Inadvertent perioperative hypothermia complicates a large percentage of surgical procedures and is related to multiple factors. Strictly regulated in normal conditions (± 0.2°C), the core body temperature of an anaesthetised patient may fall by as much as 6°C, while a 2°C decrease is very common. This is due to a combination of anaesthesia-related impairment of the central thermoregulatory control and a cool operating room temperature, which, when superimposed on insufficient insulation and a failure to actively warm the patient, may result in profound temperature disturbances. As a result, prolonged wound healing, increased risk of wound infection, a higher rate of cardiac morbidity, and greater intraoperative blood loss and postoperative blood transfusion requirements may occur. The reasons for this are said to include underlying changes in microcirculation, coagulation, immunology and an increase in the duration of action of most anaesthesia medications. As effective methods have been available for a number of years now, it is currently indicated to maintain intraoperative normothermia in order to minimise procedure-related risk and improve patient comfort.

After many years of experience in surgery, a series of recommendations have been created by a group of European specialists to improve the quality of perioperative care and maximize postoperative outcomes. Early mobilization and oral feeding, preoperative oral intake of carbohydrate-rich fluids, proper fluid and pain management, intensive postoperative nausea and vomiting prophylaxis, and antimicrobial and thromboembolism prophylaxis are the interventions that may decrease surgery-induced metabolic stress and facilitate the return of bowel function and early discharge. The Enhanced Recovery After Surgery (ERAS) Society is the group that focuses on these perioperative issues. This paper aims to summarize the role of anaesthesiologists in the implementation of the ERAS protocol.

The optimal intrathecal dose of local anaesthetic for caesarean section (CS) anaesthesia is still being debated. We performed a study to compare the effectiveness and safety of spinal anaesthesia with 12.5 mg of hyperbaric bupivacaine and a dosing regimen of conventional doses adjusted to parturient height. One hundred and forty parturients scheduled for elective CS were enrolled. The fixed-dose group (FD) received a spinal block with 12.5 mg of hyperbaric bupivacaine with fentanyl, whereas the adjusted-dose group (AD) received a height-adjusted dose of bupivacaine (9–13 mg) with fentanyl. Sensory block ≥ T5 dermatome within 10 min and no need for supplementary analgesia were set as the composite primary outcome (success). Rates of successful blocks and complications were compared. Complete data were available for 134 cases. Spinal anaesthesia was successful in 58 out of 67 patients in the FD group and 57 out of 67 in the AD group (p > 0.05). Eight spinals in each group failed to produce a block ≥ T5 in 10 min, and one patient in the FD group and two in the AD group required i.v. analgesics despite sensory block ≥ T5. No differences were noted in terms of hypotension, bradycardia and nausea between the FD and AD groups. Compared to the height-adjusted dose regimen based on conventional doses of hyperbaric bupivacaine, the fixed dose regimen of 12.5 mg was equally effective and did not increase the risk of spinal block-related complications.

Introduction: Chronic pelvic pain syndrome occurs in 4–14% of women. Pain pathomechanism in this syndrome is complex, as it is common to observe the features of nociceptive, inflammatory, neuropathic and psychogenic pain. The common findings in women with pelvic pain are endometriosis and...

Here we report on the use of neurolytic block of ganglion impar (ganglion of Walther) for the management of intractable chronic pelvic pain, which is common enough to be recognized as a problem by gynecologists, likely to be difficult to diagnose and even more challenging to manage. Following failure in controlling the symptoms with pharmacological management, nine women underwent neurolysis of the ganglion impar in our Pain Clinic from 2009 to March 2013. The indication for the procedure was chronic pelvic pain (CPP) of either malignancy-related (4) or other origin (5). The Numeric Rating Scale (NRS) and duration of pain relief were employed to assess effectiveness of the procedure. Neurolysis was efficacious in patients with both malignancy-related CPP and CPP of non-malignant origin. Reported relief time varied from 4 weeks to 3 years, while in 4 cases complete and permanent cessation of pain was achieved. No complications were noted.

Background: Sympathetic system involvement in postherpetic neuralgia (PHN) has been targeted using peripheral sympathetic nerve blocks for a number of years with variable efficacy. The aim of this report is to present the outcomes of PHN management with concomitant use of pharmacological treatment and sympathetic nerve blocks. Methods: We retrospectively evaluated clinical data on 563 patients with PHN symptoms treated in the pain clinic and identified cases in which sympathetic nerve blocks were implemented in the years 1992−2010. A Numeric Rating Scale was used as a pain severity assessment, with a reduction to values under 3 considered a positive therapy result. Three time intervals were considered: years 1992−1997 (I), 1998−2002 (II) and 2003−2010 (III). Results: In group I, 27% of patients had poor treatment results, while in group II, the failure rate dropped to 18%. The same 18% failure rate was observed in group III as well. Treatment introduced early yielded the best results, but there was no difference among groups with a similar duration from herpes zoster onset to treatment commencement in the time periods assessed; however, from 1998 onward, the same rate of poor outcomes was also noted in the groups who started the sympathetic blockade, which aided pain clinic treatment up to 3 months and between 3 and 6 months from the onset of herpes zoster. Conclusion: Major progress in the pharmacological treatment of PHN appears to be an obvious factor contributing to the overall improvement in PHN management (introduction of gabapentin). Nevertheless, safely administered regional anaesthesia techniques, although performed in a very similar manner for many years, appear to provide some support as part of a multimodal approach to PHN management. Background: Sympathetic system involvement in postherpetic neuralgia (PHN) has been targeted using peripheral sympathetic nerve blocks for a number of years with variable efficacy. The aim of this report is to present the outcomes of PHN management with concomitant use of pharmacological treatment and sympathetic nerve blocks. Methods: We retrospectively evaluated clinical data on 563 patients with PHN symptoms treated in the pain clinic and identified cases in which sympathetic nerve blocks were implemented in the years 1992−2010. A Numeric Rating Scale was used as a pain severity assessment, with a reduction to values under 3 considered a positive therapy result. Three time intervals were considered: years 1992−1997 (I), 1998−2002 (II) and 2003−2010 (III). Results: In group I, 27% of patients had poor treatment results, while in group II, the failure rate dropped to 18%. The same 18% failure rate was observed in group III as well. Treatment introduced early yielded the best results, but there was no difference among groups with a similar duration from herpes zoster onset to treatment commencement in the time periods assessed; however, from 1998 onward, the same rate of poor outcomes was also noted in the groups who started the sympathetic blockade, which aided pain clinic treatment up to 3 months and between 3 and 6 months from the onset of herpes zoster. Conclusion: Major progress in the pharmacological treatment of PHN appears to be an obvious factor contributing to the overall improvement in PHN management (introduction of gabapentin). Nevertheless, safely administered regional anaesthesia techniques, although performed in a very similar manner for many years, appear to provide some support as part of a multimodal approach to PHN management.