Management of Post-Operative Pain after Gyneco-Obstetrical Surgery: Practice of Transversus Abdominis Plane Bloc (Tap Block) Echoguide at the Ignace Deen National Hospital

Objectives: To describe the practice of ultrasound-guided TAP in the management of postoperative pain after gyneco-obstetric surgery. Methods: This was a descriptive prospective study carried out at the Gynecology-Obstetrics department of the Ignace Deen National Hospital over a period of three (03) months from February 01, 2020 to April 31, 2020. Results: In total, we collected 95 patients. These patients had a mean age of 30 ± 9.5 years. The ASA I class was the most represented with 76% of the cases and the cesarean was the most performed intervention. Regarding the assessment of the pain score by the simple verbal scale (SVE) postoperatively at rest, the mean SLE scores at H6 were 0.17 ± 0.38;at H12 of 1.15 ± 0.62;at H24 of 0.84 ± 0.51;at H36 0.45 ± 0.52 and at H48 0.09 ± 0.29. On mobilization, the mean pain scores were 0.77 ± 0.51 at H6, at H12 1.89 ± 0.61;at H24 of 1.53 ± 0.56;at H36 of 1 ± 0.29 and at H48 of 0.82 ± 0.44. The majority of our patients (66.3%) had a mobilization time of less than 24 hours. The mean length of stay was 3.1 ± 1.3 days and most patients (82%) were satisfied with the management of their pain by ultrasound-guided TAP block. Conclusion: Ultrasound-guided TAP is an effective technique for the management of postoperative pain in gyneco-obstetrics surgery. Its integration in a context of multimodal analgesia could improve the management of postoperative pain in gynecological obstetrics.

Management of Urological Lesions Secondary to Obstetrical Gyneco Surgery in the Urology Department of the Gabriel Toure University Hospital Centre

Summarizes: The objective of this work was to study the clinical, diagnostic, therapeutic and evolutionary aspects of urological lesions secondary to gynaeco-obstetrical surgery in the urology department of the Gabriel Touré University Hospital. Material and method: It was a transversal and retrospective study carried out in the urology department of the Gabriel Touré University Hospital Centre in Bamako over 8 years. It focused on the files of 25 patients operated on for a urological lesion secondary to gynaeco-obstetrical surgery. Sociodemographic, epidemiological, diagnostic, therapeutic and evolutionary parameters were analysed. Results: Urologic lesions secondary to gynaeco-obstetrical surgery were found in 0.72% of urologically operated patients. The mean age of the patients was 39 ± 10.4 years (extremes: 18 and 60 years). The average time to diagnosis was 121, 88 ± 15 days (extremes: 0 and 365 days). Clinical signs were: oligo anuria (16%), urine leakage (52%), lumbar pain (24%). The diagnosis was made by the methylene blue test in 56% of patients, by the uro-scanner (20%) and by intravenous urography (16%). In 8% of patients, the diagnosis was made during surgery. The surgical interventions involved were: hysterectomy (48%), cesarean section (40%), genital prolapse cure (8%), ovarian cystectomy (4%). Lesions were dominated by vaginal vesico fistulas (48%) followed by ureterovaginal fistulas (20%), ureteral ligatures (16%). Treatment consisted of ureterovesical reimplantation according to Lich Gregory with ureteral intubation (36%), fistulography (48%). Healing was achieved in 92% of patients. Conclusion: Hysterectomy for cervical malignancy and cesarean section are the main etiologies of urological lesions secondary to gynaeco-obstetrical surgery. Open surgery is the only alternative for the management of these lesions in our context. Controlling anatomy is the main preventive measure.