17 research outputs found
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
Effects of alfentanil or fentanyl added to propofol for sedation in colonoscopy on cognitive functions: Randomized controlled trial
Background/Aims: To assess the effect of propofol supplemented with alfentanil or fentanyl on cognitive functions
for sedation during elective colonoscopy.
Materials and Methods: Patients (n=150, 18-65 years old, American Society of Anesthesiologists risk group I-III)
scheduled undergo elective colonoscopy were included. They were randomized into three groups using the
closed envelope methodpropofol-alfentanil (Group A), propofol-fentanyl (Group F), and propofol only (Group
P).Group A patients were given an alfentanil (10 mcg/kg)-supplemented propofol bolus infusion and 5 mcg/
kg alfentanil when necessary. Group F patients were given fentanyl (1 mcg/kg)-supplemented propofol and 0.5
mcg/kg fentanyl when necessary. Group P patients were given 1 mg/kg propofol and 0.5 mg/kg propofol when
necessary. Vital signs, depth of sedation, recovery parameters, and patient and endoscopist satisfaction were
recorded. Trieger dot test (TDT) and Digit Symbol Substitution Test (DSST) were performed post procedure.
Results: Demographic data were similar among all patients in the groups. Bispectral index values were lower
in Group P (p<0.001). DSST scores were higher in Group A (p=0.004). TDT scores and Facial Pain Scale scores
were higher in Group P (p<0.005). Apnea incidence (p=0.009) and Observer’s Assessment of Alertness/Sedation
Scale scores (p=0.002) were also higher in Group P. Patient satisfaction and endoscopist satisfaction were similar
among all patients.
Conclusions: Compared with propofol-alfentanil and propofol-fentanyl, propofol alone is associated with an
increased incidence of apnea, drug consumption, and reported pain. Propofol-alfentanil has a less negative
effect on cognitive functions than propofol alone or propofol-fentanyl
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
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
Hemodynamic outcome of different ventilation modes in laparoscopic surgery with exaggerated trendelenburg: a randomised controlled trial
Purpose: To compare hemodynamic effects of two different modes of ventilation (volume controlled and pressure-controlled volume guaranteed) in patients undergoing laparoscopic
gynecology surgeries with exaggerated Trendelenburg position.
Methods: Thirty patients undergoing laparoscopic gynecology operations were ventilated using
either volume-controlled (Group VC) or pressure-controlled volume guaranteed mode (Group
PCVG) (n = 15 for both groups). Hemodynamic variables were measured using Pressure Recording
Analytical Method by radial artery cannulation in addition to peak and mean airway pressures
and expired tidal volume.
Results: The only remarkable finding was a more stable cardiac index in Group PCVG, where
other hemodynamic parameters were similar. Expired tidal volume increased in Group VC while
peak airway pressure was lower in Group PCVG.
Conclusion: PCV-VG causes less hemodynamic perturbations as measured by Pressure Recording
Analytical Method (PRAM) and allows better intraoperative hemodynamic control in exaggerated
Trendelenburg position in laparoscopic surgery
Sex difference and intra-operative tidal volume: Insights from the LAS VEGAS study
BACKGROUND: One key element of lung-protective ventilation is the use of a low tidal volume (VT). A sex difference in use of low tidal volume ventilation (LTVV) has been described in critically ill ICU patients.OBJECTIVES: The aim of this study was to determine whether a sex difference in use of LTVV also exists in operating room patients, and if present what factors drive this difference.DESIGN, PATIENTS AND SETTING: This is a posthoc analysis of LAS VEGAS, a 1-week worldwide observational study in adults requiring intra-operative ventilation during general anaesthesia for surgery in 146 hospitals in 29 countries.MAIN OUTCOME MEASURES: Women and men were compared with respect to use of LTVV, defined as VT of 8 ml kg-1 or less predicted bodyweight (PBW). A VT was deemed 'default' if the set VT was a round number. A mediation analysis assessed which factors may explain the sex difference in use of LTVV during intra-operative ventilation.RESULTS: This analysis includes 9864 patients, of whom 5425 (55%) were women. A default VT was often set, both in women and men; mode VT was 500 ml. Median [IQR] VT was higher in women than in men (8.6 [7.7 to 9.6] vs. 7.6 [6.8 to 8.4] ml kg-1 PBW, P < 0.001). Compared with men, women were twice as likely not to receive LTVV [68.8 vs. 36.0%; relative risk ratio 2.1 (95% CI 1.9 to 2.1), P < 0.001]. In the mediation analysis, patients' height and actual body weight (ABW) explained 81 and 18% of the sex difference in use of LTVV, respectively; it was not explained by the use of a default VT.CONCLUSION: In this worldwide cohort of patients receiving intra-operative ventilation during general anaesthesia for surgery, women received a higher VT than men during intra-operative ventilation. The risk for a female not to receive LTVV during surgery was double that of males. Height and ABW were the two mediators of the sex difference in use of LTVV.TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov, NCT01601223
Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries
Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely
Ultrasound Guided TAP Block For The Treatment of Postoperative Prolonged Pain - An Alternative Approach
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
Mantar Zehirlenmesinde Erken Başlangıçlı Muskarinik Bulgular ve Sendromik Sınıflandırma
Mushroom poisoning is a frequently encountered health problem around the globe. Depending on its type and toxin, it results in a wide spectrum of issues that range from asymptomatic findings to fatal organ failure. Since the toxin of the mushroom leading to poisoning is often unidentified, syndromic classification may benefit clinical management according to the findings of target organ system toxicity. A 64-year-old female patient with comorbidities such as diabetes mellitus, coronary artery disease, hypertension and hyperlipidemia was admitted to the intensive care unit. Approximately four hours after consuming wild mushrooms the patient's diarrhea, muscle cramps, cold sweating, blurry vision, coughing and shortness of breath complaints have been begun. Her respiratory system examination revealed tachypnea, generalized bilateral rhonchus, bronchorrhea and wheezing. Patient was normotensive and had bradycardia (heart rate 35 beats/minute). She had anxiety and the Glasgow Coma score was 15. Her pupillary bilateral isochoric, miotic and light reflexes were diminished. In her arterial blood gas pH level 7.26, partial carbon dioxide pressure: 34 mmHg, potassium: 5.3 mmol/L, sodium: 130 mmol/L, lactate: 5.3 mmol/L, bicarbonate: 16 mEq/L and base excess: -10,3 mmol/L was found. Target organ system toxicity findings and timing of occurrence indicated early-onset cholinergic syndrome. Treatments that consisted of intravenous atropine, fluid, electrolytes and sodium bicarbonate alleviated the toxicity in a short period of time. Late mycologic examination results that followed the treatment revealed that the patient was poisoned by Inocybe lacera, a mushroom type that contains muscarine. With this case presentation, we summarized the syndromic classification that we use in the clinical management in the light of current information in the literature
The efficacy of adding dexketoprofen trometamol to tramadol with patient controlled analgesia technique in post-laparoscopic cholecystectomy pain treatment
Objectives: Pain treatment in laparoscopic cholecystectomy, which is performed in increasing numbers as an ambulatory
procedure, is an important issue.Although laparoscopic cholecystectomy is regarded as an ambulatory procedure, patients
are often hospitalized due to pain and this increases opioid consumption and side effects caused by opioids. This study aims
at evaluating the efficacy of adding dexketoprofen trometamol to tramadol with patient controlled analgesia (PCA) in postlaparoscopic
cholecystectomy pain treatment.
Methods: 40 patients in ASA I-II risk groups aged between 18-65 years were enrolled in the study and were randomized
using closed envelope method. In Group TD 600 mg tramadol and 100 mg dexketoprofen trometamol, in Group T 600 mg
tramadol was added to 100 ml 0.9% normal saline for PCA. 8 mg lornoxicam iv was given if VAS >40 in the postoperative
period.
Results: There was no statistically significant difference in terms of adverse effects (hypotension, bradycardia, sedation) but in
Group T 4 patients complained of nausea and 3 complained of vomiting. Opioid consumption was lower and patient satisfaction
was higher in group TD.
Conclusion: This study has shown that adding dexketoprofen trometamol to tramadol in patient controlled analgesia following
laparoscopic cholecystectomy lowers VAS scores, increases patient satisfaction and decreases opioid consumption