Comparison of the Effectiveness of Ultrasound-guided Transversalis Fascia Plane Block (TFPB) and Transversus Abdominis Plane Block (TAPB) on Postoperative Pain in Caesarean Section: A Prospective Randomized Study

Objective:Postoperative peripheral trunk blocks are used for multimodal analgesia in caesarean sections. This trial was planned to compare the efficacy of transversalis fascia plane block (TFPB) and transversus abdominis plane block (TAPB) in postoperative analgesia in patients undergoing caesarean section under spinal anaesthesia.Method:In this prospective trial, ASA II-III risk group patients between the ages of 20-50 years who were scheduled for elective caesarean section under spinal anaesthesia were evaluated. Demographic data, duration of operation, presence of intraoperative and postoperative nausea & vomiting, pruritus, duration of first analgesia requirement, visual analogue scale (VAS) values for 24 hours postoperatively, paracetamol, diclofenac sodium, the total amount of non-steroidal anti-inflammatory drugs (NSAIDs) used were recorded.Results:Patients were randomized into two groups: TFPB (75, 50%) and TAPB (75, 50%) groups. There was no significant difference in demographic data, comorbidity, ASA classification and operation times between the two groups (p>0.05). When the duration of the first postoperative analgesia requirement was evaluated, it was higher in the TFPB group (p<0.05). The 24-hour pain scores (VAS 6th hour and VAS 12th hour) were lower in the TFPB group (p<0.05). The amounts of paracetamol, diclofenac and total NSAIDs were higher in the TAPB group (p<0.05).Conclusion:USG-guided bilateral TFPB is more effective than TABP for postoperative analgesia in caesarean sections

Management with Guidance of Minimally Invasive Cardiac Output Monitoring (PiCCO®) in Coronary Artery Bypass Surgery and Postoperative Results

Objective:Our study aimed to assess the correlation between the measured PiCCO® parameters and extubation time and intensive care unit (ICU) length of stay in patients who underwent coronary artery bypass grafting (CABG) surgery and were managed by monitorization of cardiac output and cardiac performance parameters with PiCCO®.Method:This study was conducted by retrospective analysis data of all 44 patients who underwent CABG surgery during December 2015-March 2016 and were managed through PiCCO® monitorization. The patients’ demographic characteristics (age, sex, weight, height, body mass index), American Society of Anesthesiologists physical conditions, comorbidities, ejection fractions, anesthetic management, operative details, hemodynamic data, PiCCO® parameters, extubation times, cardiovascular surgery ICU lengths of stay, requirements for vasoactive agent and blood transfusion, mortality, and morbidity were recorded from patient records and evaluated the correlation between the measured PiCCO® parameters and extubation time and ICU length of stay inpatients.Results:A significant increase was detected in the parameters of cardiac contractility and performance monitored with PiCCO® in the postoperative period (p<0.05). No significant correlation was found between PiCCO® parameters and extubation time and ICU length of stay (p<0.05).Conclusion:Coronary revascularization patients managed with the guidance of PiCCO® showed improved myocardial contractility and cardiac performance and no increase beyond what is anticipated in the extubation time and ICU lengths of stay of the patients. Thus, we believe that optimum volume and hemodynamic targets can be achieved in patients managed through monitorization of cardiac function parameters

The Impact of CoronaVac Vaccination on 28-day Mortality Rate of Critically Ill Patients with COVID-19 in Türkiye

Background:Vaccines against coronavirus disease-19 (COVID-19) have been effective in preventing symptomatic diseases, hospitalizations, and intensive care unit (ICU) admissions. However, data regarding the effectiveness of COVID-19 vaccines in reducing mortality among critically ill patients with COVID-19 remains unclear.Aims:To determine the vaccination status and investigate the impact of the COVID-19 vaccine on the 28-day mortality in critically ill patients with COVID-19.Study Design:Multicenter prospective observational clinical study.Methods:This study was conducted in 60 hospitals with ICUs managing critically ill patients with COVID-19. Patients aged ≥ 18 years with confirmed COVID-19 who were admitted to the ICU were included. The present study had two phases. The first phase was designed as a one-day point prevalence study, and demographic and clinical findings were evaluated. In the second phase, the 28-day mortality was evaluated.Results:As of August 11, 2021, 921 patients were enrolled in the study. The mean age of the patients was 65.42 ± 16.74 years, and 48.6% (n = 448) were female. Among the critically ill patients with COVID-19, 52.6% (n = 484) were unvaccinated, 7.7% (n = 71) were incompletely vaccinated, and 39.8% (n = 366) were fully vaccinated. A subgroup analysis of 817 patients who were unvaccinated (n = 484) or who had received two doses of the CoronaVac vaccine (n = 333) was performed. The 28-day mortality rate was 56.8% (n = 275) and 57.4% (n = 191) in the unvaccinated and two-dose CoronaVac groups, respectively. The 28-day mortality was associated with age, hypertension, the number of comorbidities, type of respiratory support, and APACHE II and sequential organ failure assessment scores (p < 0.05). The odds ratio for the 28-day mortality among those who had received two doses of CoronaVac was 0.591 (95% confidence interval: 0.413-0.848) (p = 0.004).Conclusion:Vaccination with at least two doses of CoronaVac within six months significantly decreased mortality in vaccinated patients than in unvaccinated patients