The aim of this study was to assess the analgesic efficacy of bilateral erector spinae plane
block in comparison with intrathecal morphine after elective cesarean section under spinal
anesthesia.
Spinal anesthesia is a safe technique, widely used and tested in the gynecological field, so
as to be considered the first choice technique in cesarean section, which allows to quickly
obtain a valid sensor and motor block. Bupivacaine is one of the most widely used drug for
obtaining spinal anesthesia in pregnant women undergoing caesarean section. Bupivacaine is a
local anesthetic available as a racemic mixture of its two enantiomers, the R (+)-
dextrobupivacaine and the S (-) – levobupivacaine, whose clinical use is widely validated.
Racemic bupivacaine is available as a simple or hyperbaric solution, the latter being the
most commonly used for spinal anesthesia. Levobupivacaine, which is the pure levorotatory
enantiomer of racemic bupivacaine, is a slightly hypobaric solution compared to liquor and
has shown less heart and nerve toxicity, probably due to its ability to bind proteins more
rapidly, and a greater selectivity towards the sensory component compared to Bupivacaine,
presents action and effects better predictable. Its baricity would also offer the advantage
of providing a less sensitive block to the position.
Hypotension is one of the most common complications of spinal anesthesia and is particularly
relevant in caesarean section because, in addition to the adverse effects on the parturient,
it can have repercussions on the fetus through a reduction of placental perfusion.
Some studies have showed a similar incidence of hypotension in patients treated with
bupivacaine compared to those treated with levobupivacaine, while others assert an
equivalence between the two drugs. In most studies, however, a significantly lower incidence
of hypotension and a greater hemodynamic stability were reported in pregnant patients
undergoing spinal anesthesia by caesarean section with levobupivacaine.
Being both hyperbaric bupivacaine and levobupivacaine routinely used at the "G. Rodolico"
Universitary Hospital of Catania for the spinal anesthesia of pregnant women undergoing
caesarean section and being their use decided exclusively at discretion of the treating
anesthesiologist, in the light of the discrepant data in the literature about the incidence
of hypotension with the two drugs, the main objective of this observational study is to
evaluate the hemodynamic effects mediated by levobupivacaine on pregnant women subjected to
elective cesarean section and to compare them with those mediated by hyperbaric bupivacaine
in an historical court of pregnant women subjected to caesarean section in the period between
April 2017 and April 2018. The hemodynamic parameters will be monitored in real time with a
non-invasive hemodynamic monitoring system (EV1000® platform + Clearsight® system – Edwards
LifeSciences), routinely used in the "G. Rodolico" Universitary Hospital of Catania, allowing
to obtain greater accuracy and veracity of the results compared to previous studies conducted
on such anesthetics.
Hypoxia exists to some degree in most solid tumors due to inadequate oxygen delivery of the abnormal vasculature which cannot meet the demands of the rapidly proliferating cancer cells. The levels of oxygenation within the same tumor are highly variable from one area to another and can change over time. Tumor hypoxia is an important impediment to effective cancer therapy. In radiotherapy, the primary mechanism is the creation of reactive oxygen species; hypoxic tumors are therefore radiation resistant. A number of chemotherapeutic drugs have been shown to be less effective when exposed to a hypoxic environment which can lead to further disease progression.
In Ontario, wound care support has steadily increased over the years. With the growth of the
aging population, the financial and psychological burden related to wound care will continue
to rise. Studies have shown that structured meditation programs can improve on the recovery
process for both physical and psychological disease. Therapeutic treatments like Hyperbaric
Oxygen Therapy (HBOT) for chronic wounds have shown to promote angiogenesis, cerebral blood
and neuroplasticity in patients with stroke, traumatic brain injury and chronic pain. By
combining meditation and HBOT, this have been independently shown to improve healing and
reducing costs associated with chronic wounds.
The American Society of Colon and Rectal Surgeons (ASCRS) is dedicated to ensuring high-quality patient care by advancing the science, prevention, and management of disorders and diseases of the colon, rectum, and anus. The Clinical Practice Guidelines Committee is charged with leading international efforts in defining quality care for conditions related to the colon, rectum, and anus by developing clinical practice guidelines based on the best available evidence. These guidelines are inclusive, not prescriptive, and are intended for the use of all practitioners, healthcare workers, and patients who desire information about the management of the conditions addressed by the topics covered in these guidelines. Their purpose is to provide information on which decisions can be made rather than to dictate a specific form of treatment.