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Cesarean section (CS) is one of the most common surgical procedures in female patients. We aimed to evaluate the postoperative analgesic efficacy of intrathecal fentanyl during the period of greatest postoperative analgesic demand after CS. This period was defined by detailed analysis of patient-controlled analgesia (PCA) usage.This double-blind, placebo-controlled, parallel-group randomized trial included 60 parturients who were scheduled for elective CS. Participants received spinal anesthesia with bupivacaine supplemented with normal saline (control group) or with fentanyl 25 μg (fentanyl group). To evaluate primary endpoints, we measured total pethidine consumption over the period of greatest PCA pethidine requirement. For verification of secondary endpoints, we recorded intravenous PCA requirement in other time windows, duration of effective analgesia, pain scores assessed by visual analog scale, opioid side effects, hemodynamic changes, neonatal Apgar scores, and intraoperative pain.Detailed analysis of hour-by-hour PCA opioid requirements showed that the greatest demand for analgesics among patients in the control group occurred during the first 12 hours after surgery. Patients in the fentanyl group had significantly reduced opioid consumption compared with the controls during this period and had a prolonged duration of effective analgesia. The groups were similar in visual analog scale, incidence of analgesia-related side effects (nausea/vomiting, pruritus, oversedation, and respiratory depression), and neonatal Apgar scores. Mild respiratory depression occurred in 1 patient in each group. Fewer patients experienced intraoperative pain in the fentanyl group (3% vs 23%; relative risk 6.8, 95% confidence interval 0.9–51.6).The requirement for postoperative analgesics is greatest during the first 12 hours after induction of anesthesia in patients undergoing CS. The addition of intrathecal fentanyl to spinal anesthesia is effective for intraoperative analgesia and decreases opioid consumption during the period of the highest analgesic demand after CS, without an increase in maternal or neonatal side effects. We recommend using intrathecal fentanyl for CS in medical centers not using morphine or other opioids intrathecally at present.

Axillary brachial plexus block is one of the most frequently employed peripheral blocks. The popularity of axillary block stems from its success as a safe and relatively easy technique with numerous applications. The technique of axillary block has evolved. It was modified after the development of precise nerve localization modalities. Currently, ultrasound is the most important localization technique for regional anaesthesia. Ultrasound-guided axillary block encompasses a spectrum of techniques. The selection of a specific technique can be adjusted to an operator's individual level of skill and proficiency. Axillary block under US-guidance can be performed using a traditional perivascular method and by placing a selective blockade of individual nerves that supply the surgical area. Regardless of the selected method, it enables the incorporation of individual patient anatomical variation in an anaesthesia plan. This paper discusses the technical details and efficacy issues of US-guided axillary brachial plexus block techniques.Keywords: regional anaesthesia, peripheral nerve block, brachial plexus; regional anaesthesia, peripheral nerve block, axillary block; regional anaesthesia, techniques Anaesthesiology Intensive Therapy 2015, vol. 47, no 4, 417-424 Axillary brachial plexus block is one of the most frequently employed peripheral blocks. The popularity of axillary block derives from its success as a very safe and relatively easy technique with numerous applications. The technique of axillary block has evolved. It was modified after the development of precise nerve localization modalities. Currently, ultrasonography is the most important localization technique for regional anaesthesia. Ultrasound-guided axillary block encompasses a spectrum of techniques. The selection of a specific technique can be adjusted to an operator's individual skills and proficiency. Ultrasound-guided axillary block can be performed using a traditional perivascular method and by placing a selective blockade of individual brachial plexus branches that supply the field of surgical operation. Regardless of the selected method, it enables the incorporation of individual anatomical variability into the anaesthesia plan of a patient. TECHNIQUE OF ULTRASOUND-GUIDED AXILLARY BRACHIAL PLEXUS BLOCKThe use of ultrasonography enables all steps of a regional block to be controlled, such as determination of the anatomical structure of the anaesthetized region via realtime control, operational correction of the needle position and verification of the injection site and pathway of local anaesthetic agent dispersion [2]. Ultrasonography enables the assignment of an optimal site of needle puncture and the planning of the insertion vector based on the topographic relationships among particular patients.The utilization of this technique has introduced new possibilities of axillary block performance and has significantly changed its operation compared with traditional methods. Assuming that a crucial factor of effective/failed block is the appr...

Background: Ultrasound-guided (US-guided) regional anaesthesia has gained worldwide popularity in recent years owing to the benefits the method offers to patients. The 1 st Department of Anaesthesiology and Intensive Care of Warsaw Medical University was one of the first centres in Poland to employ US-guided peripheral nerve blocks (PNB) on a routine basis. The technique was incorporated into the institution's clinical practice from 2007. The purpose of this study was to retrospectively assess changes in the clinical practice of US-guided versus non US-guided PNBs over six years of experience with the technique. Methods: Retrospective analysis assessing the prevalence of PNB methods, local anaesthetic (LA) injection techniques (i.e. single injection vs. multiple), LA volumes used, success rates and the incidence of complications. Results: This study included 4,066 PNBs performed between January 2006 and June 2012. The results showed systematic growth in the prevalence of US-guided blocks in the total number of PNBs, from 8.6% in 2007 up to 53.3% in 2012. The mean LA volume used in PNB was significantly lower in US-guided blocks compared to traditional PNB techniques (respectively, 21.83 mL vs. 31.41 mL, P < 0.05) without a decrease in the success rate (respectively, 76% vs. 74%, P > 0.05). A shift in the prevailing block technique from single injection to multiple injections was observed, regardless of the nerve location technique employed (from 29% up to 84% of PNBs performed using multiple injection technique). Conclusions: The use of ultrasound optimizes the technique of peripheral blocks and the amount of local anaesthetic used. Ultrasonography does not affect the safety of peripheral blocks.

Axillary brachial plexus block is one of the most popular and widely used approaches for brachial plexus blocks. Its main advantages are its versatility and high safety. Brachial block facilitates analgesia for the distal arm, elbow, forearm and hand. Numerous upper limb procedures, particularly orthopedic ones, can be carried out under axillary block. Axillary block is well suited for the ultrasound-guided technique. Because the brachial plexus in the axillary region is located superficially, the nerves, block needle, and local anesthetic spread are all relatively easy to visualize. A high-frequency linear probe can be used during block procedure, so the quality and resolution of the ultrasound images are excellent. An important feature of the axillary approach is its high level of safety. In the axillary area, there are no anatomical structures other than vessels, to which damage during block placement could pose a risk for the patient. For this reason, axillary block is one of the techniques that are recommended for learning ultrasound-guided regional anesthesia. This paper summarizes anatomical fundamentals and provides basic sonoanatomic knowledge that is essential for successful ultrasound-guided axillary block.Key words: regional anesthesia, peripheral nerve block, brachial plexus; regional anesthesia, peripheral nerve block, axillary block; ultrasound, sonoanatomy Anaesthesiology Intensive Therapy 2015, vol. 47, no 4, 409-416 Axillary brachial plexus block is one of the most popular and widely used techniques for brachial plexus blocks [1]. This approach is very universal and safe, and it allows analgesia for the distal arm, elbow, forearm and hand. Numerous upper limb procedures, in particular orthopedic ones, could be carried out under axillary block. Axillary block is well suited for ultrasound-guided techniques. The brachial plexus in the axillary region is located superficially, so the nerves, block needle and local anesthetic spread are relatively easy to visualize. A high-frequency linear probe can be used during block procedure, so the quality and resolution of ultrasound image are excellent. This approach is also very safe because in the axillary area there are no anatomical structures other than vessels, which damage during block placement could put a patient at risk. For this reason, axillary block is one of the techniques that are recommended for physicians learning ultrasound-guided regional anesthesia [2]. This paper is the first part of a review of the axillary brachial plexus block that summarizes the anatomical fundamentals and basic sonoanatomic knowledge that are essential for successful ultrasound-guided axillary block. Part two presents the techniques and possibilities for performing the axillary brachial plexus block when using ultrasonography.