ABSTRACT
Introduction: Caesarean section (CS) is a commonly performed major surgical procedure that causes significant postoperative pain. The objective of this study was to evaluate the efficacy of the transverse abdominal plane block (TAPB) in the management of post-caesarean pain at the Souro Sanou Teaching Hospital (CHUSS) of Bobo Dioulasso. Methodology: This was a single blind randomised clinical trial. One hundred patients admitted for CS under spinal anaesthesia were randomised into two groups using the sealed envelope method. The intrathecal morphine (ITM) group received 100 µg morphine intrathecally at induction and the TAPB group a bilateral TAPB at the end of the caesarean section with 20 ml of 0.25% bupivacaine and 4 mg dexamethasone in the same syringe on each side. The proportion of mild pain, numeric rating scale (NRS) < 3 on mobilisation at 24 hours post-caesarean was the primary outcome. Results: The 2 groups were comparable for socio-demographic and clinical characteristics. The mean age of the patients was 28.14 ± 6.34 years and 29.08 ± 5.58 years (p=0.43). At rest at 24 hours post-op, the proportion of NRS < 3 was 100% for the TAPB group and 88% for the ITM group (p=0.49). On mobilisation at 24 hours post-op, 96% of patients in the TAPB group and 74% in the ITM group (p=0.002) had a NRS < 3. At rest at 48 hours post-op, it was 100% for the TAPB group and 88% for the ITM group (p=0.027). On mobilisation at 48 hours post-op, it was 94% for the TAPB group and 70% for the ITM group (p=0.002). Postoperative nausea and vomiting (PONV) were present in 50% of patients in the ITM group and 6% in the TAPB group (p<0.001). Conclusion: TAPB significantly reduced pain scores on mobilisation in the post-caesarean period with a significant reduction in PONV.

ABSTRACT
Introduction: Encephalic death (ED) is one of the consequences of severe head trauma (TBI), and the donor in a state of encephalic death is an unavoidable solution to the shortage of transplants. The aim of our study was to detect the transition to ME in MCT and to assess the possibility of performing multi-organ retrieval from the deceased donor. Material and Method: prospective study of TCGs admitted to the Salim Zemirli health hospital who had progressed to ME, it began in February 2017 over a period of three years. We collected the following data, incidence of ME, age, sex, medical history, Glasgow score on admission, pupil status of donors in ME, mean time to onset of ME, mean duration of graft resuscitation, availability of monitoring, paraclinical investigations and treatment necessary for the management of a donor in ME. The results: A total of 175 MCTs were included, 16% of these MCTs were found to be in the ME state, the diagnosis of ME was clinical with paraclinical confirmation by transcranial doppler, these donors benefited from therapeutic management without limitation of care. The average age was 35 ± 12 years, medical history was present in 35.71% of cases. The average Glasgow score was 5.63 ± 0.324, with pupillary anomalies such as anisocoria in 28.57% and mydriasis in 21.42%. The average time to onset of ME was 3 ± 1.23 days; the average resuscitation time was 44.06 ±8.79 hours; EEG was not available in our department. For the treatment of diabetes insipidus, we noted the absence of desmopressin. Conclusion: Organ harvesting from a deceased donor is technically possible in our establishments.

ABSTRACT
Children may be at increased risk of pulmonary aspiration because of retention of gastric contents caused by pain or inadequate fasting. We performed this study to analyze the use of ultrasound for evaluation of gastric ultrasound in children less than 12 years. Two hundred children, 1-12 years of age belonging to ASA physical status I to II, scheduled to undergo elective surgery were included in the study. Patients were scanned in supine position followed by right lateral decubitus position (RLD). In qualitative assessment, the antrum was judged to contain fluid if it appeared to have an endocavitary lumen with hypoechoic content and distended walls. All measurements were taken with antrum at rest (between contraction) to avoid underestimating volume. It was observed that majority of the children were in Perlas grade 0, 116(58%) followed by 75 children in grade 1 and 9 children in grade 2. Using Karl Pearson’s Correlation coefficient, low positive correlation was found between gastric volume and fasting status solid (in hours) and the variation (correlation) was found to be statistically non-significant (r=0.139; p>0.05). There is no proportionate decline in gastric volume with increased duration of preoperative fasting. Ultrasonographic measurement of antral area can be of interest to anesthesiologist for accurate qualitative and quantitative estimation of preoperative gastric contents and volume. However, gastric ultrasonography has to be validated in further trials involving a larger patient population before it can become a routine standard of care in perioperative period.