Evaluation of factors affecting treatment and mortality in patients over 65 years of age and without chronic disease, followed in the Intensive Care Unit due to COVID-19.

OBJECTIVE: In this study, demographic, clinical, and laboratory data of patients aged 65 and over who are followed on mechanical ventilators due to COVID-19 in intensive care clinics will be useful in terms of strategies to be developed in the fight against COVID-19 and other infectious agents. PATIENTS AND METHODS: Our study included 299 patients aged 65 years and older, who were not chronically ill, and who were followed up on mechanical ventilators due to COVID-19 in intensive care clinics in the period between 2020 and 2022. Our study was designed as a retrospective cross-sectional study. The demographic characteristics of the patients included in the study, their complaints during hospitalization, the time between the beginning of the complaint and the admission to the hospital, the vital signs at the time of admission to the hospital, the lung computed tomography findings during hospitalization, and the treatments given were examined. RESULTS: 55.9% of all patients were males, and the mean age was 75.45±7.47 years. While there was no significant difference in terms of mean age between the groups of patients with/without a higher risk of mortality, there was a significant difference in gender (p=0.025). There was a statistically significant difference between the COVID-19 intensive care (p=0.001) and renal failure (p=0.014) and mortality groups. The mean nutric score, Procalcitonin (PCT), Lactate Dehydrogenase (LDH), Blood Urea Nitrogen (BUN), Phosphorus, and lactate values, which are important parameters, were statistically higher in the group with a higher risk of mortality (p<0.001). In addition, there was a statistically significant difference in terms of sepsis, neuromuscular blocker (Nmb), vasopressor, and intubation between the groups of patients with/without a higher risk of mortality (p<0.001). In the group with high mortality, 34.2% (n=55) had plasmapheresis treatment, and 14.2% had hemodiafiltration treatment (p<0.001). According to the results of the multivariate logistic regression model in determining the factors associated with a higher risk of mortality, those who were males (p=0.001), those with kidney failure (p<0.001), those with organ failure (p=0.006), increased in alanine aminotransferase (ALT) values (p=0.019), those with sedation (p=0.001) and those with vasopressors (p<0.001) were found to have an increased risk of mortality. CONCLUSIONS: We think that our study is valuable in terms of determining the most appropriate treatment strategies by following the patients in terms of parameters that are significant in the findings during their follow-up period in the Intensive Care Unit.

Is Bone Grafting Unnecessary in the Treatment of Cystic Scaphoid Pseudoarthrosis?

PURPOSE OF THE STUDY: The basic aim of the treatment of cystic nonunion is to provide stable fi xation and mechanical compression to increase union, but there is no consensus on whether to perform bone grafting in the cystic area or not. The aim of this study was to compare the clinical and radiological results of patients with cystic scaphoid non-union who received open grafting, and internal fi xation and those treated with percutaneous fi xation without grafting. MATERIAL AND METHODS A retrospective evaluation was made of patients included those determined radiologically with Slade and Dodds grade IV scaphoid cystic non-union. Two different surgical procedures were performed. Percutaneous screw fi xation was carried out on the patients in group 1. Open curettage-grafting and screw fi xation were performed on the patients in group 2. Group 1 was comprised of 16 patients treated with percutaneous screw fi xation, and group 2 was comprised of 17 patients who had open curettage-grafting and screw fi xation. RESULTS In the radiological evaluation at the fi nal follow-up examination, union was determined in 12 of the 16 (75%) patients in group 1 and 15 of the 17 (88%) patients in group 2. There was no statistically signifi cant difference between the two groups in terms of union, functional outcomes and complication rates. DISCUSSION In the current study, the union rate was higher in the patients who had open curettage-grafting and fi xation with a headless screw (88%) than in those with percutaneous screw without grafting (75%), but the difference was not determined to be statistically signifi cant. The union rate of the group that received grafting was similar to the rates reported in the literature. CONCLUSIONS We think that both of these techniques may be successfully used for cystic scaphoid nonunions but percutaneous technique should be preferred as it is minimally invasive. Nevertheless, there is a need for further prospective, randomised studies with larger series to have better comparisons. KEY WORDS: scaphoid bone, nonunion, fracture fi xation, internal, bone grafting, bone screws.

Is laparoscopic surgery risk for surgical teams during the coronavirus disease pandemic? An in vitro study with a laser and high-speed camera.

OBJECTIVE: Laparoscopic surgery has been suggested to pose a risk of infection to the surgical team due to aerosol and gas leakage during the coronavirus (COVID-19) pandemic. However, there have been no studies on the risk of gas and aerosol leakage in laparoscopic surgery. We aimed to answer the question "Is the aerosol and gas leakage in laparoscopy is hazardous in terms of coronavirus infection?" with this study. MATERIALS AND METHODS: In this study, gas and aerosol leaks were documented by simulating the entry and exit maneuvers from a trocar during laparoscopic surgery using a high-speed camera, fog, and laser in a model representing the abdomen. RESULTS: The maximum gas and aerosol leakage were found during wet gauze extraction from the 10 mm trocar, and its velocity reached 7.5 m/s. The fastest aerosol leakage rate was observed when a 5 mm grasper was extracted from the 5 mm trocar. The results of the subsequent trials were consistent with these values. CONCLUSIONS: Higher leakage speeds were observed than the velocity of the exhaled air in a resting person. The surgical crew members, who work very close to the trocars and each other, are at serious risk of infection with COVID-19 which can spread as fast as exhalation speed through trocars. Since there is an evident risk of infection for the surgical crew from laparoscopic surgery of a patient whose intraabdominal fluids are infected with COVID-19, patients must be evaluated elaborately for COVID-19 preoperatively and infected patients should undergo surgery conventionally.

Reconstruction of proximal pole scaphoid non-union with avascular necrosis using proximal hamate: A four-case series.

Union of proximal pole scaphoid fracture is challenging because the vascular supply is limited. The avascular necrosis accompanying non-union and progressive fragmentation make surgical reconstruction difficult. The present study aimed to report short-term results of reconstruction with proximal hamate in proximal pole scaphoid non-union with avascular necrosis. Four patients (3 male, 1 female) were assessed for non-union following proximal pole scaphoid fracture. Mean age was 25.7 years (range, 22-35 years). Mean interval between injury and reconstruction was 7.5 years (range, 5-9 years). In 3 patients, no treatment was given following the fracture and in the other internal fixation was performed following cast immobilization. The non-united avascular proximal scaphoid was resected and reconstructed with proximal hamate autograft. Mean follow-up was 14.0 months (range, 9-22 months) after reconstruction. At the last control, cases were evaluated in terms of clinical and functional status, and radiologic union was determined on CT scan. Three patients reported subjective decrease in pain. Mean grip strength proportionally to the unaffected side was 24% (range, 8-51%), mean flexion-extension was 55.3% (range, 21-60%), and radial-ulnar deviation was 63.6% (range, 25-100%). Mean QuickDASH score was 32.3 (range, 13.6-52.2). Union was observed in all patients. Proximal hamate reconstruction provided union and pain relief, but only moderate objective functional results. It can be used as an alternative technique in proximal pole scaphoid non-union with avascular necrosis.

Preparation and Structure of the Ion-Conducting Mixed Molecular Glass Ga2I3.17.

Modern functional glasses have been prepared from a wide range of precursors, combining the benefits of their isotropic disordered structures with the innate functional behavior of their atomic or molecular building blocks. The enhanced ionic conductivity of glasses compared to their crystalline counterparts has attracted considerable interest for their use in solid-state batteries. In this study, we have prepared the mixed molecular glass Ga2I3.17 and investigated the correlations between the local structure, thermal properties, and ionic conductivity. The novel glass displays a glass transition at 60 °C, and its molecular make-up consists of GaI4- tetrahedra, Ga2I62- heteroethane ions, and Ga+ cations. Neutron diffraction was employed to characterize the local structure and coordination geometries within the glass. Raman spectroscopy revealed a strongly localized nonmolecular mode in glassy Ga2I3.17, coinciding with the observation of two relaxation mechanisms below Tg in the AC admittance spectra.

Membrane organization of photosystem I complexes in the most abundant phototroph on Earth.

Prochlorococcus is a major contributor to primary production, and globally the most abundant photosynthetic genus of picocyanobacteria because it can adapt to highly stratified low-nutrient conditions that are characteristic of the surface ocean. Here, we examine the structural adaptations of the photosynthetic thylakoid membrane that enable different Prochlorococcus ecotypes to occupy high-light, low-light and nutrient-poor ecological niches. We used atomic force microscopy to image the different photosystem I (PSI) membrane architectures of the MED4 (high-light) Prochlorococcus ecotype grown under high-light and low-light conditions in addition to the MIT9313 (low-light) and SS120 (low-light) Prochlorococcus ecotypes grown under low-light conditions. Mass spectrometry quantified the relative abundance of PSI, photosystem II (PSII) and cytochrome b6f complexes and the various Pcb proteins in the thylakoid membrane. Atomic force microscopy topographs and structural modelling revealed a series of specialized PSI configurations, each adapted to the environmental niche occupied by a particular ecotype. MED4 PSI domains were loosely packed in the thylakoid membrane, whereas PSI in the low-light MIT9313 is organized into a tightly packed pseudo-hexagonal lattice that maximizes harvesting and trapping of light. There are approximately equal levels of PSI and PSII in MED4 and MIT9313, but nearly twofold more PSII than PSI in SS120, which also has a lower content of cytochrome b6f complexes. SS120 has a different tactic to cope with low-light levels, and SS120 thylakoids contained hundreds of closely packed Pcb-PSI supercomplexes that economize on the extra iron and nitrogen required to assemble PSI-only domains. Thus, the abundance and widespread distribution of Prochlorococcus reflect the strategies that various ecotypes employ for adapting to limitations in light and nutrient levels.

Enhancing biosensor properties of conducting polymers via copolymerization: Synthesis of EDOT-substituted bis(2-pyridylimino)isoindolato-palladium complex and electrochemical sensing of glucose by its copolymerized film.

1,3-Bis(2-pyridylimino)isoindoline derivative bearing 3,4-ethylenedioxythiophene (EDOT-BPI) and its palladium complex (EDOT-PdBPI) were synthesized and characterized by FT-IR, 1H NMR, 13C NMR, UV-Vis spectroscopies and via mass spectrometric analysis. Polymerization of EDOT-PdBPI and copolymerization with 4-amino-N-(2,5-di(thiophene-2-yl)-1H-pyrrol-1-yl)benzamide (HKCN) were carried out by an electrochemical method. In addition, P(EDOT-PdBPI-co-HKCN) modified graphite rod electrode was improved for amperometric glucose sensor based on glucose oxidase (GOx). In this novel biosensor matrix, amino groups in HKCN were used for the enzyme immobilization. On the other hand, EDOT-PdBPI used to mediate the bioelectrocatalytic reaction. Amperometric detection was carried out following oxygen consumption at -0.7V vs. the Ag reference electrode in phosphate buffer (50mM, pH 6.0). The novel biosensor showed a linear amperometric response for glucose within a concentration range of 0.25mM to 2.5mM (LOD: 0.176mM). Amperometric signals at 1mM of glucose were 17.9µA under anaerobic conditions. Amperometric response of the P(EDOT-PdBPI-co-HKCN)/GOx electrode decreased only by 13% within eight weeks. The P(EDOT-PdBPI-co-HKCN)/GOx electrode showed good selectivity in the presence of ethanol and phenol. This result shows that, modification of the proposed biosensor by copolymerization of amine functionalized monomer, which is indispensable to the enzyme immobilization, with palladium complex bearing monomer, which is mediate the bioelectrocatalytic reaction, have provided to give perfect response to different glucose concentrations.

Extension block technique for mallet fractures: a comparison of one and two dorsal pins.

The aim of this study was to compare the clinical and radiological outcomes of one or two dorsal pins for extension blocking of mallet fractures. We treated 36 mallet fractures with the extension block technique. A single pin was used in 19 fractures (Group 1) and two pins in 17 fractures (Group 2). The mean age was 33.6 years and the mean follow-up time was 12.2 months. All patients were assessed by the Crawford outcome score. Extensor lag and other complications were noted. All fractures united with a mean time of 6.0 weeks (4-9) in Group 1, and 6.1 weeks (4-7) in Group 2. We obtained 74% and 71% excellent and good outcome scores in Group 1 and in Group 2, respectively. The final extension lag was 6° in Group 1, and 7° in Group 2. No difference was found between the two groups in terms of clinical outcomes, radiological values and complications.Level 3 non-randomized controlled study.

Characteristics of Patients Who Admitted to the Emergency Department Because of Burns Due to Dens Liquids Such as Hot Milk/Oil.

OBJECTIVE: Burn is the tissue damage on body caused due to various reasons. Although all burns caused by hot liquids are investigated as scalding burns, dense liquid burns (DLB) caused by such as milk and oil are different from other burns. The aim of this study was to report the properties of DLB. MATERIALS AND METHODS: Patients admitted to the Emergency Service of Atatürk University Hospital, with DLB from June 2003 to December 2008, were examined retrospectively. RESULTS: During the study, 28 DLB patients were admitted to the emergency service. The most common admission were found in autumn 28.6% (n=8), and in May and June, 17.9% (n=5). The frequency of burns on the right upper extremity was seen in 50% (n=14) of the patients. The burn degree of all patients was determined as 2(nd) degree. Seventy-five percent (n=21) of the patients were discharged, 14.3% (n=4) were hospitalized. None of the patients died. CONCLUSION: Dense liquid burns is a burn type that is commonly seen in women, absolutely causing 2(nd) degree burns, frequently reported in upper extremity and head/neck regions, and in contrast to other studies, in our region it is completely seen in patients living in city centre.

TEMPO-functionalized zinc phthalocyanine: synthesis, magnetic properties, and its utility for electrochemical sensing of ascorbic acid.

Zinc(ii) phthalocyanine (TEMPO-ZnPc), peripherally functionalized with 2,2,6,6-tetramethyl-1-piperidinyloxy (TEMPO) radicals is synthesized and its magneto structural and electrochemical behaviors are investigated. TEMPO-ZnPc shows multi-electron ring based reduction reactions and a TEMPO based oxidation reaction. Spectroelectrochemical measurements support these peak assignments. TEMPO-ZnPc is tested as a homogeneous and heterogeneous ascorbic acid (AA) sensor. Disappearance of TEMPO-ZnPc based reduction processes and the observation of new waves at around 0 and 1.20 V with respect to increasing AA concentration indicate the interaction of TEMPO-ZnPc with AA and usability of the complex as an electrochemical AA sensor. For practical usage as heterogeneous electrocatalysts for AA sensing, a glassy carbon electrode (GCE) is coated with TEMPO-ZnPc (GCE/TEMPO-ZnPc) and this modified electrode is tested as a heterogeneous AA sensor. The redox peak of GCE/TEMPO-ZnPc at 0.81 V decreases the peak current while a new wave is observed at 0.65 V during the titration of the electrolyte with AA. GCE/TEMPO-ZnPc sense AA with 1.75 × 10(-6) mol dm(-3) LOD with a sensitivity of 1.89 × 10(3) A cm mol(-1).

Inter- and intra-tester reliability of sensibility testing in digital nerve repair.

The aim of this study was to investigate the inter- and intra-tester reliability of the static two-point discrimination and Semmes-Weinstein monofilament tests in digital nerve repair. A total of 100 digital nerves from 67 patients were included into the study. An experienced orthopaedic surgeon and a physiotherapist examined the sensory nerve recovery. The reproducibility score of both tests was at a poor level, but the reliability of the Semmes-Weinstein monofilament test was higher than the static two-point discrimination test. These tests should not be used alone in the quantitative monitoring of sensory recovery, but should be interpreted with the clinical findings.Level 3 non-randomized controlled study.

Partial capitate shortening for Kienböck's disease.

The purpose of this study was to report our experience of partial capitate shortening in seven patients with a median 38 months follow-up. Staging was made by the Lichtman classification system and stage II and III-A patients were included in the study. The mean age was 34 years (range 22-52). Patients were assessed for pain, range of motion, grip and pinch strength, and satisfaction was recorded using a scale between 0 and 4. All these parameters showed improvement after surgery. The Lichtman stage, lunate height index and carpal height index were determined radiographically. Magnetic resonance images of the wrist were studied for lunate revascularization at the final follow-up and occurred in all patients. According to our study, partial capitate shortening seems an effective treatment for Lichtman stage II and III-A patients.Level IV case series study.

EDOT-functionalized calix[4]pyrrole for the electrochemical sensing of fluoride in water.

A new calix[4]pyrrole compound bearing an electropolymerizable EDOT substituent (1) was synthesized, and its electrochemical behavior was investigated. The anion sensor ability of 1 was also studied in solution and in the solid state. Compound 1 interacts with halide ions selectively in solution, which illustrates its possible application as an anion sensor. To test possible practical applications, 1 and EDOT were electropolymerized on an ITO electrode, and this electrode was used as an effective fluoride anion sensor in the solid state.

How valuable is P-wave dispersion in the determination of carboxyhemoglobin levels?

OBJECTIVE: To determine whether or not wave/interval dispersions in electrocardiography (ECG) are increased, and to define whether wave and interval dispersions are correlated with carboxyhemoglobin (COHb) levels. METHODS: ECG, complete blood count, and biochemical parameters were taken from 87 patients with carbon monoxide (CO) poisoning as well as 90 control patients with similar age, gender, and body mass index distribution. COHb levels were recorded in CO-poisoning patients. The COHb levels and the relationships with ECG parameters were studied. RESULTS: Pmax, Pmin, Pd, PRmax, PRmin, PRd, QTmax, QTmin, QTd, cQTmax, cQTmin, cQTd, Tmax, Tmin, and Td in ECG were higher in intoxicated patients than the control group (p < 0.05 for all). Pearson's correlation analyses showed moderately significant positive correlations between COHb level and Pmax (r = 0.224; p = 0.037) and Pd (r = 0.222; p = 0.039). The receiver-operator characteristic (ROC) curve showed that a Pd value of 38 ms determined by ECG separates patients with a COHb ≥ 20% with area under the ROC curve of 0.78 (95%CI = 0.71-0.83), a sensitivity of 67.9% (95%CI = 59.4-75.6), a specificity of 95% (95%CI = 83.0-99.2], a positive predictive value of 97.9% (95%CI = 92.5-99.7), and a negative predictive value of 46.3% (95%CI = 35.3-57.7.) CONCLUSION: A significant increase in wave/interval dispersions in the ECG of CO-poisoning patients compared with controls may show that not only a part is affected but both atrium and the ventricles as a whole are affected by hypoxic ischemia. When COHb levels of the patients are unavailable, P dispersion on ECG may show CO poisoning level of the patient.

Diagnosing isolated nasal fractures in the emergency department: are they missed or overdiagnosed? Ten years experience of 535 forensic cases.

AIM: Nasal bone is the most common broken bone of the face. Incorrect assessments of nasal trauma are frequently encountered in forensic evaluations. Here, we aimed to determine the reasons and frequency of erroneous assessments of nasal trauma in emergency department (ED). METHODS: This is a cross-sectional multicentric study analyzing the Forensic Medical Department archive retrospectively. Epidemiologic features, type of fracture (depressed or non-depressed), and specialty of the doctor examining the cases in ED were studied. Forensic evaluation was reported by analyzing all radiologic examinations (CT and X-ray), medical records, and after repeated physical examination of nasal trauma by the forensic council, consisting of a forensic expert, a radiologist and an otolaryngologist. Nasal fracture was diagnosed when at least two of three physicians agreed. RESULTS: A total of 535 cases (mean age 31.7 ± 14.4, 87.1 % males) were analyzed. The most common causes of injuries were assault (81.8 %), followed by traffic accident (15.3 %) and falls from a height (2.1 %). There were misdiagnoses in ten patients (1.9 %) and overdiagnosis in 135 (24.5 %). The possibility of fracture overdiagnosis was 13.5 times higher than missing it. General practitioners and emergency physicians have 19.7 times (95 % CI 5.5-22. 3) and 3.4 times (95 % CI 1.5-7.8) the tendency to report soft tissue nasal injuries as non-depressed fractures, respectively. CONCLUSION: We found that nasal fractures are rarely missed while the overdiagnosis was very common. Examination of patients by a general practitioner or an emergency physician without consultation with a specialist and using only plain radiographs were found to be independent parameters affecting overdiagnosis.

How Quantum Coherence Assists Photosynthetic Light Harvesting.

This perspective examines how hundreds of pigment molecules in purple bacteria cooperate through quantum coherence to achieve remarkable light harvesting efficiency. Quantum coherent sharing of excitation, which modifies excited state energy levels and combines transition dipole moments, enables rapid transfer of excitation over large distances. Purple bacteria exploit the resulting excitation transfer to engage many antenna proteins in light harvesting, thereby increasing the rate of photon absorption and energy conversion. We highlight here how quantum coherence comes about and plays a key role in the photosynthetic apparatus of purple bacteria.

Thoracic epidural anesthesia and blood glucose levels in diabetic patients undergoing cardiopulmonary bypass under insulin infusion according to the Portland protocol.

BACKGROUND: We investigated the effect of thoracic epidural anesthesia on perioperative blood glucose levels in diabetic patients undergoing cardiopulmonary bypass by continuous insulin infusion according to the Portland Protocol. MATERIAL AND METHODS: Diabetic patients undergoing surgery with cardiopulmonary bypass were assigned to receive either general anesthesia alone (n=40) or general anesthesia with thoracic epidural anesthesia (n=18). Patient data were retrospectively reviewed from prospective chart records used in our anesthesia clinic. In all study patients, insulin infusion with the Portland Protocol was used to maintain stable blood glucose levels. We evaluated blood glucose levels in both groups at 6 time points including before surgery, before cardiopulmonary bypass, during cardiopulmonary bypass, immediately following cardiopulmonary bypass, and on the first and second postoperative days. The amounts of insulin required at the intraoperative period and during two postoperative days were compared between two groups. RESULTS: Groups were similar with respect to the duration of cardiopulmonary bypass, aortic cross-clamping, surgery, and blood glucose levels at any of the 6 time points, mean insulin requirements during intraoperative period and mean insulin requirements and blood glucose levels during the first 2 postoperative days (General anesthesia alone, 189+/-29 mg/dl vs. General anesthesia with thoracic epidural anesthesia, 191+/-19 mg/dl; p=0.782). CONCLUSIONS: In diabetic patients undergoing cardiopulmonary bypass receiving insulin infusion by the Portland Protocol for glycemic control, thoracic epidural anesthesia provides no additional benefit for maintaining blood glucose levels during surgery.

Retropharyngeal submucosal dissection due to nasotracheal intubation.

PROBLEM: Nasal intubation is used often by anaesthetists because it offers many advantages; however, rare complications do arise. A 67-year-old man was admitted to our otorhinolaryngology clinic for uvulopalatopharyngoplasty. Nasotracheal intubation was performed without difficulty. At the beginning of surgery, the surgeon noticed that the nasotracheal tube had penetrated the oropharyngeal mucosa through a channel in the retropharyngeal space. METHODOLOGY: The tube was left in place during surgery to prevent bleeding. After surgery, a vertical incision was made through the mucosa surrounding the tube from the inferior pouch up to the nasopharynx to prevent hematoma. RESULT: The patient was extubated without complication and discharged on the second day postoperative. The oropharyngeal mucosa was healed by the 15th day postoperative. CONCLUSION: Nasal intubation tubes should be lubricated and inserted without force; the oropharynx should be examined carefully after intubation to rule out complications.

Does left molar approach to laryngoscopy make difficult intubation easier than the conventional midline approach?

BACKGROUND AND OBJECTIVE: It has been reported that the left molar approach of laryngoscopy can make difficult intubation easier. The aim of this study was to investigate whether left molar approach to laryngoscopy provided a better laryngeal view in cases of unexpected difficult intubation. METHODS: Following the approval of local Ethics Committee and written informed consent from the patients, out of 1386 patients who underwent general anaesthesia for surgery, 20 patients who could be ventilated by face mask but could not be intubated with conventional midline approach on the first attempt were included in the study. Those 20 patients, who had Grade III-IV laryngeal views on laryngoscopy by conventional midline approach, were subjected to left molar laryngoscopy, and their laryngeal views were evaluated. The external laryngeal compression was routinely used to improve the laryngeal view. When endotracheal intubation failed by left molar laryngoscopy, we performed the conventional midline approach again. All data were recorded. RESULTS: Of the 20 patients studied, 18 had a Grade III laryngeal view and two had a Grade IV laryngeal view. Eighteen of them had a better laryngeal view with left molar laryngoscopy. Eleven of the 20 patients underwent successful intubation with the left molar laryngoscopy, which provided a significantly better laryngeal view and success rate of tracheal intubation than did the conventional midline approach (P < 0.01 and P < 0.01, respectively). CONCLUSIONS: Left molar laryngoscopy can make unexpected difficult intubation easier and should be attempted in cases of difficult intubation.

Patient-controlled analgesia with lornoxicam vs. dipyrone for acute postoperative pain relief after septorhinoplasty: a prospective, randomized, double-blind, placebo-controlled study.

BACKGROUND AND OBJECTIVE: We compared the efficacy of intravenous lornoxicam vs. dipyrone in patient-controlled analgesia for postoperative analgesia. METHODS: The study included 105 patients who had undergone elective septorhinoplasty after receiving general anaesthesia. Patients were divided into three groups to receive lornoxicam (24 mg day(-1)), dipyrone (5 g day(-1)) or placebo. Pain was evaluated using a 0-100 mm visual analogue scale at 2, 4, 6, 8, 12, 16, 20 and 24 h postoperatively. Pethidine (1 mg kg(-1)) was administered intramuscularly to patients requiring rescue analgesia. Pethidine requirements were recorded during the first 24 h postoperatively, and treatment-related adverse effects were noted. RESULTS: Postoperative pain scores were significantly lower with lornoxicam compared with dipyrone at 8 h (P = 0.016). No significant differences regarding pain scores at 2, 4, 6, 12, 16, 20 and 24 h were found. Significantly fewer patients in the lornoxicam group required rescue analgesics (vs. dipyrone, P = 0.046; vs. placebo, P = 0.001); fewer patients in the dipyrone group required rescue analgesics compared with placebo (P = 0.008). Significantly fewer patients in the lornoxicam group had nausea (vs. dipyrone, P = 0.022; vs. placebo, P = 0.006); no significant differences were found between the other two groups. Antiemetic use was significantly lower in the lornoxicam group (vs. dipyrone, P = 0.002; vs. placebo, P = 0.001). CONCLUSIONS: Lornoxicam has better tolerability and is a more effective analgesic than dipyrone when administered by patient-controlled analgesia for postoperative analgesia after septorhinoplasty.