Evaluation of attitudes and knowledge of anesthesiologists about regional anesthesia methods in ophthalmic surgery: A national survey study

Aim: The use of regional techniques in ophthalmic surgery is becoming increasingly important. Worldwide, these techniques are usually performed by ophthalmologists, while the perioperative care of patients is provided by anesthesiologists. Therefore, good communication between the surgeon and the anesthesiologist is necessary for the careful management of all techniques used in ophthalmic surgery. In this study, the willingness of anesthesiologists to assume responsibility in the use of regional techniques and their knowledge of ophthalmic nerve blocks were assessed in a national survey.Material and Methods: A total of 23 questions were asked to assess attitudes and knowledge about regional anesthesia procedures in ophthalmic surgery, and participants had three weeks to complete the Web-based questionnaire. Complete responses from 126 physicians were analyzed.Results: 60% of participants work in university hospitals as faculty members. Although 54.8% of participants had worked in ophthalmic surgery for 3 months or more, and 76% reported that they had not attended any lectures or seminars on regional block use in ophthalmic surgery. When asked who applied blocks in ophthalmic surgery, 95% of the participants answered the surgical team.Discussion: The lack of theoretical and practical knowledge about ophthalmic nerve blocks is striking even among the group of physicians who practice regional anesthesia. Even if regional techniques are performed by the surgeon himself, the anesthesiologist's responsibility in perioperative patient care cannot be ignored. For this reason, the level of knowledge of anesthesiologists on this topic should be increased through various continuing education courses

Comparison of the Effects of Alcohol and Phenol Used for Celiac Neurolysis with Endoscopic Ultrasound in Patients with Pancreas Cancer: Retrospective Analysis

Objective: In this study we aimed to compare the efficacy of ethanol and phenol used in the EUS-guided celiac plexus neurolysis procedure on pain scores and complications. Material and Methods: Between January 2009 and June 2022, 28 patients who underwent celiac neurolysis underwent sedation via EUS (endoscopic ultrasonography) guidance in the endoscopy unit were included. We retrospectively analyzed the data of the EUS-guided celiac neurolysis procedures for pain management of patients with pancreatic cancer. Results: Patients in the alcohol group had lower pain scores. Conclusion: When alcohol and phenol-based neurolytic techniques were compared, better analgesic effect was obtained in the alcohol group

Türk hekimlerinin fibromiyalji tedavisindeki tutumları; pregabalinofobi ağrı tedavisinin yeni gerçeği mi?

OBJECTIVES: This study aims to determine the treatment preferences of physicians interested in fibromyalgia treatment and to investigate their hesitations about prescribing pregabalin. METHODS: Our survey study was conducted between February 5 and 20, 2021. The survey forms were sent to the known email addresses and phone numbers of 1569 physical medicine and rehabilitation (PMR), algology, and rheumatology physicians. The replies to the surveys were checked for possible resubmissions. The pooled data were evaluated with the SPSS 22.0 statistical package program. Frequency distributions were calculated and presented as n, %. RESULTS: Four hundred and six PMR, rheumatology, and algology specialists fulfilled the study forms. About 59.0% of physicians stated that they prefer duloxetine as the first-line agent of fibromyalgia syndrome (FMS) treatment. Pregabalin was only 6.0% of the physicians' first choice for FMS. About 35.0% of the participating physicians stated that the PMR department should follow up FMS patients. About 44.3% of the participants noted that they refer FMS patients to other departments which interested in FMS treatment and do not want to follow-up FMS patients. About 81% agreed that pregabalin causes addiction. About 36.7% stated that at least 20% of the patients could abuse pregabalin and 97.8% of physicians stated that they were prejudiced about prescribing pregabalin to prisoners. Approximately two of the three physicians experienced an act of violence in their hospital regarding pregabalin prescribing. CONCLUSION: These data showed that the 'Pregabalinophobia' should be accepted. This condition is associated with life safety concerns of the physician not only from unreliability of the drug. It seems that the doctors have valid reasons to develop this prejudice.Amaç: Bu çalışma, fibromiyalji tedavisi ile ilgilenen hekimlerin tedavi tercihlerini belirlemek ve pregabalin reçetelemek konusundaki tereddütlerini araştırmayı amaçlamaktadır. Gereç ve Yöntem: Anket çalışmamız 5 Şubat 2021–20 Şubat 2021 tarihleri arasında gerçekleştirildi. Fiziksel tıp ve rehabilitasyon, algoloji ve romatoloji hekimlerinden oluşan 1569 kişinin bilinen e-posta adreslerine ve telefon numaralarına anket formları gönderildi. Anketlere verilen yanıtlar olası yeniden gönderimler açısından kontrol edildi. Veri havuzu SPSS 22.0 istatistik paket programı ile değerlendirildi. Frekans dağılımları hesaplandı ve n, % olarak sunuldu. Bulgular: Dört yüz altı fiziksel tıp ve rehabilitasyon, romatoloji ve algoloji uzmanı çalışma formlarını tamamladı. Hekimlerin %59’u fibromiyalji tedavisinde birinci basamak ajan olarak duloksetin tercih ettiklerini belirtti. Pregabalin, hekimlerin fibromi-yalji için ilk tercihinin sadece %6'sıydı. Çalışmaya katılan hekimlerin %35'i fibromiyalji hastalarının fiziksel tıp ve rehabilitasyon bölümlerinde takip edilmesi gerektiğini belirtti. Katılımcıların %44,3’ü fibromiyalji hastalarını, fibromiyalji tedavisi ile ilgilenen ve fibromiyalji hastalarını takip etmek isteyen diğer bölümlere sevk ettiklerini belirtti. Katılımcıların %81'i pregabalinin bağımlılığa neden olduğunu kabul etti. Katılımcıların %36,7'si fibromiyalji hastalarının en az %20'sinin pregabalini kötüye kullanabileceğini belirtti. Hekimlerin %97,8'i mahkumlara pregabalin reçete edilmesi konusunda ön yargılı olduğunu belirtti. Üç hekimden yaklaşık ikisi hastanelerinde pregabalin reçete edilmesi ile ilgili bir şiddet olayına maruz kaldığını belirtti. Sonuç: Bu veriler “pregabalinofobi”nin kabul edilmesi gerektiğini göstermektedir. Bu durum, yalnızca ilacın güvenilmezliğinden değil, hekimin can güvenliği endişeleriyle de ilişkilidir. Görünüşe göre doktorlarda bu ön yargının oluşmasında geçerli nedenler vardır

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

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

A randomized trial to compare serratus anterior plane block and erector spinae plane block for pain management following thoracoscopic surgery

Objective. Comparison of ultrasound (US)-guided erector spinae plane block (ESPB) and serratus anterior plane block (SAPB) in video-assisted thoracic surgery (VATS) patients. The primary outcome was to compare perioperative and postoperative (48 hours) opioid consumption. Methods. A total of 60 patients were randomized into two groups (N =30): an ESPB group and an SAPB group. All the patients received intravenous patient-controlled postoperative analgesia and ibuprofen 400 mg intravenously every eight hours. Visual analog scale (VAS) scores, opioid consumption, and adverse events were recorded. Results. Intraoperative and postoperative opioid consumption at 0-8, 8-16, and 16-24 hours and rescue analgesic use were significantly lower in the ESPB group (P 0.05 each). Conclusion. US-guided ESPB may provide better pain control than SAPB after VATS. Question. Even though there are studies about analgesia management after VATS, clinicians want to perform the technique that is both less invasive and more effective. Findings. This randomized trial showed that US-guided ESPB provides effective analgesia compared with SAPB. Meaning. Performing single-injection ESPB reduces VAS scores and opioid consumption compared with SAPB

Modified thoracoabdominal nerve block through perichondrial approach (M-TAPA) vs local infiltration for pain management after laparoscopic cholecystectomy surgery: a randomized study

Purpose: Modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) targets thoracoabdominal nerves. Our primary aim was to compare M-TAPA vs local infiltration on pain management in patients underwent laparoscopic cholecystectomy (LC) surgery. Methods: Patients with ASA class I-II patients aged between 18 and 65 years scheduled for elective LC under general anesthesia were enrolled in the study. There were two randomized groups: Group M: M-TAPA group (n = 30) and the local infiltration (LI) group (n = 30). M-TAPA was performed with totally 40 ml 0.25% bupivacaine in the M group. LI was performed in infiltration group. The primary outcome of the study was pain score in the PACU, the secondary outcomes were the patient satisfaction scores, rescue analgesic need, and adverse effects during the 24-h postoperative period. Results: The static NRS scores were significantly lower in Group M at the postoperative first 4 h (p = 0.001). There was a significant decrease in the dynamic NRS scores in Group M at the postoperative first 16 h (p = 0.001). The incidence of nausea was significantly higher in the LI group (12 vs. 5 patients, p = 0.047). The need for rescue analgesia was significantly lower in Group M (p = 0.009). The patient satisfaction scores were significantly higher in Group M (p = 0.001). Conclusion: M-TAPA provides superior analgesia compared to LI in patients undergoing LC

Serratus anterior plane block versus erector spinae plane block for thoracoscopic surgery: Response to sun et al

Dear Editor, We thank Sun et al. for their interest in our article, which compares the analgesic efficacy of erector spinae plane block (ESPB) and serratus anterior plane block (SAPB) for thoracoscopic surgery [1]. Our study is a single-center, randomized, prospective study of two groups [2]. We compared T5-level ESPB and SAPB which was performed at the level of 4th–5th ribs in our study. According to our results, ESPB provided better pain control than SAPB in patients who underwent thoracoscopic surgery. However, there may be some considerations in our study, like the other clinical studies in the literature. Sun et al. reported that “The authors only statistically differentiated postoperative pain level, but the difference in baseline (before surgery) between the two groups was not known” [1]

The efficacy of high thoracic erector spinae plane block

..