Accidental late PEG dislodgment in 3 cases with a narrow stoma: Bougie dilatation rescue.

Percutaneous Endoscopic Gastrostomy (PEG) is a simple and effective method of enteral nutrition in many patients who cannot take oral food. The accidental dislodgement of the PEG tube after the maturation of the gastro-cutaneous fistula (stoma) is called late dislodgement. If it is not detected early, the stoma lumen gets narrower; and does not permit the passage of the replacement tube. In this case, the commonly followed method is to continue enteral nutrition by opening a new gastro-cutaneous fistula after the complete closing of the original stoma. Here, we present a stoma-saving bougie dilatation method in 3 cases with severely narrowed stomas after late accidental dislodgement of the PEG tube.

Anesthesia management with ultrasound-guided thoracic paravertebral block for donor nephrectomy: A prospective randomized study.

STUDY OBJECTIVE: To determine the efficacy of ultrasound-guided thoracic paravertebral block intraoperatively and 24 hours postoperatively in patients undergoing donor nephrectomy. DESIGN: Prospective randomized controlled study. SETTING: Private foundation university hospital; November 2014 to June 2015. PATIENTS: Thirty-two patients undergoing donor nephrectomy (exclusion criteria: coagulation disorders, allergy to local anesthetics, and unwillingness to participate). The final study population comprised 30 patients (15 male, 15 female) randomly assigned to either Group P (paravertebral block, n=14) or Group M (morphine, n=16). INTERVENTIONS: In Group P, a unilateral paravertebral catheter was inserted 1 day preoperatively; on the day of surgery, a single-level unilateral paravertebral block was administered through the catheter before general anesthesia. Infusion of bupivacaine continued intraoperatively and postoperatively. Patients in Group M received only general anesthesia, and morphine patient-controlled analgesia was begun postoperatively. MEASUREMENTS: Intraoperative analgesic and anesthetic requirement, postoperative numerical rating scale pain scores, additional analgesic consumption during the postoperative period, and incidence of complications related to thoracic paravertebral block (TPVB) like pleural puncture, pneumothorax, epidural spread, injection into the subarachnoid space, intravascular injection, and Horner's syndrome and rate of opioid related adverse reactions like nausea and vomiting, itching, constipation, and respiratory depression. RESULTS: Intraoperative remifentanil consumption was significantly higher in Group M, and postoperative morphine consumption was significantly lower in Group P (P<.001). During the first 24 hours postoperatively, the mean numerical rating scale pain scores were similar and there were no significant differences between the 2 groups. There were no statistically significant differences in the additional analgesic consumption and rate of adverse reactions between the 2 groups. We didn't detect any complication related to TPVB in group P. CONCLUSIONS: Continuous thoracic paravertebral block provides good intraoperative stability with a low anesthetic requirement and reduces postoperative morphine consumption for up to 24 hours. Ultrasound guided technique enhanced the safety of TPVB and provides analgesia without major complications.