The aim of this study was to assess the efficacy of combined opioids by comparing four regimens of patient-controlled epidural analgesia (PCEA) after cesarean section. Parturient patients who underwent elective or emergent cesarean section under combined spinal and epidural anesthesia from April 2013 to March 2016 were retrospectively analyzed. Based on PCEA, they were assigned to one of 4 groups: local anesthetic alone (LA), epidural single morphine administration during surgery followed by local anesthetic alone (M), local anesthetic combined with fentanyl 10 μg/h (F10), or local anesthetic combined with fentanyl 20 μg/h (F20). The primary outcome was the number of PCEA boluses used. Secondary outcomes included the use of rescue analgesia, postoperative nausea and vomiting, and postoperative pruritus. A total of 250 parturients were analyzed. Whereas the number of PCEA boluses in the LA group was significantly higher than in the other combined opioid groups on the day of surgery and postoperative day 1 (LA: 3 [1–6] and 7 [4–9] vs M: 2 [0–4] and 4 [0–7] vs F10: 1 [0–4] and 3 [0–6] vs F20: 1 [0–3] and 2 [0–8], P = .012 and 0.010, respectively), within the combined opioid groups, the number was not significantly different. Significantly fewer patients in the F20 group required rescue analgesia on postoperative day 1 and 2 (25 and 55%) than those in the M (66 and 81%) and F10 (62 and 66%) groups (P < .001 and P = .007, respectively). Postoperative nausea and vomiting and pruritus were significantly higher in the M group (P < .008 and P = .024, respectively). The results of the present study suggest that local anesthetic alone after a single administration of morphine, or local anesthetic combined with fentanyl 10 μg/h would generally be adequate for PCEA, whereas local anesthetic combined with fentanyl 20 μg/h would be suitable for conventional epidural analgesia.

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Adrenomedullin (AM) is a potent vasodilator peptide that was first identified in extracts of human pheochromocytoma [1]. To date, it is known to be synthesised in several organs and tissues, including the heart, lungs, kidneys, adipose tissue, and vascular endothelium [2]. AM affects the physiological functions of the cardiovascular system, kidneys, and central nervous system. It regulates blood pressure and vascular tone, increases cardiac output, and promotes diuresis and natriuresis [1][2][3][4][5]. Kitamura et al. [6,7] were the first to report that two major molecular forms of AM circulate in the human blood, namely the biologically active mature AM (mature AM) form with an amidated C-terminus, and an inactive intermediate AM with a non-amidated

Background: Biologically active adrenomedullin (mature AM) has received considerable attention as a new biomarker of sepsis and septic shock. However, information about this peptide is limited. In this study, we further investigated the value of mature AM for diagnosis and outcome prediction in sepsis.Methods: This was a prospective, observational, single-centre study. Patients admitted to the intensive care unit (ICU) were retrospectively categorised into non-sepsis or sepsis groups, according to the Sepsis-3 definitions. Plasma levels of mature and total (the sum of the levels of intermediate and mature forms) AM were measured, and their usefulness was compared with those of other sepsis biomarkers, such as procalcitonin and presepsin. Results: Of the 98 patients included in the final analysis, 42 were assigned to the non-sepsis and 56 to the sepsis group. Levels of mature and total AM on admission were significantly higher in patients with sepsis than in those without sepsis. The areas under the receiver operating characteristic curves of mature and total AM for predicting 28-day mortality in patients with sepsis became significant on day 3 after admission. A good correlation between the AM forms was found, indicating that the changes in their plasma levels may directly reflect each other.Conclusion: Because the levels of mature and total AM increased significantly in patients with sepsis on admission, both forms may be used as reliable and early biomarkers for diagnosing sepsis according to the Sepsis-3 definitions. However, prediction of 28-day mortality in such patients would require several days of ICU stay.

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