P Pu ur rp po os se e: : To evaluate the safety and applicability of two local anesthetic (LA) solutions self-administered for pain treatment after inguinal hernia repair (IHR) by balloon-pumps via catheters placed in the surgical wound. Effectiveness of analgesia was also compared.

No abstract

Our study showed that tcPO2 is a reliable indicator of local ischemia. The integration of this parameter with other personal clinical criteria may be a valuable help to the surgeon in decision making.

Single fibre electromyography was used to analyse responses of the pelvic floor muscles to electrical stimulation such as applied for the treatment of urinary incontinence. Using latency variation of consecutive responses of single motoneurons as a criterion, responses of the following types have been identified in the pelvic floor muscles: direct responses due to stimulation of the motor axons, oligosynaptic reflex responses, polysynaptic reflex responses conducted through different numbers of interneurons, and recurrent responses of antidromically activated motoneurons. It has been shown that the largest proportion of the obtained motor effect is due to the polysynaptic reflex responses. This implies several important advantages as compared to direct stimulation of motor axons, e.g. the physiological recruitment order of the motor units, and coordination and plasticity of the response. Therefore, electrical stimulation seems promising in cases of upper motoneuron lesion in which the spinal reflex arcs remain preserved.

Our previous observations have shown that the electrical stimulation of muscles is prevalently reflex. One of the advantages of reflex stimulation is that it activates not only a limited number of motor units, but rather a number of muscles connected by the same reflex from a single stimulation site. Consequently, it is not necessary to place electrodes into the muscle to be activated. They can be put elsewhere provided that the same effect is obtained and that it is more convenient for the patient. Such an opportunity arises when treating urinary incontinence which involves not only the urethral sphincter but also the group of synergistic muscles of the pelvic floor. Our experiments with several patients suffering stress incontinence have shown that indirect stimulation of the levator ani with a vaginal stimulator and especially of the anal sphincter with an anal stimulator affects the urethral sphincter in the same way as direct stimulation. These findings are significant since they enable us to use external instead of implantable stimulators. External stimulation is worth trying in all cases of stress incontinence where conservative measures have failed. In our cases, the results have been very satisfactory.