Lumbar erector spinae plane block versus infrainguinal fascia iliaca compartment block for pain management after total hip arthroplasty: a randomized clinical trial.

OBJECTIVE: We aimed to evaluate the effectiveness of ultrasound-guided facia iliaca compartment (FIC) and erector spinae plane (ESP) blocks in managing postoperative pain after total hip arthroplasty surgery. METHODS: A total of 60 patients were randomized into 2 groups (n = 30): one that received FIC blocks and one that received ESP blocks. FIC and ESP blocks were performed with 30 mL 0.25% bupivacaine at the end of the surgery. The patients received intravenous tramadol and patient-controlled postoperative analgesia. The pain scores, opioid consumption, and adverse events were recorded. RESULTS: The dynamic pain scores on movement in the postoperative first hour were significantly lower in the ESP block group than in the FIC block group (3 [2-4] vs 4 [2-5], respectively; P = .035). Data are expressed as median (25th-75th percentiles). Postoperative opioid consumption within the first postoperative 8 hours was significantly higher in the FIC block group than in the ESP block group (80 mg [61-100] vs 100 mg [80-120], respectively; P = .010). The adverse effects of opioids did not differ between the 2 groups. CONCLUSION: ESP and infrainguinal FIC blocks provided similar postoperative analgesia 24 hours after total hip arthroplasty. The ESP block is more beneficial than the FIC block in terms of pain scores and opioid consumption in the early hours of the postoperative period. TRIAL REGISTRATION: www.ClinicalTrials.gov (ID: NCT05621161).

Neostigmine versus sugammadex on post-operative recovery following bariatric surgery.

OBJECTIVE: The purpose of our study was to compare the recovery characteristics and side effects of sugammadex (SM) and neostigmine (NT) in morbidly obese patients undergoing bariatric surgery. Residual neuromuscular block is a serious condition that increases pulmonary complications after anesthesia. Although acetylcholinesterase inhibitors help reverse this block, they may be insufficient, especially when administered with inhalational anesthetics. SM, a selective antagonist, may be more effective in reversing the block. METHODS: Patients were randomly divided into NT group (Group NT, n=34) and SM group (Group SM, n=34).For the induction, fentanil (1-1.5 µ/kg), propofol (2-3 mg/kg), and rocuronium (0.6 mg/kg) were used.For the maintenance, 50% O2 + air, 1% sevoflurane, and remifentanil (0.5-0.3 µg/kg/min) were used. Additional rocuronium was given to maintain the train of four (TOF) ratio ≤2. On completion of surgery and when the TOF ratio was 2, group NT received 50 µg/kg of NT with 20 µg/kg of atropine, whereas group SM received 2 mg/kg of SM. Hemodynamic parameters and peripheral oxygen saturation (SpO2) were recorded every 10 minfirst, and every 5 min after the reversal agents were given. When the TOF ratio was 0.9 or higher, time to reach a TOF ratio of 0.9, and time to extubation were recorded. Patients were observed in the recovery room for 30 min for adverse effects. RESULTS: Demographic characteristics of the patients and total rocuronium use in two groups were similar (p>0.05).Time to extubation, time to TOF ratio of 0.9, time until patients responded to stimuli, time until cooperation, and time until orientation were significantly shorter in the SM group than in the NT group. Time to reach the Aldrete score of 9 was also significantly shorter in the SM group (p<0.05).In the post-operative period, hemodynamic variables and side effects such asrespiratory difficulty, nausea, vomiting, hypo/hypertension, and presence of pain showed no statistically significant differences between the groups (p>0.05). CONCLUSION: Considering the high risk of post-operative respiratory insufficiency inmorbidly obese patients, SM could be a safer choice in this patient group.

The Effect of sevoflurane, desflurane and propofol on respiratory mechanics and integrated pulmonary index scores in laparoscopic sleeve gastrectomy. A randomized trial.

OBJECTIVES: To compare the effects of sevoflurane, desflurane, and propofol on respiratory mechanics, and integrated pulmonary index (IPI) scores in patients undergoing laparoscopic sleeve gastrectomy. METHODS: A total of 60 patients with a body mass index of ≥40 kg/m2, who underwent laparoscopic sleeve gastrectomy between September 2015 and September 2016 at Fatih Sultan Mehmet Health Application and Research Center, Istanbul, Turkey were included in this randomized prospective study. After induction, anesthesia was maintained by sevoflurane in group S, desflurane in group D, and propofol in group P. Peak inspiratory pressure (PIP), plateau pressure (Pplateau), compliance (Cdyn), respiratory resistance (Rrs), and IPI values were recorded. Mann-Whitney U, Kruskal- Wallis, Dunn's, Friedman, and Fisher-Freeman- Halton tests were performed for statistical analysis. A p value of less than 0.05 was considered statistically significant. RESULTS: A significant increase was found in PIP in group S (T1: 25; T2: 27 cmH2O), and group D (T1: 25; T2: 29,5 cmH2O) during pneumoperitoneum. Dynamic compliance decreased in all groups during pneumoperitoneum. In group S, the decrease in Cdyn was also statistically significant after pneumoperitoneum(T1:43.65;T5:41.25ml/cmH2O). Comparison between groups the values of PIP, Pplateau, Cdyn, Rrs, and IPI were similar. CONCLUSION: In morbidly obese patients, sevoflurane, desflurane, and propofol are similar in terms of the intraoperative respiratory mechanics, and perioperative respiratory parameters provided with IPI.

[Analgesia Nociception Index for perioperative analgesia monitoring in spinal surgery]. / Índice de analgesia/nocicepção para monitorização da analgesia perioperatória na cirurgia da coluna vertebral.

BACKGROUND AND OBJECTIVES: The Analgesia Nociception Index is an index used to measure the levels of pain, sympathetic system activity and heart rate variability during general anesthesia. In our study, Analgesia Nociception Index monitoring in two groups who had undergone spinal stabilization surgery and were administered propofol-remifentanil (Total Intravenous Anesthesia) and sevoflurane-remifentanyl anesthesia was compared regarding its significance for prediction of postoperative early pain. METHODS: BIS and Analgesia Nociception Index monitoring were conducted in the patients together with standard monitoring. During induction, fentanyl 2µg.kg-1, propofol 2.5mg.kg-1 and rocuronium 0.6mg.kg-1 were administered. During maintenance, 1.0 MAC sevoflurane+remifentanil 0.05-0.3µg.kg-1.min-1 and propofol 50-150µg.kg-1.min+remifentanil 0.05-0.3µg.kg-1.min-1 were administered in Group S and Group T, respectively. Hemodynamic parameters, BIS and Analgesia Nociception Index values were recorded during surgery and 30min postoperatively. Postoperative visual analog scale (VAS) values at 30minutes were recorded. RESULTS: While no difference was found between mean Analgesia Nociception Index at all times of measurement in both groups, Analgesia Nociception Index measurements after administration of perioperative analgesic drug were recorded to be significantly higher compared to baseline values in both groups. There was correlation between mean values of Analgesia Nociception Index and VAS after anesthesia. CONCLUSION: Analgesia Nociception Index is a valuable parameter for monitoring of perioperative and postoperative analgesia. In spine surgery, similar analgesia can be provided in both Total Intravenous Anesthesia with remifentanil and sevoflurane administration. Analgesia Nociception Index is efficient for prediction of the need for analgesia during the early postoperative period, and therefore is the provision of patient comfort.

Effect of intra-abdominal pressure level on gastric intramucosal pH during pneumoperitoneum.

The present study was designed to examine the effect of intra-abdominal pressure level on gastric intramucosal pH using gastric tonometry during pneumoperitoneum. One hundred patients were prospectively randomized into 5 equal groups (N = 20 each). Intra-abdominal pressure levels were 8, 10, 12, 14, and 16 mm Hg in groups I, II, III, IV, and V, respectively. Intramucosal pH measurement was done 2 times: 30 minutes following insufflation and 1 hour after the ending of the surgery. In the first and second measurements, intramucosal pH values were found as 7.39 +/- 0.02 and 7.36 +/- 0.03 in group I; 7.41 +/- 0.03 and 7.38 +/- 0.03 in group II; 7.37 +/- 0.03 and 7.37 +/- 0.03 in group III; 7.36 +/- 0.03 and 7.37 +/- 0.03 in group IV; and 7.39 +/- 0.03, 7.36 +/- 0.03 in group V, respectively. Statistical significance was not found in the comparison of these values within the groups and between the groups (P > 0.005, for each). In conclusion, intra-abdominal pressure between 8 and 16 mm Hg did not cause significant difference in gastric intramucosal pH.

Analgesia Nociception Index for perioperative analgesia monitoring in spinal surgery / Índice de analgesia/nocicepção para monitorização da analgesia perioperatória na cirurgia da coluna vertebral

Abstract Background and objectives: The Analgesia Nociception Index is an index used to measure the levels of pain, sympathetic system activity and heart rate variability during general anesthesia. In our study, Analgesia Nociception Index monitoring in two groups who had undergone spinal stabilization surgery and were administered propofol-remifentanil (Total Intravenous Anesthesia) and sevoflurane-remifentanyl anesthesia was compared regarding its significance for prediction of postoperative early pain. Methods: BIS and Analgesia Nociception Index monitoring were conducted in the patients together with standard monitoring. During induction, fentanyl 2 µg.kg-1, propofol 2.5 mg.kg-1 and rocuronium 0.6 mg.kg-1 were administered. During maintenance, 1.0 MAC sevoflurane + remifentanil 0.05-0.3 µg.kg-1.min-1 and propofol 50-150 µg.kg-1.min-1 + remifentanil 0.05-0.3 µg.kg-1.min-1 were administered in Group S and Group T, respectively. Hemodynamic parameters, BIS and Analgesia Nociception Index values were recorded during surgery and 30 min postoperatively. Postoperative visual analog scale (VAS) values at 30 minutes were recorded. Results: While no difference was found between mean Analgesia Nociception Index at all times of measurement in both groups, Analgesia Nociception Index measurements after administration of perioperative analgesic drug were recorded to be significantly higher compared to baseline values in both groups. There was correlation between mean values of Analgesia Nociception Index and VAS after anesthesia. Conclusion: Analgesia Nociception Index is a valuable parameter for monitoring of perioperative and postoperative analgesia. In spine surgery, similar analgesia can be provided in both Total Intravenous Anesthesia with remifentanil and sevoflurane administration. Analgesia Nociception Index is efficient for prediction of the need for analgesia during the early postoperative period, and therefore is the provision of patient comfort.

Resumo Justificativa e objetivos: O índice de analgesia/nocicepção (ANI) é usado para medir os níveis de dor, a atividade do sistema simpático e a variabilidade da frequência cardíaca durante a anestesia geral. Em nosso estudo, a monitoração do ANI em dois grupos que foram submetidos à cirurgia de estabilização da coluna vertebral e receberam propofol-remifentanil (Total Intravenous Anesthesia - TIVA) e sevoflurano-remifentanil foram comparados para identificar sua importância na previsão precoce de dor no pós-operatório. Métodos: Os pacientes foram monitorados com o uso de BIS e ANI juntamente com a monitoração padrão. Durante a indução, fentanil (2 µg.kg-1), propofol (2,5 mg.kg-1) e rocurônio (0,6 mg.kg-1) foram administrados. Durante a manutenção, 1 CAM de sevoflurano + remifentanil (0,05-0,3 µg.kg-1.min-1) e propofol (50-150 µg.kg-1.min-1) + remifentanil (0,05-0,3 µg.kg-1.min-1) foram administrados aos grupos S e T, respectivamente. Parâmetros hemodinâmicos, valores de BIS e ANI foram registrados durante a cirurgia e aos 30 minutos de pós-operatório. Os valores escala visual analógica (EVA) aos 30 minutos de pós-operatório foram registrados. Resultados: Enquanto não observamos diferença entre as médias do ANI em todos os tempos de mensuração de ambos os grupos, as mensurações do ANI após a administração do analgésico no perioperatório foram significativamente maiores do que os valores basais de ambos os grupos. Houve correlação entre as médias dos valores de ANI e EVA após a anestesia. Conclusão: ANI é um parâmetro importante para o monitoração de analgesia nos períodos perioperatório e pós-operatório. Na cirurgia da coluna vertebral, analgesia semelhante pode ser obtida com anestesia intravenosa total com remifentanil e com a administração de sevoflurano. O ANI é eficiente para prever a necessidade de analgesia durante o período pós-operatório imediato e, portanto, para proporcionar conforto ao paciente.