[A comparison of transversus abdominis plane block guided with ultrasonography and local anesthetic infiltration in laparoscopic cholecystectomy operations]. / Laparoskopik kolesistektomi ameliyatlarinda ultrasonografi esliginde uygulanan transversus abdominis plan blogu ile lokal anestezik infiltrasyonu yöntemlerinin karsilastirilmasi.

OBJECTIVES: The aim of this study was to compare a transversus abdominis plane (TAP) block guided with ultrasound (USG) and local anesthetic infiltration (LAI) in terms of the intraoperative and postoperative analgesia efficiency, intraoperative opioid need, and side effects in cases of laparoscopic cholecystectomy. METHODS: A total of 75 patients classified as American Society of Anesthesiologists class I or II were included in this randomized, controlled, prospective study and divided into 3 groups. 20 mL of levobupivacaine 0.5% was applied around the trocar entrance site before the operation to group L (n=25), and 30 mL 0.25% levobupivacaine was applied with a USG-guided TAP block to group T (n=25). No TAP block or LAI was applied to the control group (n=25), group K. In the first 24 hours after surgery, an infusion of tramadol was administered with a controlled analgesia device. The intraoperative fentanyl use was recorded, and a visual analogue scale was administered to assess pain while resting (VASrest) and upon coughing (VAScough) at 1, 2, 4, 8, 12, 16, and 24 hours postoperative. An evaluation of shoulder pain and the consumption of analgesia in 24 hours were also recorded. RESULTS: The VASrest and VAScough values, the dose of fentanyl used intraoperatively, and the total analgesia dose administered in 24 hours were compared between groups and there was no statistically significant difference detected (p>0.05). In group T, the vomiting rate 1 and 2 hours postoperative (20% and 12%, respectively) was significantly lower than in group K (64% and 44%, respectively). CONCLUSION: The efficiency of the analgesia provided after a laparoscopic cholecystectomy with a bilateral TAP block guided with USG and LAI was determined to be similar.

Topical levobupivacaine efficacy in pain control after functional endoscopic sinus surgery.

OBJECTIVE: The aim of this study was to find out the efficacy of a polyvinyl alcohol (PVA) sponge (Merocel Kennedy; Medtronic Xomed, Jacksonville, Florida) sinus pack soaked with levobupivacaine hydrochloride to control postoperative pain and analgesic need following functional endoscopic sinus surgery (FESS). STUDY DESIGN: The study was designed as a prospective, double-blind, randomized, controlled study. Forty-one patients who underwent FESS were included in the analysis. Setting A tertiary referral hospital in Turkey. MATERIALS AND METHODS: Patients who underwent FESS were divided into 2 groups. The PVA sponge sinus packs were soaked with 5 mL of levobupivacaine hydrochloride (chirocaine 25 mg/10 mL; Abbott, Nycomed Pharma AS, Elverum, Norway) in group I and with 5 mL of saline in group II. MAIN OUTCOME MEASURES: Postoperative pain levels were recorded using a visual analog scale (VAS score, 0-100) at 30 minutes and 1, 2, 8, 12, and 24 hours. RESULTS: There were no statistically significant differences between groups regarding age, sex, and American Society of Anesthesiologists status. Postoperative VAS values at 30 minutes and 1, 2, 8, 12, and 24 hours were significantly lower in group I than in group II (P < .05). Supplemental analgesia amount was significantly lower in group I than in group II (P = .003). CONCLUSION: Using levobupivacaine-soaked PVA sponge sinus packs after FESS is an effective, easy, and quick method to control postoperative pain, and it improves patient comfort and tolerability.

Efficacy of topical levobupivacaine in control of postoperative pain after septoplasty.

OBJECTIVE: To search the efficacy of using Merocele (Medtronic, Minneapolis, MN) soaked with 5 mL of levobupivacaine hydrocloride as a nasal pack in control of postoperative pain after septoplasty. DESIGN: The study was designed as a prospective, double-blind, randomized, controlled study. Forty-one patients who underwent septoplasty operation were included in the analysis. SETTING: A tertiary referral hospital in Turkey. MATERIAL AND METHODS: Forty-one patients undergoing septoplasty were divided into two groups. At the end of the operation, Merocele packs were placed inside the nasal cavity. In the levobupivacaine group, each Merocele pack was soaked with 5 mL of levobupivacaine hydrochloride (25 mg/10 mL), and in the control group, Merocele packs were soaked with 5 mL of saline. MAIN OUTCOME MEASURES: Postoperative pain levels were recorded using a visual analogue scale (VAS score, 0-100) at 30 minutes and 1, 2, 8, 12, and 24 hours. RESULTS: We did not find any significant difference between groups regarding age, gender, American Society of Anesthesiologists status, and body mass index. Postoperative VAS values at 30 minutes and 1, 2, 8, and 12 hours were significantly lower in the levobupivacaine group compared with the control group (p < .05). The need for supplemental analgesia was significantly lower in the levobupivacaine group compared with the control group (p < .01). CONCLUSION: Postoperative pain after septoplasty owing to nasal packing is an important problem, and using levobupivacaine-soaked Merocele as a nasal pack after septoplasty is an effective method for the control of this pain. It is a very easy, effective, and quick method and it improves patient comfort after septoplasty.