Landmark-guided versus Real-time Ultrasound-guided Combined Spinal-epidural Anesthesia Techniques: Paramedian Sagittal Oblique and Transverse Interlaminar Approach.

Background: There are different types of real-time ultrasound (US)-guided combined spinal epidural (CSE) anesthesia techniques. We aimed to investigate the effect of real-time US-guided paramedian sagittal oblique (PSO), transverse interlaminar (TI) approach method, and landmark-guided (LG) CSE anesthesia. Methods: Ninety patients who underwent CSE block were included in the study. Patients were randomized into LG (n = 30), PSO (n = 30), and TI (n = 30) groups. The primary outcome was number of needle manipulations. The secondary outcomes are the number of attempts, needle visibility, procedure time, procedure success rate, catheter placement difficulty, posterior complex distance, and complications. Results: The number of needle manipulations was statistically significantly lower in the LG technique group (P < 0.000). When the number of attempts, the difficulty of catheter placement, and the procedure's success rate were compared between the three groups, we did not find a statistically significant difference (P > 0.05). In addition, when the procedure times were compared, the time measured for the LG group was statistically significantly lower than in the PSO and TI groups (P < 0.000). Conclusion: In the results of this study, the real-time US-guided CSE anesthesia application had a similar success and complication level with LG technique. The LG method had a shorter processing time and fewer needle manipulations.

Investigation of the effect of kinesiotaping on the respiratory function and depression in male patients with chronic obstructive pulmonary disease: a prospective, randomized, controlled, and single-blind study.

OBJECTIVES: We aimed to investigate the effect of kinesiotaping (KT) on the respiratory parameters as measured by spirometry and depression in the chronic obstructive pulmonary disease (COPD) patients. METHODS: In this prospective, randomized, controlled, single-blind study 42 male patients with COPD diagnosis were randomized into two groups. In Group1 (n = 21) routine COPD medical treatment plus kinesiotaping and in Group2 (n = 21) only routine COPD medical treatment was given. KT was changed on every fifth day (for a total of three times and 15 days). The patients were assessed using Visual Analog Scale (VAS) for difficulty experienced by the patients during respiration, respiratory function test (RFT), modified medical research council (mMRC) dyspnea scale and beck depression inventory (BDI). The data were obtained before treatment and posttreatment. RESULTS: In Group 1; statistically significant improvement was found in all parameters except for FVC and FVC % following treatment compared to pretreatment values. Comparison of the difference scores (the amount of recovery between posttreatment and pretreatment) of the two groups showed significantly superior improvement in Group1 for all parameters except for FVC, FVC % and FEV1% following the treatment (p < .05). CONCLUSIONS: The results of this study showed that supplementary kinesiotaping improved respiratory function and depression significantly compared to only routine medical treatment in COPD patients who were in stable condition.

Comparison of the Efficiency of Ultrasound-Guided Injections of the Rhomboid Major and Trapezius Muscles in Myofascial Pain Syndrome: A Prospective Randomized Controlled Double-blind Study.

OBJECTIVES: We aimed to investigate the effect of ultrasound (US)-guided injections of the rhomboid major (deep) and trapezius (superficial) muscles on pain, disability, and quality of life in patients with myofascial pain syndrome. METHODS: In this prospective randomized controlled double-blind study, 65 patients with a diagnosis of myofascial pain syndrome were randomized into 2 groups. In group 1 (n = 33), US-guided rhomboid major muscle injection was performed, and in group 2 (n = 32), US-guided trapezius muscle injection was performed. The patients were assessed by a visual analog scale for pain, the Pressure Pain Threshold, the Neck Pain and Disability Scale, and Short Form 12. Data were obtained before treatment (week 0), the second week after treatment, and the fourth week after treatment. RESULTS: In both groups, significant improvements were observed for all parameters at both weeks 2 and 4 compared to pretreatment values (P < .05). A comparison of the groups showed significantly superior results in group 1 for all parameters at week 2 (P < .05) and for all parameters but the Physical Component Scale of Short Form 12 at week 4 (P < .05). CONCLUSIONS: We think that US-guided deep injection of the rhomboid major muscle was more effective than superficial injection of the trapezius muscle for pain, disability, and quality of life in patients with myofascial pain syndrome.

Comparison of photobiomodulation therapy and suprascapular nerve-pulsed radiofrequency in chronic shoulder pain: a randomized controlled, single-blind, clinical trial.

Shoulder pain can be difficult to treat due to its complex anatomic structure, and different treatment methods can be used. We aimed to examine the efficacy of photobiomodulation therapy (PBMT) and suprascapular nerve (SSN)-pulsed radiofrequency (RF) therapy. In this prospective, randomized, controlled, single-blind study, 59 patients with chronic shoulder pain due to impingement syndrome received PBMT (group H) or SSN-pulsed RF therapy (group P) in addition to exercise therapy for 14 sessions over 2 weeks. Records were taken using visual analog scale (VAS), Shoulder Pain and Disability Index (SPADI), and Nottingham Health Profile (NHP) scoring systems for pretreatment (PRT), posttreatment (PST), and PST follow-up at months 1, 3, and 6. There was no statistically significant difference in initial VAS score, SPADI, and NHP values between group H and group P (p > 0.05). Compared to the values of PRT, PST, and PST at months 1, 3, and 6, VAS, SPADI, and NHP values were statistically significantly lower in both groups (p < 0.001). There was no statistically significant difference at all measurement times in VAS, SPADI, and NHP between the two groups. We established that PBMT and SSN-pulsed RF therapy are effective methods, in addition to exercise therapy, in patients with chronic shoulder pain. PBMT seems to be advantageous compared to SSN-pulsed RF therapy, as it is a noninvasive method.

One-year follow-up results of intradiscal diode laser, radiofrequency, and pulsed radiofrequency therapies: a retrospective study.

This study aims to investigate the efficacy of three different percutaneous intradiscal therapies in patients with chronic low back pain (CLBP) due to lumbar disc herniation (LDH). Medical files of a total of 120 patients who received percutaneous intradiscal therapy were retrospectively analyzed. All patients were divided into three groups: group L: diode laser (n = 40), group R: radiofrequency (RF) (n = 40), and group P: pulsed radiofrequency (PRF) (n = 40). The visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores were calculated at 1, 3, 6, and 12 months for all patients. One-year follow-up results were as follows: group L: pre-treatment (PreT) VAS 5.6 ± -1, ODI 37.6 ± -4.7, post-treatment 12th month (PT12) VAS 2.8 ± -1.4, ODI 14.1 ± -7.1; group P: PreT VAS 6.0 ± 1, ODI 37.5 ± 5.9, PT12 VAS 3.1 ± 1.3, ODI 20.3 ± 17.0; and group R: PreT VAS 5.6 ± 1.0, ODI 37.9 ± 4.7, PT12 VAS 3.3 ± 1.4, ODI 27.2 ± 14.1. In each of the three groups, there was a statistically significant reduction in the VAS and ODI scores at 1, 3, 6, and 12 months, compared to the baseline values (p < 0.05). The highest reduction in the VAS and ODI scores was observed in group L, whereas the lowest reduction was in group R. We consider that in groups with patient selection criteria at our study; diode laser, RF, and PRF, which are administered using the percutaneous intradiscal route for CLBP patients diagnosed with LDH, may be used as an alternative treatment option.

The efficacy of serratus anterior plane block in analgesia for thoracotomy: a retrospective study.

PURPOSE: A multimodal analgesic approach is necessary for post-thoracotomy pain, which can be severe. Intravenous access, central and peripheral nerve blocks are frequently used. The aim of this study was to evaluate the efficacy of serratus anterior plane block (SAPB) in the management of post-thoracotomy pain. METHODS: A total of 40 patients who underwent thoracotomy between January 2014 and January 2016 were retrospectively analyzed. The patients were divided into two groups: Group M (intravenous patient-controlled analgesia morphine; n = 20) and Group S (intravenous patient-controlled analgesia morphine + SAPB; n = 20). The Visual Analogue Scale (VAS) was used for pain evaluation at the 1st, 2nd, 4th, 6th, 8th, 12th and 24th postoperative hours and morphine consumption was evaluated at the 6th, 12th and 24th postoperative hours. Secondary outcomes were additional analgesic requirement, side effects, the Ramsay Sedation Scale (RSS) scores, block onset time and block level. RESULTS: The VAS scores and the amount of morphine consumed at the 6th, 12th and 24th hours were found to be significantly lower in Group S than in Group M (P < 0.001). No statistically significant difference was found in the rate of side effects, including nausea, vomiting, pruritus, respiratory depression, bradycardia and hypotension, and RSS outcomes between the groups. CONCLUSION: Our study suggests that SAPB is an effective adjuvant treatment option for thoracotomy analgesia.

Efficacy of the greater occipital nerve block in recurrent migraine type headaches.

AIMS: We aimed to evaluate six months of results following repeated GON blocks. METHODS: We evaluated the results from GON block performed on 60 patients. Briefly, we applied a standard 2 mL of 0.5% Bupivacaine GON blockage once a week for 4 weeks. We recorded the Visual Analog Scale (VAS) scores, the number of migraine attacks and the Migraine Disability Assessment Questionnaire (MIDAS) scores. The study subjects were not allowed to use medication for prophylaxis, and Ibuprofen (400 mg, 1200 mg at maximum) was prescribed for any migraine attacks. RESULTS: The initial mean number of attacks per month before starting treatment was 8.33+2.31. After treatment, the initial MIDAS mean was found to be 2.82 per month; this declined to 1.47 in 3rd, and was 1.50 in the 6th month. The individual month values were found to be significant, and were listed respectively as, 1st month: 3.95+2.52, 2nd month: 3.23+1.82, 3rd month: 2.60+1.90, 4th month: 2.68+2.10, 5th month: 2.58+1.90 and 6th month: 2.58+1.90. The mean VAS scores were recorded as follows for each month: 6.28±1.24, 3.13±0.97, 2.55±1.19, 2.35±1.26, 2.38±1.20 and 2.48±1.30, respectively. This difference was noted to be statistically significant. No difference regarding the efficacy of the treatment was determined when the results were compared across age groups. CONCLUSION: We assume that GON blockage with 2 mL of 0.5% Bupivacaine can be a supportive treatment in migraine treatment, with no serious adverse effects reported.

Efficacy of intraarticular application of ketamine or ketamine-levobupivacaine combination on post-operative pain after arthroscopic meniscectomy.

PURPOSE: To evaluate the efficacy of intraarticular injection of ketamine or ketamine plus levobupivacaine on post-operative analgesia in patients undergoing arthroscopic meniscectomy. METHODS: A prospective, randomized, double-blind study was performed on 60 patients aged 18-65 years who planned to undergo elective arthroscopic meniscectomy. The patients were divided into three groups: the ketamine group (n = 20) received 1.0 mg/kg of intraarticular ketamine in 20 ml of normal saline, the ketamine-levobupivacaine group (n = 20) received 0.5 mg/kg of intraarticular ketamine plus 50.0 mg of 0.25 % levobupivacaine in 20 ml of normal saline, and the control group (n = 20) received 20 ml of intraarticular normal saline. A visual analogue scale (VAS) was used to determine the efficacy of analgesia at 1, 2, 4, 6, 8, 12, and 24 h post-operatively. RESULTS: There were statistically significant differences in the median VAS scores among the three groups according to Bonferroni adjustment at all time points (p < 0.01), with the exception of 6 and 24 h post-operatively. The median VAS scores at 1, 2, and 4 h post-operatively were higher in the control group than in the two treatment groups (p < 0.001). The median VAS scores in the control group at 1, 2, 4, 6, 8, and 12 h post-operatively and those in the ketamine group at 4, 8, and 12 h post-operatively were significantly higher than those in the ketamine-levobupivacaine group (p < 0.05). CONCLUSION: Intraarticular ketamine provides effective post-operative analgesia. Addition of intraarticular levobupivacaine to ketamine may provide better amelioration of pain after outpatient arthroscopic meniscectomy.

Effectiveness of the Ultrasound-Guided Interfascial Injection Applied in Addition to Physical Therapy Applications in Chronic Low Back Pain: A Quasi-Experimental Study.

BACKGROUND:  Anatomical and histological features of the thoracolumbar fascia may play an active role in chronic low back pain (LBP). This study aimed to evaluate the efcacy of interfascial injection in patients with LBP. METHODS:  Sixty participants with chronic LBP were recruited for this study. The patients were allocated to 2 groups: physical therapy (PT) (n=30) and PT+interfascial injection (IFI) (n=31, 10mL (0.25% bupivacaine)+methylprednisolone (40 mg) injection into the middle layer between the quadratus lumborum and erector spinae muscle). Outcome measures involved performing Numeric Rating Scale (NRS) and Oswestry Disability Index (ODI) scoring on study participants at pretreatment (PRT), as well as posttreatment at months first, second, fourth, and sixth. RESULTS:  In both groups, NRS and ODI scores were statistically significantly lower than PRT values at the first, second, third, fourth, and sixth months. (P <.05) NRS and ODI scores were significantly lower in the IFI and PT groups compared to the PT group at the first, second, fourth, and sixth months. (P <.05). CONCLUSION:  The study result shows that IFI applied to the middle layer of the thoracolumbar fascia may be efective in individuals with chronic LBP. The efect of fascial structures on LBP should be further investigated.

Orbital doppler ultrasound as an ancillary test for diagnosing brain death: A prospective, single blind comparative study.

OBJECTIVE: Transcranial Doppler ultrasound (TDUS), computed tomography angiography (CTA), and transcranial Doppler ultrasound to detect cerebral blood flow are among the adjunctive tests in diagnosing brain death. This study aimed to investigate the effectiveness of orbital doppler ultrasound (ODUS). METHODS: This prospective, single-blind study included 66 patients for whom brain death was to be diagnosed. Primary outcome measures were ODUS measurements, Ophthalmic artery peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive indices (RI) measurements recorded during the brain death determination process. Secondary outcome measures were computed tomography angio (CTA), transcranial Doppler ultrasound (TDUS), and demographic data. RESULTS: This study investigating the effectiveness of ODUS in diagnosing brain death provided diagnostic success with 100% sensitivity and 93% specificity compared to CT angiography. It was noted that anatomical variations may limit its use. CONCLUSION: ODUS was found to have high sensitivity and specificity in the diagnosis of clinical brain death. It may assist in early prognostic assessment and shorten patient follow-up and diagnostic processes.

Ultrasound-guided external oblique and rectus abdominis plane "EXORA" block for postoperative pain after laparoscopic cholecystectomy: a propensity-matched study.

BACKGROUND: Various types of plane blocks are used for analgesia in the upper abdomen. The purpose of this study was to evaluate the efficacy of the external oblique and rectus abdominis plane (EXORA) block for antero-lateral upper abdominal analgesia. METHODS: This study included 60 patients undergoing laparoscopic cholecystectomy. Patients were divided into control group, intravenous patient-controlled analgesia (IV.PCA) (N.=30) and EXORA group (block with 25 mL 0.25% bupivacaine + IV.PCA [N.=30]). Postoperative pain (at rest) was evaluated at 30 minutes, two, four, six, 12 and 24 hours using Visual Analogue Scale (VAS) scores. Postoperative activity pain at two, four, six, 12 and 24 hours was also assessed using VAS. Secondary outcomes included tramadol use at 12 and 24 hours after surgery, side effect profile, dermatomal spread, and additional analgesic use. RESULTS: The VAS scores were statistically significantly lower in the EXORA group compared to the other groups (P<0.001). In addition, mean tramadol consumption at 12 and 24 hours was statistically significantly lower in the EXORA group (P<0.001). Sensory block was recorded in the lateral and anterior abdomen at T6 to T11 after EXORA block application. CONCLUSIONS: The EXORA block used to provide analgesia after laparoscopic cholecystectomy provides analgesia to the upper abdominal wall. Further data may be obtained from cadaveric studies and other studies.

Effect of interfascial pressure on block success during anterior quadratus lumborum block application: a prospective observational study.

BACKGROUND: The quadratus lumborum block (QLB) has recently been used frequently for postoperative analgesia after abdominal surgery. The aim of this study was to investigate the effect of pressure changes between the middle thoracolumbar fascia layers to which the anterior QLB (aQLB) is applied at the level of the sensory block. METHODS: A total of 67 patients planned to undergo laparoscopic cholecystectomy were evaluated in the context of this prospective study. Bilateral aQLBs were administered to all patients, and a peripheral nerve block catheter was placed between the psoas and quadratus lumborum muscles. The correlation of interfascial pressures (IFPs) during block application, 30 min intraoperatively, and 30 min postoperatively with the sensory block level was determined as the primary outcome measure. Secondary outcome measures were the sensory block levels 30 min after block application and 30 min postoperatively; visual analog scale scores 30 min and 6, 12, and 24 h postoperatively; and 24 h tramadol consumption. RESULTS: The preoperatively and intraoperatively measured IFPs differed significantly between the right and left sides (P < 0.05). The preoperative and postoperative block levels also differed significantly between the right and left sides (P < 0.05). The preoperative and postoperative block levels and preoperatively measured IFPs showed a weakly negative correlation (right: r = 0.374; left: r = 0.470). CONCLUSIONS: The results of this study show that pressure changes between the fasciae may be effective in aQLB application.

The effect of different regional analgesia methods on chronic pain after thoracic surgery.

Introduction: Chronic postsurgical pain (CPSP) is defined as pain persisting for ≥ 3 months after surgery, severely impairing patients' long-term daily activities and quality of life. Aim: To evaluate the effects of various regional analgesia methods, including thoracic epidural (TE), serratus anterior plane (SAP) block, rhomboid intercostal block (RIB) and paravertebral block (PVB), on the incidence of chronic post-thoracic surgery pain. Material and methods: A total of 489 patients (240 thoracotomy, 249 VATS) were included in the analysis. The primary outcome measure was the VAS score (postoperative 6th month), while the secondary outcome measures were the LANSS score (postoperative 6th month), the use of analgesic medication and descriptive information. Results: In thoracotomy patients, VAS scores were statistically significantly lower in patients who underwent RIB and SAP block compared to those who underwent TE and patient-controlled anesthesia (PCA). LANSS scores did not differ between the RIB, SAP and TE groups, while higher scores were found in the PCA group. After VATS, VAS scores were statistically significantly lower in patients who underwent RIB, SAP and PVB block compared to the PCA group. LANSS scores were statistically significantly lower in the RIB and SAP block groups than in the PVB and PCA groups. Conclusions: This study found that patients who received regional anesthesia had lower LANSS scores and VAS values, indicative of neuropathic pain reduction, following thoracotomy and VATS procedures.

Application of unilateral rhomboid intercostal and subserratus plane block for analgesia after laparoscopic cholecystectomy: a quasi-experimental study.

BACKGROUND: Interfascial plane block can be used to treat postoperative pain after laparoscopic surgery. This study aimed to investigate the effect of ultrasound-guided unilateral rhomboid intercostal and subserratus plane (RISS) block after laparoscopic cholecystectomy on the amount of analgesic consumption. METHODS: Fifty patients who underwent laparoscopic cholecystectomy were included in this quasi-experimental study. Patients fulfilling the inclusion criteria were analyzed in two groups: RISS group (RISS block with 20 ml of 0.25% bupivacaine + intravenous patient-controlled analgesia [IV-PCA] tramadol [n = 25]); and Control group (IV-PCA tramadol [n = 25]). The primary outcome was the total amount of tramadol used over 24 h. Secondary outcomes included side effects, additional analgesic use, and postoperative pain (at rest and during activity) at 2, 6, 12, and 24 h according to numerical rating scale (NRS) scores. RESULTS: Postoperative tramadol consumption at 24 h was significantly lower in the RISS group than in the Control group (P < 0.001). Resting NRS scores at 2 h and 6 h were significantly lower in the RISS group. NRS scores during movement in the RISS group were significantly lower at 2, 6, and 12 h postoperatively. There was no statistically significant difference in the rate of side effects and additional analgesic use between the groups (P > 0.05). CONCLUSIONS: Unilateral RISS block was an effective method for pain management after laparoscopic cholecystectomy and can be used as a part of multimodal analgesia.

Comparison of two different lung ultrasound imaging protocols in COVID-19 pneumonia.

PURPOSE: The aim of this study was to determine the effectiveness of two different lung ultrasonography (LUS) methods that can be used in the diagnosis of coronavirus disease 2019 (COVID-19) and to investigate their correlations with computed tomography (CT). METHODS: In this prospective, randomized, and single-blind study, 60 patients with COVID-19 were included. The patients were randomized to either the 12-zone LUS group (n=30) or the 14-zone LUS group (n=30). The correlation between LUS and thoracic CT scores was evaluated. As a secondary outcome measure, the characteristic features of the findings of thoracic CT and LUS were examined. RESULTS: The study was completed with a total of 59 patients. Moderate and high correlations were found between the total CT and LUS scores in the 12-zone and 14-zone study groups. There were no statistically significant differences in the lesion types detected in patients using LUS and CT (P>0.05). The left lung lower lobe CT scores were statistically significantly lower in the 14-zone study group than in the 12-zone group (P=0.019). The left lower lobe CT and LUS scores were highly correlated in the 14-zone group (P<0.001, r=0.902). CONCLUSION: The results of our study indicated that the two different LUS examination methods performed in different patients had similar findings in terms of the diagnosis and their correlations with CT results.

Rhomboid Intercostal and Serratus Anterior Interfascial Plane Blocks for the Treatment of Post-Operative Pain after Video-Assisted Thoracoscopic Surgery: A Retrospective Propensity-Matched Study.

OBJECTIVE: Video-assisted thoracoscopic surgery (VATS) techniques are commonly used for surgical procedures within the thoracic cavity with smaller incisions. There are very few regional anesthesia methods used to achieve this goal. This study aimed to investigate the effect of two fascial plane block technique rhomboid intercostal block (RIB) and serratus anterior plane block (SAPB) administered on pain scores after VATS. METHODS: A total of 90 patients who underwent VATS were included in this study. Patients were divided in three groups: Group R (intravenous patient-controlled analgesia (IV. PCA) +RIB with (25 mL 0.25% bupivacaine; n=30), Group S (IV. PCA + SAPB with (25 mL 0.25% bupivacaine; n=30), and Group C (IV. PCA). The primary outcome was determined as a tramadol consumption amount (at hours 6, 12, and 24). Postoperative pain was evaluated using the VAS (at the 30th minute, 2nd, 6th, 12th, and 24th hours) scores. Secondary outcomes included the side effect profile and additional analgesic use. RESULTS: VAS scores of the Group R were found to be statistically significantly lower to those of Group S and Group C (p<0.05). A comparison of Groups R and S with Group C in terms of tramadol consumption amounts, at all measurement time points, revealed statistically significantly lower values (p<0.005). CONCLUSION: As per the results of this study, we believe that RIB and SAPB administration for pain palliation after VATS is an effective analgesia technique.

Comparison of lung ultrasonography findings with chest computed tomography results in coronavirus (COVID-19) pneumonia.

PURPOSE: The purpose of our study was to determine the usability of lung ultrasonography (LUS) in the diagnosis of COVID-19, and to match the morphological features of lesions detected on computed tomography (CT) with the findings observed on LUS. METHODS: Sixty patients with COVID-19 were included in this prospective study. Patients were examined by radiology and anesthesia clinic specialists for a visual CT score. A LUS 12-zone ultrasonography protocol was applied by the investigator blinded to the CT and PCR test results. The characteristics of abnormal findings and the relationship of lesions to the pleura and the distance to the pleura were investigated. RESULTS: Forty-five males and 25 females evaluated within the scope of the study had an average age of 61.2 ± 15.3 years. The total CT score was calculated as 14.3 ± 5.3, and the LUS score was found to be 19.9 ± 7.6. There was a statistically significant positive correlation between the measured LUS and CT scores (r = 0.857, p < 0.001). The mean distance of these lesions to the pleura was 5.2 ± 1.76 cm. LUS findings in 51 areas corresponded to non-pleural lesions on CT. There was a negative correlation between the measured distance to the pleura and the LUS scores (p < 0.001, r = - 0.708). CONCLUSION: The results of this study showed that the correlation between CT and LUS findings may be used in the diagnosis of COVID-19 pneumonia, although there are some limitations. ClinicalTrials.gov identifier: NCT04719234.

Effect of Various Modes of Mechanical Ventilation in Laparoscopic Cholecystectomies on Optic Nerve Sheath Diameter and Cognitive Functions.

Aim: In this study, we aim at investigating the effects of volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) modes on changes in the optic nerve diameter and cognitive functions in laparoscopic cholecystectomy operations. Materials and Methods: Sixty patients who underwent laparoscopic cholecystectomy were randomly divided into two groups based on the mode of mechanical ventilation provided: Group P; PCV, Group V; VCV. Optic nerve sheath diameter was measured when the patient was awake (T0), in the 10th minute after induction (T1), in the 10th minute after the initiation of gas insufflation (T2), when maximum gas pressure was reached in the reverse-Trendelenburg position (T3), and pre-extubation (T4). Partial oxygen saturation (PaO2), PCO2, end-tidal carbon dioxide (ETCO2), and peak airway pressure (pPEAK) were also recorded. A Mini-Mental State Examination (MMSE) was conducted on patients preoperatively and in the postoperative third month. Results: Between the groups, a statistically significant difference was found in Group P compared with Group V in terms of optic nerve diameter at measurement times T1 (P < .05). In the intragroup comparison, a significant difference was found in the initial values in all measurements except for measurement times T0 and T4 in both Group P and Group V (P < .05). pPEAK values were identified to be statistically significantly lower in Group P than Group V at all measurement times (P < .05). No difference was identified in the MMSE scores in the intergroup and intragroup comparisons. Conclusion: Laparoscopic cholecystectomy increases the optic nerve diameter due to the mechanical and systemic effects of the operation, and the PCV mode can be preferred. Clinical Trial Number: NCT04413903.

Ultrasound-guided anterior quadratus lumborum block for postoperative pain after percutaneous nephrolithotomy: a randomized controlled trial.

BACKGROUND: The Quadratus Lumborum Block (QLB), which is reported to provide analgesia to the abdominal region, is a newly defined fascial plane block method. The present study aimed to investigate the effect of ultrasound guided anterior QLB on the postoperative pain scores after percutaneous nephrolithotomy. METHODS: In this prospective, randomized, controlled single-blind study, 60 patients with elective percutaneous nephrolithotomy operations were randomized into 2 groups. In Group B (n = 30): anterior QLB+ intravenous patient-controlled analgesia (PCA) morphine and in Group C (n = 30): intravenous PCA morphine. Outcome measures were included for visual analog scale (VAS) scores and morphine consumption for 24 hours postoperatively. Adverse effects, additional analgesic requirement, and intraoperative opioid requirement were recorded. RESULTS: The mean values of the quantity of morphine used at the 6th, 12th, and 24th hours were found to be statistically significantly lower in Group B (p < 0.05). The VAS scores were found to be statistically significantly lower in Group B (p < 0.05). There were no statistically significant differences in the rate of adverse effects, additional analgesic requirement, and intraoperative opioid requirement between the groups (p > 0.05). CONCLUSION: The study results suggest that anterior QLB is an effective treatment option for postoperative analgesia of percutaneous nephrolithotomy.