A comparison of adductor canal block before and after thigh tourniquet during knee arthroscopy: A randomized, blinded study

Background: Adductor canal block (ACB) provides effective analgesia management after arthroscopic knee surgery. However, there is insufficient data about performing ACB before or after inflation of a thigh tourniquet. We aimed to investigate the efficacy of ACB when it is performed before and after thigh tourniquet and evaluate motor weakness. Methods: ACB was performed before the tourniquet inflation in the PreT group, it was performed after the inflation of the tourniquet in the PostT group. In the PO group, ACB was performed at the end of surgery after disinflation of the tourniquet. Results: There were no statistical differences between the groups in terms of demographic data. Opioid consumption showed no statistically significant differences (for total consumption; p = 0.5). The amount of rescue analgesia administered and patient satisfaction were also not significantly different between groups. There was no significant difference in terms of static and dynamic VAS scores between groups (for 24 hours; p = 0.3, p = 0.2 respectively). The incidence of motor block was higher in the PreT group (eight patients) than in the PostT group (no patients) and in the PO group (only one patient) (p = 0.005). Conclusions: Using a tourniquet before or after ACB may not result in any differences in terms of analgesia; however, applying a tourniquet immediately after ACB may lead to muscle weakness

Lomber spinal cerrahi yapılan hastalarda postoperatif analjezi yönetimi içinultrason eşliğinde yapılan modifiye-torakolomber interfasiyal plan bloğu ve yara yeriinfiltrasyonunun karşılaştırılması: Prospektif, randomize çalışma

Objectives: Pain management is an important issue following lumbar spinal surgery. Wound infiltration is a technique that a local anesthetic solution is infiltrated into the tissues around the surgical area. Previous studies reported that US-guided modified thoracolumbar interfacial plane (mTLIP) block after lumbar spinal surgery provided effective analgesia. In this study, we aimed to compare the analgesic efficacy of the US-guided mTLIP block and wound infiltration following lumbar disc surgery.Methods: 60 patients aged 18-65 years, ASA classification I-II, and scheduled for lumbar disc surgery under general anesthesia were included in the study. US-guided mTLIP block was performed via the lateral approach in group T (n=30), and wound infiltration was performed in group W (n=30). Opioid consumption, postoperative pain scores and adverse effects of opioids, such as allergic reactions, nausea, and vomiting, were recorded.Results: Opioid consumption and the use of rescue analgesia were significantly lower in group T in all the postoperative periods (1, 2, 4, 8, 16, and 24 h) (p<0.05). The VAS scores for pain during mobility and while at rest were significantly lower in group T than those in group W 8 h after the surgery (p<0.05). The incidences of nausea, vomiting, and itching in group W were higher than the incidences in group T.Conclusion: The mTLIP block provides effective analgesia for the first 24 h following lumbar disc surgery, and it may be an alternative to wound infiltration for pain management.Amaç: Lomber spinal cerrahi sonrası analjezi yönetimi önemli bir konudur. Yara yeri infiltrasyonu, lokal anesteziğin cerrahi alanetrafındaki dokulara infiltre edildiği bir tekniktir. Daha önceki klinik çalışmalar, lomber spinal cerrahi sonrası ultrason (US) eşliğinde yapılan modifiye torakolomber interfasiyal plan (mTLIP) bloğunun etkili analjezi sağladığını göstermektedir. Çalışmamızdalomber disk cerrahisi sonrası US eşliğinde mTLIP bloğun ve yara infiltrasyonunun analjezik etkinliğini karşılaştırmayı amaçladık.Gereç ve Yöntem: Çalışmaya, 18-65 yaş arası, ASA I -II sınıfında olan ve genel anestezi altında lomber disk cerrahisi planlanan60 hasta dahil edildi. Anestezi indüksiyonu yapılıp pron pozisyona alındıktan sonra T grubuna (n=30) lateral yaklaşımla USeşliğinde mTLIP blok, W grubunda ise (n=30) yara yeri infiltrasyonu yapıldı. Opioid tüketimi, postoperatif ağrı skorları ve yanetkiler (allerjik reaksiyon, bulantı, kusma) kaydedildi.Bulgular: Postoperatif tüm zaman aralıklarında (1, 2, 4, 8, 16 ve 24 saat) opioid tüketimi ve kurtarıcı analjezi kullanımı grup T’deanlamlı olarak düşüktü (p<0.05). İstirahat ve aktivite sırasındaki VAS skorları postoperatif ilk 8 saatte Grup T’de grup W ya göreanlamlı derecede düşüktü (p<0.05). Grup W da bulantı, kusma ve kaşıntı insidansı grup T’den daha yüksekti.Sonuç: mTLIP blok, lomber disk ameliyatı yapılan hastalarda postoperatif ilk 24 saat boyunca etkili bir analjezi sağlamaktadırve analjezi yönetimi için yara yeri infiltrasyonuna alternatif olarak uygulanabilir

Ultrasound-guided combined interscalene and superficial cervical plexus blocks for anesthesia management during clavicle fracture surgery

To the Editor, Fractures of the clavicle constitute 2.6–4% of all fractures in adult patients. The most frequent injury mechanism is a direct trauma on the shoulder. These fractures are mainly treated surgically (Kihlstrom et al. 2017). The cervical and brachial plexus innervate the clavicular region (Tran et al. 2013). Thus, interscalene brachial plexus block (IBPB) and superficial cervical plexus block (SCPB) may be used for pain management following clavicular surgery. Herein, we aimed to report our ultrasound (US)-guided IBPB and SCPB combination experiences for anesthetic management during clavicular surgery

The effect of transmuscular quadratus lumborum block on postoperative opioid consumption in patients undergoing percutaneous nephrolithotomy: A randomized controlled study

Background This study aimed to investigate the effect of ultrasound-guided transmuscular quadratus lumborum block (QLB) on postoperative opioid consumption in patients undergoing percutaneous nephrolithotomy (PCNL). Methodology A total of 40 patients aged between 18 and 60 who were classified as American Society of Anesthesiologists status I-II and scheduled for unilateral PCNL were randomly divided into two groups. Patients in Group QLB (n = 20) received a single-shot QLB with 20 mL of 0.25% bupivacaine in the preoperative period. No intervention was performed in the control group (Group C, n = 20). Dermatomes affected by the block procedure were evaluated in the preoperative period in the group of patients who were administered the block procedure. General anesthesia was administered to all patients in both groups. In the postoperative period, opioid consumption, pain scores, side effects related to opioid consumption, and additional analgesic requirements were recorded. Results Opioid consumption was significantly lower in Group QLB compared to Group C at all times (p < 0.05). Postoperative visual analog scale (VAS) scores during the movement were significantly lower in Group QLB compared to Group C at all times (p < 0.05). VAS scores at rest were reported to be significantly lower in Group QLB compared to Group C, except for the eighth and twelfth hours (p < 0.05). The requirement for additional analgesic agents was significantly lower in Group QLB compared to Group C (p < 0.05). Conclusions QLB reduced postoperative opioid consumption and VAS scores by providing more effective analgesia compared to the control group in patients who underwent PCNL

Ultrasound-guided erector spinae plane block versus modified-thoracolumbar interfascial plane block for lumbar discectomy surgery: A randomized, controlled study

OBJECTIVE: This study aimed to compare the ultrasound (US)-guided erector spinae plane block (ESPB) and modified-thoracolumbar interfascial plane (mTLIP) block for postoperative pain management in lumbar discectomy surgery patients.METHODS: A total of 90 patients scheduled for lumbar discectomy were randomly assigned into 3 groups (n = 30 per group): an ESPB group, an mTLIP group, and a control group. In the ESPB and mTLIP groups, a single-shot US-guided block was administered with 20 ml of 0.25% bupivacaine bilaterally. All patients received intravenous patient-controlled postoperative analgesia with fentanyl, and 1 g intravenous paracetamol every 6 hours. Fentanyl consumption, Visual Analog Scale (VAS) pain scores, rescue analgesia, block procedure time, and side-effects were evaluated.RESULTS: Postoperative opioid consumption at all time intervals were significantly lower both in ESPB and mTLIP groups compared with the control group (P < 0.05). No significant difference was observed concerning intra- and postoperative opioid consumption between the ESPB and the mTLIP group (P < 0.001). Passive VAS score at the postanesthesia care unit, second, fourth, and eighth hours, and active VAS score at the postanesthesia care unit, second, fourth, eighth, and 16th hours were significantly lower in the ESPB and mTLIP groups compared with the control group (P < 0.05). The use of rescue analgesia was significantly lower in the ESPB and mTLIP groups than in the control group (9/30, 7/30, and 21/30, respectively, P < 0.001). The block procedure time was similar between groups (P = 0.198).CONCLUSIONS: US-guided ESPB and mTLIP block may provide adequate pain control after discectomy surgery. However, there is a nonsuperiority between ESPB and the mTLIP groups

Comparison of Lidocaine and Atropine on Fentanyl-Induced Cough: A Randomized Controlled Study

Objective of the Study: Fentanyl and atropine are drugs used for analgesia during induction and for premedication, respectively. The aim of this study was to observe the effect of atropine used for premedication on cough developing in association with fentanyl use during anesthesia induction. Methods: This was a single-blind, prospective, multi-arm, parallel, randomized clinical trial involving 120 patients between ages 3 and 15 years undergoing general anesthesia. Patients were randomized into three groups: a control group (Group C), an atropine group (Group A), and a lidocaine group (Group L). Results: Incidence of cough was 45% (n = 16) in Group C, 16% (n = 6) in Group A, and 16% in Group L (n = 6) (p = 0.009). Cough was moderate in two cases in Group A and in two in Group L, and mild in all others in these groups. In Group C, cough was mild in seven cases, moderate in six, and severe in two. Conclusion: We determined that premedication with atropine suppressed the incidence and severity of fentanyl-induced cough during induction of general anesthesia. We think that, due to its antimuscarinic effect, atropine is as effective as lidocaine as a premedication

From ultrasound to artificial intelligence: a new era of the regional anesthesia

Regional anesthesia has become popular in daily anesthesia practice in recent years.1, 2 The use of US-guided regional anesthesia (URA) has increased thanks to the advantages of the US rapidly, such as direct visualization of nerves, safety, and simplicity. While the experienced clinicians and expert anesthesiologists can easily define the anatomical structures on the ultrasound, the residents and the less experienced clinicians may have difficulty at the beginning of education.3, 4 Here, a novel term emerges, ‘regional anatomy,’ which plays an essential role in UR

Bilateral Pneumothorax during Apnea Test: A Case Report and Literature Review

Brain death is characterized by irreversible loss of all brain functions and it is defined as a clinical condition where intracranial circulation stops. Apnea test is one of the tests which is used in the clinical diagnosis of brain death, absence of brain stem reflexes, and as a complement to absence of motor response to painful stimulants. Apnea test is a test which has a high complication rate. Complications such as hypoxia, hypotension, acidosis, cardiac arrhythmia, asystole, pneumothorax, pneumomediastinum and pneumoperitoneum may develop during an apnea test. In this case report, a patient with biletarel pneumothorax due to air trapping because of an oxygen cannula blocking the airway

The effect of ultrasound-guided serratus plane block on the quality of life in patients undergoing modified radical mastectomy and axillary lymph node dissection: A randomized controlled study

BACKGROUND: Modified radical mastectomy (MRM) and axillary lymph node dissection (AD) are the most commonly used surgical methods in breast cancer surgery, and they are characterized by moderate to severe pain. This study aimed to investigate the effect of ultrasound-guided serratus plane block (SPB) on postoperative acute and chronic pain in patients undergoing MRM and AD. METHODS: After ethical approval, 60 patients, aged between 18-65 years, ASA I-III, underwent unilateral MRM, and AD was assigned into 2 groups. The SPB group received ultrasound-guided SPB with 30 mL 0.25% bupivacaine, and the control group received 2 mL saline injection subcutaneously. Postoperative analgesia was performed with intravenous patient-controlled analgesia and dexketoprofen trometamol. Pain scores, opioid consumption, and rescue analgesic requirements were recorded. Chronic pain and quality of life were evaluated with the Numerical Rating Scale (NRS), short form-36 (SF-36), and painDETECT. RESULTS: Compared with the control group, the visual analogue scale scores were statistically lower in the SPB group during 4 postoperative hours in post-anaesthetic care unit PACU at 1st, 2nd (P < 0.001), and 4th hour (P = 0.014). Fentanyl consumption and rescue analgesics were lower in the SPB group than in the control group (0-4 h, P = 0.001; 4-8 h, 8-12 h, 24 h; total P < 0.001). The incidence of chronic pain was 11%, and there was no statistically significant difference between control and SPB groups in terms of SF-36, NRS, and painDETECT scores measured at the first and sixth months. CONCLUSIONS: SPB demonstrated superiority versus the control group concerning acute postoperative pain parameters. However, SPB had no influence on the quality of life and did not prevent chronic postmastectomy pain