. Patients in the control group had lower incidences of dizziness (29 versus 58%, P = 0.015), ataxia (0 versus 18%, P = 0.011), blurred vision (6 versus 26%, P = 0.028) and diplopia (0 versus 16%, P = 0.023). Presence of pain, analgesic intake due to surgery and decreased or absent sensation around the wound did not differ between the groups 1 and 3 months postoperatively.Pregabalin in the doses given decreased morphine requirements for the first 48 h postoperatively, but neither altered the analgesic requirements beyond 48 h nor had any effect on acute, late or chronic pain.

Postoperative analgesic requirements and pain scores were compared after subarachnoid versus epidural anesthesia with plain ropivacaine 0.75% for elective cesarean section.Ropivacaine 0.75% was randomly administered for subarachnoid or epidural anesthesia in 108 parturients, scheduled for cesarean section. Times for the sensory block to reach T4 level and to regress to T6 level were recorded. At 2, 4, 8 and 24 h postoperatively, pain scores at rest and cough, morphine consumption as well as patient satisfaction, incidence of headache, nausea and/or vomiting were measured.Median (min-max) time for the sensory block to reach T4 was 7 (3-0) min versus 24 (16-73) min and to regress to T6 was 126 (70-332) min versus 200 (98-439) min in the subarachnoid and epidural groups, respectively (p=0.001). Although the subarachnoid had more analgesic consumption than the epidural group at 2 and 4 h postoperatively (7.3±4.7 vs. 1.8±2.4 mg, p=0.001 and 9±5.7 vs. 3.3±3.8 mg, p=0.001, respectively) no difference was observed at 8 or 24 h postoperatively (p=0.14 and p=0.38, respectively). VAS scores at rest and after cough (p=0.56, p=0.35, respectively), patient satisfaction (p=0.61), incidence of headache (p=1.0), nausea and/or vomiting (p=0.78) did not differ between the two groups.Postoperative pain, analgesic requirements, patient satisfaction and adverse effects did not differ when subarachnoid or epidural anesthesia with ropivacaine 0.75% was used for elective cesarean section. Nevertheless, subarachnoid provides faster onset and offset of the block, compared to epidural anesthesia. The key limitation of this study is the lack of postoperative serum ropivacaine measurements taken with concurrent pain score measurements.

Background Hypothermia has a detrimental effect on hemostatic mechanism. The purpose of this experimental study was to investigate the effect of graded hypothermia on markers of the anticoagulant system (antithrombin III and protein C) and fibrinolytic system (plasminogen, α 2 -antiplasmin), and on vascular wall and other tissue specimens. Materials and methods Ten New Zealand rabbits were subjected to mild and then moderate core hypothermia of 32°C for 60 min. Blood samples were obtained at normothermic (T 1 ), mild (T 2 ), and moderate (T 3 ) hypothermic conditions. Chromogenic assay methods were used to determine quantitatively (%) the activity of antithrombin III, protein C, plasminogen, and α 2 -antiplasmin. Hypothermic values were compared with the normothermic values. Tissue and vessel wall specimens were examined under light microscope. Results Reduction of activity (%) from normothermia (T 1 ) to mild (T 2 ) and moderate (T 3 ) hypothermia was found for antithrombin III (103.40 ± 12.54, 87.40 ± 13.50, and 82.70 ± 20.78, respectively, with statistically significant difference between T 1 –T 3 : P =0.03), for protein C (70.1 ± 7.51, 56.30 ± 8.34, and 53.1 ± 7.34, with statistically significant difference between T 1 –T 2 and T 1 –T 3 : P =0.015 for both comparisons) and α 2 -antiplasmin (97 ± 9.63, 80.60 ± 11.73, and 83.70 ± 13.94, with statistically significant difference between T 1 –T 2 : P =0.006). Plasminogen activity was increased (14.50 ± 0.52, 16.30 ± 1.63, and 17.30 ± 2.45, with statistically significant difference between T 1 –T 2 and T 1 –T 3 : P =0.033 for both comparisons). Histologic examination revealed no significant lesions on tissue and vessel wall specimens. Conclusions The results of our study suggest that even though the hypothermia period was relatively short, the processes of coagulation and fibrinolysis were altered with simultaneous changes.

General anesthetics may have nociceptive actions that affect postoperative pain. In studies evaluating postoperative pain, the effect of general anesthetics on analgesic requirements has not been considered except for one recent study suggesting that propofol anesthesia provides better analgesia after surgery than isoflurane.In this prospective, blind, randomized trial we recorded postoperative analgesic requirements (mg of morphine) and pain scores (visual analog scale in mm) 2, 4, 8, and 24 h postoperatively in patients undergoing abdominal hysterectomy or myomectomy under sevoflurane, desflurane or propofol anesthesia, titrated to maintain Bispectral Index values between 35 and 45. Pain scores were also recorded immediately after transfer to the postanesthesia care unit.Cumulative morphine consumption did not differ among the three groups 2, 4, 8, or 24 h postoperatively (P = 0.50). The morphine consumed within 24 h postoperatively was 28 +/- 13.8 mg in the sevoflurane group, 25 +/- 11.7 mg in the desflurane group and 27 +/- 16.1 mg in the propofol group. The visual analog scale values at rest or after cough immediately after patient transport to the postanesthesia care unit and 2, 4, 8, and 24 h after surgery did not differ among the three groups (P = 0.40, 0.39, 0.50, 0.47, 0.06 at rest and P = 0.67, 0.45, 0.22, 0.26, 0.29 after cough respectively).Morphine consumption and pain 24 h postoperatively did not differ among the sevoflurane, desflurane, and propofol groups.

Mechanisms of ischemic stroke in young adults are poorly understood. The aim of the study was to investigate and compare the frequency of common variations in prothrombotic genes between young patients with ischemic stroke and controls. Fifty-one cases of first-ever ischemic stroke and 70 community-based controls aged below 50 years were studied. In both groups, the insertion/deletion 4G/5G variation (-675 4G/5G PAI-1) as well as the single-nucleotide polymorphism-844 G/A of the PAI-1 (-844 G/A PAI-1) gene promoter, factor V Leiden (FVL) G1691Α, the prothrombin variant (allele 20210A, FIIG20210A), factor XIII-A Val34Leu polymorphism (FXIII-AVal34Leu) and C677T methylenotetrahydrofolate reductase (C677T MTHFR) polymorphism have been assessed. The -675 4G/5G PAI-1 allele distribution differed significantly between patients and controls (P = 0.020), but no difference was found regarding the distribution of -844 G/A PAI-1 (P = 0.493), FVL (P = 0.199), FIIG20210A (P = 0.410), FXIII-AVal34leu (P = 0.160) and C677T MTHFR (P = 0.788). A lower frequency of 5G/5G genotype and a higher frequency of the 4G/5G genotype of the PAI -675 4G/5G polymorphism was found in young ischemic stroke patients compared to healthy controls. Further epidemiological studies are needed to investigate the differences between different geographic areas, and prospective cohort studies are needed to investigate the possible protective role of 5G/5G polymorphism.

Acupuncture has anxiolytic effects. We investigated the effect of acupuncture on the Bispectral Index (BIS) values and anxiety. Fifty patients were randomly assigned to group A to receive acupuncture for 15 minutes on the extra 1 point (yintang) or to group C, where they received the same treatment on a control point located 2 cm lateral to the end of the right eyebrow. BIS values were recorded before acupuncture; during acupuncture every 30 seconds for 15 minutes and every 30 seconds for 90 seconds when the acupuncture treatment was accomplished. Anxiety level was assessed before and after acupuncture by a verbal score scale (VSS) (0=no anxiety, 10=worst anxiety). BIS values were significantly decreased during acupuncture when applied on the extra 1 point (p=0.0001) but not on the control point.Acupuncture application significantly decreased the VSS values within the A group (p=0.027) and in the C group (p=0.0001), when compared to the baseline (pre-acupuncture) VSS values. However, no differences were found between the two groups regarding BIS or VSS values. In conclusion, needling the extra 1 point preoperatively significantly decreases the BIS values and the VSS for anxiety but needling of a control point decrease only VSS values.

Background Assessment of subarachnoid block, particularly the sensory component, may be incomplete and influence the conclusions of studies involving subarachnoid anesthesia, as well as their application in routine clinical practice. Methods We manually searched 175 articles concerning subarachnoid block published from 2006 to 2009 in 8 anesthesia journals to determine the components of the subarachnoid anesthetic procedure recorded as well as the extent of sympathetic and motor block. Results The level of subarachnoid injection was reported in 86% of the articles, baricity in 84%, concentration of local anesthetic in 77%, patient's position in 75%, needle size in 77%, and needle type in 71%. The stimulus used for assessing sensory block was reported in 69% of the articles; 17% described the block as unilateral or bilateral, and 11% described the lines along which the stimulus was applied. Motor and sympathetic block were assessed in 40% and 18% of studies, respectively. Conclusions These results suggest incomplete description of tools and assessment of sensory block in studies involving subarachnoid anesthesia. We propose a checklist to facilitate a more standardized evaluation of the extent of subarachnoid anesthesia.

INTRODUCTION We investigated the impact of intravenous lidocaine on anesthetic depth, as assessed by Bispectral Index score (BIS), and hemodynamic responses to rapid sequence induction/intubation. MATERIAL AND METHODS Eighty-four surgical patients with risk factors for regurgitation/aspiration were randomized to receive either lidocaine 1.5 mg/kg or normal saline in a double-blind fashion. Propofol 2 mg/kg, lidocaine or normal saline, followed by rocuronium 1 mg/kg were administered intravenously and trachea was intubated under cricoid pressure application. The BIS scores were recorded before induction of anesthesia, immediately after, at 30 s and 1 min after rocuronium injection and every 30 s after intubation, for 10 min. Systolic/diastolic blood pressure and heart rate were measured before induction, immediately after and at 1 min following rocuronium administration, and every minute for 10 min after intubation. RESULTS Data from 78 patients were analyzed. Demograpic characteristics did not differ between the study groups. A total of 24 BIS scores were recorded for each patient. No difference was found in BIS values between lidocaine and control groups at any time point (F = 2.936, p = 0.91). Also no difference was detected in heart rate, systolic and diastolic blood pressure at any time point of the study period between the two groups (F = 0.063, p = 0.80, F = 0.007, p = 0.93, F = 0.435, p = 0.51 respectively). No episodes of significant bradycardia occurred and none of the patients reported awareness/recall of the procedure. CONCLUSIONS Lidocaine 1.5 mg/kg given intravenously during rapid sequence induction does not affect BIS values, or blunt the hemodymanic response to laryngoscopy and intubation.

The Intubating Laryngeal Mask Airway FastrachTM (ILMA) has been used with success in difficult intubation cases. The purpose of this study is to evaluate the effect of mouth opening, Mallampati classification, thyromental distance and Cormack-Lehane Grade, on the ease of ILMA use.Eighty one patients ASA I-II, were assessed preoperatively for mouth opening, Mallampati classification and thyromental distance. After induction with propofol and rocuronium, the first investigator recorded Cormack-Lehane Grade by direct laryngoscopy. Subsequently an appropriate size ILMAwas inserted by the second investigator and correct placement was confirmed by adequate ventilation and normal capnogram. A maximum of three ILMA insertion attempts were allowed and the number was recorded. Then blind intubation was attempted and classified as follows, according to Intubation Difficulty Grade (IDG): IDG-1: intubation succeeded: at first attempt requiring no or minor ILMA manipulations. IDG-2: intubation succeeded at second attempt requiring major ILMA manipulations or size change. IDG-3: intubation failed after the second attempt or oesophageal intubation occurred at either attempt. In failure of the technique direct laryngoscopy was the alternative approach.Success rates in insertion of ILMA and in blind intubation were 100% and 92.6% respectively. No difference was found between Cormack-Lehane Grade I-II and II-IV or Mallampati classification and number of ILMA insertion attempts or IDG. There was also no correlation between mouth opening, or thyromental distance and number of ILMA insertion attempts or IDG. It is concluded that easiness of ILMA use is irrelevant to mouth opening, thyromental distance, Mallampati classification or Cormack-Lehane Grade.

BACKGROUND: We investigated a possible effect of ondansetron on the duration of sensory and motor block produced by ropivacaine. METHODS: Fifty male patients undergoing transurethral surgery received either 8 mg oral ondansetron the evening before surgery plus IV 8 mg ondansetron 15 min before subarachnoid anesthesia or placebo. All patients received 2.2 mL of 0.75% plain ropivacaine intrathecally. Sensory and motor block were assessed 30 min after the intrathecal injection and every 30 min thereafter until recovery from the motor block. RESULTS: Thirty minutes after spinal injection of ropivacaine, we first measured, in both groups, the time to maximum block for both sensory and motor modalities. The maximum level of the sensory block, defined as decreased sensation, was T8 in the control and T6 in the ondansetron group, and absence of sensation was defined as T11 and T9 for the control and the ondansetron groups, respectively. Regarding block duration, 180 min after spinal injection, sensory block was detected in 11 of 22 and 16 of 24 patients and motor block in 1 of 22 and 0 of 24 in the control and ondansetron groups, respectively. Sensory and motor block did not differ between groups at any measured time point. CONCLUSIONS: Ondansetron had no effect on the subarachnoid sensory or motor block produced by ropivacaine.

BACKGROUND AND OBJECTIVE Opioids are routinely administered to obtain a better control of postoperative pain. The aim of the present study was to assess the intravenous morphine effect after caesarean delivery on the postoperative morphine requirements and pain. METHODS Sixty-two parturients undergoing elective caesarean section under subarachnoid anaesthesia were randomly assigned in a double-blinded manner to the morphine or to the control group, to receive intraoperatively 0.15 mg kg morphine in 100 ml of isotonic saline or equal volume of normal saline. Postoperative analgesia was ensured with patient-controlled analgesia morphine. Postoperative pain at rest and after cough was assessed using the visual analogue scale (VAS) 2, 4, 8, and 24 h. Morphine consumption was recorded at the same time points. RESULTS Cumulative morphine consumption 2, 4, 8, and 24 h postoperatively was 6 +/- 4.8, 14 +/- 6.6, 22 +/- 9.6, and 42 +/- 15.7 mg in the morphine and 8 +/- 5.1, 18 +/- 7.7, 28 +/- 9.4, and 43 +/- 17.4 mg in the control group (F = 2.70, DF = 1, and P = 0.105 for intergroup comparisons). The VAS scores at rest did not differ between the two groups, being 28 +/- 22.3, 40 +/- 21.4, 28 +/- 18.5, and 28 +/- 22.2 mm in the morphine group and 28 +/- 21.5, 43 +/- 23.5, 29 +/- 24.2, and 19 +/- 24.8 mm in the controls (F = 0.37, DF = 1, P = 0.848). Similar results apply to the VAS scores recorded after cough. VAS values were 35 +/- 20.6, 51 +/- 22.5, 42 +/- 18.2, and 46 +/- 23.6 mm in the morphine and 40 +/- 22.1, 54 +/- 28.9, 47 +/- 26.5, and 38 +/- 26.9 mm in the control group, respectively. CONCLUSION Morphine given after caesarean delivery under subarachnoid anaesthesia has no effect on analgesic requirements or acute postoperative pain.

Pregnancy is associated with reduced local anesthetic requirements and increased pain thresholds, possibly due to hormonal changes and activation of endogenous opioids.We compared the responses to a mechanical and an electrical stimulus in 30 pregnant women (pregnant group) scheduled for cesarean section and 30 healthy female volunteers (control group) matched for age. Pain was assessed by Visual Analogue Scale (VAS) on two different days after skin application of EMLA or placebo cream on the forearms. EMLA and placebo cream were randomly applied on the medial surface of both forearms for 30 min in a blind cross over manner and the subjects received a mechanical stimulus generated through a pressor palpator followed by an electrical stimulus generated through a nerve stimulator.Average VAS values from both trials did not differ between pregnant and control group exposed to the mechanical or electrical stimulus after EMLA application or after mechanical or electrical stimulus after placebo cream application..Late pregnancy is not associated with increased sensitivity to local anesthetics (EMLA) applied to the skin, under our study conditions.

BACKGROUND: Acupressure on the "extra 1" point decreases bispectral index (BIS) values and stress. METHODS: We investigated the BIS, melatonin, beta-endorphin, and verbal stress score values before, after 10 min of acupressure application on the extra 1 point, on a sham point, after no acupressure, and 1 h after completion of each intervention in 12 volunteers. RESULTS: The BIS and verbal stress score values were decreased after acupressure on the extra 1 point (P = 0.0001 and P = 0.008, respectively), but melatonin and beta-endorphin did not change. CONCLUSION: Acupressure on the extra 1 point has no effect on melatonin and beta-endorphin levels.

Study Objective To evaluate the effect of physostigmine on 1.5% sevoflurane anesthesia and recovery. Design Prospective, randomized, double-blinded study. Setting Operating room of a university-affiliated, metropolitan hospital (Aretaieion Hospital and St Savas Hospital). Patients Forty female American Society of Anesthesiologists physical status I and II patients scheduled for breast biopsy. Interventions Patients were randomly assigned in physostigmine (PHYSO) and normal-saline (NS) group. Anesthesia was induced with sevoflurane 8% using a vital capacity breath technique, and rocuronium 0.6 mg/kg was given to facilitate Laryngeal Mask Airway (LMA) No. 4 insertion. Anesthesia was maintained with end-tidal sevoflurane 1.5 minimum alveolar concentration (MAC; 3% end-tidal concentration) throughout the procedure. Measurements After skin closure and under steady-state sevoflurane anesthesia 1.5 MAC, heart rate, blood pressure, and Bispectral Index (BIS) were recorded. Immediately after, the PHYSO group received intravenous 2 mg of physostigmine, whereas the NS group received equal volume of normal saline. Bispectral Index and hemodynamic measurements were recorded 5, 8, and 10 minutes after treatment. Anesthesia was then discontinued and the LMA was removed. Zero, 15, and 30 minutes after LMA removal, patients were evaluated for orientation, sedation, sitting ability, and the “picking up matches” test, as well as for nausea and vomiting. Main Results No difference was found in BIS (29 ± 4, 32 ± 6, 31 ± 6, 30 ± 7, 84 ± 11 in the PHYSO group vs 29 ± 6, 30 ± 6, 30 ± 5, 31 ± 5, 86 ± 7 in the NS group), hemodynamic parameters, or recovery parameters between the 2 groups at any time. No nausea or vomiting was observed in either group. Conclusions Physostigmine did not influence BIS values or early recovery when administered to patients anesthetized with 1.5 MAC sevoflurane anesthesia.