Ultrasound guided quadro-iliac plane block: another novel fascial plane block.

STUDY OBJECTIVE: We report a novel block technique aimed to provide lumbosacral, abdominal, and hip analgesia: The quadro-iliac plane (QIP) block. DESIGN: A cadaveric examination that evaluates the spread of QIP block. SETTING: Cadaver laboratory. PATIENTS: One unembalmed cadaver. INTERVENTIONS: Bilateral ultrasound-guided QIP blocks on cadavers with 40 mL of methylene blue %0.5 each side. MEASUREMENTS: Dye spread in cadaver. MAIN RESULTS: There was staining in the deep interfascial plane of the erector spinae muscles. Extensive staining of the interfascial plane corresponding to the posterior aspect of the quadratus lumborum muscle (QLM) was observed. There was extensive staining on the anterior surface of the QLM. There was spread of dye traversing along the transversalis fascia and significantly infiltrating retroperitoneal fat tissue. Bilateral staining of the ilioinguinal and iliohypogastric nerves was observed. On the right, there was minimal staining over the subcostal nerve. There was dye present bilaterally within the deep regions of the transverse processes. The lumbar plexus was stained on both sides. CONCLUSION: The local anesthetic applied from a place where the QLM reaches its largest volume and the fascial plane creates a closed gap in the caudal area may exhibit a more rounded and extensive spread.Quadro-iliac plane block, involves the administration of local anesthetic to the posterior aspect of the QLM at its origin from the iliac crest. According to our cadaver study, this technique may be a promising option for alleviating acute and chronic pain in the lumbosacral, lower abdominal, and hip regions.

High-thoracic ultrasound-guided erector spinae plane block for acute herpes zoster pain management in emergency department.

Herpes zoster is a painful, eruptive, viral condition occurring with reactivation in immunosuppressed individuals. The selection of an effective analgesic method in the acute phase of herpes zoster can decrease the incidence of postherpetic neuralgia by reducing neural sensitization. The erector spinae plane block has been reported to provide diffuse and effective analgesia in the cervical, thoracic, and lumbar regions. We report an effective decrease in pain with the application of the high-thoracic erector spinae plane block in the emergency department in a patient with herpes zoster pain in the cervicothoracic and shoulder region.

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.

Ultrasound-guided bilateral superficial cervical block and preemptive single-dose oral tizanidine for post-thyroidectomy pain: a randomized-controlled double-blind study.

PURPOSES: The postoperative analgesic effect of tizanidine has not yet been evaluated sufficiently. The role of bilateral superficial cervical plexus block (BSCPB) for postoperative analgesia after thyroidectomy remains questionable. We aimed to evaluate the analgesic effect of combined use of BSCPB and a single-dose oral tizanidine in patients undergoing elective thyroid surgery. METHODS: Sixty patients undergoing thyroidectomy were randomized into 3 groups. The control group (Group C, n = 20) received BSCPB with 0.9% saline plus oral placebo. The superficial cervical group (Group SC, n = 20) received BSCPB with 0.25% bupivacaine plus oral placebo. The superficial cervical and tizanidine group (Group SC + T, n = 20) received BSCPB with 0.25% bupivacaine plus tizanidine 6 mg capsule. Surgical site pain scores, opioid consumption, rescue analgesia, posterior neck pain, headache, and opioid-related side effects were assessed for the first 24 h. RESULTS: Compared with Group C, rest and swallowing pain scores in Group SC and Group SC + T were statistically lower at all postoperative time points (p < 0.05). Fentanyl consumption was lower in Group SC and Group SC + T than in Group C at time periods 0-4 and 4-8 h (p < 0.05). Fentanyl consumption was lower in Group SC + T than in Group SC at 0-4 h (p = 0.006). Total fentanyl consumption was higher in Group C than in the other groups (p < 0.001). Postoperative cervical pain and occipital headache were significantly lower in Group SC + T than in the other groups (p < 0.05). CONCLUSIONS: Ultrasound-guided BSCPB with or without preemptive oral tizanidine was effective at reducing postoperative pain and opioid consumption in patients undergoing total thyroidectomy. Addition of preemptive oral tizanidine to BSCPB reduced the early postoperative opioid consumption, posterior neck pain, and occipital headache. CLINICAL TRIALS REGISTRY: The study was registered with a clinical trials registry (ClinicalTrials.gov. identifier NCT02725359).

Continuous spinal anaesthesia versus ultrasound-guided combined psoas compartment-sciatic nerve block for hip replacement surgery in elderly high-risk patients: a prospective randomised study.

BACKGROUND: Our aim is to compare the hemodynamic effects of combined psoas compartment-sciatic nerve block (PCSNB) with continuous spinal anaesthesia (CSA) in elderly high-risk patients undergoing hip replacement surgery. METHODS: Seventy patients over the age of 60 with ASA III or IV physical status were randomly allocated to two groups: In the PCSNB group, ultrasound-guided psoas compartment block was performed with modified Winnie technique using 30 mL of 0.25% bupivacaine with 1:200.000 epinephrine (5 µgr/mL) and iliac crest block was performed using the same local anaesthetic solution (5 mL). All patients in the PCSNB group needed continuing infusion of propofol (2 mg/kg/h) during operation. In the CSA group, CSA was performed in the L3-L4 interspaced with the patient in lateral decubitus position using 2.5 mg of isobaric bupivacaine 0.5%. When sensory block was not reached to the level of T12 within 10 minutes in the CSA group, additional 2.5 mg of isobaric bupivacaine 0.5% was administered through the catheter at 5-min intervals by limiting the total dose of 15 mg until a T12 level of the sensory block was achieved. RESULTS: The PCSNB group had significantly higher mean arterial blood pressure values at the beginning of surgery and at 5(th), 10(th) and 20(th) minutes of surgery compared to the CSA group (P = 0.038, P = 0.029, P = 0.012, P = 0.009 respectively). There were no significant differences between groups in terms of heart rate and peripheral oxygen saturation values during surgery and the postoperative period (P >0.05). Arterial hypotension required ephedrine was observed in 13 patients in the CSA and 4 patients in the PCSNB group (P =0.012). CONCLUSIONS: CSA and PCSNB produce satisfactory quality of anaesthesia in elderly high-risk patients with fewer hemodynamic changes in PCSNB cases compared with CSA cases. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12614000658617, Registered 24 June 2014.

Efficacy of modified thoracoabdominal nerve block through perichondrial approach following laparoscopic inguinal hernia repair surgery: a randomized controlled trial.

BACKGROUND: Modified thoracoabdominal nerve block through perichondrial approach is a novel fascial plane block and provides abdominal analgesia by blocking thoracoabdominal nerves. Our primary aim was to evaluate the efficacy of M-TAPA on quality of recovery and pain scores in patients who underwent laparoscopic inguinal hernia repair surgery (Trans Abdominal Pre-Peritoneal approach ‒ TAPP). METHODS: Patients with American Society of Anesthesiologists (ASA) physical status I-II aged between 18 and 65 years scheduled for elective TAPP under general anesthesia were enrolled in the study. After intubation, the patients were randomized into two groups: M: M-TAPA group (n = 30) and the control group (n = 30). M-TAPA was performed with total 40 ml 0.25% bupivacaine in the M group. Surgical infiltration was performed in the control group. The primary outcome of the study was the global quality of recovery score, the secondary outcomes were pain scores, rescue analgesic demands, and adverse effects during the 24-h postoperative period. RESULTS: The global quality of recovery scores at 24 h were significantly higher in the M group (p < 0.001). There was a reduction in the median static and dynamic NRS for the first postoperative 8 h in the M group compared to the control group (p < 0.001). The need for rescue analgesia was significantly lower in the M group compared to the control group (13 patients vs. 24 respectively, p < 0.001). The incidence of side effects was significantly higher in the control group (p < 0.001). CONCLUSION: In our study, M-TAPA increased patient recovery scores, and provided pain relief in patients who underwent TAPP. REGISTER NUMBER: NCT05199922.

YouTube Educational Videos for Peripheral Block Learning and Application: A Survey of Turkish Anesthesiologists; How Successful.

OBJECTIVE: The aims of this survey study were to evaluate the contribution of YouTube to nerve-block learning/education and the advantages and disadvantages of the YouTube. MATERIALS AND METHODS: A total of 24 questions were selected for the survey by consensus of the authors. Information in the form of web data was obtained through an electronic data form that was distributed via WhatsApp to known email addresses and phone numbers of 300 practitioners (anesthesia residents, anesthesiologists, and academicians). There were a total of 24 questions on the survey. The first section included 5 questions collecting demographic data, and the second part encompassed 19 questions about the YouTube nerve block videos. RESULTS: Among the participants, 232 of practitioners (86.9%) performed peripheral nerve blocks, and only 35 practitioners (13.1%) had no experience of nerve blocks so and used YouTube videos for educational purposes. According to our results, YouTube videos frequently improved performance. In addition, YouTube improved the training of practitioners in terms of the type of block procedure, identifying anatomical landmarks, target structures like nerves and blood vessels, needle visualization, needle depth, and patient position. CONCLUSION: YouTube contributes to the performance of regional anesthesia and to learning at all academic levels. It should not be forgotten that such videos are not peer reviewed by professionals in the relevant field.

In vitro and in vivo effects of some benzodiazepine drugs on human and rabbit erythrocyte carbonic anhydrase enzymes.

Carbonic anhydrase inhibitors (CAIs) are a class of pharmaceuticals used as antiglaucoma agents, diuretics and antiepileptics. Thus, discovery of novel CAIs has become of great importance in the recent years. In the current study, in vitro and in vivo inhibition effects of benzodiazepine drugs, diazepam and midazolam, on human erythrocytes carbonic anhydrase I and II isozymes were investigated. After purification of the isoenzymes, in vitro inhibition assays were performed and K(i) values were determined to be of 141.5 µM and 40.7 µM for hCA I and of 5.11 µM and 0.58 µM against hCA II by the esterase activity assay, respectively. The drugs showed strong inhibitory effects on hCA II, in the same range as the clinically used sulphonamide acetazolamide. For in vivo studies, five adult male New Zealand White rabbits (3-4.2 kg) were selected for intravenous administrations of the drugs (2 mg/kg and 0.2 mg/kg body weight, respectively). The enzyme was significantly inhibited by 2 mg/kg diazepam (p < 0.05), and 0.2 mg/kg midazolam (p < 0.05) for up to 30 min following intravenous administration.

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.

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.

Ultrasound-guided low thoracic paravertebral block versus peritubal infiltration for percutaneous nephrolithotomy: a prospective randomized study.

The aim of this study was to investigate the efficacy of peritubular infiltration and ultrasound-guided low thoracal paravertebral block in patients undergoing percutaneous nephrolithotomy (PCNL). Sixty patients, American Society of Anesthesiologists I-II, between the ages of 18 and 65 years undergoing PCNL were randomized into three groups. Group peritubal infiltration (Pi, n = 20) received infiltration along the nephrostomy tube 20 ml 0.25% bupivacaine, in 6 and 12 o'clock position. Group paravertebral block (Pv, n = 20) received single-shot paravertebral block with 20 ml 0.25% bupivacaine at the level of T8-T9. Group control (C, n = 20): no intervention is performed. Postoperative opioid consumption and pain scores, opioid-related side effects, and additional analgesic requirement were recorded. The fentanyl consumption in Group Pv was significantly lower in comparison to Group C in all time intervals (p < 0.05). In the comparison of Group Pv and Group Pi, fentanyl consumptions in the postoperative 0-4th hours (100.00 ± 50.65 and 145.00 ± 61.55, respectively), 4-8th hours (50.00 ± 64.88 and 121.25 ± 56.93 respectively), and in the total of 24 h (197.50 ± 133.74 and 368.75 ± 116.66 respectively) were significantly lower in Group Pv (p < 0.05). The dynamic VAS scores analyzed at the 1st and 2nd hours were significantly lower in Group Pv than Group Pi (p < 0.05). Eight patients in Group C, two patients in Group Pi and 1 patient in Group Pv required additional analgesics and the difference was significant (p < 0.05). Paravertebral block achieved more effective analgesia by reducing postoperative opioid consumption and VAS scores comparison to the control and peritubal infiltration groups in patients undergoing percutaneous nephrolithotomy.

Less painful ESWL with ultrasound-guided quadratus lumborum block: a prospective randomized controlled study.

Objectives: Extracorporeal shock wave lithotripsy (ESWL) has been widely used for the treatment of urinary tract stones and is usually administered as an outpatient procedure, although the vast majority of patients do not tolerate it without sedoanalgesia. The quadratus lumborum block (QLB) is a newly-defined technique for abdominal surgery. The aim of this study was to evaluate the analgesic efficacy of ultrasound-guided QLB in ESWL.Materials and methods: Forty patients, aged 18-65, with ASA physical status I-II and scheduled for ESWL were randomly assigned to Group C (control group) and Group QLB (treatment group). Group QLB received single-shot USG-guided transmuscular QLB with 10 ml of 0.5% bupivacaine and 10 ml of 2% lidocaine before a 20-min ESWL procedure. No intervention was performed on Group C. Visual analogue scale (VAS) scores, opioid consumption, patient satisfaction, ESWL and stone details were recorded.Results: VAS scores were significantly lower in Group QLB at all time intervals (p < 0.05). Fentanyl consumption during ESWL was significantly lower in Group QLB than in Group C (p < 0.001). The fragmentation success rate was significantly higher in Group QLB than in Group C (19/20 vs 14/20, respectively, p = 0.046). Patient satisfaction was also higher in Group QLB (p = 0.011).Conclusions: This study shows that QLB provided adequate analgesia for ESWL and that it reduced extra opioid consumption significantly compared to the control group.

Subhypnotic propofol infusion plus dexamethasone is more effective than dexamethasone alone for the prevention of vomiting in children after tonsillectomy.

BACKGROUND: Postoperative vomiting (POV) is a common complication after tonsillectomy. Dexamethasone is known to decrease postsurgical vomiting. In this study, we compared the effects of dexamethasone alone to dexamethasone plus propofol on postoperative vomiting in children undergoing tonsillectomy. METHODS: In a randomized double-blinded study, we evaluated 80 healthy children, aged 4-12 years, who underwent tonsillectomy with or without adenoidectomy. After anesthesia was induced by inhalation of sevoflurane, 0.15 mg x kg(-1) dexamethasone and 2 microg x kg(-1) fentanyl was administered i.v. to all patients. The patients in the dexamethasone plus propofol group received 1 mg x kg(-1) propofol before intubation and continuously after intubation at a rate of 20 microg x kg(-1) x min(-1) until the surgery was completed. Data for postoperative vomiting were grouped into the following time periods: 0-4 and 4-24 h. Data were analyzed using a Student's t-test and chi-squared analysis. RESULTS: The percentage of patients exhibiting a complete response (defined as no retching or vomiting for 24 h) increased from 37.5% in the dexamethasone-alone group to 75% in the dexamethasone plus propofol group (P = 0.001). Twenty-two patients (55%) in the dexamethasone-alone and nine patients (22.5%) in the dexamethasone plus propofol groups experienced vomited during 0-4 h (P = 0.003). Eight patients in the dexamethasone-alone group and three patients in the dexamethasone plus propofol group received ondansetron as a rescue antiemetic during the postoperative period. CONCLUSION: For children undergoing tonsillectomy, intraoperative subhypnotic propofol infusion combined with dexamethasone treatment provides a better prophylaxis against postoperative vomiting than does dexamethasone alone.

Efficacy of modified thoracoabdominal nerve block through perichondrial approach following laparoscopic inguinal hernia repair surgery: a randomized controlled trial

Abstract Background: Modified thoracoabdominal nerve block through perichondrial approach is a novel fascial plane block and provides abdominal analgesia by blocking thoracoabdominal nerves. Our primary aim was to evaluate the efficacy of M-TAPA on quality of recovery and pain scores in patients who underwent laparoscopic inguinal hernia repair surgery (Trans Abdominal Pre-Peritoneal approach ‒ TAPP). Methods: Patients with American Society of Anesthesiologists (ASA) physical status I-II aged between 18 and 65 years scheduled for elective TAPP under general anesthesia were enrolled in the study. After intubation, the patients were randomized into two groups: M: M-TAPA group (n = 30) and the control group (n = 30). M-TAPA was performed with total 40 ml 0.25% bupivacaine in the M group. Surgical infiltration was performed in the control group. The primary outcome of the study was the global quality of recovery score, the secondary outcomes were pain scores, rescue analgesic demands, and adverse effects during the 24-h postoperative period. Results: The global quality of recovery scores at 24 h were significantly higher in the M group (p < 0.001). There was a reduction in the median static and dynamic NRS for the first postoperative 8 h in the M group compared to the control group (p < 0.001). The need for rescue analgesia was significantly lower in the M group compared to the control group (13 patients vs. 24 respectively, p < 0.001). The incidence of side effects was significantly higher in the control group (p < 0.001). Conclusion: In our study, M-TAPA increased patient recovery scores, and provided pain relief in patients who underwent TAPP. Register Number: NCT05199922.

Ultrasound-guided versus conventional injection for caudal block in children: A prospective randomized clinical study.

STUDY OBJECTIVE: The aim of this study was to compare the efficacies of ultrasound guided sacral hiatus injection and conventional sacral canal injection performed for caudal block in children. DESIGN: Randomized controlled clinical trial. SETTING: Operating rooms of university hospital of Erzurum, Turkey. PATIENTS: One hundred-thirty four children, American Society of Anesthesiologists I-II, between the ages of 5 and 12, scheduled for elective phimosis and circumcision surgery. INTERVENTIONS: Patients assigned to two groups for ultrasound guided caudal block (Group U, n=68) or conventional caudal block (Group C, n=66). Caudal solution was prepared as 0.125% levobupivacaine plus 10mcg/kg morphine (total volume: 0.5ml/kg), and was administered to both groups. MEASUREMENTS: The block performing time, the block success rate, the number of needle puncture, the success at first puncture and the complications were recorded. MAIN RESULTS: The block performing time and the success rate of block were similar between Group U and Group C (109.96±49.73s vs 103.17±45.12s, and 97% vs 93%, respectively p>0.05). The first puncture success rate was higher in Group U than in Group C (80% vs 63%, respectively p=0.026). No significant difference was observed between the groups with regard to the number of needle punctures (p=0.060). The rates of vascular puncture and subcutaneus bulging were higher in Group C than in Group U (8/66 vs 1/68, and 8/66 vs 0/68, respectively p<0.05). CONCLUSIONS: Despite the limitations in central neuroaxial anesthesia we recommend the use of ultrasound since it reduces the complications and increases the success rate of first puncture in pediatric caudal injection.