Analgesic efficacy of ultrasound guided unilateral erector spinae plane block for laparoscopic inguinal hernia repair: a randomized controlled study.

BACKGROUND: Although laparoscopic inguinal herniorrhaphy is associated with faster return to daily activity, inadequate postoperative pain control can cause prolonged hospital stays and patient discomfort. Erector spinae plane block (ESP) can be administered for postoperative pain management in abdominal and thoracic surgery. We investigated the effects of unilateral ESP block application in laparoscopic hernia surgery. METHODS: A total of 60 patients who were scheduled for laparoscopic inguinal hernia surgery were included. ESP block was performed in group E (n = 30) after induction of anesthesia. There was no intervention in Group C (n = 30). Postoperative pain was assessed by the patient using the numeric rating scale (NRS) at postanesthetic care unit (PACU),1, 4, 6, 12, and 24 h after surgery. The quality of postoperative functional recovery was evaluated using the quality of recovery-40 questionnaire. RESULTS: NRS scores were lower in Group E (n = 30) than in Group C (n = 30) at PACU, 1th, 4th, 6th hours in both rest and movement. Total tramadol consumption was reduced at postoperative 24 h by the ESP block [median(IQR), 60(40) versus 85(30)]. Quality of recovery score of the patients after operation was better in the ESP group than in the control group [mean(SD), 177.9(6.5) in group E and 173.2(7.09) in group C with mean differences: 4.633 and CI: 95% (1.11 to 8.15) respectively]. DISCUSSION: Unilateral ESP blocks in laparoscopic inguinal hernia surgery reduce both postoperative pain levels and analgesic consumption. In addition, the ESP block could be used safely in pain management of this type of surgery and improve the quality of recovery.

The effect of play distraction on anxiety before premedication administration: a randomized trial.

STUDY OBJECTIVE: The majority of children scheduled to undergo surgery experience substantial anxiety in the preoperative holding area before induction of anesthesia. Pharmacological interventions aimed at reducing perioperative anxiety are paradoxically a source of stress for children themselves. Midazolam is frequently used as premedication, and the formula of this drug in Turkey is bitter. We aimed to assess the role of distraction in the form of playing with play dough (Play-Doh) on reducing premedication anxiety in children. DESIGN: Prospective randomized clinical trial. SETTING: Preoperative holding area. PATIENTS: One hundred four healthy children aged 3 to 7 years scheduled to undergo elective surgery were enrolled into the study. INTERVENTIONS: All children routinely receive sedative premedication (oral midazolam) before anesthesia. Children were randomized to 2 groups to receive either play dough (group PD) (n=52) or not (group C) (n=52) before administration of oral premedication. MEASUREMENTS: Children's premedication anxiety was determined by the modified Yale Preoperative Anxiety Scale (mYPAS). MAIN RESULTS: The difference in mYPAS scores between groups at T0 (immediately after entering the preoperative holding area) was not significant (P=.876). Compared with group C, group PD was associated with lower mYPAS scores at T1 and T2 (P<.001). In group PD, mYPAS scores were significantly lower at both T1 and T2 as compared with the scores at T0 (P<.001); they were similar between T1 and T2 (P>.001). CONCLUSION: This study showed that distraction in the form of playing with play dough facilitated administration of oral midazolam in young children.

Comparison of Siccoral® spray, Stomatovis ® gargle, and Strefen ® lozenges on postoperative sore throat.

PURPOSE: Postoperative sore throat (POST) is a frequent complication caused by mucosal trauma to the pharyngeal, laryngeal, and tracheal airway after endotracheal intubation. We compared the effectiveness of Siccoral, Strefen, and Stomatovis treatments in alleviating POST. METHODS: This prospective, randomized, single-blinded, controlled trial compares the incidence of POST with Strefen lozenges, Siccoral spray, or Stomatovis gargle. Three hundred and twenty American Society of Anesthesiologists class I-III patients undergoing elective genitourinary surgery under general orotracheal anesthesia were randomly allocated to four groups of 80 patients each. In the postoperative awakening unit and during related services, POST was evaluated by a blinded anesthesiologist at 0, 1, 6, and 24 h post extubation. RESULTS: The highest incidence of POST occured at 0 and 1 h post extubation in all groups (P = 0.002 × 10(-7), P = 0.004 × 10(-6), respectively). A significantly lower incidence of POST was observed in Strefen and Siccoral groups at 0 and 1 h compared to Control group (Strefen: P = 0.004 × 10(-2), P = 0.007 × 10(-4); Siccoral: P = 0.003 × 10(-8), P = 0.007 × 10(-5), respectively). A significantly lower incidence of POST was observed with Siccoral treatment at 0 h post extubation (P = 0.002 vs. Strefen treatment). Although POST incidence was not significantly different between the Stomatovis and Control groups, it was lower in the Stomatovis group at 0 and 1 h (P = 0.026 and 0.013, respectively). The incidence of POST was similar in all groups at 6 and 24 h post extubation (P = 0.141 and 0.426, respectively). CONCLUSION: Siccoral and Strefen can be effective in relieving POST in the early hours after extubation.