The effect of preemptive retrolaminar block on lumbar spinal decompression surgery.

PURPOSE: Spinal decompression surgery causes severe pain. Retrolaminar block (RLB) is block, which is done by infiltration of local anesthetic to block spinal nerves between the lamina and superior costotransversospinalis muscle. The primary aim of this study is to evaluate the effectiveness of RLB on postoperative analgesia in patients undergoing spinal surgery. Secondary aims are effects on additional anesthetic and analgesic consumption. METHODS: The sixty (60) patients who underwent lumbar spinal surgery between May 2020 and May 2021 under general anesthesia with or without applied preemptive RLB for postoperative analgesia were included in this prospective observational study. Group I received ultrasound-guided preemptive RLB. In Group II, no intervention was performed. Postoperative VAS scores were compared in groups as primary outcome, perioperative additional anesthetic and analgesic needs were compared as secondary outcome. RESULTS: There was a significant difference between the groups in favor of the RLB group in terms of postoperative VAS scores at rest [1.33 (0.33-3.509)] and movement [2.40 (1.20-4.00)] (p < 0.001). Perioperative sevoflurane consumption was significantly low in block group (p < 0.001). Postoperative tramadol consumption was lower in Group I compared with Group II [Group 1: 200 (100-300); Group 2: 37.5 (0-200); p < 0.001]. CONCLUSION: Preemptive RLB may be used to reduce patients' pain in lumbar decompression surgery as well as to be part of a multimodal analgesia and anesthesia regimen to reduce anesthetic and analgesic drug consumption. Trial registration numberClinicalTrials.gov (No. NCT04209907).

The Effect of Erector Spinae Plane Block on Laparoscopic Cholecystectomy Anesthesia: Analysis of Opioid Consumption, Sevoflurane Consumption, and Cost.

Background: Erector spinae plane (ESP) block has been increasingly suggested for laparoscopic cholecystectomy (LC) as a part of multimodal analgesia in many studies. However, there is not any study that investigated the perioperative effects of ESP block on anesthetic agent consumption and cost of LC anesthesia. This is the first study that evaluates the effect of ESP block in terms of cost-effectiveness, intraoperative consumption of inhalation agents, and perioperative consumption of opioids. Materials and Methods: In this prospective observational study, 81 patients who underwent LC were included. Patients were divided into two groups: In Group ESP (n = 39) bilateral ultrasound-guided ESP block was performed in preoperative period and in Group non-ESP (n = 42) ESP block was not performed. After standard general anesthesia protocol, anesthesia was maintained with 2% sevoflurane in 50% air and 50% oxygen with controlled ventilation in both groups. All patients were monitored with electrocardiography, noninvasive blood pressure, pulse oximetry, end-tidal carbon dioxide, and bispectral index. The consumption of sevoflurane and opioids in the intraoperative and postoperative 24 hours was recorded. The costs of drugs were determined by multiplying total consumed amounts with unit prices. Results: The costs and the consumed amounts of remifentanyl, sevoflurane, and tramadol were significantly higher in non-ESP group in the perioperative period (respectively, P < .001, P = .01, and P < .001). Conclusions: ESP block for LC decreased the consumed amount and cost of inhaled agents and opioids in the perioperative period.

HEPATOPROTECTIVE EFFECT OF DEXMEDETOMIDINE AGAINST RADIOIODINE TOXICITY IN RATS: EVALUATION OF OXIDATIVE STATUS AND HISTOPATHOLOGICAL CHANGES.

OBJECTIVE AND BACKGROUND: Based on the anti-inflammatory, antioxidant and anti-apoptotic properties of DEX, the present study was conducted to investigate the possible radioprotective effects of DEX against hepatic radioiodine (I-131) toxicity. METHODS: Thirty six rats were randomly divided into three groups as untreated control (group 1); oral radioiodine (RAI, 111 MBq) administrated rats (group 2), and DEX group (oral radioiodine and daily intraperitoneal 25 µg/kg DEX administrated rats-group 3). In the third group, DEX administration was started 2 days before and continued for five days after RAI administration. Twenty-four hours after the administration of the last dose of DEX, liver samples were taken for evaluation of oxidative stress parameters and histopathological changes. RESULTS: The tissue malondialdehyde and advanced oxidation protein product levels in DEX group were significantly lower than RAI group. The total tissue sulphydryl and catalase levels of DEX group were higher than RAI group and the difference was statistically significant. The histopathological damage in the DEX-treated group was significantly less than the damage in the RAI group (p<0.05 for all pathological parameters). Treatment with DEX decreased the histopathological abnormalities when compared with the RAI group. CONCLUSION: It was presented that DEX had radioprotective effect on the liver after I-131 therapy and anti-inflammatory and antioxidant activities are likely to be involved in the mechanism underlying the radioprotective effects of DEX. After further studies, DEX might be used as a hepatoprotective treatment regimen before administering radioactive iodine therapy particularly in patients with hepatic disease.