The effect of pre-incisional wound site infiltration with multimodal analgesia on postoperative pain in total knee arthroplasty

Background: Though Total knee arthroplasty (TKA) is an effective treatment method for osteoarthritis, insuffient postoperative pain management affects paitents satisfaction and functional results. To an effective postoperative pain management, several methods are used for analgesia. Aim of this study was to evaluate the effect  of the application of pre-incisional wound site infiltration on postoperative analgesia, additional to multi-modal analgesia methods for the provision of analgesia following Total Knee Arthroplasty. Material and methods: Total of 80 patients aged ≥55 years posted to undergo TKA were randomly separated into 2 groups. Pre-incisional injection was administered to the skin for the group I patients, wherreas patiemts of group II were not administered pre-incisional injection. For postoperative pain management additional multi-modal analgesia methods were applied in both groups. To evaluate the level of postoperative pain, a Visual Analog Scale (VAS) score at rest and dynamic VAS (DVAS) during activity were used. The time of requirement for first analgesia and the amount of analgesia required were recorded. The patients were monitored throughout the operation and in the postoperative period for side-effects. Results: Postoperative VAS scores of Group I were found to be statistically significantly lower than those of Group II (p<0.05). The DVAS scores which were evaluated together with mobilisation, determined to be statistically significantly lower in Group I (p<0.05). The time of requirement for analgesia was determined to be later in Group I and the total amount of analgesia administered in the postoperative period was lower in Group I. No statistically significant difference was determined between the two groups in side-effects. Conclusion: The application of pre-incisional infiltration can be considered to be a safe and effective method, which is easy to apply and has low potential for side-effects, while increasing the efficacy of multi-modal analgesia.

Significance of Tomography and CRP in Abdominal Pain Management

Purpose: We evaluated whether abdominal tomography is necessary for patients who have been admitted to the emergency service because of non traumatic abdominal pain and effect of C-Reactive Protein (CRP) and tomography to the patient management. Materials and Method: On retrospective study, we recorded demographic data, tomography diagnoses, CRP and leucocyte values operation and following decisions of 199 patient who were 18 years old and over and were admitted to emergency service because of abdominal pain and were scanned abdominal tomography. 104 patient were hospitalized and their CRP values, tomography diagnoses, end of operation diagnoses were recorded from patient files. The statistical analysis was performed using the Chi-square test and the diagnostic value was assessed through the logistic regression test. Results: A statistically significant relationship was observed between anormal tomography findings and high CRP and leukocyte values of the 199 patients included in the study. The tomography findings and CRP values were found to be efficient in discharge and hospitalization rates. When tomography finding and CRP value were combined, the operation decision was effected. Conclusion: Based on our study; in the event of abdominal pain, CRP can predict abnormal tomography finding and it is more valuable than leucocyte. When tomography was used with CRP, it affects the operation decision. [Cukurova Med J 2015; 40(4.000): 766-773

Comparison of Ultrasound-Guided Subcostal Transversus Abdominis Plane Block and Quadratus Lumborum Block in Laparoscopic Cholecystectomy: A Prospective, Randomized, Controlled Clinical Study

Background. The aim of this study was to compare the effectiveness of ultrasound-guided (USG) subcostal transversus abdominis plane (TAP) block and quadratus lumborum (QL) block as preventive analgesia methods after laparoscopic cholecystectomy. Methods. A total of 120 patients, 18–75 years of age, were separated into 2 groups preoperatively. Patients in group TAP (n = 60) received 0.3 ml/kg bupivacaine with USG bilateral subcostal TAP block; patients in group QL (n = 60) received 0.3 ml/kg bupivacaine with USG bilateral QL block. Patients were assessed 24 h postoperatively, and pain scores, time to first analgesia requirement, total analgesia dose, and postoperative complications during the first 24 h were recorded. Results. Fifty-three patients in group TAP and 54 in group QL were ultimately evaluated. No statistically significant difference was found in at rest and dynamic visual analog scale scores between the groups. There was also no statistically significant difference between the groups with regard to total analgesia consumption. Although the duration of anesthesia was significantly longer in group QL, no statistically significant difference was found in the duration of surgery between the groups (p<0.05). Conclusions. Results of this study demonstrated that USG subcostal TAP and QL blocks similarly reduced postoperative pain scores and analgesia consumption, with high patient satisfaction. However, subcostal TAP block could be considered preferable to QL block because it can be applied easily and in a shorter time

Recent Advances in Cochlear Implant Electrode Array Design Parameters

© 2022 by the authors. Licensee MDPI, Basel, Switzerland.Cochlear implants are neural implant devices that aim to restore hearing in patients with severe sensorineural hearing impairment. Here, the main goal is to successfully place the electrode array in the cochlea to stimulate the auditory nerves through bypassing damaged hair cells. Several electrode and electrode array parameters affect the success of this technique, but, undoubtedly, the most important one is related to electrodes, which are used for nerve stimulation. In this paper, we provide a comprehensive resource on the electrodes currently being used in cochlear implant devices. Electrode materials, shape, and the effect of spacing between electrodes on the stimulation, stiffness, and flexibility of electrode-carrying arrays are discussed. The use of sensors and the electrical, mechanical, and electrochemical properties of electrode arrays are examined. A large library of preferred electrodes is reviewed, and recent progress in electrode design parameters is analyzed. Finally, the limitations and challenges of the current technology are discussed along with a proposal of future directions in the field

Relationship between cigarette smoking and the carbon monoxide concentration in the exhaled breath with perioperative respiratory complications

Background: The purpose of the current study was to determine the effects of preoperative cigarette smoking and the carbon monoxide level in the exhaled breath on perioperative respiratory complications in patients undergoing elective laparoscopic cholecystectomies. Methods: One hundred and fifty two patients (smokers, Group S and non-smokers, Group NS), who underwent laparoscopic cholecystectomies under general anesthesia, were studied. Patients completed the Fagerstrom Test for Nicotine Dependence. The preoperative carbon monoxide level in the exhaled breath levels were determined using the piCO+ Smokerlyzer 12 h before surgery. Respiratory complications were recorded during induction of anesthesia, intraoperatively, during extubation, and in the recovery room. Results: Statistically significant increases were noted in group S with respect to the incidence of hypoxia during induction of anesthesia, intraoperative bronchospasm, bronchodilator treatment intraoperatively, and bronchospasm during extubation. The carbon monoxide level in the exhaled breath and the Fagerstrom Test for Nicotine Dependence, and number of cigarettes smoked 12 h preoperatively were designated as covariates in the regression model. Logistic regression analysis of anesthetic induction showed that a 1 unit increase in the carbon monoxide level in the exhaled breath level was associated with a 1.16 fold increase in the risk of hypoxia (OR = 1.16; 95% CI 1.01–1.34; p = 0.038). Logistic regression analysis of the intraoperative course showed that a 1 unit increase in the number of cigarettes smoked 12 h preoperatively was associated with a 1.16 fold increase in the risk of bronchospasm (OR = 1.16; 95% CI 1.04–1.30; p = 0.007). While in the recovery room, a 1 unit increase in the Fagerstrom Test for Nicotine Dependence score resulted in a 1.73 fold increase in the risk of bronchospasm (OR = 1.73; 95% CI 1.04–2.88; p = 0.036). Conclusions: Cigarette smoking was shown to increase the incidence of intraoperative respiratory complications while under general anesthesia. Moreover, the estimated preoperative carbon monoxide level in the exhaled breath level may serve as an indicator of the potential risk of perioperative respiratory complications. Resumo: Justificativa: O objetivo deste estudo foi determinar os efeitos do tabagismo pré-operatório e o nível de monóxido de carbono no ar expirado sobre complicações respiratórias perioperatórias em pacientes submetidos a colecistectomias laparoscópicas eletivas. Métodos: No total, 152 pacientes (Grupo F: fumantes; Grupo NF: não-fumantes) submetidos a colecistectomias laparoscópicas sob anestesia geral foram avaliados. Os pacientes completaram o Teste para Dependência de Nicotina de Fagerstrom. Os níveis pré-operatórios de monóxido de carbono no ar expirado foram determinados usando o piCO + Smokerlyzer 12 h antes da cirurgia. As complicações respiratórias foram registradas durante a indução da anestesia, no intraoperatório, durante a extubação e na sala de recuperação. Resultados: Aumentos estatisticamente significativos foram observados no Grupo F em relação à incidência de hipoxia durante a indução da anestesia, broncoespasmo intraoperatório, tratamento broncodilatador intraoperatório e broncoespasmo durante a extubação. O nível de monóxido de carbono no ar expirado, o Teste para Dependência de Nicotina de Fagerstrom e o número de cigarros fumados em 12 h no pré-operatório foram designados como covariáveis no modelo de regressão. A análise de regressão logística da indução anestésica mostrou que um aumento de uma unidade no nível de monóxido de carbono no ar expirado foi associado a um aumento de 1,16 vezes do risco de hipoxia (OR = 1,16; IC de 95% 1,01–1,34; p = 0,038). A análise de regressão logística do período intraoperatório mostrou que um aumento de uma unidade no número de cigarros fumados em 12 h no pré-operatório foi associado a um aumento de 1,16 vezes no risco de broncoespasmo (OR = 1,16; IC de 95% 1,04–1,30, p = 0,007). Enquanto na sala de recuperação, um aumento de uma unidade no escore do Teste para Dependência de Nicotina de Fagerstrom resultou em um aumento de 1,73 vezes no risco de broncoespasmo (OR = 1,73; IC de 95% 1,04–2,88; p = 0,036). Conclusões: O tabagismo mostrou aumentar a incidência de complicações respiratórias intraoperatórias sob anestesia geral. Além disso, o nível estimado de monóxido de carbono no ar expirado no pré-operatório pode servir como um indicador do risco em potencial de complicações respiratórias perioperatórias. Keywords: Smoking, CO exhaled, Peri-operative, Respiratory complications, Laparoscopic cholecystectomy, Palavras-chave: Tabagismo, CO expirado, Perioperatório, Complicações respiratórias, Coleistectomia laparoscópic

Isolated Cerebral Fat Embolism After Lower Extremity Fracture: Case Report

Fat embolism syndrome (FES) is characterized with petechiae, mental confusion, and respiratory failure, occurs generally after lower extremity long bone fractures or orthopedic surgery within 24-72 hours. Isolated cerebral fat embolism occurs at a rate of 0.9-2.2% that is a fatal event. The clinical diagnosis of isolated cerebral fat embolism is difficult since neurological symptoms are variable. On the other hand methemoglobinemia is a rare complication occurring after administration of local anesthetics. We aimed to present a case in whom isolated cerebral fat embolism and methemoglobinemia caused by intraoperative high dose of local anesthetic agents and who was taken to operation in the first 24 hours because of the left femoral diaphysis fracture in this study

Clinical Study The Effect of Peritubal Infiltration with Bupivacaine and Morphine on Postoperative Analgesia in Patients Undergoing Percutaneous Nephrolithotomy

Objective. We aimed to investigate the effect of peritubal local anesthetic and opioid infiltration on pain scores and analgesic consumption in patients who underwent percutaneous nephrolithotomy. Material and Methods. Patients aged between 18 and 65 years and ASA I-III were included in this double-blind, randomized study. The patients were divided into two groups. All patients underwent spinoepidural anesthesia. 20 mL of 0.25 percent bupivacaine + 5 mg morphine (0.5 mL), in Group P ( = 66), infiltrated the renal capsule, perinephric fat, muscles, subcutaneous tissue, and skin under fluoroscopy. In Group C ( = 64), none of the patients received a peritubal injection. In the first 24 h pain scores, time of the first analgesic demand, the mean number of analgesic demands, and postoperative complications were compared between groups. Results. The mean VAS score at postoperative 8, 12, and 24 h and dynamic VAS score at postoperative 4, 8, 12, and 24 h were significantly lower in Group P. VAS score at postoperative 4 h was not significant. Time of the first analgesic demand was significantly longer in Group P. Conclusion. Our study results suggest that peritubal infiltration of bupivacaine with morphine after percutaneous nephrolithotomy is an effective method for postoperative pain control and reduces analgesic consumption

The Effect of Peritubal Infiltration with Bupivacaine and Morphine on Postoperative Analgesia in Patients Undergoing Percutaneous Nephrolithotomy

Objective. We aimed to investigate the effect of peritubal local anesthetic and opioid infiltration on pain scores and analgesic consumption in patients who underwent percutaneous nephrolithotomy. Material and Methods. Patients aged between 18 and 65 years and ASA I-III were included in this double-blind, randomized study. The patients were divided into two groups. All patients underwent spinoepidural anesthesia. 20 mL of 0.25 percent bupivacaine + 5 mg morphine (0.5 mL), in Group P (n=66), infiltrated the renal capsule, perinephric fat, muscles, subcutaneous tissue, and skin under fluoroscopy. In Group C (n=64), none of the patients received a peritubal injection. In the first 24 h pain scores, time of the first analgesic demand, the mean number of analgesic demands, and postoperative complications were compared between groups. Results. The mean VAS score at postoperative 8, 12, and 24 h and dynamic VAS score at postoperative 4, 8, 12, and 24 h were significantly lower in Group P. VAS score at postoperative 4 h was not significant. Time of the first analgesic demand was significantly longer in Group P. Conclusion. Our study results suggest that peritubal infiltration of bupivacaine with morphine after percutaneous nephrolithotomy is an effective method for postoperative pain control and reduces analgesic consumption