Rider sitting position widens lumbar intervertebral distance: a prospective observational study.

BACKGROUND: Reduced lumbar lordosis may make the process of identifying the intervertebral distance easier. The primary aim of this study was to measure the L3...L4 intervertebral space in the same patients undergoing spinal anesthesia in three different sitting positions, including the classic sitting position (CSP), hamstring stretch position (HSP) and rider sitting position (RSP). The secondary aim was to compare ultrasonographic measurements of the depth of the ligamentum flavum and intrathecal space in these three defined positions. METHODS: This study is a single-blinded, prospective, randomized study. Ninety patients were included in final analysis. the patients were positioned on the operating table in three different positions to perform ultrasonographic measurements of the spinal canal. The intervertebral distance (IVD), the distance between the skin and the ligamentum flavum (DBSLF) and the intrathecal space (IS) were measured in the L3...L4 intervertebral space in three different positions. RESULTS: The RSP produced the largest mean distance between the spinous processes. The RSP yielded a significantly larger IVD than did the CSP (p < 0.001) and HSP (p < 0.001). The DBSP was larger in the CSP than in the HSP (p = 0.001). The DBSLF was significantly larger in the RSP than in the HSP (p = 0.009). CONCLUSIONS: Positioning the patient in the RSP significantly increased the intervertebral distance between L3...L4 vertebrae compared to the CSP and HSP, suggesting easier performance of lumbar neuraxial block.

Erector Spinae Plane Block for anesthesia of open ventral hernia repair in severe Ankylosing Spondylitis.

Ankylosing spondylitis is a challenging disease for anesthesiologist due its airway and axial skeleton involvement. A 55 years old male patient suffering from severe ankylosing spondylitis, admitted to Anesthesiology Clinic. He was planned to receive a midline open ventral hernia repair. We decided to perform bilateral ultrasound-guided erector spinae plane (ESP) block at the level of T8 with 0.4 mcg kg-1 hour-1 dexmedetomidine sedation for complete anesthesia of the surgery. We performed ESP block with 25 mL of 0.25% bupivacaine and repeated the same procedure at the contralateral side. Twenty minutes later, the skin incision was started. We didn't need to apply an additive anesthetic or analgesic drug throughout the surgery. ESP block provides analgesia for different dermatomes by effecting ventral rami and rami communicantes of spinal nerves depending on the level of injection site. When performed between T7-T9 levels, it has been reported to effectively attenuate postoperative pain after different types of surgeries.

Rhomboid Intercostal Block for Analgesia of Multiple Rib Fractures in an Infant.

Rhomboid intercostal block (RIB) is a novel plane block, which is thought to provide analgesia for both the anterior and the posterior hemithorax. Herein, we represent the successful usage of ultrasound-guided RIB on an infant patient to provide analgesia for multiple rib fractures and insertion of a chest tube. A 10-month-old, 8 kg, male infant was scheduled for insertion of a chest tube. The patient had right sided pneumothorax and multiple rib fractures from T4 to T8 after a car crush. Following induction of anaesthesia, he was placed in lateral decubitis position and RIB was performed with 8mL 0.125% bupivacaine. A paediatric epidural catheter was placed into the interfacial plane for post-operative intermittent local anaesthetic injection as a part of multimodal analgesia with administration of intravenous paracetamol 60 mg. The postoperative pain assessment was conducted with FLACC scale at the post-operative 10th minute, 30th minute, 1st, 2nd, 6th, 12th and 24th hours, and the Face, Legs, Activity, Cry, Consolability scale score was 2 at all time-points. Ultrasound-guided RIB provided effective analgesia for insertion of a chest tube and attenuation of pain due to multiple rib-fractures in our infant patient.

Early and late blood flow changes in the brachial artery following brachial plexus block.

BACKGROUND: A nerve block causes various hemodynamic changes in the vessel system. The primary objective of the present study is to examine the volume flow values in the brachial artery in the early and late period following an infraclavicular brachial plexus block. The secondary objective is to evaluate arterial diameter, forearm temperature and other Doppler ultrasound measurements in the late period. METHODS: An infraclavicular brachial plexus block was performed in ASA class I-II patients aged 18-65 years who were to undergo upper extremity surgery. Hemodynamic measurements and the measurement of the Doppler ultrasound parameters at five minutes before and five, 15, 30 minutes, 24, 48 hours after the block. RESULTS: Volume flow was increased at the 30th min after nerve block. A 47.17% decrease in the collected volume flow data was noted between the 30th min and 24th hour, and this change was found to be statistically significant. It is also worth highlighting the decrease in volume flow at 24 hours and 48 hours, which became closer to the volume flow value at time 0, but was still relatively higher than the value at time 0. CONCLUSIONS: The increase in volume flow following a change in the flow morphology after an infraclavicular nerve block persists for at least 24 hours. This may be the explanation for clinical advantage in all types of surgery and in particular after fractures, graft and reimplantation surgery.

Evaluation of the effect of the mouth gag use on optic nerve sheath diameter of pediatric patients undergoing tonsillectomy or Adenotonsillectomy: An observational study.

BACKGROUND: A mouth gag is usually used during tonsillectomy and adenotonsillectomy surgeries, cleft palate repair, obstructive sleep apnea surgery, and intraoral tumor excision. The placement of the gag causes hemodynamic changes similar to laryngoscopy. The aim of this study was to evaluate the effect of mouth gag placement on the optic nerve sheath diameter (ONSD) of pediatric patients. The secondary aim was to assess the relationship between neck extension and changes in ONSD. METHODS: The trial was prospectively registered to the Australian New Zealand Clinical Trials Registry (Trial ID: ACTRN12618000551291) on 12.04.2018. This prospective, observational study was performed in a tertiary university hospital operating room between 01.05.2018-01.07.2018. Thirty-five children aged < 18 years, with ASA I status, who were scheduled for tonsillectomy and adenotonsillectomy surgeries were prospectively included in the study. Measurements of ONSD were performed (T0) after induction of anesthesia, (T1) after endotracheal intubation, (T2) after mouth gag placement, and (T3) 20 min after mouth gag placement. After the mouth gag was placed and the head was positioned for surgery, the degree of neck extension was calculated. RESULTS: All participants completed the study. There were significant differences in ONSD values at time points T1, T2, and T3 (p < 0.001, CI: - 0.09,-0.05; p < 0.001, CI: - 0.09,-0.05; p < 0.001, CI: - 0.05,-0.02; respectively). The maximum increase in ONSD was after intubation (0.69 ± 0.06 mm) and immediately after mouth gag placement (0.67 ± 0.07 mm). ONSD values continued to increase 20 min after gag placement (0.36 ± 0.04). There was no relation between the degree of neck extension and ONSD values (ß = 0.63, p = 0.715). CONCLUSIONS: The use of a mouth gag causes significant increases in ONSD measurements of children. Therefore, attention to the duration of mouth gag placement should be considered during surgery. TRIAL REGISTRATION: The trial was prospectively registered to the Australian New Zealand Clinical Trials Registry (Trial ID: ACTRN12618000551291 ) on 12.04.2018.

Can coffee consumption be used to accelerate the recovery of bowel function after cesarean section? Randomized prospective trial.

OBJECTIVES: To evaluate whether coffee consumption accelerates the recovery of bowel function after cesarean section or not. MATERIAL AND METHODS: This study was designed as randomized controlled study. Patients were randomly assigned to one of two groups: Ultimately, Group 1 (n = 51) was the study group and drank three cups of coffee after cesarean, whereas group 2 (n = 52) was not given any treatment. The primary outcome measure was the time to first defecation after surgery, the secondary outcomes were time to first bowel movement, passage of flatus, time to toleration of a solid diet, additional antiemetic and analgesic requirement. RESULTS: There were no significant differences in demographic variables between the groups. The mean time to passage of first flatus was significantly shorter in the study group than the control group (8.6 ± 3.3 h vs 11.3 ± 7.5 h, respectively; p = 0.022). First defecation was 20.7 ± 11.5 h for the study group and at 29.1 ± 14.3 h for the control group (p = 0.001). In addition, there was a significant difference in mean time to toleration of solid food between the study and control groups (8.78 ± 2.33 h vs 12.88 ± 4.2.60 h, respectively; p < 0.001). CONCLUSIONS: Coffee can be used in patients to enhance the recovery of gastrointestinal function after elective cesarean section.

Evaluation of ultrasound-guided rhomboid intercostal nerve block for postoperative analgesia in breast cancer surgery: a prospective, randomized controlled trial.

BACKGROUND AND OBJECTIVES: Mastectomy has many potential sources of pain. Rhomboid intercostal block (RIB) is a recently described plane block. The primary hypothesis of the study is that ultrasound-guided RIB combined with general anesthesia would accelerate global quality of recovery scores of patients following mastectomy surgery. Secondary hypothesis is that RIB would reduce postoperative opioid consumption, pain scores, and the need for rescue analgesia. METHODS: Patients aged between 18 and 70 years, with American Society of Anesthesiologists physical status I-II and scheduled for an elective unilateral modified radical mastectomy surgery with axillary lymph node dissection were enrolled to the study. Following endotracheal intubation, patients were randomly allocated into two groups. Patients in the first group (group R) received ultrasound-guided RIB with 30 mL 0.25% bupivacaine. In the control group (group C), no block intervention was applied. All patients received intravenous dexamethasone 8 mg, dexketoprofen trometamol 50 mg intraoperatively and tramadol 1 mg/kg 30 min before the end of surgery for postoperative analgesia. All patients received intravenous morphine patient-controlled analgesia device at the arrival to the recovery room. RESULTS: The descriptive variables of the patients were comparable between group R and group C. Mean quality of recovery-40 score at 24 hours was 164.8±3.9 in group R and 153.5±5.2 in group C (mean difference 11.4 (95% CI 8.8 to 13.9; p<0.001). At 24th hour, median morphine consumption was 5 mg (IQR 4-7 mg) in group R and 10 mg (IQR 8-13 mg) in group C, p<0.001. Intraoperative fentanyl administration, pain scores and the need for rescue postoperative analgesia was similar between groups. CONCLUSIONS: In the current study, ultrasound-guided RIB promoted enhanced recovery and decreased opioid consumption after mastectomy surgery. TRIAL REGISTRATION NUMBER: ACTRN12619000879167.

The effect of preoperative anxiety level on mean platelet volume and propofol consumption.

BACKGROUND: The mean platelet volume (MPV) is an important indicator of platelet function with large platelets showing higher enzymatic and metabolic activity than other platelets. There can be a relationship between increased platelet activity and anxiety and depression. Our primary hypothesis was that patients with high anxiety scores would have higher MPV, and the secondary hypothesis was that propofol induction time and total propofol consumption within the first 30 min of surgery would be higher in patients with higher anxiety scores. METHODS: The Beck Anxiety Inventory (BAI) was administered to the participating patients 1 day before surgery to evaluate the level of anxiety. Based on the scores from the BAI, 40 patients with an anxiety score of < 8 were assigned to the non-anxious group (Group NA) and 40 patients with an anxiety score of ≥8 were assigned to the anxious group (Group A). At the anesthesia induction the mean time to achieve an entropy value below 60 (T1) was recorded. The total intraoperative propofol consumption within the first 30 min was recorded. RESULTS: There was a statistically significant difference between the groups in terms of preoperative MPV and demographic data, including age and sex. The mean total propofol consumption at 30 min after induction in the groups was statistically significant. The cut-off value for MPV was calculated as 9.65. CONCLUSIONS: The preoperative MPV values and propofol consumption at 30 min among patients with high preoperative anxiety scores were high. We suggest that MPV is helpful in the clinical practice in predicting the amount of anesthetic agents required for the 30 mins of anesthesia.

Efficacy of ultrasound-guided erector spinae plane block for analgesia after laparoscopic cholecystectomy: a randomized controlled trial / Eficácia do bloqueio do plano do músculo eretor da espinha guiado por ultrassom para analgesia após colecistectomia laparoscópica: um estudo controlado randômico

Abstract Background and objectives: The primary aim of this study is to assess the effect of ultrasoung-guided erector spinae block on postoperative opioid consumption after laparoscopic cholecystectomy. The secondary aims are to assess the effects of erector spinae plane block on intraoperative fentanyl need and postoperative pain scores. Methods: Patients between 18-70 years old, ASA I-II were included in the study and randomly allocated into two groups. In Group ESP, patients received bilateral US-ESP with 40 ml of 0.25% bupivacaine at the level of T7, while in Group Control, they received bilateral US-ESP with 40 ml of saline before the induction of anesthesia. Then a standard general anesthesia procedure was conducted in both groups. NRS scores at the postoperative 15th, 30th, 60th minutes, 12th and 24th hours, intraoperative fentanyl need and total postoperative tramadol consumption were recorded. Results: There were 21 patients in Group ESP and 20 patients in Group Control. Mean postoperative tramadol consumption was 100 ± 19.2 mg in Group ESP, while it was 143 ± 18.6 mg in Group Control (p < 0.001). The mean intraoperative fentanyl need was significantly lower in Group ESP (p = 0.022). NRS scores at the postoperative 15th, 30th min, 12th hour and 24th hour were significantly lower in ESP group (p < 0.05). According to repeated measures analysis, NRS score variation over time was significantly varied between two groups (F[1, 39] = 24.061, p < 0.0005). Conclusions: Bilateral US-ESP block provided significant reduction in postoperative opioid consumption, intraoperative fentanyl need and postoperative pain scores of patients undergoing laparoscopic cholecystectomy.

Resumo Justificativa e objetivos: O objetivo primário deste estudo foi avaliar o efeito do bloqueio do plano do músculo eretor da espinha guiado por ultrassom (US-ESP) sobre o consumo de opioides no pós-operatório após colecistectomia laparoscópica. Os objetivos secundários foram avaliar os efeitos do bloqueio do plano eretor da espinha sobre a necessidade de fentanil no intraoperatório e nos escores de dor pós-operatória. Métodos: Pacientes entre 18 e 70 anos, ASA I-II, foram incluídos no estudo e alocados randomicamente em dois grupos. No Grupo ESP, os pacientes receberam o bloqueio bilateral US-ESP com 40 mL de bupivacaína a 0,25% no nível de T7, enquanto no Grupo Controle os pacientes receberam o bloqueio bilateral US-ESP com 40 mL de solução salina antes da indução da anestesia. Em seguida, um procedimento-padrão de anestesia geral foi feito em ambos os grupos. Os escores da NRS aos 15, 30 e 60 minutos e em 12 e 24 horas de pós-operatório, a necessidade de fentanil no intraoperatório e o consumo total de tramadol no pós-operatório foram registrados. Resultados: O grupo ESP foi constituído por 21 pacientes e o Grupo Controle por 20. O consumo médio de tramadol no pós-operatório foi de 100 ± 19,2 mg no Grupo ESP e de 143 ± 18,6 mg no grupo controle (p < 0,001). A necessidade média de fentanil no intraoperatório foi significativamente menor no grupo ESP (p = 0,022). Os escores da NRS aos 15, 30 e 60 minutos e em 12 e 24 horas de pós-operatório foram significativamente menores no grupo ESP (p < 0,05). De acordo com a análise de medidas repetidas, a variação do escore NRS ao longo do tempo foi estatisticamente significativa entre dois grupos (F [1,39] = 24,061, p < 0,0005). Conclusões: O bloqueio bilateral US-ESP reduziu de forma significativa o consumo de opioides no pós-operatório, a necessidade de fentanil no intraoperatório e os escores de dor no pós-operatório dos pacientes submetidos à colecistectomia laparoscópica.

Bi-level erector spinae plane block for the control of severe back pain related to vertebral metastasis.

Pain is the most common reason for emergency department visits. Traditionally, pain management has been provided by narcotics, non-steroidal anti-inflammatory drugs and non-narcotics. Erector spinae plane block is a new interfascial plane block that has been successfully used for acute pain control in different surgeries. Two female patients with severe back pain related to breast cancer metastasis applied to emergency department. The pain scores of the patients were between 8 and 10. We performed bilateral erector spinae plane block at the levels of T3 and T6. The pain scores decreased under 2 within 30 min and none of the patients required additional analgesic agent for 24 hours. Previously erector spinae plane block was used for rib and spine fractures in emergency department. Different from previous cases, we performed bi-level blocks to cover a larger area and the block abruptly and effectively reduced pain scores of the patients with breast cancer.