Efficacy of intravenous magnesium sulfate infusion on postoperative pain and quality of recovery for septorhinoplasty: a randomized controlled study.

BACKGROUND: The pain that occurs after septorhinoplasty is an important factor affecting the comfort of the patient. OBJECTIVES: To investigate the effect of perioperative intravenous magnesium sulfate infusion on postoperative pain and quality of recovery in patients underwent septorhinoplasty surgery. MATERIAL AND METHODS: One hundred twenty patients who underwent septorhinoplasty were randomly divided into two groups. Magnesium group received intravenous magnesium after induction of anesthesia (30 mg/kg), then infused until the end of the surgical procedure (9 mg/kg). The placebo group received the same volume of saline infusion. The VAS score was used for postoperative pain assessment, and the Quality of Recovery-40 (QoR-40) score was used for the assessment of recovery status. RESULTS: The postoperative 30 min, 1st, 2nd, 4th (p < .001) and 24th hour (p < .05) VAS scores of the patients in the magnesium infusion group were significantly lower compared to the placebo group. Also; in terms of physical comfort (p < .001), emotional state (p < .05), psychological support, pain and total score values (p < .001), patients in magnesium group had significantly higher QoR-40 scores than those in placebo group. CONCLUSION: Intraoperative magnesium infusion, which is widely used in many surgeries to provide controlled hypotension, also contributes significantly to patient comfort with its positive effect on postoperative pain and recovery scores.

Intravenous lidocaine vs. NSAIDs for migraine attack in the ED: a prospective, randomized, double-blind study.

PURPOSE: Although different forms of lidocaine are used for migraine attack headaches, the effect of intravenous lidocaine is still limited. This study aimed to investigate the effects of intravenous lidocaine infusion for the treatment of migraine attack headaches. METHODS: A hundred patients with migraine attacks, aged between 18 and 65, were randomly divided into two groups. The lidocaine group (n = 50) received a 1.5 mg/kg lidocaine bolus and a 1 mg/kg infusion (first 30 min), followed by a 0.5 mg/kg infusion for a further 30 min intravenously. The non-steroidal anti-inflammatory drug (NSAID) group (n = 50) received 50 mg dexketoprofen trometamol and saline at the same volume as the lidocaine at the same time intervals intravenously. The Visual Analog Scale (VAS) pain scores, additional analgesia requirement, side effects, and revisits to the emergency department were recorded. RESULTS: The VAS score was significantly lower in the lidocaine group than in the NSAID group for the first 20th and 30th minutes (p = 0.014 and p = 0.024, respectively). There was no difference between the VAS scores for the remaining evaluation times (p > 0.05). In terms of secondary outcomes, rescue medication requirement was not different between the two groups at both the 60th and 90th minutes (p > 0.05). However, the number of patients revisiting ED within 48-72 h was statistically less in the lidocaine group than in the NSAID group (1/50 vs. 8/50; p = 0.031). CONCLUSION: Intravenous lidocaine may be an alternative treatment method for patients with migraine attack headaches in the emergency department.

Can ultrasound-guided infraclavicular block be an alternative option for forearm reduction in the emergency department? A prospective randomized study.

OBJECTIVE: Ultrasound-guided infraclavicular nerve block (IB) has become a well-established method in several outpatient procedures; however, its use in emergency departments (EDs) remains limited. The aim of this study was to compare procedural sedation and anlagesia (PSA) and IB in the pain management for patients who underwent forearm fracture reduction in the ED. METHODS: This prospective randomized study included 60 patients aged 18 to 65 years, who visited the ED with forearm fractures. They were randomly divided into two groups: Group PSA (n=30) and Group IB (n=30). The pain scores of patients were evaluated before and during the procedure with the visual analog scale. Complications and patient and operator satisfaction levels were recorded. RESULTS: There was no difference between the two groups in terms of demographic characteristics. The median (interquartile range) pain scores observed during the procedures were significantly higher in Group PSA than in Group IB (4 [4-6] vs. 2 [0-2], respectively; P<0.001). Patient and operator satisfaction levels were significantly higher in Group IB (P<0.001). Oxygen desaturation was statistically higher in Group PSA than in Group IB (40.00% vs. 3.33%, respectively; P=0.002). CONCLUSION: IB was an effective alternative for reducing pain and increasing patient satisfaction in ED patients undergoing forearm fracture reduction.

Erector spinae plane block vs non-steroidal anti-inflammatory drugs for severe renal colic pain: A pilot clinical feasibility study.

AIM: Ultrasound-guided plane blocks are increasingly used in the multi-modal analgesic concept for reducing opioid consumption. The present study was conducted to compare the analgesic effect of intravenous non-steroidal anti-inflammatory drugs (NSAIDs) and erector spinae plane (ESP) block in renal colic patients. METHODS: In this prospective randomised study, 40 patients with renal colic pain were randomly assigned into two groups: Group NSAID (n = 20) received an intravenous infusion of 50 mg of dexketoprofen trometamol and Group ESP (n = 20) received ultrasound-guided ESP block with 30 ml 0.25% bupivacaine at the T8 level. The pain severity of patients was assessed using the visual analogue scale (VAS) at baseline, 5, 15, 30, 45 and 60 minutes after intervention. Opioid consumption, patient satisfaction and side effects were recorded. RESULTS: In the ESP group, the VAS scores were significantly lower than the NSAID group at 5, 15, 30, 45 and 60 minutes after the procedure (P < .001). Opioid consumption was significantly higher in the NSAID group compared with the ESP group (10/20 vs 0/20, respectively; P < .001). Patient satisfaction was significantly higher in the ESP group (P < .001). CONCLUSIONS: ESP block can be an alternative, efficient and safe method for the relief of acute renal colic pain.

Pre-procedure intravenous lidocaine administration on propofol consumption for endoscopic retrograde cholangiopancreatography: A prospective, randomized, double-blind study.

BACKGROUND AND AIM: The endoscopic retrograde cholangiopancreatography (ERCP) procedure is generally performed in patients with high comorbidity. We aimed to reduce the consumption of propofol by adding lidocaine before ERCP. METHODS: Eighty ERCP patients with ASA I-III, aged between 45-75 years, were randomly divided into two groups. Lidocaine group (group L, n = 40), received 1-mg midazolam, 1.5 mg/kg lidocaine, and 1 mg/kg propofol intravenously. The control group (group C, n = 40) received 1-mg midazolam, saline in the same volume as the lidocaine group, and 1 mg/kg propofol intravenously. Propofol was administered with intermittent bolus doses. Propofol consumption, oropharyngeal reflex, recovery time, endoscopist satisfaction, ketamine need, and side-effects were recorded. RESULTS: Propofol consumption during the procedure was statistically lower in group L than in the control group (157.25 ± 39.16 mg vs 228.75 ± 64.62 mg respectively, P < 0.001). Additionally, recovery time was statistically faster in group L compared with the control group (7.78 ± 3.95 min vs 11.92 ± 3.24 min respectively, P < 0.001). The oropharyngeal reflex was less in group L than control group (6/40 vs 15/40 respectively, P = 0.042). There was no significant difference between the two groups regarding visual analogue scale scores and endoscopist satisfaction (P > 0.05). CONCLUSIONS: We recommend the use of intravenous lidocaine before the ERCP procedure as it reduces propofol consumption, recovery times, and oropharyngeal reflex.

Postoperative analgesic efficacy of perioperative intravenous lidocaine infusion in patients undergoing septorhinoplasty: a prospective, randomized, double-blind study.

PURPOSE: Intravenous lidocaine infusion has been used for postoperative analgesia in many surgical procedures in recent years. The aim of this randomized, double-blind study was to investigate the postoperative analgesic efficacy of perioperative intravenous lidocaine infusion in patients undergoing septorhinoplasty surgery. MATERIALS AND METHODS: Forty-eight American Society of Anesthesiologists I and II patients, aged 18-40 years scheduled for septorhinoplasty surgery, were assigned into two groups. Before anesthesia induction, patients in the lidocaine group (Group L, n = 24) received an intravenous bolus infusion of 1.5 mg/kg lidocaine followed by a continuous infusion of 1.5 mg/kg/h during the operation and until the end of the first postoperative hour. Patients in the control group (Group C, n = 24) received normal saline according to the same protocol. In the postoperative period, 50 mg dexketoprofen trometamol was administered and repeated every 12 h. Postoperative pain scores, rescue analgesia, intraoperative opioid requirements, and side effects were recorded. RESULTS: Postoperative pain scores were significantly lower in Group L than in Group C at postoperative 30 min, 1, 2, 4, 8, 12 and 24 h (p < 0.05). There was no difference between groups intraoperative remifentanil consumption (p > 0.05). Rescue analgesia use was statistically significantly higher in Group C than in Group L (12/24 versus 1/24, respectively, p â€Š= â€Š0.001). Postoperative nausea was statistically higher in Group C than in Group L (13/24 versus 5/24 respectively, p â€Š= â€Š0.017), whereas other side-effects were similar for the two groups (p > 0.05). DISCUSSION: We recommended the use of intravenous lidocaine infusion for intraoperatively and first postoperative hours in septorhinoplasty surgery as it reduces pain scores and the need for additional opioid use.

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.

Predestinating Role of Cardiac Ganglia on Heart Life Expectancy in Rabbits After Brain Death Following Subarachnoid Hemorrhage: An Experimental Study.

BACKGROUND: Cardiac ganglia are rechargeable batteries of the heart. The essential role of cardiac ganglia on cardiac life expectancy has not been examined following brain death. The aim of this study was to determine cardiac ganglia numbers and neuron density following subarachnoid hemorrhage (SAH). METHODS: Twenty-five hybrid rabbits were grouped as control (n = 5), sham (n = 5), and SAH (n = 15). The SAH groups' animals were subjected to injections of lethal dose of 2.00 cc autologous blood into their cisterna magna until linear EEG was obtained. The hearts of all animals were extracted following intracardiac formalin injection and examined. Cardiac ganglia and normal/degenerated neuron densities of cardiac neurons were recorded. RESULTS: The mean volume of normal neuron density of ganglia was 6.980 ± 830/mm3, and the degenerated neuron density of ganglia was 3 ± 1/mm3 in the control group, 6134 ± 712/mm3; 23 ± 9/mm3 in the sham group, 3456 ± 589; 1161 ± 72/mm3 in the surviving group; and 1734 ± 341/mm3, 4259 ± 865/mm3 in the dead animals in the SAH group. The algebraic results of heart work capacity (Wh) were estimated as 1375 ± 210 Wh in the control group, 1036 ± 225 in the sham group, 800 ± 110 Wh in the surviving group, and < 100 ± 20 in the dead animals in the SAH group. Degenerated cardiac neuron density/Wh correlation is statistically meaningful between the dead in the SAH group versus the SAH-surviving, sham, and control groups (P < .0005). CONCLUSIONS: Normal cardiac ganglia numbers and/or cardiac ganglia neuron density may be related to cardiac survival following brain death after subarachnoid hemorrhage.

Preemptive Analgesic Efficacy of the Ultrasound-Guided Bilateral Superficial Serratus Plane Block on Postoperative Pain in Breast Reduction Surgery: A Prospective Randomized Controlled Study.

PURPOSE: Breast surgery is an exceedingly common procedure and associated with an increased incidence of acute and chronic pain. Preemptive regional anesthesia techniques may improve postoperative analgesia for patients undergoing breast surgery. The aim of this study was to evaluate the effect of preoperative bilateral serratus plane block on postoperative opioid consumption in patients undergoing breast reduction surgery. METHODS: After ethical board approval, 40 patients undergoing breast reduction surgery were randomized into 2 groups: control group (Group C, n = 20) and serratus plane block group (Group SPB, n = 20). Group C received bilateral ultrasound-guided 2 ml 0.9% saline subcutaneously each block side, Group SPB received ultrasound-guided bilateral SPB with 0.25% bupivacaine 30 ml each side. The groups were administered the routine general anesthesia protocol. All operations were performed with the mediocentral pedicled reduction mammaplasty technique by the same surgeon. Postoperative analgesia was performed intravenously in the 2 groups twice a day with dexketoprofen trometamol 50 mg and patient-controlled analgesia with fentanyl. Postoperative analgesia was evaluated using the visual analog scale (VAS). Fentanyl consumption, additional analgesia requirement and opioid-related side effects were recorded during the first 24 h after surgery. RESULTS: Compared with control, the VAS score was statistically lower in the SPB group during all measurement times (p < 0.05). The 24-h opioid consumption was significantly higher in the control group compared with the SPB group (372.50 ± 39.65 vs. 296.25 ± 58.08 µq, respectively; p < 0.001). In addition, the analgesia requirement was statistically lower in the SPB group (8/20 vs. 2/20, respectively, p < 0.028). Nausea or vomiting was observed more often in the control group than in SPB block (9/20 vs. 2/20, respectively, p = 0.013), whereas other side effects were similar for the two groups. CONCLUSIONS: SPB can be used safely bilaterally in the management of pain for breast reduction surgery as it is easy to perform, provides excellent analgesia, and reduces opioid consumption and opioid sparing effect. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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.

Effects of Bupivacaine Versus Bupivacaine Plus Dexamethasone-Soaked Nasal Packing After Endoscopic Nasal Surgery.

BACKGROUND: The aim of this randomized prospective study was to investigate the postoperative analgesic effectiveness of bupivacaine versus bupivacaine plus dexamethasone-soaked nasal packing in patients scheduled for endoscopic nasal surgery. METHODS: Sixty American Society of Anesthesiologists groups I and II patients aged 18 to 65 years and scheduled for endoscopic nasal surgery were assigned into 2 groups. Group B received 8 mL 0.5% bupivacaine and 2 mL saline, and group BD received 8 mL 0.5% bupivacaine and 8 mg (2 mL) dexamethasone-soaked nasal packing. In the postoperative period, 1000 mg paracetamol was administered and repeated every 6 hours. Postoperative pain scores, additional analgesia requirements and nausea-vomiting were recorded. RESULTS: Postoperative pain scores were significantly lower in group BD than in group B at 1, 2, 4, 8, and 12 hours, and during tampon removal (P < 0.05), but there was no difference between the groups' 24-hour visual analog scale scores (P = 0.115). Postoperative additional analgesia use was statistically significantly higher in group B than in group BD (25/30 versus 13/30 respectively, P = 0.001). Postoperative nausea and vomiting was statistically higher in group B than in group BD (11/30 versus 4/30 respectively, P = 0.037). CONCLUSION: The addition of dexamethasone to bupivacaine via soaked nasal packing in endoscopic nasal surgery reduced postoperative pain scores, additional analgesia requirements, and PONV. The authors recommended a combination of bupivacaine plus dexamethasone-soaked nasal packing after endoscopic nasal surgery.

Relief of refractory renal colic in emergency department: A novel indication for ultrasound guided erector spinae plane block.

Plane blocks have become very popular in recent years with the introduction of ultrasonography into the regional anesthesia and algology practice. Erector spinae plane (ESP) block involves injection of local anesthetics between erector spinae muscles and transverse process of vertebrae and can block the dorsal and ventral rami of thoracolumbar spinal nerves. The primary factor in the great popularity of this block is easy sonographic identification of landmarks and lower complication rate compared to paravertebral or central neuroaxial blocks. These characteristics mean that it will in all probability be widely used in the future, not just for anesthetists, but also for emergency physicians. Here we first report a novel indication for ESP block in emergency department; renal colic.