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PURPOSE: Spinal decompression surgery causes severe pain. Retrolaminar block (RLB) is block, which is done by infiltration of local anesthetic to block spinal nerves between the lamina and superior costotransversospinalis muscle. The primary aim of this study is to evaluate the effectiveness of RLB on postoperative analgesia in patients undergoing spinal surgery. Secondary aims are effects on additional anesthetic and analgesic consumption. METHODS: The sixty (60) patients who underwent lumbar spinal surgery between May 2020 and May 2021 under general anesthesia with or without applied preemptive RLB for postoperative analgesia were included in this prospective observational study. Group I received ultrasound-guided preemptive RLB. In Group II, no intervention was performed. Postoperative VAS scores were compared in groups as primary outcome, perioperative additional anesthetic and analgesic needs were compared as secondary outcome. RESULTS: There was a significant difference between the groups in favor of the RLB group in terms of postoperative VAS scores at rest [1.33 (0.33-3.509)] and movement [2.40 (1.20-4.00)] (p < 0.001). Perioperative sevoflurane consumption was significantly low in block group (p < 0.001). Postoperative tramadol consumption was lower in Group I compared with Group II [Group 1: 200 (100-300); Group 2: 37.5 (0-200); p < 0.001]. CONCLUSION: Preemptive RLB may be used to reduce patients' pain in lumbar decompression surgery as well as to be part of a multimodal analgesia and anesthesia regimen to reduce anesthetic and analgesic drug consumption. Trial registration numberClinicalTrials.gov (No. NCT04209907).
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AIMS: This study aimed to compare the efficacy of gabapentin, dexamethasone, and gabapentin + dexamethasone for pain control after septoplasty. MATERIALS AND METHODS: This prospective randomized trial included 120 patients that underwent septoplasty and were randomly divided into 4 groups: group G (preoperative gabapentin 600 mg p.o.); group D (intraoperative dexamethasone 8 mg i.v.); group GD (preoperative gabapentin 600 mg p.o. + intraoperative dexamethasone 8 mg i.v.); group C (placebo control). RESULTS: The median VAS score was significantly lower in groups G and GD at 1, 2, 4, 6, 12, and 24 hours postsurgery than in group C (P < .008 for all). The median VAS score was significantly lower in group D than in group C at 1, 2, and 4 hours postsurgery (P < .008 for all). There weren't any significant differences in the VAS score between groups D, G, and GD at any time point. Groups G, D, and GD had a significantly lower frequency of rescue analgesic use than group C; however, there were no differences between groups G, GD, and C (P < .001 and P = .108, respectively). CONCLUSION: Gabapentin, dexamethasone, and gabapentin + dexamethasone are equally more effective analgesics during the first 4 hours postsurgery than placebo. The addition of dexamethasone to gabapentin does not provide extra analgesia. Both gabapentin and gabapentin + dexamethasone have a more prolonged analgesic effect than dexamethasone alone.
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Analgesia , Ácidos Cicloexanocarboxílicos , Humanos , Gabapentina/uso terapêutico , Estudos Prospectivos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Analgésicos/uso terapêutico , Dexametasona , Método Duplo-Cego , Ácidos Cicloexanocarboxílicos/uso terapêutico , Aminas/uso terapêuticoRESUMO
BACKGROUND: Bleeding during rhinoplasty leads to many undesirable effects, such as loss of vision in the surgery area, complications during the procedure, and postoperative complications. The most important effect that increases bleeding is hemodynamic changes during surgery. Considering that osteotomy is the most challenging process in rhinoplasty, this study aimed to examine the hemodynamic changes during osteotomy and changes in the depth of anesthesia. METHODS: A total of 50 patients, aged 18 to 65 years with an ASA (American Society of Anesthesiology) score of 1 and 2, who underwent osteotomy during rhinoplasty under general anesthesia, were examined retrospectively. After routine monitoring, the patients underwent general anesthesia induction and endotracheal intubation. Before the surgery, they received remifentanil 1âµg/kg as an intravenous bolus followed by 0.5âµg/(kg·min) as intravenous infusion until the end of the surgery. The hemodynamic parameters and depth of anesthesia [bispectral index (BIS) values] of the patients were examined before anesthesia, 10âminutes before osteotomy, during osteotomy, and 10âminutes after osteotomy. RESULTS: A significant difference was found in heart rate (beats/min), systolic and diastolic blood pressures (mm Hg), and BIS values of the patients measured before, during, and after osteotomy (P < 0.001). The heart rate, systolic and diastolic blood pressures, and BIS values were significantly higher during osteotomy. Until the 10th minute after osteotomy, all 4 parameters nearly reached the values measured before osteotomy. CONCLUSIONS: Osteotomy directly affects hemodynamic parameters and depth of anesthesia. Hence, it is of utmost importance that the analgesic need and depth of anesthesia are adequately monitored and adjusted during osteotomy. By suppressing hemodynamic stress responses, the amount of bleeding can be reduced, thus increasing the surgical success and the patient's comfort.
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Rinoplastia , Adolescente , Adulto , Idoso , Anestesia Geral , Pressão Sanguínea/efeitos dos fármacos , Feminino , Frequência Cardíaca/efeitos dos fármacos , Hemodinâmica/efeitos dos fármacos , Humanos , Infusões Intravenosas , Intubação Intratraqueal , Masculino , Pessoa de Meia-Idade , Osteotomia , Remifentanil/farmacologia , Estudos Retrospectivos , Adulto JovemRESUMO
Background: Erector spinae plane (ESP) block has been increasingly suggested for laparoscopic cholecystectomy (LC) as a part of multimodal analgesia in many studies. However, there is not any study that investigated the perioperative effects of ESP block on anesthetic agent consumption and cost of LC anesthesia. This is the first study that evaluates the effect of ESP block in terms of cost-effectiveness, intraoperative consumption of inhalation agents, and perioperative consumption of opioids. Materials and Methods: In this prospective observational study, 81 patients who underwent LC were included. Patients were divided into two groups: In Group ESP (n = 39) bilateral ultrasound-guided ESP block was performed in preoperative period and in Group non-ESP (n = 42) ESP block was not performed. After standard general anesthesia protocol, anesthesia was maintained with 2% sevoflurane in 50% air and 50% oxygen with controlled ventilation in both groups. All patients were monitored with electrocardiography, noninvasive blood pressure, pulse oximetry, end-tidal carbon dioxide, and bispectral index. The consumption of sevoflurane and opioids in the intraoperative and postoperative 24 hours was recorded. The costs of drugs were determined by multiplying total consumed amounts with unit prices. Results: The costs and the consumed amounts of remifentanyl, sevoflurane, and tramadol were significantly higher in non-ESP group in the perioperative period (respectively, P < .001, P = .01, and P < .001). Conclusions: ESP block for LC decreased the consumed amount and cost of inhaled agents and opioids in the perioperative period.
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Anestésicos Locais , Bupivacaína , Colecistectomia Laparoscópica , Análise Custo-Benefício , Bloqueio Nervoso/métodos , Músculos Paraespinais/inervação , Adolescente , Adulto , Idoso , Analgésicos Opioides/economia , Analgésicos Opioides/uso terapêutico , Anestésicos Inalatórios/economia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Bloqueio Nervoso/economia , Manejo da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/economia , Dor Pós-Operatória/prevenção & controle , Estudos Prospectivos , Sevoflurano/economia , Turquia , Adulto JovemRESUMO
Objective: The aim of this study was to compare the effectiveness of epidural block (EDB) and paravertebral block (PVB) for minimally invasive pectus repair with the conventional method in terms of pain control during and after pectus operations, patient comfort, and length of stay in hospital. Materials and Methods: A retrospective review was made of patients who underwent minimally invasive pectus repair. The patients were allocated into three groups as follows: PVB group (Pre-emptive ultrasound-guided bilateral thoracic single injection PVB, n = 15); EDB group (Pre-emptive landmark-guided single injection thoracic EDB, n = 8); and Control group (Neither PVB nor EPB, n = 9). The intraoperative analgesic requirement was recorded, and a visual analog scale (VAS) for pain evaluation and the Postoperative Patient Satisfaction Scale were applied to all patients. Results: The intraoperative analgesic requirement, VAS scores, postoperative satisfaction level, and time to first requirement for postoperative analgesia were different between the control and PVB groups (P < .001) and between the control and EDB groups (P < .001), but not different between the PVB and EDB groups. Although the length of stay in hospital was shorter in the PVB and EDB groups compared to the control group, the difference was not statistically significant (P = .422). Conclusion: Epidural and bilateral paravertebral blockades performed in conjunction with general anesthesia decrease the intraoperative and postoperative need for analgesics, and might be beneficial for pain management and contribute to a shorter length of hospital stay for patients undergoing minimally invasive pectus repair operations. Both blockades also significantly improved the patient satisfaction.
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Anestesia Epidural , Tórax em Funil/cirurgia , Bloqueio Nervoso , Dor Pós-Operatória/prevenção & controle , Pectus Carinatum/cirurgia , Adolescente , Analgésicos/uso terapêutico , Anestesia Geral , Feminino , Humanos , Tempo de Internação , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Bloqueio Nervoso/métodos , Medição da Dor , Satisfação do Paciente , Estudos Retrospectivos , Adulto JovemAssuntos
Anestesia Obstétrica/métodos , Biomarcadores/sangue , Parto Obstétrico/métodos , Troponina T/sangue , Adolescente , Adulto , Biomarcadores/análise , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/diagnóstico , Estudos de Coortes , Feminino , Humanos , Pessoa de Meia-Idade , Complicações do Trabalho de Parto/sangue , Complicações do Trabalho de Parto/diagnóstico , Gravidez , Estudos Retrospectivos , Troponina T/análise , Adulto JovemRESUMO
Pressure ulcers are a common problem in intensive care unit (ICU). Recently, topical sevoflurane has been used especially for treatment of venous ulcers and infected skin ulcers. We present a case of topical sevoflurane treatment of a pressure ulcer. Treatment was applied for one month without any antibiotic supplementation. After one month, the ulcer size was decreased, necrotic tissues were cleared, and wound cultures were negative. There are three beneficial effects of local sevoflurane treatment: good analgesic action, antibiotic effects, and acceleration of wound healing. These beneficial effects may make sevoflurane an alternative treatment for pressure ulcers in an ICU.
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Úlcera por Pressão/tratamento farmacológico , Sevoflurano/administração & dosagem , Cicatrização/efeitos dos fármacos , Administração Tópica , Idoso , Feminino , Humanos , Inibidores da Agregação Plaquetária/administração & dosagem , Úlcera por Pressão/diagnóstico , Região SacrococcígeaRESUMO
INTRODUCTION: Flap surgery is one of the most commonly used techniques of reconstructive surgery for effective repair of damaged tissue. Optimal anesthetic technique and anesthetic agent plays an important role in flap perfusion. This study aimed to evaluate the effects of dexmedetomidine infusion on the microcirculation in the cremaster muscle flap by direct in vivo monitoring. MATERIALS AND METHODS: We randomly divided 9 Wistar albino rats into 3 groups. The rats in the control group underwent the surgical procedure (isolation of the cremaster muscle) alone; the rats in the experimental groups 1 and 2 received an infusion of dexmedetomidine (10 and 30 min) after the surgical procedure. RESULTS: The means of vessel diameters, number of functional capillaries, and movements of leukocytes in all groups were evaluated using intravital microscopic examination. The diameters of the arterioles and venules of the cremaster muscle significantly increased in the dexmedetomidine groups. The number of functional capillaries was higher in the dexmedetomidine groups than in the control group. No difference was observed in the movements of leukocytes between the control and experimental groups. Dexmedetomidine significantly increased the diameters of the arterioles and venules of the cremaster flap and the number of functional capillaries. CONCLUSION: On the basis of the effects of dexmedetomidine on microcirculation, we suggest that dexmedetomidine continue to be used as an anesthetic agent, and may be considered also for reconstructive procedures, particularly flap surgery.
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Anestésicos/farmacologia , Dexmedetomidina/farmacologia , Músculos Abdominais , Animais , Capilares , Leucócitos , Microcirculação , Ratos , Ratos Wistar , Retalhos CirúrgicosRESUMO
Apert syndrome is one of the acrocephalosyndactilia syndromes that is characterized with calvarial an extremity deformities. Anesthesia management of this syndrome is commonly related with difficult airway. However, hyponatremia is another insistent complication that can occur during craniosynostosis surgeries. Hyponatremia is a common complication during calvarial remodeling surgeries and it can result in serious neurologic damage. Development of mild hyponatremia in a patient with Apert syndrome that went under craniosynostosis surgery was presented in this study.
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Acrocefalossindactilia/cirurgia , Hiponatremia/etiologia , Complicações Intraoperatórias/diagnóstico , Procedimentos Ortopédicos , Complicações Pós-Operatórias/diagnóstico , Feminino , Humanos , Hiponatremia/diagnóstico , LactenteRESUMO
PURPOSE: To investigate the protective effect of dexmedetomidine (Dex) on testicular damage induced by ischemia-reperfusion injury in rats. METHODS: Sham group underwent left scrotal exploration only (group 1). The ischemia-reperfusion only group underwent left testicular torsion and detorsion (group 2). The ischemia-reperfusion plus Dex group underwent left testicular torsion, received 50 µg/kg Dex (group 3) and 100 µg/kg Dex (group 4) intraperitoneally at minute 180 of ischemia and then underwent detorsion. We determined histopathological findings and performed specific biochemical analyses. RESULTS: Increasing doses of Dex significantly increased TAS, and significantly decreased OSI. Analyzing the antioxidant effects of increasing doses of Dex in torsion and contrlateral testicles: Dex 100 µg/kg statistically significant increased the tissue total antioxidant status (TAS) and oxidative stress index (OSI) when compared with Dex 50 µg/kg but not found significantly change on the tissue total oxidant status (TOS). However, Dex did not significantly improve these histological alterations. CONCLUSION: The antioxidant effects of dexmedetomidine on testicular ischemia-reperfusion injury in ipsilateral and contrlateral testis, but in the histopathological level, there was no difference statistically according to Johnsen's scoring system between groups at both sides.
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Agonistas de Receptores Adrenérgicos alfa 2/farmacologia , Antioxidantes/farmacologia , Dexmedetomidina/farmacologia , Traumatismo por Reperfusão/prevenção & controle , Torção do Cordão Espermático/prevenção & controle , Testículo/irrigação sanguínea , Agonistas de Receptores Adrenérgicos alfa 2/uso terapêutico , Animais , Dexmedetomidina/uso terapêutico , Imuno-Histoquímica , Isquemia/patologia , Isquemia/prevenção & controle , Masculino , Estresse Oxidativo/efeitos dos fármacos , Estudos Prospectivos , Distribuição Aleatória , Ratos Wistar , Valores de Referência , Traumatismo por Reperfusão/patologia , Índice de Gravidade de Doença , Torção do Cordão Espermático/patologia , Testículo/patologia , Fatores de TempoRESUMO
PURPOSE: To investigate the protective effect of dexmedetomidine (Dex) on testicular damage induced by ischemia-reperfusion injury in rats. METHODS: Sham group underwent left scrotal exploration only (group 1). The ischemia-reperfusion only group underwent left testicular torsion and detorsion (group 2). The ischemia-reperfusion plus Dex group underwent left testicular torsion, received 50 µg/kg Dex (group 3) and 100 µg/kg Dex (group 4) intraperitoneally at minute 180 of ischemia and then underwent detorsion. We determined histopathological findings and performed specific biochemical analyses. RESULTS: Increasing doses of Dex significantly increased TAS, and significantly decreased OSI. Analyzing the antioxidant effects of increasing doses of Dex in torsion and contrlateral testicles: Dex 100 µg/kg statistically significant increased the tissue total antioxidant status (TAS) and oxidative stress index (OSI) when compared with Dex 50 µg/kg but not found significantly change on the tissue total oxidant status (TOS). However, Dex did not significantly improve these histological alterations. CONCLUSION: The antioxidant effects of dexmedetomidine on testicular ischemia-reperfusion injury in ipsilateral and contrlateral testis, but in the histopathological level, there was no difference statistically according to Johnsen's scoring system between groups at both sides. .
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Animais , Masculino , /farmacologia , Antioxidantes/farmacologia , Dexmedetomidina/farmacologia , Traumatismo por Reperfusão/prevenção & controle , Torção do Cordão Espermático/prevenção & controle , Testículo/irrigação sanguínea , /uso terapêutico , Dexmedetomidina/uso terapêutico , Imuno-Histoquímica , Isquemia/patologia , Isquemia/prevenção & controle , Estresse Oxidativo/efeitos dos fármacos , Estudos Prospectivos , Distribuição Aleatória , Ratos Wistar , Valores de Referência , Traumatismo por Reperfusão/patologia , Índice de Gravidade de Doença , Torção do Cordão Espermático/patologia , Fatores de Tempo , Testículo/patologiaRESUMO
While patients with obstructive sleep apnea (OSA) or multiple sclerosis (MS) are at high risk of developing postoperative complications, both of them have special anesthetic considerations in intraoperative and postoperative periods. A careful preoperative evaluation, use of the optimal anesthetic regimen and close postoperative care is essential for these patients. Rarity of coexistence of both obstructive sleep apnea and multiple sclerosis in a surgical patient necessitates careful anesthetic management. We here report anesthetic management of a female patient with OSA and MS who underwent anesthesia three times for surgery and review the literature.