The effect of tramadol on oxidative stress total antioxidant levels in rats with renal ischemia-reperfusion injury.

OBJECTIVE: To evaluate the protective effect of tramadol on renal tissue in rats with induced renal ischemia-reperfusion injury (I/R injury), and its effects on oxidative stress. MATERIAL AND METHODS: Thirty adult, male Wistar rats weighing 250-300 g were selected as subjects. Rats were randomized into 3 groups: group 1, sham; group 2, renal I/R injury; and group 3, renal I/R+Tramadol. In order to obtain ischemia in groups 2 and 3, renal artery was clamped for 1 h. Total oxidant status (TOS) and total antioxidant capacity (TAC) were analyzed using biochemical assays in the serum samples. RESULTS: TOS values were measured as 1.68±0.4 in group 1, 3.35±1.0 in group 2, and 3.49±0.9 in group 3. When group 1 was compared with group 2 and group 3, the TOS values of group 1 were significantly lower (p<0.05), whereas there was no difference between group 2 and group 3 (p>0.05). TAC values were measured as 1.65±1.4 in group 1, 1.85±0.1 in group 2, and 2.79±0.6 in group 3. The antioxidant status of group 1 was not significantly different from that of group 2 (p>0.05), whereas there was a significant difference between group 1 and group 3 (p>0.05). CONCLUSIONS: Tramadol has positive effects on antioxidant levels in renal I/R injury. We think that tramadol may be used in patients who underwent renal surgery and have I/R injury risk. There is a need for studies on this subject including human series.

Parieto-Occipital Interhemispheric Precuneal Approach to the Lesions of the Atrium: Experience with 66 patients.

AIM: The atrium (trigone) is the most common site for intraventricular lesions. The parieto-occipital interhemispheric precuneal approach (POIPA) is one of the particular ways to reach these lesions. The aim of this study was to draw specific attention to the surgical difficulties of these lesions and to present our experience with this operative approach. MATERIAL AND METHODS: Sixty-six patients with lesions located in the atrium of the lateral ventricles underwent surgical treatment in our institution using POIPA over a 13-year period. The clinical, radiological and surgical characteristics of these patients were retrieved and reviewed retrospectively. The histological diagnosis of the cases and postoperative complications were specifically focused on in this study. RESULTS: Thirty-six (54.5%) patients were male and 30 patients were female with a mean age 37.9 years (range between 8 and 74 years). The lesion was in the right atrium in 25 cases and in the left in 41 (62.1%) patients. POIPA was used in all cases to remove the lesions. The most common tumor was glioblastoma (34.8%), followed by glial tumors grade I, II and III and meningiomas. The other lesions were metastases, ganglioglioma, epidermoid cysts and arteriovenous malformations. Gross total resection of the tumors was achieved in 59 patients (89.4%) while subtotal removal was performed in 7 cases. Five (7.5%) patients died within the first month after surgery. Conclusion: POIPA provides a safe and effective way to reach lesions located in the atrium of the lateral ventricle. Knowledge of precise anatomy associated with the meticulous surgical techniques decreases the surgical morbidity and mortality of the patients.

Anterior Skull Base Defects Reconstructed Using Three-Layer Method: 78 Consecutive Cases with Long-Term Follow-Up.

Objectives Anterior skull base defects are potentially lethal and surgical treatment must be performed as soon as possible. The purpose of this study was to evaluate whether our technique is effective or not in long-term period. Design Retrospective chart review of all patients whose data were entered into the Hospital Registry System between 1995 and 2015. Setting/Participants This study was performed at the Gaziantep University School of Medicine, Gaziantep, Turkey, in 2015 and included 78 patients who in the past 20 years underwent three-layer reconstruction surgery for anterior skull base defects at the same university. Main Outcome Measures Among the patients, defects repaired by transcranial approach had the lowest recurrence rate. Overall, successful repair was achieved in 100% of the patients. Results Pure transbasal approach was used as a single procedure on 71 (91%) patients. Combined approaches were used in seven (9%) cases. The extended transbasal approach was combined with a transfacial approach in four patients and with a pterional approach in three patients. Conclusion We encourage the use of three-layer reconstruction and recommend free fascia lata grafts and galeal flaps with vascularized pedicle as sealing material of choice in all types of cases such as tumor and trauma.

[Comparison of two different antiseptics on contamination of epidural catheter tip]. / Epidural kateter ucu kontaminasyonunda iki farkli antiseptigin etkinliginin karsilastirilmasi.

OBJECTIVES: The aim of the present study was to compare preventive effects of 10% povidone-iodine, and combination of 2-propanol and benzalkonium chloride skin antiseptics on contamination of epidural catheter tip. METHODS: Included were 160 patients aged 18-65 years with American Society of Anesthesiologists (ASA) physical status classifications of I-II. Patients were randomized. Povidone-iodine was administered to group P (n=80) prior to insertion of antibiotic prophylaxis catheter; 2-propanol and benzalkonium chloride was administered to group B. Swabs obtained before and after administration of antiseptics were sent for culture. Antiseptics were applied to skin prior to catheter removal, as well as 48 hours after insertion. In sterile conditions, 2-3 cm pieces of catheter tips were sent to laboratory. Preoperative and postoperative complete blood count, body temperature, and signs of postoperative localized skin infection were recorded. RESULTS: Leukocyte, neutrophil, and lymphocyte counts were all within normal ranges in preoperative and postoperative. Swab cultures obtained following use of antiseptics were positive in 6 group P patients; coagulase-negative Staphylococcus was found in 5 patients, E. coli in 1, and were negative in group B. Difference between groups was statistically significant (p=0.013). Epidural catheter tip cultures were negative. CONCLUSION: Combination of 2-propanol and benzalkonium chloride was determined to be more effective in reducing skin flora around epidural catheter insertion site.

Endotracheal intubation of a paediatric patient with an umbrella wire embedded in the palate to the posterior wall of the nasopharynx using a GlideScope video laryngoscope.

The penetration of foreign bodies into the oropharynx can be life-threatening. Airway management in patients who have a foreign body penetrated into their oropharynx is a challenging problem for the anaesthetist. In this case report, we aimed to share our experience of endotracheal intubation performed with GlideScope video laryngoscopy in a 3-year-old, 15 kg patient. The patient underwent general anaesthesia to facilitate the removal of an umbrella wire that had become embedded in her soft palate.

[Preemptive analgesic efficacy of gabapentin and nimesulide in the functional endoscopic sinus surgery]. / Fonksiyonel endoskopik sinüs cerrahisinde gabapentin ve nimesulidin preemptif analjezik etkinligi.

OBJECTIVES: Preemptive analgesia is an important factor in controlling the postoperative pain and avoiding the stress response caused by the surgery. We aim to compare impact of gabapentin and nimesulide on postoperative analgesic consumption on the visual analog scale (VAS) as well as any potential side effects, to those of the placebo group. METHODS: Ninety patients aged 18-70 under ASA I-II risk, who were to undergo Functional Endoscopic Sinus Surgery (FESS), were included in the study. Patients were randomized into three groups. One hour before the surgery, oral placebo capsules were administered to Group I patients, Gabapentin 1200 mg to Group II patients and Nimesulide 100 mg to Group III patients. Perioperative hemodynamic parameters were measured for all patients. During the first 24 hours of the postoperative period, side effects such as nausea, vomiting, hypotension, hypertension, bradycardia, tachycardia were noted, and the time from end of the surgery to the first diclofenac need was recorded in addition to VAS scores. RESULTS: In all of the follow-ups for 24 hours of the postoperative period, time from end of the surgery until the first diclofenac requirement; Group 2 > Group 3 > Group 1. Total diclofenac consumption of group 2 was found to be significantly lower than Group 1 and Group 3 on a statistical basis. Postoperative VAS score in Group 2 was lower than Group 1 and Group 3. CONCLUSION: To conclude, we believe that gabapentin or nimesulide may be safely used preemptively for the purposes of postoperative analgesia after FESS procedures.

The effects of preemptive tramadol and dexmedetomidine on shivering during arthroscopy.

BACKGROUND: Shivering, the rate of which in regional anesthesia is 39% is an undesired complication seen postoperatively. AIMS: This study aims to compare the ability of preventing the shivering of preemptive tramadol and dexmedetomidine during the spinal anesthesia (SA). METHODS: A total of 90 patients with American Society of Anesthesiologists physical status I-II, aged 18-60 years and undergoing elective arthroscopic surgery with SA were divided into three groups randomly. After spinal block, 100 mg tramadol in 100 ml saline was applied in group T- (n = 30) and 0.5 µg/kg dexmedetomidine in 100 ml saline was applied in group D- (n = 30) and 100 ml saline was administered in group P- (n = 30) in 10 min. The hemodynamics, oxygen saturation, tympanic temperature, shivering and sedation scores were evaluated and recorded intraoperatively and 45 min after a postoperative period. RESULTS: In group T and D, shivering scores were significantly lower when compared with group P in the intraoperative 20(th) min (P = 0.01). Sedation scores in group D were significantly higher than the baseline values (P = 0.03) and values in group T and P (P = 0.04). CONCLUSIONS: Preemptive tramadol and dexmedetomidine are effective in preventing the shivering under SA. In addition, dexmedetomidine was superior in increasing the level of sedation which is sufficient to prevent the anxiety without any adverse effects.

GlideScope video laryngoscopy use tracheal intubation in patients with ankylosing spondylitis: a series of four cases and literature review.

Airway management in patients with ankylosing spondylitis (AS) is a challenging problem for anesthesiologists. The GlideScope video laryngoscope (GVL) is designed to assist tracheal intubation for patients with a difficult airway. The aim of the study was to report the successful intubation by GVL of four AS patients, and to discuss the use of GVL for tracheal intubation in patients with AS by performing a review of the literature. Four patients with chronic, severe AS were evaluated preoperatively; all had features associated with a difficult direct laryngoscopy. We performed the necessary preparations for difficult airway and intubation. Patients were kept in supine position, with their head and neck supported on pillows. Following sufficient preoxygenation, patients received i.v. remifentanil at 1 µg kg(-1), propofol at 2 mg kg(-1), and succinylcholine at 1 mg kg(-1). GVL intubation was provided after full muscle relaxation. GVL is reasonable alternative to awake fiberoptic bronchoscopy or any other device, as it appears that less training and skill is involved in the actual intubation process. Adequate laryngeal exposure was obtained in all patients were successfully intubated in the first attempt. As with any challenging airway management, it is essential to have a rescue strategy. We believe that GVL can be a good alternative for oral endotracheal intubation in patients with AS. This series is very small and the reader should be very cautious about drawing broad conclusions regarding the GVL and patients with AS.

Glidescope Video Laryngoscope Use for Tracheal Intubation in a Patient with CHARGE Syndrome.

CHARGE syndrome is an autosomal dominant syndrome in which ocular coloboma (C), heart defects (H), choanal atresia (A), growth retardation (R), genital hypoplasia (G), ear abnormalities (E), and tracheoesophageal fistula, dysphagia, cleft palate, micrognathia, facial paralysis, hypopituitarism, and brain abnormalities may be seen in patients. The patients with CHARGE syndrome face surgical procedures many times from birth. Especially, the problems we meet in the airway may be special. In this case report, we aimed to share our experience of endotracheal intubation performed with Glidescope video laryngoscopy for a patient at the age of 20 months, weight 7.5 kg and height 70 cm, with CHARGE syndrome who was undergoing cochlear implantation.

The effects of DEX premedication on volatile induction of mask anesthesia (VIMA) and sevoflurane requirements.

We investigated the effect of intravenous premedication with single dose of dexmedetomidine (DEX) on volatile anesthetic induction time and sevoflurane requirements of anesthesia maintenance in adults by monitoring the bispectral index (BIS). Sixty adult patients with status of ASA I-II undergoing general anesthesia with endotracheal intubation were randomly divided into two groups: The first group; a control group (group C, n = 30) and the second group; DEX group (group D, n = 30). Each patient in group D was premedicated with intravenous DEX 0.5 µg/kg or placebo 10 min before the induction of anesthesia. Anesthesia was induced by fentanyl 1 µg/kg, 1:1 ratio of nitrous oxide and oxygen and sevoflurane of 5-8 % and rocuronium bromur (Esmeron) 0.5 mg/kg keeping BIS values at 40-50. Time to induction of anesthesia, BIS, End-tidal sevoflurane concentration (Etsevoflurane), End-tidal CO2 concentration, duration of surgery, recovery time, hemodynamic variables, adverse effects were recorded intraoperatively. Analgesic requirement was noted in postoperative 24 h-period. The time to induction of anesthesia (p < 0.0001) and Etsevoflurane at 1 min (p < 0.05) were significantly lower in group D than in group C. Intravenous premedication with 0.5 µg/kg of DEX decreased the induction time by almost 75 % and provided a significant decrease in Etsevoflurane.

Does dexmedetomidine affect intraoperative blood loss and clotting tests in pediatric adenotonsillectomy patients?

BACKGROUND: We hypothesize that dexmedetomidine (DEX), a selective α(2) adrenergic receptor agonist, may affect the intraoperative blood loss and clotting tests such as prothrombin time, activated partial thromboplastin time, and international normalized ratio in children undergoing adenotonsillectomy (ADT). METHODS: Sixty patients scheduled for elective ADT under general anesthesia. The patients were randomly assigned to receive either DEX 0.5 µg/kg (group D) or placebo bolus (group C) with a total volume of 10 mL, 10 min before the induction of anesthesia. Mean arterial pressure (MAP), heart rate, blood loss, preoperatively and immediately after awakening clotting tests, agitation, sedation, visual analog scale, and analgesic requirement, were assessed and recorded. RESULTS: The postoperative hemoglobin was significantly lower than the preoperative value in both groups (P < 0.05). The postoperative agitation scale and analgesic requirement and visual analog scale at the 15th min were significantly lower in group D than those in group C (P < 0.05). Total blood loss and postoperative sedation score in group D was significantly higher than that in group C (P < 0.05). The postoperative prothrombin time, activated partial thromboplastin time, international normalized ratio tests between the groups, additionally pre-postoperative MAP, heart rate, and clotting tests were similar in each group. CONCLUSIONS: The premedication with DEX 0.5 µg/kg decreased postoperative agitation, pain, and analgesic requirement without significant change in the clotting tests and MAP but increased bleeding slightly during ADT.

Dexmedetomidine use in direct laryngoscopic biopsy under TIVA.

BACKGROUND: The purpose of this study is to investigate the suitability of dexmedetomidine as a helpful sedative agent in direct laryngoscopic biopsy (DLB), under total intravenous anesthesia (TIVA). METHODS: In this double blind randomised study, patients were allocated to receive dexmedetomidine 0.5 microg/kg (group D, n = 20) or saline placebo (group P, n = 20) intravenously. Forty ASA I-III patients were infused propofol and administered rocuronium bromur. They were intubated and performed biopsy. Aldrete scores, intraoperative propofol and postoperative analgesic requirements, satisfaction scores, recovery time, Ramsay sedation scale (RSS), haemodynamic changes and side effects were recorded. RESULTS: Postoperative analgesic requirement in group D was significantly lower and satisfaction scores and RSS were significantly higher than in group P. Additionally, MAP (mean arterial blood pressure) significantly decreased at post-extubation time in group D. CONCLUSION: The premedication with a single dose of dexmedetomidine decreases intraoperative propofol and postoperative analgesic requirements, increases the postoperative satisfaction and RSS considerably in patients undergoing DLB under TIVA.

Cardiovasular changes after placement of a classic endotracheal tube, double-lumen tube, and Laryngeal Mask Airway.

STUDY OBJECTIVE: To compare hemodynamic responses, P wave dispersion (Pd), and QT dispersion (QTd) after placement of a classic endotracheal tube (ETT), double-lumen tube (DLT), or Laryngeal Mask Airway (LMA). DESIGN: Prospective study. SETTING: Outpatient surgery center. PATIENTS: 75 adult, ASA physical status 1 and 2 patients undergoing cystoscopy and thoracoscopic surgery. INTERVENTIONS: Patients were randomized to undergo placement of an ETT (Group T; n = 25), DLT (Group D; n = 25), or LMA (Group L; n = 25). Anesthesia was induced by etomidate 0.3 mg/kg and fentanyl 1.0 µg/kg, and maintained with nitrous oxide, oxygen, 2% to 3% sevoflurane, and rocuronium 0.5 mg/kg. MEASUREMENTS: Mean arterial pressure (MAP) and heart rate (HR) were recorded immediately before intubation and after intubation at one, 3, 5, 10,15, 20, 25, and 30 minutes after intubation/airway insertion. RESULTS: QT dispersion after tube placement was significantly higher than before tube placement in Group D (P = 0.0001) and Group L (P = 0.03). Mean arterial pressure and HR in Group T were significantly higher than in Group L at the first minute after tube placement (P = 0.02). Heart rate and MAP at baseline were significantly higher than the other measurement times in Groups T and D (P < 0.01). CONCLUSIONS: The LMA caused no change in Pd, HR, or MAP values during or after airway placement, but caused QTd after airway insertion. The ETT caused a sudden increase at the first minute after tube placement, without any Pd or QTd. In addition, DLT caused QTd without any serious change in hemodynamics.

Dexmedetomidine premedication of outpatients under IVRA.

PURPOSE: Dexmedetomidine is approximately 8 times more selective toward the alpha-2-adrenoceptors than clonidine. It induces analgesia in patients and decreases anesthetic requirements by up to 90%. The current study aimed to evaluate the effects of dexmedetomidine premedication on tourniquet pain, intraoperative - postoperative analgesic requirements, sedation levels, quality of anesthesia, and the hemodynamic parameters when used as a single dose before intravenous regional anesthesia (IVRA). MATERIAL AND METHODS: Fifty-four patients undergoing hand surgery (carpal tunnel and tendon release) were randomly divided into 2 groups for IVRA. IVRA was performed with 40 mL of 0.5 % lidocaine in both groups. A single dose of dexmedetomidine 0.5 microg/kg in 20 mL saline was administered to group D (n = 27) and placebo solution 20 mL to group C (n = 27) through the non-IVRA catheter 15 minutes before IVRA. Sensory and motor block onset and recovery time, hemodynamic variables, tourniquet pain, analgesic requirements according to verbal rating scale (VRS) and visual analog scale(VAS), sedation score, and anesthesia quality were recorded in the intraoperative and postoperative period. RESULTS: Improved quality of anesthesia, reduced postoperative pain scores, and total analgesic requirements were found in group D during postoperative period. Additionally, the patients experienced a higher degree of sedation during intraoperative and postoperative period. CONCLUSION: The premedication of 0.5 microg/kg low dose dexmedetomidine before IVRA improves the quality of anesthesia and decreases the postoperative analgesic requirement of outpatients undergoing hand surgery without any serious side effects.

Dexmedetomidine use during strabismus surgery in agitated children.

OBJECTIVE: We aimed to investigate the effects of dexmedetomidine premedication before intravenous infusion of ketamine in agitated children undergoing strabismus surgery. SUBJECTS AND METHODS: We enrolled 60 agitated pediatric patients, aged 4.5-11 years. The patients were randomly allocated to one of two anesthesia regimens. Group D patients were premedicated with a single dose of intravenous dexmedetomidine 0.5 µg/kg whereas group P patients received a placebo. Patients in both groups were administered intravenous ketamine 1 mg/kg i.v. over 1 min followed by a continuous infusion of ketamine 1-3 mg/kg/h i.v. (n = 30). Patients were intubated after receiving fentanyl 1 µg/kg and rocuronium bromide 0.5 mg/kg. RESULTS: 21 (70%) patients in group D did not show the oculocardiac reflex (OCR) versus 7 (23%) in group P (p = 0.0006). The preoperative and postoperative agitation scores (p = 0.0001 and p = 0.03, respectively), the score on the Faces Pain Scale during awakening [3.0 (interquartile range, IQR 2.0-4.0) in group D and 0.0 (IQR 1.0-2.25) in group P] (p = 0.001) and at the 60th postoperative minute [IQR 2.0 (1.5-3.0) in group D and 2.0 (IQR 1.5-3.0) in group P] (p = 0.004), sore throat (26.6% in group D and 60% in group P) (p = 0.01) and analgesic requirement (20% in group D and 53% in group P) (p = 0.01) in group P were significantly higher than in group D. The Ramsay Sedation Score (RSS) in group D was significantly higher than in group P during awakening [2.0 (2.0-2.0) in group D and 4.5 (4.0-5.0) in group P] (p = 0.0001). CONCLUSION: Dexmedetomidine premedication followed by intravenous infusion of ketamine was effective in decreasing OCR, agitation, pain, analgesic requirement in agitated children undergoing strabismus surgery.

Ultrasound-guided infraclavicular brachial plexus block enhances postoperative blood flow in arteriovenous fistulas.

OBJECTIVE: Brachial plexus block offers several advantages when creating vascular access for hemodialysis. However, no controlled studies have directly evaluated arteriovenous fistula (AVF) blood flow in patients anesthetized by this method. We compared the effects of ultrasound-guided, infraclavicular brachial plexus block and local infiltration anesthesia on blood flow in the radial artery and AVF during the early and late postoperative periods. METHODS: Sixty patients were randomly assigned to an experimental group, which received infraclavicular brachial plexus block (IB), or to a control (C) group that received local infiltration anesthesia. Blood flow in the distal radial artery was measured before and after IB or infiltration anesthesia. AVF flow during the early and late postoperative period was evaluated using duplex ultrasound imaging. The rates of primary fistula failure were also compared. RESULTS: After anesthesia, preoperative radial arterial flow was 56 ± 8.6 mL/min in group IB vs 40.7 ± 6.11 mL/min in group C (P < .0001). Blood flow in the fistula, measured in mL/min at 3 hours, 7 days, and 8 weeks postoperatively, was also greater in group 1B vs group C, respectively, at 69.6 ± 7.9 vs 44.8 ± 13.8 (P < .001), 210.6 ± 30.9 vs 129 ± 36.1 (P < .001), and 680.6 ± 96.7 vs 405.3 ± 76.2 (P < 0.001). CONCLUSION: When used for AVF access surgery, infraclavicular brachial plexus block provides higher blood flow in the radial artery and AVF than is achieved with infiltration anesthesia.

How is electrocardiogram influenced by electroconvulsive therapy in males and females?

OBJECTIVES: We aimed to investigate and compare the P duration and P dispersion (Pd) between male and female patients with a primary diagnosis of chronic schizophrenia disorder before and after the electroconvulsive therapy (ECT) period. METHODS: We obtained electrocardiograms of 50 healthy young volunteers which included 25 female (group F, n = 25) and 25 male patients (group M, n = 25). We measured minimum and maximum P wave durations (Pmin, Pmax) and Pd in milliseconds. Electrocardiography was performed before electroconvulsive therapy (ECT) and immediately after the ECT period after awakening. A 12-lead surface electrocardiogram was obtained from each subject in the supine position. RESULTS: The post-ECT P duration was significantly longer than the pre-ECT P duration in groups F and M (P = 0.01 and P = 0.008, respectively). The post-ECT Pd was significantly longer than the pre-ECT Pd in groups F and M (P = 0.0001 in both groups). A higher correlation (r) in group M was observed between the pre-ECT Pd and post-ECT P duration than in group F (r = 0.538, P = 006 in group M; r = 0.349, P = 08 in group F). There was no significant difference between the groups regarding hemodynamics. CONCLUSIONS: Electroconvulsive therapy in both sexes may influence atrial conduction as evidenced by the significantly prolonged Pmax and Pd in patients with a primary diagnosis of schizophrenia disorder.

Efficacy of fentanyl and/or lidocaine on total antioxidants and total oxidants during craniotomy.

OBJECTIVE: The aim of this study was to investigate the oxidative, hemodynamic, and analgesic effects of local lidocaine infiltration, or intravenous (IV) fentanyl injection, or a combination of lidocaine and IV fentanyl during head fixation in a 3-pin headrest in patients undergoing elective craniotomy. DESIGN: Double-blind, randomized, placebo-controlled study. SETTING: Gaziantep University Medical Faculty, Department of Anesthesiology and Reanimation. METHODS: Eighty patients were randomly assigned to one of four groups. Five minutes before pin fixation, patients in group L received 1 mg/kg of lidocaine 2% for scalp infiltration (n=20), group F received 1 µg/kg of IV fentanyl (n=20), group FL received 1 mg/kg of lidocaine 2% and 1 µg/kg of fentanyl (n=20), and group P received a placebo (n=20). Following standard anesthesia, basal, pre- and post-fixational hemodynamic data were recorded. Blood samples were taken for evaluation of oxidant and antioxidant levels before and after pin fixation. RESULTS: The total antioxidant levels after pin fixation were highest in group FL followed by group F, then group L and finally group P (ie, FL>F>L>P) (P<0.05). The mean arterial blood pressure (MAP) after pin fixation was higher than the MAP before pin fixation in groups L and P (P<0.05), but was lower in groups F and FL (P<0.05). CONCLUSION: The combination of fentanyl and lidocaine before pin fixation is useful in preventing severe hemodynamic response to pain stimuli, such as pin fixation, and in increasing total antioxidant levels in the post-fixational period during craniotomy in adults.

Tramadol use for axillary brachial plexus blockade.

BACKGROUND: We investigated the effects of tramadol added to the mixture of local anesthetic for axillary brachial plexus blockade (ABB) in patients to have undergone hand and forearm surgery. MATERIALS AND METHODS: Forty patients from the ASA classification I and II, between 18 and 60 y of age, were included in this randomized double-blind study. Group C: levobupivacaine (150 mg) + lidocaine (200 mg) (n = 20), Group T: levobupivacaine (150 mg), + lidocaine (200 mg) + tramadol (100 mg) (n = 20). Intravenous midazolam of 0.02 mg/kg was given for premedication. ABB was performed with 42 mL mixture of local anesthetic, using peripheral nerve stimulator. The duration of onset of motor and sensory blockades was recorded. The postoperative first analgesic need, sedation, and satisfaction score and side effects were recorded. RESULTS: There was no significant difference between the groups regarding intraoperative visual analog scale (VAS), hemodynamics, adverse effects, sedative and analgesic requirement, and the patient satisfaction. The development of motor block at the median nerve on the 5th min (P = 0.03) and at the ulnar nerve on 10th and 15th min in Group T were (P = 0.01, P = 0.03, respectively) considerably longer than that in Group C. CONCLUSIONS: Adding 100 mg of tramadol to the combination of levobupivacaine and lidocaine during ABB could not provide an important clinical effect in patients undergoing hand and forearm surgery.