In the sensory examination performed 20 min later, sensory loss was noted in the LFCN, genitofemoral, anterior femoral cutaneous, obturator, and saphenous nerves. ...patient reported significant ...quadriceps weakness with the inability to achieve a straight leg raise. The advantages of PENG block to LPB are as follows: it can be applied in the supine position; injection point is far from neurovascular tissues; it is relatively safer for patients using anticoagulants; and bilateral block probability is nearly zero. ...although quadriceps weakness has been previously reported after PENG block 2, its probability is delivered at high volumes as in our case 1. ...although it is not yet possible, in the future, cadaveric, radiologic, and randomized controlled studies will provide answers to the following questions: can PENG block be an alternative to lumbar plexus block?
Since initial description by Forero for thoracic region, ultrasound guided erector spinae plane (ESP) block has experienced several surgeries for postoperative pain management, chronic pain or ...surgical anesthesia. Although ESP block has been reported to provide effective analgesia in the thoracic region, its effect in lumbar region still unclear. In this study we aimed to showed our successful experience with lumbar ESP block as a main anesthetic technique in fifteen high risk elderly patients undergoing hip surgery with mild propofol sedation.
In this observational study high risk elderly fifteen patients received lumbar ESP block as a main anesthetic technique with mild propofol sedation. 40 mL of local anesthetic mixture (20 mL bupivacaine 0.5%, 10 mL lidocaine 2%, and 10 mL normal saline) was administered between the erector spinae muscles and transverse process at the level of the 4th lumbar vertebra. Also we demonstrate magnetic resonance images and discuss the anatomic basis of lumbar ESP block.
All patients' surgeries were completed without requirement for general anesthesia or local anesthesia infiltration of the surgical site. All patients' pain scores were <2/10 in the recovery room. Significant contrast spread was observed between the Th12 and L5 transverse process and erector spinae muscle and between multifidus muscle and iliocostal muscle at the L2-4 levels. Contrast material was observed at the anterior of the transverse process spreading to the paravertebral, foraminal and partially epidural area/spaces and also in the areas where the lumbar nerves enter the psoas muscle.
Lumbar ESP block when combined with mild sedoanalgesia provides adequate and safe anesthesia in high risk elderly patients undergoing hip surgery.
Purpose
Breast surgery is an exceedingly common procedure and associated with an increased incidence of acute and chronic pain. Preemptive regional anesthesia techniques may improve postoperative ...analgesia for patients undergoing breast surgery. The aim of this study was to evaluate the effect of preoperative bilateral serratus plane block on postoperative opioid consumption in patients undergoing breast reduction surgery.
Methods
After ethical board approval, 40 patients undergoing breast reduction surgery were randomized into 2 groups: control group (Group C,
n
= 20) and serratus plane block group (Group SPB,
n
= 20). Group C received bilateral ultrasound-guided 2 ml 0.9% saline subcutaneously each block side, Group SPB received ultrasound-guided bilateral SPB with 0.25% bupivacaine 30 ml each side. The groups were administered the routine general anesthesia protocol. All operations were performed with the mediocentral pedicled reduction mammaplasty technique by the same surgeon. Postoperative analgesia was performed intravenously in the 2 groups twice a day with dexketoprofen trometamol 50 mg and patient-controlled analgesia with fentanyl. Postoperative analgesia was evaluated using the visual analog scale (VAS). Fentanyl consumption, additional analgesia requirement and opioid-related side effects were recorded during the first 24 h after surgery.
Results
Compared with control, the VAS score was statistically lower in the SPB group during all measurement times (
p
< 0.05). The 24-h opioid consumption was significantly higher in the control group compared with the SPB group (372.50 ± 39.65 vs. 296.25 ± 58.08 μq, respectively;
p
< 0.001). In addition, the analgesia requirement was statistically lower in the SPB group (8/20 vs. 2/20, respectively,
p
< 0.028). Nausea or vomiting was observed more often in the control group than in SPB block (9/20 vs. 2/20, respectively,
p
= 0.013), whereas other side effects were similar for the two groups.
Conclusions
SPB can be used safely bilaterally in the management of pain for breast reduction surgery as it is easy to perform, provides excellent analgesia, and reduces opioid consumption and opioid sparing effect.
Level of Evidence II
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors
www.springer.com/00266
.
Patients operated under emergency conditions have a higher risk of death and complications than those per-formed under elective conditions. Especially the patient group with high comorbidity needs to ...be evaluated more specifically. Accord-ing to the surgical risk and American Society of Anesthesiologists (ASA) scoring, the perioperative risk should be determined quickly, and the relatives of the patients should be informed. This study aimed to evaluate the factors affecting mortality and morbidity in patients undergoing emergency abdominal surgery.
A total of 1065 patients aged 18 years and older who underwent emergency abdominal surgery in 1 year were included in the study. The primary aim of this study was to determine the mortality rates in the first 30 days and 1 year and the variables af-fecting these rates.
Of 1065 patients, 385 (36.2%) were female and 680 (63.8%) were male. The most common procedure was appendectomy (70.8%), followed by diagnostic laparotomy (10.2%), peptic ulcus perforation (6.7%), herniography (5.5%), colon resection (3.6%), and small bowel resection (3.2%). There was a significant difference between the age of the patients and mortality (p<0.05). There is no statistically significant relationship between gender and mortality. A statistically significant correlation was found between ASA scores, perioperative complication, perioperative blood product use, reoperation, intensive care unit admission, hospitalization time, periop-erative complication, and 30-day mortality and 1-year mortality. There is a significant relationship between trauma and only 30-day mortality (p=0.030).
The morbidity and mortality of patients operated on under emergency conditions increased compared to elective surgical operations, especially those over age 70. The 30-day mortality rate of patients who underwent emergency abdominal surgery is 3%, while the 1-year mortality rate is 5.5%. Mortality rates are higher in patients with a high ASA risk score. However, mortality rates in our study were found to be higher than the mortality rates in ASA risk scoring.
Aim:The recommendation to avoid general anesthesia in pregnant women with coronavirus disease-2019 (COVID-19) and to use neuraxial blockade techniques, if possible, has not changed over time. On the ...other hand, general anesthesia also has to be applied to some patients in clinical practice. In this study, we evaluated anesthesia management, maternal outcomes, and clinical course in pregnant women with COVID-19 who delivered by cesarean section.Methods:One hundred and seven pregnant women with COVID-19 who underwent cesarean sections between October 2020 and April 2021 were included in the study. Anesthesia methods, presenting symptoms, comorbidities, laboratory test results, and radiological data at admission, length of hospital stay, intensive care unit admissions, and mortality rates were retrospectively analyzed.Results:Out of 107 pregnant women, 85 underwent cesarean surgery under spinal anesthesia and 22 under general anesthesia. Forty patients (37%) had at least one symptom, whereas sixty-seven (63%) had no symptoms at all. Fifty percent of symptomatic and only 6% of asymptomatic pregnant women were admitted to the intensive care unit, and there was a significant difference between them. Mortality was 30% in symptomatic patients and only 1% in asymptomatic patients, and the difference in mortality was significant (p<0.05).Conclusion:Since the risk of intensive care and mortality is higher, particularly in symptomatic pregnant women with COVID-19, these patients should be evaluated, operated and followed up by experienced teams.
Abstract Objectives To investigate the effects of the pre-emptive local infiltration of dexamethasone vs. levobupivacaine on postoperative pain and morbidity in pediatric adenotonsillectomy patients. ...Methods A total of 60 patients (32 males and 28 females), aged 3–14 years, were included in this double-blind prospective randomized controlled clinical study from September of 2011 until May of 2012. Patients admitted for adenotonsillectomies after informed consent was obtained from the parents, and randomized into three groups receiving either dexamethasone sodium phosphate (Group 1, mean age 5.9 ± 1.6), levobupivacaine with epinephrine (Group 2, mean age 6.1 ± 2.6), or saline (Group 3, mean age 6.0 ± 3.4). Pain scores at the 1st, 4th, 8th, 12th, 16th, and 20th hours, and first, second, third and seventh days post-operatively were recorded by the parents using McGrath’s face scale. The operation type, operation time and anesthesia time, the time of the first request for postoperative analgesia, and the total number of analgesic interventions were recorded. Results Pain scores were revealed in this order: Group 1 (steroid) < Group 2 (levobupivacaine) < Group 3 (saline) at all times ( p = 0.000). The anesthesia times for Group 1 and Group 2 were different (steroid vs. levobupivacaine), and the time to first analgesic was longer in Groups 1 (steroid) and 2 (levobupivacaine) than in Group 3 (saline) ( p < 0.000). The total number of analgesic interventions was lower in Group 1 (steroid) than in Group 2 (levobupivacaine) and Group 3 (saline) (steroid vs. saline, p = 0.000, and steroid vs. levobupivacaine, p < 0.05). Conclusion Peritonsillar dexamethasone infiltration was more effective than both levobupivacaine and saline in reducing post-tonsillectomy pain. It was proven to be a safe and effective method.
Modified radical mastectomy (MRM) and axillary lymph node dissection (AD) are the most commonly used surgical methods in breast cancer surgery, and they are characterized by moderate to severe pain. ...This study aimed to investigate the effect of ultrasound-guided serratus plane block (SPB) on postoperative acute and chronic pain in patients undergoing MRM and AD.
After ethical approval, 60 patients, aged between 18-65 years, ASA I-III, underwent unilateral MRM, and AD was assigned into 2 groups. The SPB group received ultrasound-guided SPB with 30 mL 0.25% bupivacaine, and the control group received 2 mL saline injection subcutaneously. Postoperative analgesia was performed with intravenous patient-controlled analgesia and dexketoprofen trometamol. Pain scores, opioid consumption, and rescue analgesic requirements were recorded. Chronic pain and quality of life were evaluated with the Numerical Rating Scale (NRS), short form-36 (SF-36), and painDETECT.
Compared with the control group, the visual analogue scale scores were statistically lower in the SPB group during 4 postoperative hours in post-anaesthetic care unit PACU at 1st, 2nd (P < 0.001), and 4th hour (P = 0.014). Fentanyl consumption and rescue analgesics were lower in the SPB group than in the control group (0-4 h, P = 0.001; 4-8 h, 8-12 h, 24 h; total P < 0.001). The incidence of chronic pain was 11%, and there was no statistically significant difference between control and SPB groups in terms of SF-36, NRS, and painDETECT scores measured at the first and sixth months.
SPB demonstrated superiority versus the control group concerning acute postoperative pain parameters. However, SPB had no influence on the quality of life and did not prevent chronic postmastectomy pain.
Thiopental sodium (TPS) needs to be applied together with adrenalin in order to establish its analgesic effect in general anesthesia. We aimed to investigate the effect of TPS on the claw pain ...threshold in rats and evaluated its relationship with endogenous adrenalin (ADR), noradrenalin (NDR), and dopamine (DOP) levels. Intact and adrenalectomized rats were used in the experiment. Intact animals were divided into the following groups: 15 mg/kg TPS (TS), 0.3 mg/kg ADR+15 mg/kg TPS (ATS) and 0.3 mg/kg ADR alone (ADR). Adrenalectomized animals were divided into the following groups: 15 mg/kg TPS (A-TS), 0.3 mg/kg ADR+15 mg/kg TPS (A-ATS) and 0.3 mg/kg ADR alone (A-ADR). Claw pain threshold and blood ADR, NDR, and DOP levels were measured. The TS group’s claw pain threshold was found low. However, the claw pain thresholds of the ATS and ADR groups increased significantly. In the A-TS group, the pain threshold decreased compared with normal, and in the A-ATS and A-ADR groups, the pain threshold increased. TPS reduced the blood ADR levels in intact rats; however, no significant changes were observed in the NDR and DOP levels. #TPS provides hyperalgesia by reducing the production of ADR in rats. The present study shows that to achieve analgesic activity, TPS needs to be applied together with ADR.
Pulmonary complications are important sepsis (such as ARDS, diffuse pneumonia). Acute respiratory distress syndrome (ARDS) is characterized by the extensive migration of neutrophils into alveoli of ...the lungs. Propofol and midazolam are the most widely used agents for sedation in intensive care units. Aimed to investigate the effects of anaesthesia with propofol and midazolam on measured hemodynamic variables and neutrophil migration induced by Escherichia Coli endotoxin (ECE) in pulmonary viscera.
Forty Sprague Dawley male rats were randomly assigned to four groups: Thiopental Sodium 30 mg/kg was administered intraperitoneally to anesthetize the rats. They were ventilated via tracheotomy. Femoral artery was cannulated for the measurement of continuous blood pressure and gases. Group C was the control. After the administration of 1 mL/kg 0.9% NaCL, infusion began at 1 mL/kg/h rate. In Group E 15 mg/kg lipopolysaccharide derived from ECE was administered iv. In Group PE, after a bolus dose of 10 mg/kg propofol and 15 mg/kg ECE, 10 mg/kg/h infusion was applied. In Group ME, after 0.1 mg/kg midazolam bolus dose and 15 mg/kg ECE administration, 0.1 mg/kg/h infusion was administered iv. Rats were sacrified by iv potassium chloride. The lungs were then removed, fixed in 10% buffered formalin for 3 days and embedded in paraffin. They were graded on a scale of 0-3 according to the aggregation of neutrophils.
There was intense neutrophil migration in Group E (grade 2, 3). However, although mild neutrophil migration was obtained in 70% of the rat lungs in Group ME (grade 1, 2), it was recorded in only 30% of Group PE (grade 1).
The sepsis model induced by ECE and compared with midazolam, propofol anaesthesia is associated with less neutrophil infiltration. In the light of the literature, propofol attenuate the free-radical-mediated lipid peroxidation and systemic inflammation in patients.
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