A comparison of angled (D-Blade) and Macintosh (C-MAC) videolaryngoscopes for simulated pediatric difficult airway: a randomized single-blind study.

BACKGROUND: Being prepared for difficult airway (DA) is nevertheless of great importance. Failed or delayed tracheal intubation (TI) can increase morbidity and mortality, and the pediatric population is more prone to hypoxia. With the development of different types of videolaryngoscope (VL), these have become the device of choice in patients with DA. Our primary aim was to compare intubation times with D-blade and Macintosh blade of Storz C-MAC in a simulated pediatric DA scenario with this randomized controlled trial. METHODS: Children aged 1-5 years scheduled for elective surgery were included in the study. Patients were randomized into two groups: the D-Blade (n = 20) and MAC (n = 21) groups. All children underwent inhalational induction, and a neuromuscular relaxant was routinely administered (rocuronium 0.6 mg.kg-1). After the appropriate size of semirigid foam neck collar had been positioned around the patient's neck, the D-Blade group patients were intubated using a size 2 D-Blade, and the MAC group patients used a size 2 VL Macintosh blade. Intubation, time was measured. Patients' modified Cormack-Lehane system scores (MCLS), pre and postintubation blood pressure values and heart rates, and complications during intubation were recorded. RESULTS: Demographic data were similar between the groups. There were also no significant differences in pre and postintubation heart rates, blood pressure, or SpO2 values (p > 0.05 for all). Mean intubation times for the MAC and D-Blade groups were 12.14 ± 2.79 s and 18.31 ± 10.86 s, respectively (p = 0.022). MCLS scores were lower in the D-Blade group (p = 0.030).

Erector spinae block for postoperative pain management in lumbar disc hernia repair.

PURPOSE: Lumbar disc herniation is the most common spinal disorder and various less invasive techniques such as microdiscectomy have been described. However, postoperative pain management in patients undergoing discectomy is still commonly inadequate. Erector spinae plane (ESP) block is a relatively easier technique with lower risks of complications, and can be performed to provide postoperative analgesia for various procedures. The current study aimed to determine the effect of ESP block on postoperative analgesia in patients who underwent elective lumbar disc herniation repair surgeries. METHODS: Fifty-four ASA I-II patients aged 18-65 years scheduled for elective discectomy surgery were included in the study. Patients were randomized either to the ESP or control group. Ultrasound-guided ESP block with 20 mL of 0.25% bupivacaine was performed preoperatively in the ESP group patients and a sham block was performed with 20 mL normal saline in the control group patients. All the patients were provided with intravenous patient-controlled analgesia devices containing morphine. Morphine consumption and numeric rating scale (NRS) scores for pain were recorded 1, 6, 12, and 24 h after surgery. RESULTS: A significantly lower morphine consumption was observed at 6, 12, and 24 h timepoints in the ESP group (p < 0.05 for each timepoint). Total morphine consumption at 24 h after surgery decreased by 57% compared to that of the control group (11.3 ± 9.5 mg in the ESP group and 27 ± 16.7 mg in the control group). NRS scores were similar between the two groups. CONCLUSION: This study showed that ESP block provided effective analgesia in patients who underwent lumbar disc herniation surgery. CLINICAL TRIALS REGISTRY: NCT03744689.

Subcapsular local anesthesia approach in percutaneous liver biopsy: less pain, more comfort

Background/aim: To compare the subjective level of pain in patients who underwent an ultrasound-guided percutaneous liver biopsy (PLB) after either pericapsular anesthesia (PA) or subcapsular anesthesia (SA), based on the numeric rating scale (NRS). Materials and methods: A total of 323 patients, mean age 51, range 21­82 years; 160 (49.5%) male, referred to the Interventional Radiology Clinic of Kocaeli University Faculty of Medicine for image-guided PLB, between June 2019 and May 2020 were included and randomized into two groups by anesthetic type; the first (n = 171) consisted of patients undergoing SA while the second (n = 152) included patients undergoing PA. The intensity of pain at 0, 1, and 6 h after PLB was evaluated between the groups using NRS. Results: At hours 0, 1, and 6, the median [range] NRS scores in the subcapsular and pericapsular groups were 2 [1­2] versus 3 [2­4] (P < 0.001), 1 [0­1] versus 1 [1­2] (P < 0.001), and 0 [0­0] versus 1 [0­1] (P < 0.001), respectively. Subgroup analysis revealed that the patients who underwent the subcostal procedure with subcapsular anesthesia reported the lowest pain scores and intercostal procedure with pericapsular anesthesia reported the worst pain scores for each time point: 0 h 1 [1­2] versus 3 [3­4], P < 0.001; 1 h 1 [0­1] versus 1 [1­2], P < 0.001; and 6 h 0 [0­0] versus 0 [0­1], P < 0.001, respectively. Conclusion: Subcapsular anesthesia is a well-tolerated procedure compared to a pericapsular procedure. Furthermore, the application of a subcapsular anesthetic with a subcostal approach was reported to result in the lowest pain and greatest patient comfort.

Ultrasound-guided dorsal penile nerve block vs neurostimulator-guided pudendal nerve block in children undergoing hypospadias surgery: A prospective, randomized, double-blinded trial.

BACKGROUND AND AIMS: Hypospadias is a common congenital malformation in pediatric patients. Surgical repair of this malformation is a painful procedure and has long-term effects. Pudendal and penile nerve blocks are commonly preferred techniques for maintaining postoperative analgesia. However, the conventional landmark-based penile block technique involves numerous potential complications and provides a shorter analgesic period compared to the pudendal block. A promising ultrasound-guided dorsal penile nerve block was recently described. We aimed to compare the analgesic effectiveness of ultrasound-guided penile nerve block with that of neurostimulator-guided pudendal nerve block. METHOD: Thirty-three patients aged 1-7 years were included in this prospective, double-blinded, randomized controlled trial. Patients were divided into two groups and received either ultrasound-guided dorsal penile nerve block or neurostimulator-guided pudendal nerve block. All blocks were performed by the same two anesthesiologists, and the same surgeons performed the surgical procedures. The Face, Legs, Activity, Cry, and Consolability (FLACC) scale was used for postoperative pain management. The primary outcome of the study was time to first analgesic requirement. Secondary outcomes were FLACC scores at different time points, and types and cumulative doses of analgesic drugs. RESULTS: Dorsal penile nerve block provided longer analgesia than pudendal nerve block (32.29 ± 5.47 hours and 21.13 ± 3.53 hours, respectively; differences in mean: 11.16, 95% CI: 7.873-14.465) (P < .001). FLACC scores at the time of first analgesic requirement were significantly lower in dorsal penile nerve block group than pudendal nerve block group (median [IQR]: 2 [2-2.5] and 3 [3-5], respectively; differences in median: -1, 95% CI: -1.851 to -0.149) (P < .001). CONCLUSION: Ultrasound-guided dorsal penile nerve block provided a longer analgesic period and reduced opioid consumption compared to neurostimulator-guided pudendal nerve block.

Comparison of Univent tube and EZ blocker in one lung ventilation; airway pressures and gas exchange.

Univent tube (UT) and EZ-blocker were used for one-lung ventilation (OLV). UT is a single lumen tube with a small separate lumen containing a bronchial blocker. EZ-blocker differs with its unique y-shaped double-cuffed distal end. We aimed to compare these two airway devices effects on airway pressures, oxygenation, ventilation and haemodynamics during OLV. Patients undergoing elective thoracotomy for the first time were included in this prospective randomized study. Patients were divided into two groups as UT and EZ. Bronchial blockers (BB) placement time was recorded. In lateral decubitus position, airway pressures, static compliance, tidal volume (TV), respiratory rate (RR) and haemodynamic findings were recorded before inflating the BB cuff (Pre-OLV) and during OLV every 15 min. Arterial blood gas (ABG) samples were obtained before and during OLV. 70 patients were enrolled in the study. The demographic characteristics and data related to anesthesia and surgery were similar in both groups. It took longer to place EZ than UT (p = 0.02). Ppeak values were similar in both groups. Pplateau was significantly lower at the beginning of OLV (OLV15th min) and higher at the end of OLV (pre-DLV) in EZ group compared to UT (p = 0.01, p = 0.03). Cstatic were significantly higher at the beginning of OLV (OLV15th min) in EZ group compared to UT (p = 0.01). During the following measurements, Cstatic values were similar for both groups. Ventilation were achieved with similar TV and RR. ABG findings and haemodynamic variables were similar. EZ and Univent tube affected the airway pressures, oxygenation, ventilation and haemodynamic variables similarly during OLV in patients with normal respiratory function. These devices can be alternatives to each other based on clinical conditions.

Tracheal injury: late symptom after double-lumen tube intubation - A case report.

As a basic skill, endotracheal intubation, performed throughout the world by health care professionals is a relatively safe and effective maneuver. However, this technique is not risk free and could lead to many serious complications. We wanted to report that in a patient with double lumen tube intubation, airway trauma can cause late symptoms . We thought that such complications must be published to share experiences.

One operator's experience of ultrasound guided lumbar plexus block for paediatric hip surgery.

Lumbar plexus block has been shown to be effective for providing postoperative analgesia after major hip surgeries in children. The goal of the study was to evaluate the feasibility of ultrasound guidance during lumbar plexus block in children undergoing hip surgery for congenital hip dislocation. After obtaining local institutional ethical committee approval and parental informed consent, ASA I or II, 1-6 years old children undergoing hip surgery were included into the study. Lumbar plexus block was performed after general anaesthesia using ultrasound guided Shamrock Method. Bupivacaine 0.25 % was used during block performance. Dose of the local anaesthetic was 1 ml/kg and the maximum dose was limited to 20 ml. In the postoperative period pain was assessed using modified CHEOPS (Children's Hospital Eastern Ontario Pain Scale) pain score. If pain score in the postoperative period exceeded 3, patients received IV paracetamol 15 mg/kg-1. Morphine 0.1 mg/kg-1 IV was planned to administer if pain scores were still higher than 3 despite paracetamol treatment. 75 patients whose mean age was 47 months were enrolled into the study. All blocks were performed successfully and without complications. Mean time for the first analgesic is found as 10 h after surgery. Only one patient required morphine in the recovery unit and 23 patients received paracetamol. US guided lumbar plexus block using Shamrock Method is an effective technique for providing postoperative analgesia after hip surgeries in children and it's effect lasts for 8-12 h after surgery.

Comparison of Postoperative Opioid Consumption of Paravertebral Block and Erector Spinae Plane Block After Thoracotomy: A Randomized Controlled Trial.

Background Thoracotomy is associated with severe postoperative pain. Pain developing after thoracotomy causes lung infections, inability to expel secretions, and atelectasis as a result of deep breathing. Effective management of acute pain after thoracotomy may prevent these complications. A multimodal approach to analgesia is widely employed by thoracic anesthetists using a combination of regional anesthetic blockade and systemic analgesia, with both non-opioid and opioid medications and local anesthesia blockade. Nowadays, regional anesthesia techniques such as thoracic epidural paravertebral block (PVB), erector spinae plane block (ESPB), and serratus plane block are frequently used to prevent pain after thoracotomy. In this study, we compared paravertebral block with erector spinae block for pain relief after thoracotomy. Our primary aim was to determine whether there was a difference between postoperative opioid consumption and pain scores. We also compared the two regional anesthesia techniques in terms of intraoperative hemodynamic data and postoperative complications. Methodology Patients aged between 18 and 75 years with an American Society of Anesthesiology (ASA) physical status I-III and scheduled for elective thoracotomy were included in the study. Using www.randomizer.org, patients were divided into two different groups, namely, ESPB and PVB. All patients were provided with a patient-controlled analgesia device preloaded with morphine. Postoperative 24-hour morphine consumptions were recorded. Results Data from 45 patients were used in the final analyses. Morphine consumption was higher in the ESPB group than in the PVB group at 24 hours postoperatively (19.2 ± 4.26 mg and 16.2 ± 2.64 mg, respectively; p < 0.05). There was no significant difference in numerical rating scale scores both at rest and with coughing (p > 0.05). Intraoperative heart rates were similar between groups. However, mean intraoperative blood pressure was significantly lower in the PVB group at 30 minutes (p < 0.05). Nausea and vomiting were observed in two patients in the ESPB group and one patient in the PVB group. The complication of nausea and vomiting was not statistically significant between the two groups (p > 0.05). Catastrophic complications such as hematoma, pneumothorax, and local anesthetic systemic toxicity were not observed in either group. Conclusions We found that patients who underwent PVB consumed less morphine postoperatively than patients who underwent ESPB. However, we did not observe any difference in pain scores between both groups. We think that ESPB can be considered a reliable method in thoracotomy surgery due to its ease of application and the fact that the place where the block is technically performed is farther from the central structures compared to PVB. In light of the results of our study, ESPB can be used as an alternative to PVB, which has been proven as postoperative analgesia in thoracic surgery.

Modified pectoral nerve block versus bi-level erector spinae plane block for postoperative analgesia after radical mastectomy surgery: a prospective, randomized, controlled trial.

BACKGROUND: Regional anesthesia techniques constitute an important part of successful analgesia strategies in the perioperative care of patients undergoing breast surgery. The advent of ultrasound-guided regional anesthesia has led to the development of fascial plane blocks. The large array of blocks available for postoperative analgesia in breast surgery has increased the accessibility of regional anesthesia but has also created a dilemma of choice. This study compared the analgesic efficacy of the ultrasound-guided modified pectoral nerve (PECS) block and erector spinae plane block (ESPB) in patients undergoing radical mastectomy. METHODS: Seventy women were enrolled in this prospective, double-blind, randomized control trial. After exclusion, 67 female patients who underwent radical mastectomy were finally analyzed. Ultrasound-guided PECS blocks and ESPBs were performed with 30 ml 0.25% bupivacaine. Postoperative morphine and pain scores were compared between the groups. RESULTS: Postoperative total morphine consumption in the first 24 h was significantly higher in the PECS group (P < 0.001). The ESPB group exhibited significantly reduced morphine consumption at all postoperative time points. Numeric rating scale scores were lower in the ESPB group at 6, 12, and 24 h postoperatively at rest and when coughing. CONCLUSIONS: Ultrasound-guided bi-level ESPBs provided better postoperative analgesia than PECS blocks after radical mastectomy surgery.

[Plan A blocks]. / Plan A bloklari.

With the increase in ultrasound use, regional anesthesia practices have gained popularity and many novel techniques are being described. However, the rapidly increasing number of new block techniques also led to confusion. Therefore, seven basic regional anesthesia techniques that are effective in most of the surgeries have been listed as 'Plan A Blocks.' The purpose of this review is to introduce the basic sono-anatomy and indications of Plan A blocks.

Anterior approach to suprascapular nerve block combined with axillary nerve block for shoulder arthroplasty.

Arthroscopic shoulder operations are associated with postoperative pain, which can lead to chronic pain if not treated effectively. The classic posterior approach for the suprascapular nerve is associated with higher technical failures, and it is a more painful procedure for the patients. We report a case of a 72-year-old male patient who underwent right shoulder arthroplasty. We performed ultrasound-guided suprascapular nerve block with an anterior approach, combined with an axillary nerve block, and provided effective analgesia.

Bilateral versus unilateral erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: a randomized controlled study.

INTRODUCTION: Laparoscopic cholecystectomy (LC) is the common surgical intervention for benign biliary diseases. Postoperative pain after LC remains as an important problem, with two components: somatic and visceral. Trocar entry incisions lead to somatic pain, while peritoneal distension with diaphragm irritation leads to visceral pain. Following its description by Forero et al., the erector spinae plane (ESP) block acquired considerable popularity among clinicians. This led to the use of ESP block for postoperative pain management for various operations. MATERIALS AND METHODS: This study was conducted between January and June 2019. Patients aged between 18 and 65 years with an American Society of Anesthesiologists (ASA) physical status I.ÇôII, scheduled for elective laparoscopic cholecystectomy were included in the study. All the patients received bilateral or unilateral ESP block at the T8 level preoperatively according to their groups. RESULTS: There was no significant difference between the groups in terms NRS scores either at rest or while coughing at any time interval except for postoperative 6th hour (p = 0.023). Morphine consumption was similar between the groups but was significantly lower in group B at 12 and 24 hours (p = 0.044 and p = 0.022, respectively). Twelve patients in group A and three patients in group B had shoulder pain and this difference was statistically significant (p = 0.011). DISCUSSION: In conclusion, bilateral ESP block provided more effective analgesia than unilateral ESP block in patients undergoing elective LC. Bilateral ESP block reduced the amount of opioid consumption and the incidence of postoperative shoulder pain.

[Erector spinae plane block for a pediatric patient undergoing thoracotomy]. / Torakotomi yapilan pediyatrik bir hastada erektör spina plan bloku.

We aimed to share our experience with erector spina plan block for postoperative analgesia after hydatid cyst operation in a six-year-old girl. Erector spina plan block is a new interfasial block defined by Forero in 2016. It has been reported that it can be used effectively in many different indications. Ultrasound guided erector spina plan block is a method that can be applied for postoperative analgesia after thoracotomy.

The first case of primary testicular germ cell tumor containing nephroblastoma as the only one non-germ cell component.

Adult extrarenal nephroblastomas (Wilms' tumor) are extremely rare tumors. They show a higher incidence of non-seminomatous elements and these so-called 'teratoid' Wilms' tumors are suggested to be of germ cell origin. To date, however, the number of reported cases with gonadal teratoma containing nephroblastoma is very low, and due to this reason, there are no standardized criteria for the categorization and treatment of these lesions. To our knowledge, the first case of nephroblastoma arising in a non-atrophic testis has been reported and it is associated with a teratoma as morphologically identifiable germ cell tumor and rhabdomyosarcoma as a second non-germ cell element. We report the second case of an adult nephroblastoma that arose within the primary testicular teratoma in a non-atrophic testis. Teratoma and nephroblastoma within the same testis may have an important point to clarify the developmental mechanism in nephroblastomatous differentiation of germ cell tumors.

[Superficial cervical plexus block in ear surgery: A case report]. / Kulak cerrahisinde yüzeyel servikal pleksus blogu: Olgu sunumu.

The aim of this study was to share our experience with the application of a superficial cervical plexus block in the ear operation of a 59-year-old male patient. The superficial cervical plexus provides sensory innervation of the superficial structures of the anterolateral neck, ear, and shoulder. Ultrasound-guided cervical plexus block may be an alternative method for both anesthesia and analgesia in ear surgery.