Ultrasound-guided transversalis fascia plane block or transversus abdominis plane block for recovery after caesarean section: A randomised clinical trial.

BACKGROUND: Caesarean section is a widely performed surgical procedure that often results in moderate-to-severe postoperative pain. If left untreated, this pain can lead to short-term and long-term consequences. Transversalis fascia plane (TFP) block and transversus abdominis plane (TAP) block are among the regional anaesthesia techniques employed for managing pain after a caesarean section. OBJECTIVE: We aimed to compare the impact of these two blocks on the quality of recovery in patients undergoing elective caesarean section under spinal anaesthesia. DESIGN: A single-centre, double-blind, randomised trial. SETTINGS: Operating room, postanaesthesia recovery unit, and ward in a tertiary hospital. PARTICIPANTS: Ninety-three patients (ASA 2 to 3) were recruited. After exclusion, 79 patients were included in the final analysis: 40 in the TFP block group and 39 in the TAP block group. INTERVENTIONS: After surgery, participants received either TFP block (20 ml 0.25% bupivacaine for each side) or TAP block (20 ml 0.25% bupivacaine for each side). MAIN OUTCOME MEASURES: The primary outcome was the difference in obstetric quality of recovery 11-Turkish (ObsQoR-11T) scores between groups. Secondary outcomes included pain scores, opioid consumption and incidence of opioid-related complications. RESULTS: The mean ObsQoR-11T score was higher in the TFP block group compared with the TAP block group (97.13 ±â€Š6.67 points vs. 87.10 ±â€Š9.84 points, respectively; P < 0.001). The pain scores in the TFP block group were slightly lower between postoperative 4 and 24 h. The mean total morphine consumption was 15.08 ±â€Š2.21 mg in the TFP block group and 22.21 ±â€Š3.04 mg in the TAP block group (P < 0.001). More patients required rescue analgesia between 4 and 8 h in the TAP block group [2.00 (5.00%) vs. 9.00 (23.08%), P = 0.02]. No significant differences were observed between groups in terms of opioid-related side effects. CONCLUSION: TFP block used for analgesic purposes yielded a better quality recovery period than TAP block and also reduced opioid consumption. TRIAL REGISTRATION: Clinicaltrials.gov (NCT05999981). VISUAL ABSTRACT: http://links.lww.com/EJA/B6.

Comparison of the genotoxicity of propofol and desflurane using the comet assay in the lymphocytes of patients who underwent lumbar discectomy: A randomized trial.

OBJECTIVES: To compare the genotoxic effects of desflurane and propofol using comet assay in patients undergoing elective discectomy surgery. METHODS: This was a randomized controlled study. Patients who underwent elective lumbar discectomy under general anesthesia with propofol or desflurane were included in the study. Venous blood samples were obtained at 4 different time points: 5 minutes before anesthesia induction (T1), 2 hours after the start of anesthesia (T2), the first day after surgery (T3), and the fifth day following surgery (T4). Deoxyribonucleic acid damage in lymphocytes was assessed via the comet assay. RESULTS: A total of 30 patients, 15 in each group, were included in the analysis. The groups were similar in terms of age and gender distribution. There were no significant differences in demographics, duration of surgery, total remifentanil consumption, and total rocuronium bromide consumption. The comet assay revealed that head length, head intensity, tail intensity, tail moment at T1 were similar in the desflurane and propofol groups. Head length, tail length and tail moment measured in the desflurane group at T4 were significantly higher compared to the propofol group. Tail lengths of the desflurane group at T1, T2 and T3 were significantly higher than the corresponding values in the propofol group. CONCLUSION: Propofol and desflurane do not appear to induce DNA damage in lymphocytes. However, when the quantitative data were compared, it was determined that propofol had relatively lower genotoxic potential than desflurane.ClinicalTrials.gov Reg. No.: NCT05185167.

In Vitro Effects of Propofol on Cytotoxic, Apoptotic and PI3K-Akt Signaling Pathway Genes on Brain Cancer Cells.

AIM: The study aimed to determine the cytotoxic and apoptotic effect of propofol on glioma cells. BACKGROUND: Propofol [2,6-diisopropylphenol] is a commonly used intravenous anesthetic. Propofol is known to have a mechanism of action on the PI3K-AKT pathway. OBJECTIVE: This study aimed to evaluate the effect of propofol on the proliferation and apoptosis of human glioma cells, as well as to investigate changes in expression levels of the PI3K-AKT signaling pathway genes. MATERIALS AND METHODS: The cytotoxic effect of propofol on the U-87 MG cell line was determined by WST-1 method. Annexin V-FITC and Mitoprobe JC-1 assay were used to measure apoptosis by flow cytometry. The expression levels of genes in the PI3K-AKT signaling pathway were investigated by qRT-PCR. RESULTS: We have shown that propofol induced apoptosis in U-87 MG cells by 17.1 fold compared to the untreated control. Furthermore, significant differences were found in the expression levels of the PI3K-AKT signaling pathway genes. CONCLUSION: As a result of our study, it was found that propofol caused differences in expression levels of PI3K-AKT signaling pathway genes and it was suggested that these differences may be related to apoptosis induction.

Evaluation of ultrasound-guided rhomboid intercostal nerve block for postoperative analgesia in breast cancer surgery: a prospective, randomized controlled trial.

BACKGROUND AND OBJECTIVES: Mastectomy has many potential sources of pain. Rhomboid intercostal block (RIB) is a recently described plane block. The primary hypothesis of the study is that ultrasound-guided RIB combined with general anesthesia would accelerate global quality of recovery scores of patients following mastectomy surgery. Secondary hypothesis is that RIB would reduce postoperative opioid consumption, pain scores, and the need for rescue analgesia. METHODS: Patients aged between 18 and 70 years, with American Society of Anesthesiologists physical status I-II and scheduled for an elective unilateral modified radical mastectomy surgery with axillary lymph node dissection were enrolled to the study. Following endotracheal intubation, patients were randomly allocated into two groups. Patients in the first group (group R) received ultrasound-guided RIB with 30 mL 0.25% bupivacaine. In the control group (group C), no block intervention was applied. All patients received intravenous dexamethasone 8 mg, dexketoprofen trometamol 50 mg intraoperatively and tramadol 1 mg/kg 30 min before the end of surgery for postoperative analgesia. All patients received intravenous morphine patient-controlled analgesia device at the arrival to the recovery room. RESULTS: The descriptive variables of the patients were comparable between group R and group C. Mean quality of recovery-40 score at 24 hours was 164.8±3.9 in group R and 153.5±5.2 in group C (mean difference 11.4 (95% CI 8.8 to 13.9; p<0.001). At 24th hour, median morphine consumption was 5 mg (IQR 4-7 mg) in group R and 10 mg (IQR 8-13 mg) in group C, p<0.001. Intraoperative fentanyl administration, pain scores and the need for rescue postoperative analgesia was similar between groups. CONCLUSIONS: In the current study, ultrasound-guided RIB promoted enhanced recovery and decreased opioid consumption after mastectomy surgery. TRIAL REGISTRATION NUMBER: ACTRN12619000879167.

The antinociceptive effects of systemic administration of tramadol, gabapentin and their combination on mice model of acute pain.

OBJECTIVES: The aim of the present study was to investigate the possible antinociceptive effects of systemic administration of tramadol and gabapentin either alone or in combination on acute pain models in mice. METHODS: After obtaining the approval of Animal Ethics Committee; 96 BALB/c albino male mice were divided into 12 groups: (I) control without injection, (II) control treated with saline, (III)-(IV) mice treated with tramadol 10 mg/kg or 30 mg/kg, (V)-(VIII) mice treated with gabapentin; 30, 100, 200, 300 mg/kg respectively. In order to determine possible interactions between tramadol gabapentin and; mice received four different combinations of tramadol + gabapentin (30+30, 30+100, 30+200 and 30+300 mg/kg) (Groups IX-XII respectively). Mice received 0.1 ml solution for every 10 g of their weight. The drug was injected into peritonea. Thirty minutes after the drug injection, tail-flick and hot-plate tests were conducted. RESULTS: Ten and 30 mg/kg tramadol produced dose dependent antinociceptive effect in tail-flick and hot plate tests. Gabapentin had no antinociceptive effect in the tail flick test except 300 mg/kg dose, and had dose dependent antinociceptive effect in hot-plate test. In both tests, various combinations of tramadol and gabapentin produced an antinociceptive effect that is greater than that produced by tramadol and gabapentin alone. But, just 30 mg/kg tramadol + 300 mg/kg gabapentin combination caused statistically significant increase in both tests (p<0.05). CONCLUSION: When gabapentin and tramadol were used in combination, gabapentin had no additive antinociceptive effect except for 300 mg/kg in tail-flick and hot-plate tests. Tail-flick test showed that tramadol produced better antinociceptive effect than gabapentin.

Comparing the administration of fentanyl 1 µg kg⁻¹ and fentanyl 0.5 µg kg⁻¹ in dilation and curettage procedures.

PURPOSE: This study was carried out to compare fentanyl 0.5 µg kg⁻¹ -propofol as opposed to fentanyl 1 µg kg⁻¹ -propofol in terms of providing adequate analgesia, and a comparable recovery profile in dilation and curettage (D&C) procedures. METHODS: Verbal Pain Scale (VPS) scores, modified Aldrete scores, and hemodynamic parameters were recorded during and after the surgical procedure. In addition, a record was also kept of adverse events, and patients and surgeons were questioned about their satisfaction with the anesthesia. RESULTS: No difference was found between the two groups in terms of hemodynamic parameters, the VPS scores, or patient and surgeon satisfaction. The fentanyl 0.5 µg group displayed significantly higher modified Aldrete scores at both 5- and 10-min postoperative. Adverse events in both groups were considerably few. The incidence of postoperative nausea and vomiting (PONV) in the fentanyl 0.5 µg group was lower eventhough it did not reach the statistically significance level. In addition, faster recovery times were recorded with the administration of fentanyl 0.5 µg kg⁻¹ . CONCLUSION: Fentanyl 0.5 µg kg⁻¹ appears to be as reliable as that of fentanyl 1 µg kg⁻¹ with faster recovery times when used in D&C procedures.

Usage of remifentanil and fentanyl in intravenous patient-controlled sedo-analgesia.

Our aim was to investigate the effects of patient-controlled sedo/analgesia with fentanyl or remifentanil during cataract surgery with phacoemulsification method under topical anaesthesia. The ethical committee has approved the prospective, randomized, double-blind study. ASA I-III, 120 patients underwent cataract surgery were randomly allocated to 3 groups. Fentanyl was administered in 0.7 microg/kg loading, 10 microg bolus dose with 5 minutes lockout time, remifentanil was administered 0.3 microg/kg loading, 20 microg bolus dose with 3 minutes lockout time by patient controlled analgesia (PCA) equipment. In the control group, saline solution was given without any analgesic drug. Cardiorespiratory system findings, verbal pain scale and sedation scores were recorded preoperatively and intraoperatively at the 5th, 10th, 15th, 20th and 30th minutes. Discomfort during surgery, pressing the PCA button, and complications were recorded. The verbal pain scale scores was significantly lower in the drug groups than the those in control group at the 15th minute. The sedation scores was significantly higher in the remifentanil group at the 5th minute (p=0.019) and in the fentanyl group at the 10th minute (p=0.007) than those in the control group. The number of patients pressing the PCA button was much higher in the control group than the drug groups (p<0.05). Patient comfort and surgeon satisfaction were higher in the drug groups (p<0.05). Intravenous-PCA sedo/analgesia addition to topical anaesthesia provides an advantage in sedo/analgesia, patient comfort, and surgeon satisfaction. PCA is a convenient and safe method, especially at the beginning of the operation when anxiety is intense, and during healon/lens implantation.

Ropivacaine versus lidocaine for deep-topical, nerve-block anaesthesia in cataract surgery: a double-blind randomized clinical trial.

PURPOSE: To evaluate the safety and efficacy of ropivacaine versus lidocaine for deep-topical, nerve-block anaesthesia in cataract surgery. METHODS: This prospective controlled randomized double-blind study comprised 64 patients undergoing clear corneal phacoemulsification. Patients were equally divided into two group receiving either deep-topical anaesthesia with 1% ropivacaine-soaked sponge (Group R, n = 32) or 2% lidocaine-soaked sponge (Group L, n = 32). The level of intraoperative and postoperative pain was assessed by patients using a verbal analogue scale from 1 to 10. The duration of surgery, the need for supplemental anaesthesia, surgeon satisfaction, and intraoperative and early postoperative complications were recorded. The patients' heart rate, arterial blood pressure and peripheric oxygen saturation (SpO(2)) were obtained just before the anaesthesia and during the surgery. RESULTS: The demographic data of the patients and duration of surgery were similar in both groups. No significant difference in the mean pain scores of patients were found in the ropivacaine and lidocaine groups. Surgical satisfaction was also statistically insignificant. None of the patients had significant difference in heart rate, blood pressure or SpO(2) during the surgical procedure. CONCLUSION: Deep-topical anaesthesia with ropivacaine and lidocaine in cataract surgery is safe and the two anaesthetic agents do not present differences in the degree of analgesia achieved. Deep-topical anaesthesia with ropivacaine or lidocaine was equally effective in providing anaesthesia with sufficient quality for cataract surgery.

Effects of positioning in laparoscopic adnexal surgery on QT dispersion and heart rate variability under sevoflurane anesthesia.

PURPOSE: This study compared the intraoperative changes in the corrected QT dispersion and heart rate variability, predictors of autonomic cardiac function, in laparotomic and laparoscopic adnexal surgery. MATERIALS AND METHODS: The study was conducted on 46 American Society of Anaesthesiologists class I/II patients, aged 33-51 years, randomized to one of two groups, for elective gynecologic laparotomy or laparoscopy for a benign adnexal mass. Anesthesia was induced and maintained with sevoflurane. Corrected QT dispersion and spectral powers of heart rate variability were measured at baseline, before the induction of anesthesia, and intraoperatively during the adnexal surgery for 15 minutes. The lithotomy and Trendelenburg positions were set at 145 degrees and 30 degrees between thigh and body, respectively. Pneunoperitoneum was established at 12 mm Hg. Laparoscopic surgery was performed via one principal and two ancillary ports. Data were analyzed using the Wilcoxon and Mann-Whitney tests. RESULTS: A significant increase was observed in intraoperative standard deviation of RR interval values of heart rate variability in both groups compared to preoperative values (P < 0.05). The corrected QT dispersion and low and high frequency heart rate variability showed no significant changes between the two groups. CONCLUSION: Gynecologic laparoscopy with pneumoperitoneum in the lithotomy and Trendelenburg positions is as safe as laparatomy and seems not to deteriorate the autonomic cardiac function.

Effects of esmolol, lidocaine and fentanyl on haemodynamic responses to endotracheal intubation: a comparative study.

BACKGROUND AND OBJECTIVE: Predicting the haemodynamic changes that may result in myocardial ischaemia for patients undergoing laryngoscopy and tracheal intubation will help to avoid events that trigger ischaemia and allow immediate treatment. The objective of this study was to compare the effects of esmolol with those of lidocaine (lignocaine) and fentanyl on prevention of tachycardia and hypertension caused by endotracheal intubation. METHODS: This was a prospective, randomised, double-blind study. The study was conducted at the Adnan Menderes University Hospital in Aydin, Turkey and involved 120 patients of American Society of Anesthesiologists physical status I or II aged 20-50 years. The patients were randomised into four equal groups. The control group (group C) received dextrose 5% 5 mL, the esmolol group (group E) received esmolol 1.5 mg/kg, the fentanyl group (group F) received fentanyl 1 microg/kg and the lidocaine group (group L) received lidocaine 1.5 mg/kg 2 minutes before endotracheal intubation. Heart rate (HR), mean arterial pressure (MAP) and rate-pressure product (RPP) were recorded before and after induction of anaesthesia, immediately after intubation, and 1, 3, 5, 7 and 10 minutes after intubation. RESULTS: Compared with control, HR decreased significantly in group E after induction, immediately after intubation and 1 minute after intubation (p < 0.0083). In group F there was an increase in MAP immediately after intubation, but the increase was less than in other groups. Compared with control, RPP decreased significantly in groups E and F after induction, immediately after intubation and 1 minute after intubation (p < 0.0083). RPP was significantly lower in group E than in controls and group L 3 minutes after intubation (p < 0.0083), and it was significantly lower in group F than in controls 10 minutes after intubation (p < 0.0083). CONCLUSION: It can be concluded that administration of esmolol 1.5 mg/kg 2 minutes before intubation prevents tachycardia and an increase in RPP caused by laryngoscopy and tracheal intubation, and can be beneficial when administered before laryngoscopy and tracheal intubation in patients with tachycardia.

Pain prevention with intraoperative ketamine in outpatient children undergoing tonsillectomy or tonsillectomy and adenotomy.

STUDY OBJECTIVES: To evaluate the effectiveness of ketamine in the prevention of postoperative pain after tonsillectomy. DESIGN: Randomized, prospective, double-blind study. SETTING: University hospital. PATIENTS: 90 ASA physical status I and II patients, aged 5 to 15 years, scheduled for tonsillectomy or adenotonsillectomy. INTERVENTIONS: Patients were divided into three groups. The pain preventive group received intravenous (IV) ketamine 0.5 mg/kg in 2 mL saline before the tonsils were surgically removed, followed by a continuous IV infusion of ketamine at 6 micro/(kg/min). In the ketamine group, 2 mL saline was given before the tonsils were surgically removed; saline infusion (10 mL/h) was continued until bleeding control, and 0.8 mg/kg ketamine was given during bleeding control in 2 mL saline. In the control group, only saline was given. MEASUREMENTS AND MAIN RESULTS: Cardiorespiratory system data, recovery from anesthesia and discharge parameters, tramadol requirement, and complications were recorded. Recovery from anesthesia and discharge parameters were similar among the groups. Total dose of tramadol was lower in the pain preventive group than in the other groups. In the pain preventive group, verbal pain scale scores were lower in the early postoperative period in the fourth and sixth hours (P < 0.05). CONCLUSIONS: Ketamine decreases postoperative analgesic requirements and has analgesic effects when used before surgery in tonsillectomy/adenotonsillectomy.

Effects of intravenous lidocaine on QTd and HRV changes due to tracheal intubation during sevoflurane induction.

The aim of the present study was to evaluate the effects of IV lidocaine on autonomic cardiac function changes in tracheal intubation (TI) during sevoflurane anaesthesia by using more reliable parameters, namely, the analysis of QT dispersion and heart rate variability (HRV) from Holter monitoring. In this prospective, double-blind study, 44 American Society of Anaesthesiologists class I-II patients scheduled for hysterectomy were randomly and equally divided into 2 groups; a control sevoflurane group (group S, n = 22) and a lidocaine sevoflurane group (group LS, n = 22). Before the induction of anaesthesia, the electrocardiograms (ECG) of all patients were recorded for 3 minutes as baseline parameters. In both groups, the anaesthesia was induced with 7% sevoflurane in O(2 )at 6L min(-1) via a facemask for 2 minutes. However, before the induction of sevoflurane anaesthesia in group LS, 1 mg kg(-1) of lidocaine was given intravenously (IV). For muscle relaxation during TI, vecuronium was given to all participants. Three minutes after administration of vecuronium, TI was performed and an ECG was recorded synchronously for another 3 minutes. The results from the later records were used as postintubation parameters. Baseline and postintubation data were analysed. When compared to baseline values, postintubation LF/HF and SDNN values were increased in group S (P = 0.005, P = 0.001, respectively), whereas postintubation LF and HF values were decreased in group LS (P = 0.014, P = 0.041, respectively). Under the influence of sevoflurane anaesthesia, TI resulted in sympathetic activation. However, this activation was attenuated by the administration of IV 1 mg kg(-1) lidocaine 5 minutes prior to TI.

Effects of sevoflurane on QT dispersion and heart rate variability.

The purpose of this study was to use estimates of corrected QT dispersion (QTcd) and heart rate variability (HRV) to assess the effects of sevoflurane, an inhalation agent used frequently in clinical practice, on autonomic cardiac function. This study was conducted prospectively and in a blind manner on 20 women between 38 and 51 y of age who were classified as American Society of Anesthesiologists stage I-II and whose treatment required total abdominal hysterectomy. Electrocardiograms were recorded by 12-lead Holter monitor for 5 min before sevoflurane induction and again for 5 min at 10 min after tracheal intubation. Data on the first recording were considered as baseline; those on the second recording were viewed as final data. The study was terminated at this point, and surgery was allowed to proceed. QTcd and HRV values were assessed by a cardiologist, who was blinded to all data. All parameters were expressed as a mean value +/- standard deviation. Wilcoxon's test was used to compare baseline and final data. Statistical significance was considered as P<.05. No significant changes were observed between baseline and final QTcd values and between low- and high-frequency components (LF and HF) of HRV; nor were changes seen in the LF/HF ratio. With the patient under sevoflurane/ nitrous oxide anesthesia, no significant changes were detected in QTcd, LF, and HF values, and in the LF/HF ratio, whereas a significant increase (P=.001) was seen in standard deviation of the R-R interval, which was used as a measure of cardiac autonomic tone.

The analgesic effect of nitroglycerin added to lidocaine on intravenous regional anesthesia.

We evaluated the analgesic effect of nitroglycerine (NTG) when added to lidocaine in IV regional anesthesia. Thirty patients undergoing hand surgery were randomly assigned to two groups. The control group (group C, n = 15) received a total dose of 40 mL with 3 mg/kg of lidocaine diluted with saline, and the NTG group (group NTG, n = 15) received an additional 200 mug NTG. Hemodynamic variables, tourniquet pain measured before and 1, 5, 10, 20, and 30 min after tourniquet inflation, and analgesic requirements were recorded during the operation. After the tourniquet deflation, at 1 and 30 min and 2 and 4 h, visual analog scale (VAS) score, time to first analgesic requirement, total analgesic consumption in the first 24 h after operation, and side effects were noted. Shortened sensory and motor block onset time (3.2 +/- 1.1 versus 4.5 +/- 1.2 min; P = 0.01 and 3.3 +/- 1.6 versus 5.2 +/- 1.8; P = 0.009 in group NTG and group C, respectively), prolonged sensory and motor block recovery times (6.8 +/- 1.6 versus 3.1 +/- 1.2 min P < 0.0001 and 7.3 +/- 1.3 versus 3.6 +/- 0.8 P < 0.0001 in group NTG and group C, respectively), shortened VAS scores of tourniquet pain (P = 0.023), and improved quality of anesthesia were found in group NTG (P < 0.05). VAS scores were lower in group NTG after tourniquet release and in the postoperative period (P = 0.001). First analgesic requirement time was longer in group NTG (225 +/- 74 min versus 39 +/- 33 min) than in group C (P < 0.0001). Postoperative analgesic requirements were significantly smaller in group NTG (P < 0.0001) but the side effects were similar in both groups. We conclude that the addition of NTG to lidocaine for IV regional anesthesia improves sensory and motor block, tourniquet pain, and postoperative analgesia without side effects.

Effect of single-dose fentanyl on the cardiorespiratory system in elderly patients undergoing cataract surgery.

STUDY OBJECTIVES: To evaluate the effects of fentanyl on the cardiorespiratory system in elderly patients undergoing cataract surgery with phacoemulsification method. DESIGN: Randomized, prospective, double-blind study. SETTING: University hospital. PATIENTS: 70 ASA physical status I, II, and III patients (>60 years) who underwent cataract surgery with topical anesthesia. INTERVENTIONS: Patients were randomly divided into two groups. The fentanyl group (35 patients) received fentanyl in 0.7 microg/kg bolus doses in a 2-mL balanced salt solution prior to surgery. The control group (35 patients) received a 2-mL balanced salt solution without any analgesic drug. MEASUREMENTS AND MAIN RESULTS: Systolic (SBP), diastolic (DBP), mean arterial pressure (MAP), heart rate (HR), peripheral oxygen saturation (SpO(2)), respiratory rate (RR), end-tidal carbon dioxide (ETCO(2)), inspired CO(2) concentration, and sedation scores were measured preoperatively and at 5, 10, 15, 20, and 30 minutes intraoperatively. Postoperatively, patients were questioned about the presence of intraoperative pain. In the fentanyl group, no significant differences were observed in SPB, DBP, MAP, RR, or peripheral SpO(2). In the control group, RR was higher than baseline values at 10, 15, and 20 minutes. Diastolic blood pressure was higher than baseline values at 20 minutes. End-tidal CO(2) and inspired CO(2) levels were higher than baseline levels in both groups at all measurement times. Intraoperative ETCO(2) levels were higher in the fentanyl group than the control group (p < 0.01). Finally, no hypoxemia was observed in either group. CONCLUSION: Fentanyl can be used safely in 0.7-microg/kg dosages in elderly patients to improve patient comfort without any cardiorespiratory side effects, when undergoing cataract surgery with topical anesthesia.