Background: There are few case reports describing maternal mortality and intensive care of the pregnant patient with COVID-19 infection. Case: A 27-year-old patient at 34 weeks of gestation was admitted for the evaluation of cough, fever, tachypnea, and oligohydramnios. The day of admission she underwent cesarean delivery for a non-reassuring fetal heart rate tracing. Over the next 6 days her clinical condition deteriorated, she developed multi organ system failure, and died despite aggressive supportive care. Conclusion: Although mortality related to COVID-19 in pregnancy has been rarely reported to date, we describe a case of progressive clinical deterioration postpartum despite aggressive supportive care. Management strategies specific for pregnant women have not been developed. In timing delivery, the obstetrician must consider the possibility that the inflammatory response associated with CD may increase the risk for multiorgan system failure in parturients with COVID-19 while recognizing that risks to the fetus may be higher in patients with COVID-19 than in other critically ill parturients. Vertical transmission of infection to the neonate did not occur in our case and has not been demonstrated in other pregnancies with COVID-19 disease.

Introduction: Interfascial plane blocks (IPB) are truncal blocks with local anesthetic injected into space between two muscle layers. IPBs are easy to learn, simple to perform, provide satisfactory analgesia up to 24 hours, having a minimal risk of...

Introduction/Objective. Тo ensure that all patients receive the best possible anesthetic care, it is essential to continuously evaluate our practices and strive for improvement. The objective of this study is to internally assess the anesthesia services provided during the peripartum period. Methods. The Anesthesiology Department of Leskovac General Hospital, Serbia (LGH) aimed to evaluate patient satisfaction with spinal anesthesia (SA) for Cesarean delivery (CD) using a questionnaire consisting of four open-ended questions. Following Institutional Review Board approval, an institutional-based survey was conducted from August 2021 to July 2022. During the study period, 624 (40.6%) of the total 1,535 deliveries in LGH were CDs, with 311 (49.8%) of them performed under SA. Of the patients who underwent CD under SA, 87 agreed to anonymously complete the questionnaire. Results. Although patients had sufficient space to provide detailed responses, the majority of participants opted for brief answers, often limited to “yes” or “no”. Of the surveyed participants, 78% were informed about SA for CD before delivery, and 96.6% expressed satisfaction with the information provided during the preoperative anesthesiologist's visit. Additionally, the majority of participants (94.3%) reported satisfaction with the postoperative analgesia they received. Conclusion. Our patients expressed high levels of satisfaction with the preoperative anesthesiologist's visit and the SA provided for CD. However, there is a need to improve antenatal education for expectant mothers in the field of anesthesia. Conducting a new and more detailed survey would be necessary to further explore the influence of patient education and socioeconomic status on patient satisfaction.

Background/aim: The Quadratus lumborum block (QLB) is an interfascial block recommended for multimodal pain therapy after cesarean section in patients who cannot receive intrathecal morphine. We wanted to investigate whether QLB contributes to better analgesia after total abdominal hysterectomy (TAH). The study was registered on the website ClinicalTrials.gov (registration number NCT05765318). Materials and methods: Patients scheduled for TAH were randomized into two groups of 30 members each. The treatment group received QLB, while the control group did not undergo any block. The primary outcome was the amount of morphine during the first 12 postoperative h. Secondary outcomes included the total amount of morphine for 24 h, time to the first request for additional analgesia, pain intensity at rest and during activity, frequency of nausea and vomiting, and the degree of sedation at 2, 6, 12, and 24 h postoperatively. Results: Patients in the QLB group received significantly less morphine (4.13 mg) compared to the control group (9.73 mg) during the first 12 postoperative h (p < 0.001) and also during the first 24 h. The patients in the QLB group had longer time interval to the first breakthrough pain (7.87 h) compared to the control group (2.63 h) (p < 0.001), lower NRS scores at rest and during activity after 2, 12, and 24 h, and better satisfaction with provided pain relief during the first 24 h postoperatively. Conclusion: QLB reduces postoperative morphine use and postoperative pain intensity on the NRS scale, both at rest and during activity, as part of multimodal pain therapy for TAH.

Abdominal wall blocks became a part of clinical anesthesia practice 40 years ago. Their popularity has dramatically increased in the last decade thanks to the introduction of simple and effective ultrasound guided techniques, such as the transversus abdominis plane (TAP) block and more recently the quadratus lumborum block (QLB). QLB is a posterior abdominal wall block that is performed only under ultrasound guidance. Since its first description, this technique has been further investigated and modified. Currently, there are four approaches of QLB relative to the site of local anesthetic injection. QLB provides both visceral and somatic analgesia. QLB is safe, and it has a role in the postoperative analgesia after abdominal laparotomy and laparoscopy in adults and children. It can also be used after Cesarean deliveries, gynecological cases, gastrectomy, bowel resection, abdominal hernia repair, prostatectomy, nephrectomy, scrotum surgery, both hip and femur fractures and surgery, lumbar vertebra surgery and femorofemoral bypass. QLB is a new variant of abdominal wall blocks. Clear sonographic landmarks allow it to be easily performed. Analgesia lasts 24 - 48 hours. The complications have not been shown. QLB has great potential to improve and facilitate postoperative pain management.

Introduction. The quadratus lumborum block (QLB) was the first interfascial plane block introduced in Leskovac General Hospital thanks to the international teaching Kybele Inc. program in April 2017. Outline of cases. During the period from April 2017 to December 2019, 22 pediatric patients underwent various surgical procedures and had the QLB type 1 block as a part of a multimodal perioperative pain management plan. Unilateral QLB was provided for unilateral inguinal hernia repair, orchidopexy, testicular torsion repair, and open appendectomy. Bilateral QLB was provided for laparoscopic appendectomy and cholecystectomy. Decreased use of fentanyl and sevoflurane was noticed in the cases when QLB was performed preoperatively. All patients had well-controlled pain. Conclusion. QLB is a simple and safe technique. Clear sonographic landmarks allow it to be easily performed. QLB has great potential to improve and facilitate postoperative pain management.