Objectives: Quadratus Lumborum Block in contrast to Transversus Abdominis Plane Block contains a unique component which not only stops somatic pain but also inhibits visceral pain by spreading the local anesthetic to the paravertebral space. This study was designed to determine whether performing the Quadratus Lumborum Block type I in patients undergoing cesarean section would be associated with both decreased morphine consumption and decreased pain levels in the postoperative 48-hour period. Material and methods:Sixty patients undergoing caesarean section under spinal anesthesia were randomly and equally assigned to one or other of two groups: QLB I (who received Bilateral Quadratus Lumborum Block type I with the use of 24 mL 0.375% ropivacaine per side) or a Control group. In both groups, on-demand morphine analgesia was administered postoperatively within the first 48 hours. The following were measured: the morphine consumption; the time elapsed from the C-section until the first dose of morphine; and the levels of pain intensity among patients in rest (numeral pain rating scale).Results: There were no statistically significant demographic data differences between the QLB I and Control groups. The following significant differences were observed in the 48-hour postoperative period: morphine consumption was higher in the Control group (p = 0.000); the time elapsed from the C-section until the first dose of morphine was longer in QLB I group (p < 0.05); and the median of the pain numeric rating scale was higher in the Control group (p < 0.05). Conclusions:Quadratus Lumborum Block type I significantly reduces morphine consumption and pain levels up to 48 hours postoperatively.

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Continuous renal replacement therapy (CRRT) in critically ill patients has significant impact on one's ability to provide efficient nutritional therapy. CRRT may help in the prevention of intestinal oedema and the maintenance of the proper function of the gastrointestinal tract by enabling strict control of the fluid balance. It facilitates early introduction of nutrition via the enteral route, as well as allowing for the composition of high-volume feeding mixtures. It is necessary to take into consideration that during CRRT, together with blood purification of toxic substances, nutritive elements are also eliminated to some extent (micro-and macronutrients). In this article, the authors discuss the impact of CRRT on nutritive elements loss, energetic balance and present the principles of adjusting feeding prescriptions to changes implied by CRRT.Anaesthesiology Intensive Therapy 2017, vol. 49, no 4, 309-316 Key words: critical care, nutrition; kidney injury; continuous renal replacement therapy, energy requirements, protein needs Nutritional therapy is one of the basic elements of the multifaceted treatment of patients in intensive care units (ICUs). The Nutrition Day ICU survey, based on a seven-year observation period of nutritional practices in 880 units from 46 countries, has demonstrated that the majority of ICU patients do not receive the recommended amounts of calories and proteins [1]. According to the findings of this survey, as well as of some other studies, an increasing energy-protein deficit is positively correlated with prolonged ICU stay, which in turn increases the risk of infections and death. On the other hand, it should be clearly emphasised that an excessive energy supply may also be associated with complications and increased mortality [1,2]. Adequate tailoring of nutritional therapy is a great challenge; firstly, because the nutritional status of patients on admission to an ICU can differ markedly, ranging from cachexia to morbid obesity while secondly, the critical conditions presented by patients have extremely relevant metabolic implications. Unfortunately, the majority of studies that are the basis for guidelines of nutritional therapy are observational or involve small groups of patients and are therefore characterised by low precision and relatively high changeability over time.Several randomised controlled studies have recently been published which have re-started the discussion on optimal nutritional practices in the ICU setting. One of the issues inadequately described and connected with nutritional therapy in ICU patients, concerns the effects of other elements of the multifaceted treatment of critically ill patients on the efficacy of nutritional interventions. It should be clearly stressed that continuous renal replacement therapy (CRRT) belongs to those interventions which most highly affect the outcomes of nutritional therapy in critically ill pa-310 Anaesthesiol Intensive Ther 2017, vol. 49, no 4, 309-316 tients. Firstly, the use of CRRT facilitates optimal nut...

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