Sünnetlerde postoperatif ağrı kontrolünde levobupivakain; kaudal blok veya dorsal penil sinir bloğu

Objectives: In this study, we evaluated the analgesic efficacy and adverse effect profile of levobupivacaine in caudal and DPNB in postcircumcision pediatric patients. Methods: Sixty boys between 2-10 years of age undergoing circumcision were enrolled. The patients were divided into two groups: Group C (n=30) and Group P (n=30) were applied caudal block or dorsal penile nerve block (DPNB), respectively. Blocks were performed before surgery as a supplement to general anesthesia with 1 mL kg-1 0.25% levobupivacaine. Postoperative pain and sedation scores were assessed on the 10th and 30th minutes, and hours 1-6. The number of pain free patients in the first 6 hours, the duration of analgesia, time to first analgesic administration, walking, micturition, and total paracetamol demands, and length of stay were recorded. Results: Demographic data were similar between groups. The number of children who spent the first 6 hours pain-free was larger in Group C than Group P (p=0.0001). The time to first analgesic (p=0.000033) and walking (p=0.004) were longer in Group C. There were 14 patients with motor block in Group C (p=0.00007). In view of AUC, FPRS, OPS and MPOPS were significantly better in Group C on the first postoperative 6 hours. Conclusion: Caudal block done using levobupivacaine for postoperative pain management in circumcision is more successful than penile block, however there is a significant delay in time to first walking and as might be expected there is an increased risk of motor block

Uzamış postoperatif ağrının tedavisinde ultrason yardımıyla TAP blok - alternatif bir yaklaşım

Transversus abdominis plane (TAP) block is a relatively new regional anesthesia technique in which T7-12 intercostal nerves, ilioinguinal and iliohypogastric nerves, and cutaneous branches of L1-3 nerves are blocked between the internal oblique and transversus abdominis muscles. This technique is mostly used for the treatment of acute postoperative pain following abdominal surgery. In this case report, we evaluate the usage of TAP block in prolonged pain following upper abdominal surgery

Surgical Treatment of Peripheral Aneurysms in Patients with Behcet’s Disease

AbstractIntroductionOur aim was to report our experience with 23 patients presenting with 32 peripheral aneurysms secondary to Behcet’s disease (BD) and their outcome after vascular surgery.MethodsThe study was retrospective in nature. Except for those presenting with aneurysm rupture, patients underwent surgery after treatment of acute inflammatory lesions. All aneurysms appeared to be pseudo-aneurysms. Graft interposition with polytetrafluoroethylene or saphenous vein was most commonly employed. Postoperatively, all patients were put on immunosuppressive and antiplatelet therapy. Follow-up was done every 6–12 months, complications recorded and managed appropriately.ResultsAll the patients were males. The mean age at diagnosis of a peripheral aneurysm was 41.0 ± 9 years. There were 17 (53%) femoral, 8 (25%) popliteal, two carotid, two external iliac, two brachial and one internal iliac aneurysms. Fourteen (61%) patients had a single peripheral aneurysm while nine had two. Surgery was performed for all initially presenting 23 aneurysms. Six patients with multiple peripheral aneurysms had surgery for their second asymptomatic aneurysm. The mean follow-up period was 84 ± 62 months. Of 29 aneurysms operated on, 7 (24%) anastomotic pseudo-aneurysms and 11 (38%) graft occlusions developed. Five (22%) patients underwent major lower extremity amputations. Six (26%) mortalities were recorded.ConclusionSurgery for peripheral aneurysms in BD is warranted in many instances. Results of operation can be improved by prolonged monitoring. However, despite all efforts, peripheral aneurysm involvement in BD worsens the prognosis

A clinical analysis of microvascular decompression surgery with sacrification of the superior petrosal venous complex for trigeminal neuralgia a single-surgeon experience

AIM: To report the surgical outcomes in patients with trigeminal neuralgia (TN) who underwent microvascular decompression (MVD) with superior petrosal vein sacrification. MATERIAL and METHODS: Data from 63 patients, whose information was obtained from a group of 113 patients who underwent surgery from 2008 to 2018, were reviewed retrospectively by the first author who was not part of the surgical team, and the pain conditions were evaluated objectively. RESULTS: Following surgery, pain relief occurred in 84% of patients during the early postoperative period and in 69.8% of patients during long-term follow-up. The major offending vessel was the superior cerebellar artery. CONCLUSION: MVD surgery, in particular for patients with typical pain, is one of the most effective treatment strategies for TN. Superior petrosal vein sacrification is a safe method that helps neurosurgeons to visualise the surgical area and perform a better work-up. Neurosurgeons should not be afraid to carry out superior petrosal vein sacrification

Dejeneratif spondilolistezis, spinal stenoz, lomber kompresyon fraktürü olan yüksek riskli hastalarda spinal anestezi ile posterior lomber stabilizasyon cerrahisi

AIm: Spinal anesthesia is an appropriate technique for lumbar spine surgeries of two to three hours duration. The aim of this study is todocument our experience on spinal anesthesia administered to the patients with degenerative lumbar spine.Ma terIal and Methods: A total of 497 patients underwent spinal stabilization surgery with spinal anesthesia for degenerative lumbarspinal disorders in an 8-year period. Spinal anesthesia was performed at the L3-L4 or L4-L5 level and subarachnoid block was achieved with15 mg of 0.5% plain bupivacaine with 2 µg of fentanyl and 0.2 mg of epinephrine. There was no failure of anesthesia. The patients wereclosely monitored for complications associated with the SA technique and especially hypotension and bradycardia but no gross alterations incardiovascular stability were noted.Results: Among the 497 patients, 139 were male and 358 were female with a median age of 51 years. The average anesthesia durationwas 130 minutes and the average operative time was 85 minutes. In the postoperative period 36 patients has nausea (7.2%) and 18 of themhad vomiting (3.6%) that required one dose of antiemetic. No spinal headache was observed and 36 (7.2%) patients complained of urinaryretention. All recovered with urinary cannulation within 24 hours. No respiratory complication occurred and no patient died.ConclusIon: Spinal anesthesia is a safe and effective procedure for the lumbar spinal stabilization surgery, especially in high-riskpatients.Proper precautions should be taken in order to achieve an effective anesthesia for these operations

Intraarticular levobupivacaine or bupivacaine administration decreases pain scores and provides a better recovery after total knee arthroplasty

Purpose The aim of this prospective randomized blinded controlled study was to compare the efficacy of the two local anesthetics, intraarticular bupivacaine and levobupivacaine administration, versus control for postoperative pain control and functional recovery. Length of hospital stay, opioid consumption, and the side effects of opioids were also evaluated. Methods Sixty patients of American Society of Anesthesiologists class I–III undergoing elective knee arthroplasty under spinal anesthesia were randomized into three groups. Groups B (n = 20) and L (n = 20) both received 150 ml solution intraarticularly, containing 200 mg bupivacaine or 200 mg levobupivacaine combined with 0.5 mg epinephrine, respectively, at the end of the surgery. Group C (n = 20) received 150 ml saline intraarticularly. Postoperatively, all groups received injections through the intraarticular catheters in quantities of 120 mg (levobupivacaine for group L, bupivacaine for group B) and 0.5 mg epinephrine whereas group C received a saline bolus at 10 and 22 h. Patients were given tramadol by intravenous patientcontrolled analgesia (PCA), and sodium diclofenac 75 mg intramuscularly was used for rescue analgesic medication. Visual analogue score (VAS) for pain at rest and during mobilization (which was defined as flexion exercise supported by physiotherapist in postoperative first 8 h and afterward a 3-m walk with walker), consumption of tramadol, side effects, and patient satisfaction were recorded until the 48th hour postoperatively. Results Area under the curve values for VAS were lower in groups B and L compared to the control, both at rest and during mobilization (first 48 h) (P = 0.032 and P = 0.029, respectively). Tramadol consumption was lower (P\0.05), patient satisfaction as evaluated with a five-point Likert score (completely comfortable; quite comfortable; slight discomfort; painful; very painful) was higher (P = 0.03), and length of hospital stay was shorter (P = 0.03) in groups B and L compared to group C. Conclusion Intraarticular bupivacaine and levobupivacaine provided better postoperative analgesia both at rest and during mobilization in total knee replacement surgery compared to control. Tramadol consumption and hospital stay were also decreased in the study groups

The efficacy of submucosal tramadol in the postoperative treatment of pain following septoplasty operations

Tramadol is a centrally acting opioid which is effective for moderate-severe pain and is being used for various acute and chronic pain scenarios. The primary endpoint of this controlled, randomized double blind study was to evaluate the effect of submucosal tramadol on VAS scores after septoplasty operations and secondary endpoint was to investigate the effects on total opioid and additional analgesic consumption and patient satisfaction. 60 patients scheduled for septoplasty under general anaesthesia were enrolled. In Group T, at the end of surgery following hemostasis, 2 mg/kg tramadol was applied as submucosal infiltration to both surgical sites, 2 ml (total 4 ml), by the surgeon. In Group P, at the end of surgery following hemostasis, 2 ml isotonic solution (total 4 ml) was applied as submucosal infiltration to both surgical sites by the surgeon. Total opioid consumption, VAS scores, patient satisfaction was evaluated at the end of 24 h VAS values were higher in Group P on the first and second postoperative hours. Patient controlled analgesia demand and delivery values were higher in Group P on the postoperative 1, 2, 4, 6, 12 and 24th hours. Patient satisfaction was higher and opioid consumption was lower in Group T compared to Group P. There was no difference in additional analgesic consumption between two groups.The results show that patients receiving tramadol had lower VAS scores compared with the placebo groups postoperatively

The effect of magnesium added to levobupivacaine for femoral nerve block on postoperative analgesia in patients undergoing ACL reconstruction

Purpose The aim of this prospective randomised doubleblind study is to investigate the effect of magnesium added to local anaesthetics on postoperative VAS scores, total opioid consumption, time to first mobilisation, patient satisfaction and rescue analgesic requirements in arthroscopic ACL reconstruction surgery. Methods A total of 107 American Society of Anaesthesiologists physical status grade I and II patients between 18 and 65 years of age who were scheduled to undergo elective anterior crucial ligament (ACL) reconstruction with hamstring autografts were enrolled in the study. The patients were randomly allocated to Groups L (n = 51) and LM (n = 56) using the closed-envelope method. Group LM was administered 19 ml of 0.25 % levobupivacaine and 1 ml of 15 % magnesium sulphate, while Group L was administered 20 ml of 0.25 % levobupivacaine for femoral blockade. General anaesthesia was administered using laryngeal airway masks following neural blockade in both groups. The patients were evaluated for heart rate and mean arterial pressure, oxygen saturation, visual analogue score (VAS), verbal rating scale (VRS), rescue analgesic requirements, total opioid consumption, side effects and time to first mobilisation at the 1st, 2nd, 4th, 6th, 12th and 24th hours postoperatively. Results There was no statistically significant difference in terms of demographic data, mean arterial pressure, heart rate or oxygen saturation between groups. The area under the curve VAS and VRS scores were lower at 4, 6, 12 and 24 h in Group LM (p = 0.001, p = 0.016, respectively). The rescue analgesic requirement and the total opioid consumption were significantly lower in Group LM (p = 0.015, p = 0.019, respectively). The time to first mobilisation and the Likert score (completely comfortable; quite comfortable; slight discomfort; painful; very painful) were higher, and the block onset time was lower in Group LM (p = 0.014 and p = 0.012, respectively). There was no difference in terms of side effects. Conclusions The addition of magnesium to levobupivacaine prolongs the sensory and motor block duration without increasing side effects, enhances the quality of postoperative analgesia and increases patient satisfaction; however, the addition of magnesium delays the time to first mobilisation and decreases rescue analgesic requirements

Agents of nosocomial bacteremia and microorganisms ısolated from blood cultures in an ıntensive care unit patients

Amaç: Nozokomiyal infeksiyonlar içinde nozokomiyal bakteriyemiler önemli bir yer tutmaktadır. Biz bu çalışmada 1998 yılı boyunca reanimasyon ünitesinde izlenen hastalara ait kan kültürlerinde üreyen mikroorganizmalar ile bu hastalarda tanımlanan nozokomiyal bakteriyemi etkenlerini birlikte değerlendirmeyi amaçladık. Yöntem: 1998 yılı boyunca izlenen hastalara ait 557 kan kültürü BACTEC 9120 (Becton Dickinson, ABD) otomatize kan kültür sisteminde izlenmiştir. Kateter kültürleri ise Maki ’nin tanımladığı semikantitatif yöntemle yapılmıştır. Bulgular: Nozokomiyal bakteriyemi etkenleri içinde gram negatif basillerin % 63 oranı ile ön planda olduğu belirlenmiştir. Bu üniteden gelen kan kültürlerinde izole edilen mikroorganizmalar içinde de gram negatif basillerin oranı % 57 olarak bulunmuştur. Sonuç: Reanimasyon ünitesinde tanımlanan nozokomiyal bakteriyemi etkenlerinin dağılımında, yoğun bakım ünitelerinde beklendiği üzere gram negatif basillerin ön planda olduğu, bunu gram pozitif kokların izlediği belirlenmiştir. Kan kültürlerinde üreyen mikroorganizmalar irdelendiğinde ise (klinik olarak anlamlı bulunmayan gram pozitif koklara ait üremelerden dolayı yine ikinci sırada yer almakla birlikte) gram pozitif kokların oranı biraz daha yüksek bulunmuştur.Objective: Blood-stream infections consist a high proportion of nosocomial infections. Blood cultures and nosocomial bacteremia agents were evaluated in patients hospitalized in our reanimation unit during 1998. Material and Method: A total of 557 blood cultures were observed in automatic culture system BACTEC 9120 (Becton Dickinson, USA) whereas catheter cultures were evaluated according to Makis semi-quantitative method. Results: Gram negative bacilli constituted 63 % of all nosocomial blood-stream infection agents and 57 % of all microorganisms isolated from blood cultures. Conclusion: As expected in intensive care units, gram negative bacteria were the leading agents of nosocomial bacteremia