Yüksek riskli hastada karotis endarterektomi cerrahisi için ultrason eşliğinde karotis kılıf bloğu ve literatür taraması

Carotid endarterectomy (CEA) surgery is generally performed for patients who under the risk of ischemic cerebral stroke due to the critical obstruction of the carotid artery. Ischemic complications may occur during the surgery. So, the awakeness of the patient is very important during the surgery. Regional anesthesia techniques may be performed instead of general anesthesia for shunt placement during CEA surgery. Herein, we aimed to share our successful US-guided carotid sheath block experience for anesthesia management during CEA surgery.Karotid endarterektomi cerrahisi genellikle karotis arterin tıkanıklığından dolayı iskemik serebro-vaskuler olay riski altındaki hastalara uygulanır. Cerrahi sırasında iskemik komplikasyonlar gelişebilir. Bu nedenle cerrahi sırasında hastanın uyanıklığı çok önemlidir. Cerrahi sırasında şant yerleşimi için genel anestezi yerine rejyonal anestezi teknikleri tercih edilebilir. Bu makalemizde karotid endarterektomi cerrahisi sırasında anestezi yönetimi için ultrason eşliğinde uyguladığımız başarılı karotis kılıf bloğu deneyimimizi paylaşmayı amaçladık

Anesthesia management for ALS and WPW

WOS: 000435650500021Epidural anesthesia can provide anesthesia and analgesia for unilateral or bilateral lower extremity surgery and is associated with a low complication rate. We present our epidural anaesthetic management of a patient with both Amyotrophic lateral sclerosis (ALS) and Wolff-Parkinson-White (WPW) syndrome after intertrochanteric femur fracture surgery. It should be kept in mind that the choice of correct anaesthetic method in such patients with complicated neurological, pulmonary, and cardiac symptoms will significantly reduce postoperative mortality and morbidity

The efficacy of ultrasound-guided anterior quadratus lumborum block for pain management following lumbar spinal surgery: A randomized controlled trial

Background: Quadratus lumborum block (QLB) is a fascial plane block. There is no randomized study on the efficacy of QLB for lumbar surgery. We evaluated the efficacy of QLB for postoperative pain management and patient satisfaction after lumbar disc herniation surgery (LDHS). Methods: Sixty patients with ASA score I-II planned for LDHS under general anesthesia were included. We allocated the patients into two groups: the QLB group (n = 30) or the control group (n = 30). QLB was performed with 30 ml 0.25% bupivacaine in the QLB group. Paracetamol 1 g IV 3 × 1 was ordered to the patients at the postoperative period. If the NRS score was ≥ 4, 1 mg/ kg tramadol IV was administered as rescue analgesia. Results: There was a reduction in the median static NRS at 0 h and 2 h with QLB compared to the control group (p < 0.05). There was no difference in the resting NRS at any other time point up to 24 h. The median dynamic NRS was significantly lower at 0, 2, 4, 8, and 16 h in the QLB group (p < 0.05). The need for rescue analgesia was significantly lower in the QLB group. The incidence of nausea was significantly higher in the control group. The postoperative patient satisfaction was significantly higher in the QLB group (p < 0.05). Conclusion: We found that the QLB is effective for pain control following LDHS

Erector spinae plane block vs interscalene brachial plexus block for postoperative analgesia management in patients who underwent shoulder arthroscopy

Background Interscalene brachial plexus block (ISB) is the gold standard method used for postoperative analgesia after arthroscopic shoulder surgery. Ultrasound guided erector spinae plane block (ESPB) is an interfascial plane block. The aim of this study is to compare the analgesic efficacy of ESPB and ISB after shoulder arthroscopy. The primary outcome is the comparison of the perioperative and postoperative opioid consumptions. Methods Sixty patients with ASA score I-II planned for arthroscopic shoulder surgery were included in the study. ESPB was planned in Group ESPB (n = 30), and ISB was planned in Group ISB (n = 30). Intravenous fentanyl patient-controlled analgesia was administered to both groups in the postoperative period. Intraoperative and postoperative opioid and analgesic consumption of both groups, side effects and complications related to opioid use, postoperative pain scores and rescue analgesic use were recorded in the first 48 h postoperatively. Results Pain scores were significantly higher in the ESPB group in the first 4 h postoperatively than in the ISB group (p < 0.05). The total fentanyl consumption and number of patients using rescue analgesics in the postoperative period were significantly higher in the ESPB group (p < 0.05). The incidence of nausea in the postoperative period was significantly higher in the ESPB group (p < 0.05). Conclusions In our study, it was seen that ISB provided more effective analgesia management compared to ESPB in patients underwent shoulder arthroscopy surgery

A comparison of adductor canal block before and after thigh tourniquet during knee arthroscopy: A randomized, blinded study

Background: Adductor canal block (ACB) provides effective analgesia management after arthroscopic knee surgery. However, there is insufficient data about performing ACB before or after inflation of a thigh tourniquet. We aimed to investigate the efficacy of ACB when it is performed before and after thigh tourniquet and evaluate motor weakness. Methods: ACB was performed before the tourniquet inflation in the PreT group, it was performed after the inflation of the tourniquet in the PostT group. In the PO group, ACB was performed at the end of surgery after disinflation of the tourniquet. Results: There were no statistical differences between the groups in terms of demographic data. Opioid consumption showed no statistically significant differences (for total consumption; p = 0.5). The amount of rescue analgesia administered and patient satisfaction were also not significantly different between groups. There was no significant difference in terms of static and dynamic VAS scores between groups (for 24 hours; p = 0.3, p = 0.2 respectively). The incidence of motor block was higher in the PreT group (eight patients) than in the PostT group (no patients) and in the PO group (only one patient) (p = 0.005). Conclusions: Using a tourniquet before or after ACB may not result in any differences in terms of analgesia; however, applying a tourniquet immediately after ACB may lead to muscle weakness

Video yardımcılı torakal cerrahi sonrası postoperatif analjezi yönetimi için ultrasonografi rehberliğinde yapılan erektor spina plan bloğu ve torakal paravertebral blok etkinliği: Prospektif, randomize, kontrollü çalışma

Objective: Evaluation of the effectiveness of ultrasound (US)-guided erector spinae plane block (ESPB) and thoracic paravertebral block (TPVB) compared to no intervention control group for postoperative pain management in video assisted thoracic surgery (VATS) patients. Method: Three groups - Group ESPB, Group TPVB and the control group (n=30 per group) were included in this prospective, randomized, controlled study. The US-guided blocks were performed preoperatively in the ESPB and TPVB groups. Intravenous patient-controlled postoperative analgesia via fentanyl was administered in all of the patients. The patients were evaluated using visual analogue scale (VAS) scores, opioid consumption, and adverse events. Results: At all time intervals fentanyl consumption and VAS scores were significantly lower both in ESPB and TPVB groups compared to the control group (p<0.001). Block procedure time was significantly lower and success of one time puncture was higher in Group ESPB as compared with that in Group TPVB (p<0.001). Conclusion: ESPB and TPVB provide more effective analgesia compared to control group in patients who underwent video-assisted thoracic surgery. ESPB had a shorter procedural time and higher success of single-shot technique compared to TPVB.Amaç: Video yardımcılı torakal cerrahi yapılan hastalarda postoperatif analjezi yönetimi içinultrasonografi (US) eşliğinde yapılan erektor spina plan bloğu (ESPB) ve torakal paravertebralbloğun (TPVB) kontrol grubuna göre etkinliğinin değerlendirilmesi amaçlanmıştır.Yöntem: Bu çalışmaya her grup için 30 hasta olmak üzere toplam 90 hasta dahil edilmiştir.Çalışma 3 gruptan oluşmaktadır; Grup ESPB, Grup TPVB ve Kontrol Grubu. ESPB ve TPVB gruplarındaki hastalara preoperatif olarak US eşliğinde blok yapıldı. Tüm gruplardaki hastalara fentaniliçeren hasta kontrollü analjezi (HKA) uygulandı. Hastalar vizuel analog skala (VAS), opioid tüketimi ve yan etkiler kaydedilerek değerlendirildi.Bulgular: Tüm zaman aralıklarında fentanil tüketimi ve VAS Grup ESPB ve Grup TPVB de kontrolgrubuna göre anlamlı olarak daha düşüktü (p<0.001). Blok işlem süresi ESPB grubunda anlamlıolarak daha kısaydı ve iğne ile tek giriş başarısı ESPB grubunda TPVB grubuna göre anlamlı olarakdaha yüksekti (p<0.001).Sonuç: ESPB ve TPVB, video yardımcılı torakal cerrahi yapılan hastalarda kontrol grubuna göreetkili analjezi oluşturmaktadır. ESPB, TPVB’ye göre daha kısa işlem süresi ve tek iğne girişi ile dahayüksek başarı oranına sahiptir

Pediatrik hastada preemtif erector spina plan bloğunun toraks cerrahisi sonrası analjezik etkinliği

The ultrasound-guided erector spinae plane block (ESPB) is a novel interfascial plane block that provides thoracic analgesia at T5 level. ESPB is easy to perform and it is safe due to USG guidance.[1] Thus, ESPB may be a good alternative to other invasive techniques, such as thoracal epidural analgesia in the postoperative analgesia treatment following thoracic surgery. In this correspondence, our aim is to present our effective ESPB experience for a pediatric patient

Ultrason eşliğinde yapılan torakolomber interfasiyal plan bloğunun klasik ve modifiye tekniklerini karşılaştıran prospektif ve randomize çalışma

Objectives: A thoracolumbar interfascial plane (TLIP) block is a novel ultrasound (US)-guided technique that provides effective analgesia after lumbar spinal surgery.Two approaches for a TLIP block have been defined: a classical (cTLIP) technique and a modified (mTLIP) technique. A literature review revealed no published comparison of the 2 techniques.This study examined the practicality and analgesic efficacy of US-guided mTLIP and cTLIP blocks following lumbar disc surgery.Methods: Sixty patients aged 18-65 years with an American Society of Anesthesiologists classification of I or II who were scheduled for lumbar disc surgery under general anesthesia were included. US-guided mTLIP (n=30) and cTLIP (n=30) blocks were performed. The performance time of the block procedures, the success of a one-time block, postoperative pain scores, opioid consumption, adverse effects, and block-related complications were recorded and analyzed.Results: The performance time was significantly less in the mTLIP group (p0.05).Conclusion: The results showed that a US-guided mTLIP block had a shorter performance time and a higher one-time block success rate compared with the cTLIP block. The quality of analgesia provided by the mTLIP and cTLIP blocks was similar.Amaç: Torakolomber interfasiyal plan (TLIP) bloğu, lumbar spinal cerrahi sonrası etkili analjezi sağlayan, ultrason (US) eşliğinde yapılan yeni bir rejyonal anestezi tekniğidir. Bu bloğun iki farklı tekniği tanımlanmıştır: klasik (cTLIP) ve modifiye (mTLIP)teknik. Literatürde henüz bu iki tekniği karşılaştıran bir çalışma bulunmamaktadır. Çalışmamızda lomber disk cerrahisi sonrasıUS eşliğinde mTLIP ve cTLIP bloklarının işlem uygulama kolaylığını ve analjezik etkinliğini karşılaştırmayı amaçladık.Gereç ve Yöntem: Amerikan Anestezistler Derneği (American Society of Anesthesiologist/ASA) anestezi risk sınıflamasınagöre sınıf I-II, 18-65 yaş arası ve genel anestezi altında lomber disk cerrahisi planlanan 60 hasta çalışmaya dahil edildi. HastalaraUS eşliğinde mTLIP (n=30) ve cTLIP (n=30) blok uygulandı. Blok uygulama süresi, tek seferde blok başarısı, opioid tüketimi,postoperatif ağrı skorları, yan etkiler ve bloğa bağlı komplikasyonlar kaydedildi.Bulgular: Blok uygulama süresi mTLIP grubunda anlamlı derecede düşüktü (p0.05).Sonuç: Çalışmamızın sonuçlarına göre US eşliğinde yapılan mTLIP blok ve cTLIP blok lomber cerrahi geçiren hastalarda benzeretkinlikte analjezi sağlar. mTLIP blok daha kısa uygulama süresine ve daha yüksek tek girişimde blok başarısına sahiptir

Ultrasound-guided single-shot preemptive erector spinae plane block for postoperative pain management

WOS: 000463691000052PubMed ID: 30477888Thoracotomy is a procedure that causes severe pain as a result of muscle incision, retraction of the ribs, and damage to the intercostal nerves. Postoperative analgesia management is very important for respiratory functions, and successful pain management reduces postoperative complications and length of hospital stay.1 A variety of procedures have been described for the first-step treatment of thoracic analgesia, including intercostal nerve blocks, thoracic epidural analgesia (TEA), and thoracic paravertebral blocks.2 However, their usage is limited because of complications and failure rates (up to 15% in TEA).3 The other option for analgesia is intravenous opioid medications that can be used in combination with nonsterioidal anti-inflammatory drugs.4 Adverse effects such as sedation, hypoventilation, nausea, and vomiting can occur, especially in systemic high opioid doses used for severe pain such as after thoracotomy

Erector spinae plane block for a patient who underwent both bilateral mastectomy and right video-assisted thoracic surgery

Clinicians usually opt for a procedure that is easy and simple to perform and has low risk of complications duringpostoperative analgesia management. Techniques such as thoracal epidural analgesia (TEA) and paravertebral blockare invasive and difficult to use in practice (1). Opioids are usually preferred for intravenous analgesia, but their usemay cause adverse events, such as respiratory depression, nausea and vomiting (2). Thus, ultrasound (US)-guidedinterfascial plane blocks are increasingly being used in daily anaesthesia practice. Erector spinae plane block (ESPB)is a novel US-guided interfascial plane block that may provide both thoracic and abdominal analgesia (3, 4). Herewe would like to report our experience of performing ESPB for a patient who underwent multiple surgeries. Writteninformed consent was obtained from the patient for reporting of this case