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

Comparison about the efficacy of erector spinae plane block and thoracic epidural analgesia for postoperati̇ve analgesia management following video assisted thoracic surgery

Giriş/Amaç: Torakotomi sonrası analjezi yönetimi için altın standart olan torakal epidural analjezi (TEA), video yardımlı torakoskopik cerrahi (Video-assisted thoracic surgery-VATS) sonrası analjezi için de kullanılmaktadır. Ultrasound (US) eşliğinde yapılan erektör spina plan bloğu (ESPB), Forero ve ark. tarafından 2016 yılında tanımlanmış yeni bir interfasiyal plan bloğudur. Erektör Spina Plan Bloğu'nun T5 vertebra seviyesinde uygulanınca torakal analjezi sağladığı bildirilmiştir. Bu çalışmanın amacı, VATS sonrası analjezi yönetiminde ESPB ve TEA' nın analjezik etkinliklerini kıyaslamaktır. Gereç/Yöntem: İstanbul Medipol Üniversitesi Tıp Fakültesi etik kurul onayı (28.12.2018 tarihli 21 karar no.lu) ve hasta onamları alındıktan sonra, genel anestezi altında elektif video yardımlı torakoskopik cerrahi planlanan, ASA risk skoru I-II olan 50 hasta çalışmaya dahil edildi. Kanama diyatezi hikayesi bulunan, antikoagülan tedavi alan, lokal anestezik ve opioid ilaçlara karşı alerjisi veya duyarlılığı olan, blok uygulanacak bölgede infeksiyonu olan, gebelik şüphesi ve/veya gebe olan, emziren anneler ve işlemi kabul etmeyen hastalar çalışma dışı bırakıldı. Hastalar bilgisayar randomizasyon programı yardımıyla iki gruba ayrıldı. Grup ESPB' (n=25) de ESPB, Grup TEA' (n=25) da TEA planlandı. Her iki gruba blok kateterinden hasta kontrollü analjezi (HKA) uygulandı. Postoperatif ilk 24 saatte her iki grubun VAS skorları, ek analjezik kullanımı, bulantı-kusma insidansları ve komplikasyonlar kaydedildi. Bulgular: ESPB grubunda TEA grubuna göre intraoperatif opioid (remifentanil) tüketimi, istatistiksel olarak anlamlı düşük saptandı (p0.05). Sonuç: Çalışmamızda, VATS sonrası analjezi yönetiminde ESPB ve TEA' nın benzer etkinlikte analjezi sağladığı görüldü. ESPB hem uygulama kolaylığı hem de güvenliği açısından torakoskopi sonrası analjezi yönetimi için TEA' ya iyi bir alternatif olabilir.Objective: Thoracic epidural analgesia (TEA) is the clinical gold standard post-thoracotomy analgesic technique, but it is also being used for analgesia management following video-assisted thoracic surgery (VATS). The ultrasound (US)-guided erector spinae plane block (ESPB) is a novel interfacial plane block described by Forero et al. in 2016. ESPB provides thoracic analgesia when it is performed on the level of T5 vertebrae. The aim of this study is to compare the efficacy of ESPB and TEA for postoperative analgesia management following VATS. Methods: After the approval of the Istanbul Medipol University ethical committee and obtaining consent from the patients, patients who had American Society of Anesthesiologists (ASA) classification of I–II and an age of 18 to 65 years old- scheduled for elective VATS under general anesthesia were included in this study. We excluded patients with bleeding diathesis histories, patients receiving anticoagulant treatment, patients with known local anesthetic or opioid allergies, patients with skin infections at the needle puncture site, pregnant or lactating patients, and those who did not agree to the procedure. The patients were divided into two groups of 25 patients each using a randomizing computer program: an ESPB group (n=25) and a TEA group (n=25). Patient-controlled analgesia (PCA) device was attached to patients via the catheter. The analgesic using in the postoperative first 24 hours, the incidence of nausea and vomiting, and complications were recorded. Results: The intraoperative opioid consumption was significantly lower in ESPB group compared to TEA group (p<0,05). The static (at rest) and dynamic (while cough) VAS at 16th and 24th hours were significantly higher in ESPB group compared to TEA group. There was no difference in terms of side effects and complications between the groups. Conclusions: ESPB and TEA provided similar effective analgesia management following VATS. ESPB may be a good alternative to TEA for analgesia management after thoracoscopy, due to its safety and ease of application

Ultrasound-guided pectoral nerve block for pain control after breast augmentation: A randomized clinical study

Background and objective: Pectoral nNerve (PECS) block type-1 is an Ultrasound (US)-guided interfacial block that can be performed for postoperative analgesia management after breast surgery. In the procedure, a local anesthetic solution is injected into the interfacial area between the Pectoralis Major muscles (PMm) and Pectoralis minor muscles (Pmm). The present study compared PECS block type-1 administered preoperatively or postoperatively for postoperative analgesia after breast augmentation surgery. Methods: The patients were randomly divided into three groups (n = 30 in each): a preoperative PECS block group (Pregroup), postoperative PECS block group (Postgroup), and control group (Group C). Opioid consumption and Visual Analogue Scale (VAS) scores were evaluated at postoperative period. Results: The pains scores in the Pregroup were significantly lower than those in the control group. Although there was no significantly difference in the VAS scores of the Postgroup and control group at postoperative 1 hour, the scores in the Postgroup were significantly lower than those in the control group at all the other evaluated times (p < 0.05). The VAS scores in the Pregroup were significantly lower than those in the Postgroup 8 hours after the surgery. Opioid consumption was significantly lower in the Pregroup as compared with that in the other two groups (p < 0.05). The use of rescue analgesia in the Pregroup was significantly lower than that in the other groups (p < 0.05). Conclusion: Performing PECS block type-1 preoperatively reduced VAS scores and opioid consumption after breast augmentation

Airway obstruction due to intraoperative endotracheal tube cuff herniation: Case report

Endotracheal tube obstruction by blood, mucus material or kinking is not uncommon however endotracheal cuff herniation is an extremely rare condition. It could easily be overlooked and may cause airway obstruction. Bronchoscopy is the gold standard method of diagnosis. In this case report, we aimed to present an unusual case of intraoperative endotracheal tube cuff herniation in a 62 year-old patient scheduled for nephrectomy

Efficacy of an ultrasound-guided erector spinae plane block for postoperative analgesia management after video-assisted thoracic surgery: A prospective randomized study

Objectives: Investigate whether an ultrasound-guided erector spinae plane block (ESPB) can be used to manage postoperative pain in video-assisted thoracic surgery (VATS) patients. Design: Prospective, randomized study. Setting: Single institution, academic university hospital. Participants: Adult patients who underwent VATS under general anesthesia between September 2018 and March 2019. Interventions: This study was an interventional study. Measurements and Main Results: A total of 60 patients were randomly assigned into 2 groups (n = 30 per group): an ESPB group and a control group. In the ESPB group, a single-shot ultrasound-guided ESPB was administered preoperatively. The control group received no such intervention. All of the patients received intravenous patient-controlled postoperative analgesia, and they were assessed using visual analogue scale (VAS) scores, opioid consumption, and adverse events. There were no statistically significant intergroup differences with respect to the age, sex, weight, American Society of Anesthesiologists status, anesthesia duration, and surgery length (p> 0.05 for each). The opioid consumption at 1, 2, 4, 8, 16, and 24 hours and the active and passive VAS scores at 0, 2, 4, 8, 16, and 24 hours were statistically lower in the ESPB group at all of the time periods when compared with the control group (p <0.05). In the control group, the nausea and itching rates were higher, but there were no intergroup differences in terms of other adverse effects. Conclusions: A preemptive single-shot ESPB may provide effective analgesia management after VATS

Comparison of ultrasound-guided type-II pectoral nerve block and rhomboid intercostal block for pain management following breast cancer surgery: A randomized, controlled trial

Purpose Although breast-conserving surgery-axillary dissection (BCS-AD) is a minimally invasive surgery, patients may suffer from moderate-to-severe pain. Several regional techniques can be used for pain control. The type II pectoral nerve block (PECS II) and the rhomboid intercostal block (RIB) are interfascial plane blocks that have been reported to provide effective analgesia after breast surgery. This study aims to compare the analgesic efficacy of the PECS II block and the RIB after breast surgery. Patients and Methods Ninety female patients aged 18 to 65 years with American Society of Anesthesiologists (ASA) classes I and II physical status who underwent unilateral BCS-AD surgery were included. Patients were divided into three groups (n = 30 in each): the PECS II group, the RIB group, or the control group. PECS II block and RIB were performed with 30 mL 0.25% bupivacaine. Ibuprofen 400 mg IV 3 x 1 was given in the postoperative period. A patient control analgesia device included a dose of 10 mu g/mL fentanyl, which was prepared and connected to the patients. Results There were no statistical differences between groups in terms of demographical data. Postoperative fentanyl consumption was significantly lower in the PECS II and RIB groups than the control group. The need for rescue analgesia use was significantly higher in the control group than the other groups. At all times, visual analog scale scores were significantly lower in the PECS II and RIB groups than the control group. Conclusions The PECS II block and the RIB provide similar effective analgesia after BCS-AD

Comparison of Ultrasound‐Guided Type‐II Pectoral Nerve Block and Rhomboid Intercostal Block for Pain Management Following Breast Cancer Surgery: A Randomized, Controlled Trial

Purpose Although breast-conserving surgery-axillary dissection (BCS-AD) is a minimally invasive surgery, patients may suffer from moderate-to-severe pain. Several regional techniques can be used for pain control. The type II pectoral nerve block (PECS II) and the rhomboid intercostal block (RIB) are interfascial plane blocks that have been reported to provide effective analgesia after breast surgery. This study aims to compare the analgesic efficacy of the PECS II block and the RIB after breast surgery. Patients and Methods Ninety female patients aged 18 to 65 years with American Society of Anesthesiologists (ASA) classes I and II physical status who underwent unilateral BCS-AD surgery were included. Patients were divided into three groups (n = 30 in each): the PECS II group, the RIB group, or the control group. PECS II block and RIB were performed with 30 mL 0.25% bupivacaine. Ibuprofen 400 mg IV 3 x 1 was given in the postoperative period. A patient control analgesia device included a dose of 10 mu g/mL fentanyl, which was prepared and connected to the patients. Results There were no statistical differences between groups in terms of demographical data. Postoperative fentanyl consumption was significantly lower in the PECS II and RIB groups than the control group. The need for rescue analgesia use was significantly higher in the control group than the other groups. At all times, visual analog scale scores were significantly lower in the PECS II and RIB groups than the control group. Conclusions The PECS II block and the RIB provide similar effective analgesia after BCS-AD