Postoperative analgesic effectiveness of ultrasound-guided transmuscular quadratus lumborum block in congenital hip dislocation surgery : A randomized controlled study.

BACKGROUND/OBJECTIVE: Congenital hip dysplasia (CHD) defines a spectrum of pathologies in which the acetabulum and proximal femur of babies and children abnormally develop. Open surgery in congenital hip dysplasia leads to severe postoperative pain. The aim of this study was to evaluate the effectiveness of ultrasound-guided quadratus lumborum block (QLB) in pediatric patients undergoing surgery for congenital hip dysplasia. MATERIAL AND METHODS: Following ethical board approval, 40 children aged between 1-5 years undergoing surgery for congenital hip dysplasia were randomized into two groups. Patients (n = 20) received ultrasound guided quadratus lumborum block (group QLB) using 0.5 mL/kg body weight 0.25% bupivacaine preoperatively. The same standard postoperative analgesia protocol was used in both groups. Pain scores, parental satisfaction, requirement for ibuprofen and opioids were recorded. Pain was measured using the face, legs, activity, crying, consolability (FLACC) scale. RESULTS: The FLACC scores were lower at 30min and 1h, 2h, 4h, 6h, 12h and 24h in the QLB group when compared to the control group (p < 0.05). The requirement for rescue opioid analgesia was statistically significantly higher in the control group when compared to the QLB group (15/20 vs. 3/20, p < 0.001). Rate of ibuprofen usage in the ward was higher in the control group when compared to the QLB group (14/20 vs. 4/20, p = 0.004). Parental satisfaction was higher in the QLB group (p < 0.001). CONCLUSION: Ultrasound-guided quadratus lumborum block reduces pain scores and analgesic requirements following congenital hip dysplasia surgery.

Efficacy of Ultrasound-Guided Transversus Thoracic Muscle Plane Block on Postoperative Opioid Consumption After Cardiac Surgery: A Prospective, Randomized, Double-Blind Study.

OBJECTIVES: The postoperative analgesic efficacy of transversus thoracic muscle plane block (TTMPB) has not yet been evaluated sufficiently. This randomized controlled study evaluated the effect of TTMPB on postoperative opioid consumption in patients undergoing cardiac surgery. DESIGN: Prospective, randomized, double-blind study. SETTINGS: Single institution, academic university hospital. PARTICIPANTS: Forty-eight adult patients having cardiac surgery with median sternotomy. INTERVENTIONS: Patients were randomly assigned to receive preoperative ultrasound-guided TTMPB with either 20 mL of 0.25% bupivacaine or saline bilaterally. Postoperative analgesia was administered intravenously in the 2 groups 4 times a day with 1000 mg of paracetamol and patient-controlled analgesia with fentanyl. MEASUREMENTS AND MAIN RESULTS: The primary outcome was opioid consumption in the first 24 hours. Secondary outcomes included postoperative pain scores, first analgesic requirement time, rescue analgesia, intensive care discharge time, and side effects. Compared with the control group (median 465 µg, interquartile range 415-585), the transversus thoracic muscle plane (TTMP) group (median 255 µg, interquartile range 235-305) had reduced postoperative 24-hour opioid consumption (p < 0.001). Pain scores were significantly lower in the TTMP group compared with the control group up to 12 hours after surgery both at rest and active movement (p < 0.001). Compared with the TTMP group, the proportion of postoperative nausea and pruritus was statistically higher in the control group (p < 0.001). CONCLUSIONS: A single preoperative TTMPB provided effective analgesia and decreased opioid requirements in patients undergoing cardiac surgery.

Preemptive Analgesic Efficacy of the Ultrasound-Guided Bilateral Superficial Serratus Plane Block on Postoperative Pain in Breast Reduction Surgery: A Prospective Randomized Controlled Study.

PURPOSE: Breast surgery is an exceedingly common procedure and associated with an increased incidence of acute and chronic pain. Preemptive regional anesthesia techniques may improve postoperative analgesia for patients undergoing breast surgery. The aim of this study was to evaluate the effect of preoperative bilateral serratus plane block on postoperative opioid consumption in patients undergoing breast reduction surgery. METHODS: After ethical board approval, 40 patients undergoing breast reduction surgery were randomized into 2 groups: control group (Group C, n = 20) and serratus plane block group (Group SPB, n = 20). Group C received bilateral ultrasound-guided 2 ml 0.9% saline subcutaneously each block side, Group SPB received ultrasound-guided bilateral SPB with 0.25% bupivacaine 30 ml each side. The groups were administered the routine general anesthesia protocol. All operations were performed with the mediocentral pedicled reduction mammaplasty technique by the same surgeon. Postoperative analgesia was performed intravenously in the 2 groups twice a day with dexketoprofen trometamol 50 mg and patient-controlled analgesia with fentanyl. Postoperative analgesia was evaluated using the visual analog scale (VAS). Fentanyl consumption, additional analgesia requirement and opioid-related side effects were recorded during the first 24 h after surgery. RESULTS: Compared with control, the VAS score was statistically lower in the SPB group during all measurement times (p < 0.05). The 24-h opioid consumption was significantly higher in the control group compared with the SPB group (372.50 ± 39.65 vs. 296.25 ± 58.08 µq, respectively; p < 0.001). In addition, the analgesia requirement was statistically lower in the SPB group (8/20 vs. 2/20, respectively, p < 0.028). Nausea or vomiting was observed more often in the control group than in SPB block (9/20 vs. 2/20, respectively, p = 0.013), whereas other side effects were similar for the two groups. CONCLUSIONS: SPB can be used safely bilaterally in the management of pain for breast reduction surgery as it is easy to perform, provides excellent analgesia, and reduces opioid consumption and opioid sparing effect. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Erector spinae plane block for bilateral lumbar transverse process fracture in emergency department: A new indication.

Plane blocks have become very popular in recent years with the introduction of ultrasonography into the regional anesthesia and algology practice. Ultrasound guided erector spinae plane (ESP) block was first described in 2016. ESP block involves injection of local anesthetics between erector spinae muscles and transverse process of thoracic or lumbar vertebrae and can block the dorsal and ventral rami of thoracolumbar spinal nerves. ESP block has been successfully reported to relieve the pain of multiple rib fracture in the emergency department (ED). Here we first report a novel indication for ESP block in ED; transverse process fracture of lumbar vertebra.

The double-edged sword: effects of pregabalin on experimentally induced sciatic nerve transection and crush injury in rats.

AIM: The aim of this study was to research the effects of pregabalin on experimentally induced peripheral nerve crush injuries in rats. MATERIAL AND METHOD: Forty-two adult female Wistar albino rats were divided into seven groups: 1st group: healthy; 2nd group: axonotmesis control; 3rd group: anastomosis control; 4th group: axonotmesis+30 mg/kg of pregabalin; 5th group: axonotmesis+60 mg/kg of pregabalin; 6th group: anastomosis+30 mg/kg of pregabalin; 7th group: anastomosis+60 mg/kg of pregabalin. Evaluation of the sciatic functional index (SFI) was performed one day before and on days 7, 14, 21, and 28 following surgery. The right sciatic nerves of all animals were examined histopathologically and molecularly. RESULTS: After 28 days post-injury, the histopathological regeneration in peripheral nerve injuries for pregabalin 30 mg/kg treated groups was significantly better than that of the control groups. Also the SFI increases and TGF-ß gene expression up-regulation were significantly better in pregabalin 30 mg/kg treated groups. CONCLUSION: The histopathological, functional and molecular data suggest that pregabalin 30 mg/kg treatment in axonotmesis and anostomosis groups improves nerve regeneration and increases SFI in peripheral nerve injuries by activating antiinflammatory cytokine TGF-ß1.

The effectiveness of the erector spinae plane block using methylprednisolone and bupivacaine in post-herpetic neuralgia: Case series.

Post-herpetic neuralgia (PHN) is the most common chronic complication of herpes zoster and the most common pain syndrome associated with infections. There are medical and interventional treatment options in PHN, and some patients may be resistant to the preferred medical treatments. This situation negatively affects the quality of life of the patient. Interventional treatments come to the fore, especially in patients in whom medical treatments are not sufficient, and systemic side effects such as hepatotoxicity and nephrotoxicity occur. Erector spinal plane block (ESPB) is a recently described ultrasound-guided regional anesthesia technique. It is especially used to prevent post-operative pain due to trunk surgeries. In this study, ESPB was administered with methylprednisolone and bupivacaine in five patients who developed PHN after thoracic herpes zoster and did not have an expected response to three-month medical treatments. Pain severity was assessed using the Numerical Pain Rating Scale. We want to emphasize that ESPB, which is applied with steroids and anesthetics, is a speedy and longacting treatment option that increases the quality of life of the patient, has low side effects, and is a cost-effective treatment option.

Variables affecting mortality rates in patients undergoing emergency abdominal surgery: A retrospective cross-sectional study.

BACKGROUND: Patients operated under emergency conditions have a higher risk of death and complications than those per-formed under elective conditions. Especially the patient group with high comorbidity needs to be evaluated more specifically. Accord-ing to the surgical risk and American Society of Anesthesiologists (ASA) scoring, the perioperative risk should be determined quickly, and the relatives of the patients should be informed. This study aimed to evaluate the factors affecting mortality and morbidity in patients undergoing emergency abdominal surgery. METHODS: A total of 1065 patients aged 18 years and older who underwent emergency abdominal surgery in 1 year were included in the study. The primary aim of this study was to determine the mortality rates in the first 30 days and 1 year and the variables af-fecting these rates. RESULTS: Of 1065 patients, 385 (36.2%) were female and 680 (63.8%) were male. The most common procedure was appendectomy (70.8%), followed by diagnostic laparotomy (10.2%), peptic ulcus perforation (6.7%), herniography (5.5%), colon resection (3.6%), and small bowel resection (3.2%). There was a significant difference between the age of the patients and mortality (p<0.05). There is no statistically significant relationship between gender and mortality. A statistically significant correlation was found between ASA scores, perioperative complication, perioperative blood product use, reoperation, intensive care unit admission, hospitalization time, periop-erative complication, and 30-day mortality and 1-year mortality. There is a significant relationship between trauma and only 30-day mortality (p=0.030). CONCLUSION: The morbidity and mortality of patients operated on under emergency conditions increased compared to elective surgical operations, especially those over age 70. The 30-day mortality rate of patients who underwent emergency abdominal surgery is 3%, while the 1-year mortality rate is 5.5%. Mortality rates are higher in patients with a high ASA risk score. However, mortality rates in our study were found to be higher than the mortality rates in ASA risk scoring.

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.

High-Frequency Chest Wall Oscillation in Patients with COVID-19: A Pilot Feasibility Study.

OBJECTIVE: Coronavirus 2019 disease presents in a spectrum that can range from mild viral infection to pneu- monia. Common symptoms of coronavirus disease 2019 pneumonia include cough, sputum, and shortness of breath. High-frequency chest wall oscillation is a pulmonary rehabilitation method used for the recovery of pulmonary functions and removal of secretions in the lungs. The aim of the study was to evaluate the efficacy of high-frequency chest wall oscillation on patients with coronavirus disease 2019 pneumonia. MATERIALS AND METHODS: In this study, 100 patients, between 18 and 70 years old, with a positive polymerase chain reaction result for coronavirus disease 2019, were included. Standard medical treatment was applied to all patients. In group rehabilitation, high-frequency chest wall oscillation treatment was applied twice a day for 20 minutes for 5 days. No additional intervention was made to the control group. Pulmonary function tests and oxygenation were evaluated on the first and fifth days. Patients' high-flow oxygen, non-invasive mechani- cal ventilation, and invasive mechanical ventilation needs were evaluated and recorded. RESULTS: Compared with the control group, the forced expiratory volume in 1 second, forced vital capacity, and peak expiratory flow rates were statistically higher in the rehabilitation group on the fifth day (P < .05). On evaluating the oxygenation of patients, the fifth day to first-day oxygen saturation difference was signifi- cantly higher in rehabilitation group than in control group (P < .05). Furthermore, the number of patients who needed non-invasive mechanical ventilation was lower in the rehabilitation group (P < .05). CONCLUSION: This study demonstrated that pulmonary rehabilitation applied with the high-frequency chest wall oscillation device in patients with coronavirus disease 2019 in the early period contributed to the improvement of oxygenation by providing significant improvement as observed in the pulmonary function tests of the patients.

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.

Burned spinal cord in acidotic cerebrospinal fluid during subarachnoid hemorrhage: Experimental study.

OBJECTIVE: We investigated the effect of carotid body ischemia-induced cerebrospinal fluid acidosis on spinal cord during subarachnoid hemorrhage (SAH). METHODS: Twenty-three hybrid rabbits were divided into three groups: control (n = 5), Sham (injected with 0.5 ml isotonic) (n = 6), and the SAH (n = 12) (injected with 0.5 ml autologous blood into the 4th ventricle) and then monitored for 3 weeks. Cerebrospinal fluid pH and degenerated ependymal cell density and volume of cervical central canal were analyzed. RESULTS: The mean cervical central canal volumes, degenerated ependymal cells densities, and cerebrospinal pH values were 1.056 ± 0.053 mm3-6 ± 2 per mm2-7.342 ± 0.034, 1.321 ± 0.12 mm3-35 ± 9 per mm2-7.314 ± 0.056, and 1.743 ± 0.245 mm3-159 ± 24 per mm2-7.257 ± 0.049 in the Control, Sham, and SAH groups, respectively. The more degenerated carotid body neuron density induced decreased cerebrospinal fluid pH values (p < 0.0001) could result in the more ependymal cells desquamation (p < 0.0005) and central canal dilatation (p < 0.00001). CONCLUSION: Increased neurodegeneration of carotid bodies can reduce cause cerebrospinal fluid pH-induced ependymal cell degeneration and central canal dilatation following SAH.

OBJETIVO: El objetivo de este estudio fue investigar el efecto de la isquemia inducida del cuerpo carotideo por la acídosis de líquido cefalorraquídeo en la médula espinal durante una hemorragia subaracnoidea (SAH). METODO: Conejos híbridos (n = 23) fueron divididos en Control (n = 5), Sham (inyectados con 0.5 mil de solución isotónica) (n = 6), y SAH (n = 12) (inyectados en el 4º ventrículo con 0.5 ml de sangre autológa) y monitoreados por tres semanas. Se analizaron: El pH del líquido cerebro espinal, la densidad de las células ependimarias y el volúmen del canal cervical central. RESULTADOS: La media del volumen del canal cervical central, la densidad de las células ependimarias degeneradas y los valores de pH fueron 1.056 + 0.053 mm3-6 + 2 per mm2-7.342 + 0.034, 1.321 + 0.12 mm3-35 + 9 per mm2-7.314 + 0.056 y 1.743 + 0.245 mm3-159 + 24 per mm2-7.257 + 0.049 en los grupos Control, Sham y SHA, respectivamente. La mayor densidad inducida de la neurona del cuerpo carotideo degenerado, disminuyó los valores de pH del líquido cefalorraquideo lo que podría dar como resultado un aumento en la descamación de las células ependimarias asi como la dilatación del canal central. CONCLUSIÓN: Un aumento en la neurodegeneración del cuerpo carotideo puede reducir la degeneración de los ependimocitos y la dilatacióm del canal central siguiendo SAH.

Lumbar Erector Spinae Plane Block as a Main Anesthetic Method for Hip Surgery in High Risk Elderly Patients: Initial Experience with a Magnetic Resonance Imaging.

OBJECTIVE: Since initial description by Forero for thoracic region, ultrasound guided erector spinae plane (ESP) block has experienced several surgeries for postoperative pain management, chronic pain or surgical anesthesia. Although ESP block has been reported to provide effective analgesia in the thoracic region, its effect in lumbar region still unclear. In this study we aimed to showed our successful experience with lumbar ESP block as a main anesthetic technique in fifteen high risk elderly patients undergoing hip surgery with mild propofol sedation. MATERIALS AND METHODS: In this observational study high risk elderly fifteen patients received lumbar ESP block as a main anesthetic technique with mild propofol sedation. 40 mL of local anesthetic mixture (20 mL bupivacaine 0.5%, 10 mL lidocaine 2%, and 10 mL normal saline) was administered between the erector spinae muscles and transverse process at the level of the 4th lumbar vertebra. Also we demonstrate magnetic resonance images and discuss the anatomic basis of lumbar ESP block. RESULTS: All patients' surgeries were completed without requirement for general anesthesia or local anesthesia infiltration of the surgical site. All patients' pain scores were <2/10 in the recovery room. Significant contrast spread was observed between the Th12 and L5 transverse process and erector spinae muscle and between multifidus muscle and iliocostal muscle at the L2-4 levels. Contrast material was observed at the anterior of the transverse process spreading to the paravertebral, foraminal and partially epidural area/spaces and also in the areas where the lumbar nerves enter the psoas muscle. CONCLUSION: Lumbar ESP block when combined with mild sedoanalgesia provides adequate and safe anesthesia in high risk elderly patients undergoing hip surgery.

Decreased incidence of headache after unintentional dural puncture in patients with cesarean delivery administered with postoperative epidural analgesia.

PURPOSE: To investigate how subsequent placement of a catheter into the epidural space after unintentional dural puncture for postoperative analgesia for 36-72 h affected the incidence of post-dural puncture headache (PDPH). METHODS: The records of 52 parturients who had had accidental dural puncture in cesarean delivery were reviewed. The parturients were assigned to two groups. Twenty-eight parturients were assigned to the study group, in whom an epidural catheter was inserted and was used for anesthesia and postoperative analgesia. Twenty-four parturients were assigned to the control group, in whom spinal anesthesia (n = 20) or general anesthesia (n = 4) was applied. For postoperative analgesia in patients with incision pain above visual analog scale (VAS) 3, 3 mg morphine in 15 ml saline was administered through the epidural catheter in the study group, while intramuscular meperidine or tramadol was administered in the control group. Once PDPH was observed, conservative treatment was tried first. If the headache persisted despite conservative treatment, an epidural blood patch was applied through the catheter or a reinserted epidural needle. RESULTS: The study group demonstrated significant reduction of the incidence of PDPH and reduction in the indication for an epidural blood patch compared to the control group (7.1% vs 58% [P = 0.000] and 3.6% vs 37.5% [P = 0.002], respectively). CONCLUSION: Subsequent catheter placement into the epidural space after unintentional dural puncture in cesarean delivery and leaving the catheter for postoperative analgesia for 36-72 h may reduce the incidence of PDPH.

The Effect of Anaesthetic Techniques on Maternal and Cord Blood Brain-Derived Neurotrophic Factor Levels.

OBJECTIVE: Brain-derived neurotrophic factor (BDNF), a member of neurotrophins, plays a critical role in neuronal tissue. In this study, the effects of spinal or general anaesthesia on cord and maternal peripheral blood BDNF and malondialdehyde (MDA) levels were investigated in patients undergoing elective caesarean section. METHODS: Eighty patients with term pregnancy were included. General anaesthesia was induced with intravenous (IV) propofol 2 mg kg-1 in the general anaesthesia group (n=36). In the spinal anaesthesia group (n=35), hyperbaric bupivacaine 0.5%, 9 mg (1.8 mL) was injected intrathecally. Maternal blood samples were taken immediately after positioning the patient on the operating table (T1), before clamping the umbilical cord (T2) and 24 hours after the first sample was obtained (T3). Cord blood samples were drawn from the umbilical artery (T4). RESULTS: Maternal BDNF levels (pg mL-1) measured at T2 time point were higher in the general anaesthesia group compared to the spinal anaesthesia group (p<0.001). Cord blood BDNF levels were higher in the general anaesthesia group compared to the spinal anaesthesia group (p<0.001). In both groups, cord blood BDNF levels were significantly lower compared to the maternal blood samples collected at any time point (p<0.001, for all). There was a negative association between both maternal and cord blood BDNF levels with maternal MDA and cord blood MDA levels, respectively (r=-0.379, p<0.001; r=-0.375, p=0.001, respectively). CONCLUSION: The anaesthetic technique may have an influence on maternal peripheral and cord blood BDNF levels.

The use of ultrasound in planned cesarean delivery under spinal anesthesia for patients having nonprominent anatomic landmarks.

STUDY OBJECTIVE: The aim of the study was to compare conventional landmark method with ultrasound-guided spinal anesthesia in cesarean delivery cases where spinous processes and interspinous spaces were not prominent on physical examination. DESIGN: Randomized controlled clinical trial. SETTING: Operating rooms of university hospital of Erzurum, Turkey. PATIENTS: Sixty-four 18- to 45-year-old American Society of Anesthesiologists I-II patients scheduled for cesarean delivery under spinal anesthesia having hardly palpated anatomic landmarks on vertebral column. INTERVENTIONS: Palpation difficulty of vertebral column landmarks was scored as 0, 1, 2, or 3 from easy to difficult for all patients in sitting position. The patients with score 2 or 3 were randomly allocated into 2 groups as group C (conventional, n=32) and group U (ultrasound, n=32) in which ultrasound guidance was used. MEASUREMENTS: The number of skin punctures, the number of needle steering, the number of puncture tried vertebral levels, and procedure time were all recorded. MAIN RESULTS: The number of skin punctures was significantly lower in group U (P<.001). Successful subarachnoid puncture on first attempt was also significantly higher in group U (P<.01). The duration of procedure in the patients with score 2 was determined to be significantly longer in the ultrasound-guided group (P<.001). CONCLUSIONS: Ultrasound guidance is an effective and safe method to reduce the number of puncture attempts, improve the success rate of subarachnoid access on the first attempt, and reduce the need to puncture multiple levels, although it prolongs procedure time in patients with score 2 according to our scoring system designed for this current study.

Can We Perform Distal Nerve Block Instead of Brachial Plexus Nerve Block Under Ultrasound Guidance for Hand Surgery?

OBJECTIVE: Distal nerve blocks are used in the event of unsuccessful blocks as rescue techniques. The primary purpose of this study was to determine the sufficiency for anesthesia of distal nerve block without the need for deep sedation or general anesthesia. The secondary purpose was to compare block performance times, block onset times, and patient and surgeon satisfaction. MATERIALS AND METHODS: Patients who underwent hand surgery associated with the innervation area of the radial and median nerves were included in the study. Thirty-four patients who were 18-65 years old and American Society of Anesthesiologists grade I-III and who were scheduled for elective hand surgery under conscious nerve block anesthesia were randomly included in an infraclavicular block group (Group I, n=17) or a radial plus median block group (Group RM, n=17). The block performance time, block onset time, satisfaction of the patient and surgeon, and number of fentanyl administrations were recorded. RESULTS: The numbers of patients who needed fentanyl administration and conversion to general anesthesia were the same in Group I and Group RM and there was no statistically significant difference (p>0.05). The demographics, surgery times, tourniquet times, block perfomance times, and patient and surgeon satisfaction of the groups were similar and there were no statistically significant differences (p>0.05). There was a statistically significant difference in block onset times between the groups (p<0.05). CONCLUSIONS: Conscious hand surgery can be performed under distal nerve block anesthesia safely and successfully.

Pneumothorax after trigger point injection: A case report and review of literature.

BACKGROUND: Myofascial pain syndrome is defined as ``pain and/or autonomic phenomena referred from active myofascial trigger points''. Trigger point injection is an effective treatment option, which is widely used to treat myofascial pain. Trigger point injection in the cervicothoracic regions can be associated with pneumothorax. CASE: In this paper, we presented a patient who developed pneumothorax after trigger point injection. RESULT: This case report indicates there is a risk of pneumothorax during trigger point injection in the cervicothoracic regions.

Is infusion of subhypnotic propofol as effective as dexamethasone in prevention of postoperative nausea and vomiting related to laparoscopic cholecystectomy? A randomized controlled trial.

BACKGROUND: Postoperative nausea and vomiting (PONV) is one of common complications in patients undergoing laparoscopic cholecystectomy (LC). Aim of this study was to compare the efficacy of subhypnotic (1 mg/kg/h) infusion of propofol with dexamethasone on PONV in patients undergoing LC. METHODS: A total of 120 patients were included in this randomized, double-blind, placebo-controlled study. Patients were randomly assigned to 3 groups; patients of group dexamethasone (group D) were administrated 8 mg dexamethasone before induction of anesthesia, patients of group propofol (group P) were infused to subhypnotic (1 mg/kg/h) propofol during operation and patients of group control (group C) were applied infusion of 10% intralipid. The incidence of PONV and needs for rescue analgesic and antiemetic were recorded in the first 24 h postoperatively. RESULTS: In the 0-24 h, the incidence of PONV was significantly lower in the group D and group P compared with the group C (37.5%, 40%, and 72.5%, resp.). There was no significant difference in the incidence of PONV and use of antiemetics and analgesic between group D and group P. CONCLUSION: We concluded that infusion of propofol 1 mg/kg/h is as effective as dexamethasone for the prevention of PONV during the first 24 hours after anesthesia in patients undergoing LC.

Does Montelukast Have an Effect on Post-tonsillectomy Pain Control in Children? A Randomized Trial Study.

OBJECTIVE: Tonsillectomy surgery is associated with severe postoperative pain that usually requires analgesics including opioids. Pain control is still a big problem after tonsillectomy surgery. We aimed to evaluate the efficacy of preemptive analgesia using montelukast for pediatric post-tonsillectomy pain management. This is the first-time use of montelukast in post-tonsillectomy pain. STUDY DESIGN: Double-blind, controlled-randomized study. SETTINGS: University teaching and research hospital. SUBJECTS AND METHODS: A total of 60 children, aged 5 to 15 years, American Society of Anesthesiologist class I-II, scheduled for elective tonsillectomy were enrolled in this clinical trial study. The patients were randomized into 2 groups: the montelukast group (group M, n = 30) and control group (group C, n = 30). Group M recieved an oral montelukast tablet and group C recieved placebo at 2400pm on the morning before surgery. Post-tonsillectomy pain was evaluated with the Wong-Baker FACES Scale during the 24 hours after surgery. Patients' intraoperative hemodynamic parameters and intraoperative and postoperative complications were recorded. RESULTS: There were statistically significant differences between group C and group M for Wong-Baker FACES pain rating scale scores (P < .05). In the 24 hours after surgery, the total number of patients using rescue analgesics was higher in group C than in group M, and the difference was statistically significant (P < .001). There was no significant difference in demographic parameters (P > .05). There were no significant differences in postoperative nausea and vomiting, otalgia, trismus, fever, or halitosis between the groups (P > .05). CONCLUSION: Preemptive montelukast can be used safely to reduce the serious pain caused by tonsillectomy in children.