Efficacy of ultrasound-guided Transversus Abdominis Plane (TAP) block in inguinal hernia surgery and the immunomodulatory effects of proinflammatory cytokines: prospective, randomized, placebo-controlled study.

BACKGROUND: Tumor Necrosis Factor-α (TNF-α) and Interleukin-1ß (IL-1ß) are among the cytokines released secondary to the surgical stress response. The objective of this study was to investigate the effect of a Transversus Abdominis Plane (TAP) block on postoperative pain and its immunomodulatory activity through proinflammatory cytokines. METHODS: TAP (study group; n=40) or p-TAP (placebo group; n=40). Patients in the TAP group underwent an Ultrasound (US) guided unilateral TAP block using 20-cc 0.5% bupivacaine solution. Patients in the p-TAP group underwent a sham block using 20-cc isotonic solution. The TNF-α and IL-1ß levels were measured three times at preoperative hour-0 and postoperative hours 4 and 24. Visual Analog Scale (VAS) scores were recorded at 0-hours, 30-minutes, 4-hours, and 24-hours. Analgesic use within the first 24-hours following surgery was monitored. RESULTS: The postoperative VAS score was decreased in the TAP group at all time points (0, 4, and 24hours), and the differences between groups were statistically significant (p< 0.001 for all comparisons). In the TAP group, the TNF-α and IL-1ß levels at 4 and 24 hours post operation were significantly lower than the preoperative levels (p< 0.001 for all comparisons). CONCLUSION: The TAP block for pre-emptive analgesia enabled effective hemodynamic control during the intraoperative period, provided effective pain control in the postoperative period, and decreased inflammation and surgical stress due to the decreased levels of the proinflammatory cytokines TNF-α and IL-1ß in the first postoperative 24hours, indicating immunomodulatory effect.

Comparison of the effects of continuous versus intermittent enteral feeding on plasma leptin and ghrelin levels in Intensive Care Units / Comparação do efeito da alimentação enteral contínua com o efeito da alimentação intermitente nos níveis plasmáticos de leptina e grelina em Unidades de Terapia Intensiva

ABSTRACT Objective: The aim of this prospective randomized trial is to verify whether there is an association between the methods of administration of enteral nutrition and the leptin and ghrelin hormones, which have a major role in the regulation of energy metabolism. Methods: This study enrolled 38 enteral-fed patients aged 18 to 85 in the Intensive Care Unit. The patients were prospectively randomized to receive either continuous infusion (n=19) or intermittent feeding (n=18) of enteral nutrition. In addition to routine biochemical assays, blood samples were taken from the patients for leptin and ghrelin analyses on the 1th, 7th, and 14th days of enteral nutrition. Results: There was no statistically significant difference between the groups regarding descriptive statistics and categorical variables such as underlying diseases, complications, steroid use and others (p>0.05). The decrease in the number of white blood cells and in creatinine and C-reactive protein levels over time were statistically significant (p=0.010, p=0.026, p<0.001 respectively). There was no statistically significant difference between the groups with respect to leptin and ghrelin levels (p=0.982 and p=0.054). Leptin levels did not change over time; however, the ghrelin levels of both groups were significantly higher on the 7th and 14th days than on the first day of analysis (p=0.003). Conclusion: This study revealed that both continuous and intermittent enteral nutrition feeding regimens were well tolerated in Intensive Care Unit patients showing minor complications. The method of administration of enteral nutrition alone did not affect the leptin and ghrelin levels. Randomized controlled large cohort trials are needed to to compare intermittent and continuous enteral nutrition to determine which one is more adaptable to diurnal patterns of secretion metabolic hormones.

RESUMO Objetivo: Este ensaio aleatório prospectivo tem por objetivo verificar se existe uma associação entre o programa de administração de nutrição enteral e os hormonios leptina e grelina, os quais funcionam no metabolismo energético. Métodos: Este estudo incluiu 38 pacientes de Unidades de Terapia Intensiva, com idades entre os 18 e os 85 anos, que receberam nutrição enteral. Os pacientes foram escolhidos aleatoriamente para receberem nutrição enteral utilizando infusão contínua (n=19) ou intermitente (n=18). Além de exames bioquímicos de rotina, foram colhidas amostras de sangue dos pacientes para análises dos níveis de leptina e grelina no 1º, 7º e 14º dias de nutrição enteral. Resultados: Não houve diferença estatística significante entre os grupos em relação a dados descritivos e variáveis categóricas tais como doenças subjacentes, complicações, utilização de esteroides e outros (p>0,05). A diminuição no número de leucócitos e nos níveis de creatinina e proteína C-reativa com o tempo foi estatisticamente significativa (p=0,010, p=0,026, p<0,001, respetivamente). Não existiu diferença com significância estatística entre os grupos em relação aos níveis de leptina e grelina (p=0,982 e p=0,054). Embora os níveis de leptina não mudaram com o tempo, os níveis de grelina de ambos os grupos foram significativamente superiores no 7° e 14° dias quando comparados aos verificados na análise do primeiro dia (p=0,003). Conclusão: Este estudo revelou que os programas de nutrição enteral contínua e intermitente foram bem tolerados com pequenas complicações apresentadas pelos pacientes em Unidades de Terapia Intensiva. O padrão de administração de nutrição enteral por si só não afetou os níveis de leptina e grelina. Estudos controlados aleatórios em coortes maiores são necessários para verificar qual programa de administração de nutrição enteral, intermitente ou a contínuo, é mais adaptável ao padrão de secreção diurno de hormônios metabólicos.

Comparison of the effects of sugammadex and neostigmine on postoperative nausea and vomiting.

BACKGROUND AND OBJECTIVES: The aim of our study is to compare the effects of sugammadex and neostigmine, used for neuromuscular blockage antagonism, on postoperative nausea and vomiting (PONV). METHODS: Our study was completed with 98 ASA I-II risk patients undergoing endotracheal intubation under general anesthesia. At the end of the surgery patients were randomly divided into two groups given 2mgkg-1 sugammadex (Group S) or 50µgkg-1 neostigmine plus 0.2mgkg-1 atropine (Group N). Monitoring and recording times were set as 1 hour postoperative and from 1-6, 6-12, and 12-24hours. The anti-emetic amounts administered were recorded. RESULTS: In the first hour postoperative 13 patients in Group N (27%) and 4 in Group S (8%) were observed to have nausea and/or vomiting and the difference was statistically significant (p=0.0016). During the 24 hours of monitoring there was no significant difference in the incidence and severity of PONV (p>0.05), however the number of patients given ondansetron for PONV treatment in Group N was statistically significantly higher than the number in Group S (16 in Group N, 6 in Group S, p<0.011). CONCLUSIONS: At the end of our study comparing neostigmine with sugammadex for neuromuscular blockage antagonism, we found use of sugammadex had lower incidence of PONV in the postoperative 1st hour and less anti-emetic use in 24 hours of monitoring.

[Comparison of the effects of sugammadex and neostigmine on postoperative nausea and vomiting]. / Comparação dos efeitos de sugamadex e neostigmina em náusea e vômito no pós­operatório.

BACKGROUND AND OBJECTIVES: The aim of our study is to compare the effects of sugammadex and neostigmine, used for neuromuscular blockage antagonism, on postoperative nausea and vomiting (PONV). METHODS: Our study was completed with 98 ASA I-II risk patients undergoing endotracheal intubation under general anesthesia. At the end of the surgery patients were randomly allocated into two groups given 2mgkg-1 sugammadex (Group S) or 50µgkg-1 neostigmine plus 0.2mgkg-1 atropine (Group N). Monitoring and recording times were set as 1 hour postoperative and from 1-6, 6-12, and 12-24hours. The anti-emetic amounts administered were recorded. RESULTS: In the first postoperative hour 13 patients in Group N (27%) and 4 in Group S (8%) were observed to have nausea and/or vomiting and the difference was statistically significant (p=0.0016). During the 24hours of monitoring there was no significant difference in the incidence and severity of PONV (p>0.05), however the number of patients given ondansetron for PONV treatment in Group N was significantly higher than the number in Group S (16 in Group N, 6 in Group S, p<0.011). CONCLUSIONS: At the end of our study comparing neostigmine with sugammadex for neuromuscular blockage antagonism, we found use of sugammadex had lower incidence of PONV in the postoperative 1st hour and less anti-emetic use in 24hours of monitoring.

A comparison of different densities of levobupivacaine solutions for unilateral spinal anaesthesia / Uma comparação das diferentes densidades das soluções de levobupivacaína para raquianestesia unilateral

ABSTRACT BACKGROUND AND OBJECTIVES: The aim of the study was to compare the block characteristics and clinical effects of dextrose added to levobupivacaine solutions at different concentrations to provide unilateral spinal anaesthesia in lower extremity surgery. METHODS: This prospective, randomised, double-blind study comprised 75 ASA I-II risk patients for whom unilateral total knee arthroscopy was planned. The patients were assigned to three groups: in Group I, 60 mg dextrose was added to 7.5 mg of 0.5% levobupivacaine, in Group II, 80 mg and in Group III, 100 mg. Spinal anaesthesia was applied to the patient in the lateral decubitus position with the operated side below and the patient was kept in position for 10 min. RESULTS: The time for the sensorial block to achieve T12 level was slower in Group I than in Groups II and III (p < 0.05, p< 0.00). The time to full recovery of the sensorial block was 136 min in Group I, 154 min in Group II and 170 min in Group III. The differences were statistically significant (p < 0.05). The mean duration of the motor block was 88 min in Group I, 105 min in Group II, and 139 min in Group III and the differences were statistically significant (p < 0.05). The time to urination in Group I was statistically significantly shorter than in the other groups (p < 0.00). CONCLUSIONS: The results of the study showed that together with an increase in density, the sensory and motor block duration was lengthened. It can be concluded that 30 mg mL-1 concentration of dextrose added to 7.5 mg levobupivacaine is sufficient to provide unilateral spinal anaesthesia in day-case arthroscopic knee surgery.

RESUMO JUSTIFICATIVA E OBJETIVOS: Comparar as características do bloqueio e os efeitos clínicos da adição de dextrose às soluções de levobupivacaína em diferentes concentrações para proporcionar raquianestesia unilateral em cirurgia de extremidade inferior. MÉTODOS: Estudo prospectivo, randômico e duplo-cego conduzido com 75 pacientes, estado físico ASA I-II, programados para artroplastia unilateral total do joelho. Os pacientes foram divididos em três grupos: no Grupo-I, 60 mg de dextrose foram adicionados a 7,5 mg de levobupivacaína a 0,5%; no Grupo II, 80 mg e no Grupo III, 100 mg. A raquianestesia foi aplicada ao paciente posicionado em decúbito lateral, com o lado operado abaixo, e o paciente foi mantido em posição durante 10 minutos. RESULTADOS: O tempo para o bloqueio sensorial atingir o nível T12 foi mais lento no Grupo-I do que nos grupos II e III (p < 0,05,p < 0,00). O tempo de recuperação total do bloqueio sensorial foi de 136 minutos no Grupo-I, 154 minutos no Grupo-II e 170 minutos no Grupo III. As diferenças foram estatisticamente significativas (p < 0,05). A média da duração do bloqueio motor foi de 88 minutos no Grupo-I, 105 minutos no Grupo-II e 139 minutos no Grupo-III e as diferenças foram estatisticamente significativas (p< 0,05). O tempo de micção foi significativamente menor no Grupo-I do que nos outros grupos (p < 0,00). CONCLUSÕES: Os resultados do estudo mostraram que, junto com um aumento da densidade, a duração dos bloqueios sensorial e motor foi prolongada. Pode-se concluir que uma concentração 30 mg mL-1 de dextrose adicionada a 7,5 mg de levobupivacaína é suficiente para proporcionar raquianestesia unilateral para artroscopia do joelho em regime ambulatorial.

A comparison of different densities of levobupivacaine solutions for unilateral spinal anaesthesia.

BACKGROUND AND OBJECTIVES: The aim of the study was to compare the block characteristics and clinical effects of dextrose added to levobupivacaine solutions at different concentrations to provide unilateral spinal anaesthesia in lower extremity surgery. METHODS: This prospective, randomised, double-blind study comprised 75 ASA I-II risk patients for whom unilateral total knee arthroscopy was planned. The patients were assigned to three groups: in Group I, 60mg dextrose was added to 7.5mg of 0.5% levobupivacaine, in Group II, 80mg and in Group III, 100mg. Spinal anaesthesia was applied to the patient in the lateral decubitus position with the operated side below and the patient was kept in position for 10min. RESULTS: The time for the sensorial block to achieve T12 level was slower in Group I than in Groups II and III (p<0.05, p<0.00). The time to full recovery of the sensorial block was 136min in Group I, 154min in Group II and 170min in Group III. The differences were statistically significant (p<0.05). The mean duration of the motor block was 88min in Group I, 105min in Group II, and 139min in Group III and the differences were statistically significant (p<0.05). The time to urination in Group I was statistically significantly shorter than in the other groups (p<0.00). CONCLUSIONS: The results of the study showed that together with an increase in density, the sensory and motor block duration was lengthened. It can be concluded that 30mg mL(-1) concentration of dextrose added to 7.5mg levobupivacaine is sufficient to provide unilateral spinal anaesthesia in day-case arthroscopic knee surgery.

[A comparison of different densities of levobupivacaine solutions for unilateral spinal anaesthesia]. / Uma comparação das diferentes densidades das soluções de levobupivacaína para raquianestesia unilateral.

BACKGROUND AND OBJECTIVES: The aim of the study was to compare the block characteristics and clinical effects of dextrose added to levobupivacaine solutions at different concentrations to provide unilateral spinal anaesthesia in lower extremity surgery. METHODS: This prospective, randomised, double-blind study comprised 75 ASA I-II risk patients for whom unilateral total knee arthroscopy was planned. The patients were assigned to three groups: in Group I, 60mg dextrose was added to 7.5mg of 0.5% levobupivacaine, in Group II, 80mg and in Group III, 100mg. Spinal anaesthesia was applied to the patient in the lateral decubitus position with the operated side below and the patient was kept in position for 10min. RESULTS: The time for the sensorial block to achieve T12 level was slower in Group I than in Groups II and III (p<0.05, p<0.00). The time to full recovery of the sensorial block was 136min in Group I, 154min in Group II and 170min in Group III. The differences were statistically significant (p<0.05). The mean duration of the motor block was 88min in Group I, 105min in Group II, and 139min in Group III and the differences were statistically significant (p<0.05). The time to urination in Group I was statistically significantly shorter than in the other groups (p<0.00). CONCLUSIONS: The results of the study showed that together with an increase in density, the sensory and motor block duration was lengthened. It can be concluded that 30mgmL(-1) concentration of dextrose added to 7.5mg levobupivacaine is sufficient to provide unilateral spinal anaesthesia in day-case arthroscopic knee surgery.