Prevalence study for postoperative nausea vomiting: A training hospital example.

BACKGROUND: Simplified risk models, such as the Apfel score, have been developed to calculate the risk of postoperative nausea-vomiting (PONV) for adult patients. In the absence of any risk factors, PONV risk is assumed to be 10%. While the presence of one of the four risk factors determined as female gender, non-smoking, PONV/car sickness history, and postoperative opioid use is associated with 20% risk for PONV, the risk increases by 20% with the addition of each risk factor, and reaches to 80% if four factors are present. AIM: : Our aim in this study is to investigate the prevalence of PONV, and whether the scoring systems used for nausea-vomiting in the literature are still valid. PATIENTS AND METHODS: Five groups of patients were included in the study with an Apfel score of 0, 1, 2, 3, 4. Each case was taken to the recovery room at the end of the operation. They were observed whether had nausea-vomiting was recorded according to the Abramowitz emesis score. RESULTS: While the PONV risk for women is 24.637 times higher than men, the PONV risk of those who had gynecological surgery is 6.27 times higher than that of the other type of surgery. Those who had urological surgery are 0.345 times less than the other type of surgery. Those who had lower abdominal surgery had a risk of PONV of 4.56 times higher than the others. As the duration of the case increases, the risk of PONV increases 1.01 times (P values P < 0.001, P < 0.001, P < 0.001, P = 0.048, P < 0.001, respectively). CONCLUSION: As a result, our PONV prevalence is considerably lower than the frequency rates mentioned in the literature. PONV scoring systems need long-term studies with larger populations to be updated.

Evaluation of the effects of intraarticular glucocorticoid injections on blood glucose levels in diabetes mellitus and nondiabetes mellitus patients with adhesive capsulitis of the shoulder.

AIMS: The aim of this study was to assess the effect of intraarticular glucocorticoid injections on blood glucose levels in diabetes mellitus (DM) and non-DM patients with adhesive capsulitis of the shoulder and investigate the risk factors for hyperglycemia. METHODS: The study included 40 DM and 38 non-DM patients. The DM status, HbA1c levels, baseline fasting blood glucose (FBG) level, and post-injection 1-, 7-, 15-, and 21-day FBG levels were evaluated retrospectively. RESULTS: The FBG levels were significantly higher 1 and 7 day after the glucocorticoid injection as compared with the baseline levels (P = 0.001 and <0.001, respectively). The increase was greatest in DM patients and then returned to baseline levels 15-day post-injection. In terms of the mean difference in post-injection and baseline FBG levels, the increase on day 1 was statistically significantly greater in the DM group as compared with that in the non-DM group (P = 0.01). Linear regression model showed that only the baseline FBG level predicted the glucose level 1-day post-treatment (ß = 0.839, P < 0.01). CONCLUSION: Intraarticular glucocorticoid injections can safely be administered as a treatment for adhesive capsulitis of the shoulder in patients with well-controlled DM. Baseline FBG levels may predict peak blood glucose levels in patients with well-controlled DM. We recommend that DM patients with adhesive capsulitis should undergo frequent monitoring of blood glucose in the 2 week following intraarticular glucocorticoid injection treatment.

Relationship between sleep quality and the psychological status of patients hospitalised with COVID-19.

AIM: We explored the sleep quality of patients who required mental health and clinical interventions in our hospital after being diagnosed with COVID-19. METHOD: We enrolled 189 patients hospitalised with COVID-19 in April and May of 2020, of whom 78 were female and 111 male. We evaluated sleep quality and related factors in terms of demographic characteristics, the duration of hospitalisation, and Pittsburgh Sleep Quality Index (PSQI) and Hospital Anxiety-Depression Scale scores. RESULTS: All participants were divided into two groups according to PSQI score: n = 102 (54%) patients with PSQI scores ≥5 and n = 87 (46%) patients with PSQI scores <5. No significant between-group difference was evident in terms of age, gender, marital status, educational level, or chronic disease history. The duration of hospitalisation (p = 0.002) and the depression rate (p = 0.010) were higher in the group exhibiting poor sleep quality (PSQI score ≥5). CONCLUSION: The duration of hospitalisation was longer in patients experiencing poor sleep quality. Therefore, improvement in sleep quality will reduce the length of hospital and intensive care unit stays.

Assessment of the use of dredged marine materials in sanitary landfills: A case study from the Marmara sea.

Worldwide production of large volumes of dredged materials (DMs) has become a pressing environmental problem. In Turkey, the government has yet to develop management strategies that successfully prevent or minimize dumping into the Marmara Sea. One potential solution is the utilization of the DMs as a source of material for earthworks, particularly in sanitary landfills in Istanbul and Kocaeli. The most economically developed cities in Turkey, they were evaluated in terms of potential environmental impacts and regulatory compliance. Five ports/harbors representing specific portions of the study area and different industrial activities were selected as pilot regions. Physical, chemical, mineralogical, toxicological, and leaching potential measurements of DMs dredged from the seabed revealed they qualify as non-hazardous waste. Index and engineering tests performed on raw and processed DMs were assessed to determine the geotechnical requirements for soil-based materials (SBM) used in sanitary landfills. The results showed that non-hazardous DMs could be utilized as a cover, base/cap liner, and/or fill material at various sections within the landfills. This method provides environmental advantages not seen with other management strategies for DMs such as dumping at sea or upland disposal.

The effects of rehabilitation on the outcomes of surgically treated acute and chronic thumb metacarpophalangeal ulnar collateral ligament ruptures.

The aim of this study was to compare the outcome of patients who received rehabilitation to those who did not receive it after surgical treatment of acute and chronic tears of the ulnar collateral ligament (UCL) of the thumb. Forty-two patients with an acute UCL injury repaired with two soft mini-anchors to bone insertion sites, and 40 patients with a chronic UCL injury reconstructed with autografts were involved in this study. The patients were divided two subgroups depending on rehabilitation. Patient characteristics were not significantly different between the two groups and subgroups. Range of motion, grip strength and pinch strength were evaluated. There was no significant change in terms of grip and pinch strength in patients with acute UCL injury who received rehabilitation after surgical treatment. However, significantly better results were achieved in flexion, extension, ulnar and radial deviation. There was no significant change in pinch strength in patients with chronic UCL reconstructions, but significantly better results were achieved in grip strength, flexion, extension, ulnar and radial deviation. A rigid MCP splint in patients with acute and chronic UCL tears is effective in preventing early ligament insufficiency.

Retraction Note: Obturator nerve block transurethral surgery for bladder cancer: comparison of inguinal and intravesical approaches: prospective randomized trial.

The Editor-in-Chief has retracted this article [1] because it shows significant overlap with a previously published article by Pladzyk et al. [2].

Investigation of topsoil production from marine dredged materials (DMs) in Turkey for urban landscaping works.

As known, marine dredged materials (DMs) are highly nuisance wastes if they are not correctly reused or removed. In this work, the usability of DMs to the technical terms as manufactured topsoil (MT) in the urban landscaping works is discussed. Firstly, the leaching potentials of DMs were determined according to the related legislations to identify their hazardousness features. Secondly, DMs were subject to some treatment stages such as sieving, desalination, organic amelioration via peat and sheep manure, and pH adjustment to turn into an alternative natural soil pursuant to the British Standard in the scope of soil quality improvement studies as there is not any national standard in Turkey for the production of topsoil from different materials. Then, MT mixtures were prepared with washed and unwashed DM, peat and sheep manure in different mixing ratios (v/v); 33%, 50% and 67% DM, respectively. Consequently, high quality grass seed mixtures used for the landscaping applications were monitored for six months. The results demonstrate the availability of DM as alternative MT in the urban landscaping areas. Thus, important data were obtained as to the use of DM at alternative areas such as green city, green roof, shopping centers, organized industry, etc.

Obturator nerve block transurethral surgery for bladder cancer: comparison of inguinal and intravesical approaches: prospective randomized trial.

AIM: Transurethral resection of bladder tumors close to these areas may stimulate the obturator nerve, causing violent adductor contraction and possible inadvertent bladder perforation. To avoid this reaction, local anesthetic blockade of the obturator nerve as it passes through the obturator canal is effective in stopping adductor spasm during spinal anesthesia. METHODS: Forty-one patients undergoing (transurethral resection of bladder tumor) TUR-BT with spinal anesthesia who required (obturator nerve block) ONB were included in the study. After spinal anesthesia, ONB was performed with an inguinal approach (group 1) (n = 21) or an intravesical approach (group 2) (n = 20). In this study, we used 10 ml of 2 % lidocaine to perform the ONB. RESULTS: The mean age of patients was 60.8 ± 7.5 years. The groups were not different with regards to age, tumor localization and tumor size. There were two bladder perforations in group 1 and six perforations in group 2 (p = 0.130). However, the efficacy of ONB was significantly higher in inguinal approach group compared to intravesical approach group (p = 0.032). CONCLUSION: Obturator nerve block plays an additive role on the quality of analgesia for bladder surgery. Our data suggests that identification of the obturator nerve with ultrasound is easy and the block can be assessed by observing avoidance of bladder spasm.

Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb.

This study sought to demonstrate that successful outcomes can be achieved with the new technique presented here for chronic ulnar collateral ligament (UCL) injury of the thumb metacarpophalangeal (MCP) joint, as well as with K-wire pinning for acute UCL injury. We followed 19 patients who suffered an UCL rupture (mean follow-up: 14.26±4.65 months) and 32 patients who presented with UCL avulsion fracture (mean follow-up: 16.81±7.54 months). We used a free tendon graft for UCL reconstruction in the UCL rupture group. Both ends of the graft were stabilized with bioabsorbable suture anchors, which were used as biotenodesis interference screws. Closed reduction and K-wire fixation was used in UCL avulsion fracture group. There were no statistically significant differences between operated and contralateral healthy thumb MCP joint in both groups in the grip strength, tip pinch strength, flexion, extension, ulnar deviation, and radial deviation movements at final follow-up. Grip strength, tip pinch strength, ulnar deviation and radial deviation were significantly better in the avulsion group than the rupture group. All patients regained full stability at the MCP joint in avulsion group; 16 patients regained full stability and 3 patients presented with mild laxity (less than 10° laxity) in rupture group. Glickel grading scale used as a functional score was excellent for 30 patients and good for 2 patients in avulsion group; it was excellent for 17 patients and good for 2 patients in rupture group. Our study shows that closed reduction and percutaneous K-wire fixation of acute displaced large UCL avulsion fracture is a simple technique and achieves adequate stability of UCL. For UCL rupture, free tendon reconstruction with bioabsorbable suture anchors provides adequate stability and stable fixation within the tunnels.

Short segment pedicle screw instrumentation with an index level screw and cantilevered hyperlordotic reduction in the treatment of type-A fractures of the thoracolumbar spine.

The purpose of this study was to evaluate and compare the effect of short segment pedicle screw instrumentation and an intermediate screw (SSPI+IS) on the radiological outcome of type A thoracolumbar fractures, as judged by the load-sharing classification, percentage canal area reduction and remodelling. We retrospectively evaluated 39 patients who had undergone hyperlordotic SSPI+IS for an AO-Magerl Type-A thoracolumbar fracture. Their mean age was 35.1 (16 to 60) and the mean follow-up was 22.9 months (12 to 36). There were 26 men and 13 women in the study group. In total, 18 patients had a load-sharing classification score of seven and 21 a score of six. All radiographs and CT scans were evaluated for sagittal index, anterior body height compression (%ABC), spinal canal area and encroachment. There were no significant differences between the low and high score groups with respect to age, duration of follow-up, pre-operative sagittal index or pre-operative anterior body height compression (p = 0.217, 0.104, 0.104, and 0.109 respectively). The mean pre-operative sagittal index was 19.6° (12° to 28°) which was corrected to -1.8° (-5° to 3°) post-operatively and 2.4° (0° to 8°) at final follow-up (p = 0.835 for sagittal deformity). No patient needed revision for loss of correction or failure of instrumentation. Hyperlordotic reduction and short segment pedicle screw instrumentation and an intermediate screw is a safe and effective method of treating burst fractures of the thoracolumbar spine. It gives excellent radiological results with a very low rate of failure regardless of whether the fractures have a high or low load-sharing classification score.

Ligament reconstruction and tendon interposition arthroplasty of the trapeziometacarpal joint with the use of the full thickness of the flexor carpi radialis tendon.

We analyzed the outcomes of the ligament reconstruction and tendon interposition arthroplasty of the trapeziometacarpal joint with use of the full thickness of the flexor carpi radialis. We reviewed 19 patients, with 23 thumbs at mean follow-up of 59 ± 15 months. According to Dell classification, 11 thumbs were grade 2, and 12 thumbs were grade 3.The preoperative VAS pain score was 7 ± 0.9 and thumb web space was 23 ± 2.4°. The preoperative grip strength was 13 ± 0.7 kg, tip pinch strength was 2.8 ± 0.5 kg and lateral pinch strength was 4 ± 0.9 kg. None of the thumbs could touch the palmar crease of the little finger. The final outcome was 0.9 ± 1.4 for VAS, 19 ± 1 kg for grip strength, 4.5 ± 0.3 kg for tip pinch strength, 5.6 ± 0.5 kg for lateral pinch strength and 38 ± 2.4° for thumb web space. Mobility of the thumbs was improved; 19 thumbs could touch the base of the fifth finger, and five thumbs could touch the crease of the proximal interphalangeal joint. We compared the operated side with the healthy one in 15 patients, the grip strengths were 82% of the contralateral side, tip pinch strengths 78%, and lateral pinch strengths as 75%. According to our series, this surgical technique relieves pain and provides stability and mobility of the thumb.

Assesment of correlation between bispectral index and four common sedation scales used in mechanically ventilated patients in ICU.

PURPOSE: The aim of this study was to compare the correlation between bispectral index (BIS) monitor and four commonly used subjective clinical scales (Ramsay Sedation Scale (RSS), Richmond Agitation Sedation Scale (RASS), Sedation Agitation Scale, Adaptation to Intensive Care Environment scale) in mechanically ventilated patients in intensive care unit (ICU). In addition, comparison of responsiveness of the clinical scales in respect to BIS changes is another goal of this study. MATERIALS AND METHODS: Mechanically ventilated thirty patients who required sedation for any reason were enrolled to study. Patients who needed neuromuscular blockade, patients with known hearing and visual problems, neurological diseases, anoxic encephalopathy, mental retardation and who developed hemodynamic instability (mean arterial pressure below 60 mmHg) and hypoxemia (sPO2 below 90%) during follow-up were excluded. Starting before the initiation of sedation, first BIS scores then clinical sedation scales were evaluated. This procedure is repeated every 2 hours for 24 hours. RESULTS: All of the four clinical scales were significantly correlated with BIS. BIS and clinical scale values, except Adaptation to Intensive Care Environment scale, showed significant changes compared to baseline after the initiation of sedation. Ramsay and Richmond scales showed the highest correlation with BIS (respectively, r = 0.758, r = 0.750). Adaptation to Intensive Care Environment revealed the lowest correlation (r = 0.565). CONCLUSIONS: All of the scales were significantly correlated with BIS. RSS and RASS showed higher correlation than other scales. As a conclusion: RSS and RASS can be used for monitoring the depth of sedation in mechanically ventilated patients in ICU.

Determination of DNA damage after exposure to inhalation anesthetics in human peripheral lymphocytes and sperm cells in vitro by comet assay.

In this study, genotoxic activities of four halogenated anesthetics (halothane, isoflurane, sevoflurane and desflurane) were investigated in human peripheral blood lymphocytes (PBLs) and sperm cells in vitro by alkaline comet assay. For this purpose, sperm or lymphocyte suspension was exposed to different concentrations (0.1 mM, 1 mM, 10 mM and 100 mM) of anesthetic agents and 1% dimethyl sulfoxide (DMSO) or phosphate-buffered saline (PBS) as controls. The DNA strand breaks as well as alkali-labile sites were measured as percentage tail intensity with comet assay. The results of this study demonstrate that all analyzed drugs were capable of inducing DNA damage on PBLs in a dose-dependent manner in vitro. However, the results in sperm cells were slightly different since we did not observe any genotoxic effect for desflurane in any of the exposure doses, and the genotoxic effect of halothane was not dose dependent. This experimental study points out to the presence of DNA damage after exposure to halogenated anesthetics in both PBLs and sperm cells, although this effect seems to be higher in PBLs.

Giant condyloma acuminata of Buschke-Löwenstein: successful treatment with a combination of surgical excision, oral acitretin and topical imiquimod.

Human papillomavirus (HPV) is the most common sexually transmitted disorder in young, sexually active populations in the USA and Europe. Giant condyloma acuminatum (GCA) is a unique variant of condyloma acuminata, characterized by local aggressive behaviour despite benign histology. It carries a substantial risk of squamous cell carcinoma. Various treatments have been used, but response is often poor and recurrence rates high. We present a case of GCA successfully treated with a combination of surgical excision, oral acitretin and topical imiquimod. The diagnosis was based on histological examination, immunohistochemical analysis and in situ hybridization for HPV 6 and 11. We recommend a trial of oral retinoid and topical imiquimod in selected cases of GCA.

The use of low dose plain solutions of local anaesthetic agents for spinal anaesthesia in the prone position: bupivacaine compared with levobupivacaine.

In this study, we aimed to test the hypothesis that 1-ml plain solution of 0.5% bupivacaine or 0.5% levopubivacaine administered in a subarachnoid block can provide adequate anaesthesia and operating conditions for pilonidal cyst/sinus operations performed in the prone position. There were no significant differences between the two groups in terms of patient demographic data, duration of operation, patient-surgeon satisfaction, haemodynamic changes and side effects. There were no significant differences found in the onset time, highest block level achieved, two segment regression, time to S(2) regression of sensory block and the number of anaesthetised dermatomes, between the two groups (p = 0.077, 0.057, 0.091, 0.084 and 0.057 respectively). The incidence of complete motor blockade was 16% and 8% in Group B at the start and at the end of the operation. There was no complete motor blockade in Group L (p = 0.110 and 0.490 respectively). We conclude that both regimens are effective and safe for use in subarachnoid anaesthesia for pilonidal cyst/sinus operations performed in the prone position.

Spinal anesthesia for transurethral resection operations: bupivacaine versus levobupivacaine.

BACKGROUND: This study tested the hypothesis that 0.5% levobupivacaine might be a good alternative to 0.5% plain bupivacaine for local spinal anesthesia during transurethral resection (TUR) operations. METHODS: A prospective, randomized, double-blinded study was conducted on 50 male ASA I-III patients aged >60 years who were scheduled for elective transurethral resection operations. After routine monitoring, spinal anesthesia was performed with patients in the left lateral position using a 25G Quincke needle in the L3-4 interspace with a midline approach. Group B (N.=25) received 2.5 mL of 0.5% plain bupivacaine and Group L (N.=25) received 2.5 mL of 0.5% levobupivacaine via intratechal injection. The characteristics of sensory and motor block, hemodynamic data, side effects, and patient and surgeon satisfaction were recorded. Patients were observed until the level of sensory block was S1 and the Bromage score was 0. RESULTS: There were no significant differences between the two groups for patient demographic data, American Society of Anesthesiologists (ASA) classification, type and duration of operation, side effects, and patient and surgeon satisfaction. Hemodynamic parameters were similar in both groups before and during the operation. The highest level of sensory block was T(7)(T(3)-T(10)) in Group B and T9(T4-T12) in Group L (P=0.001). CONCLUSION: Administration of 0.5% levobupivacaine may be a good alternative to 0.5% plain bupivacaine for local spinal anesthesia during TUR operations.

Oxidative DNA damage and total antioxidant status in rats during experimental gram-negative sepsis.

Sepsis and septic shock remains as leading cause of death in adult intensive care units. It is widely accepted that gram-negative bacteria and their endotoxins cause sepsis and septic shock, predominantly. Enhanced generation of reactive oxygen species may be responsible for tissue injury in septic shock and endotoxemia. The aim of this study was to assess oxidative DNA damage and the total antioxidant status (TAS) in peripheral lymphocytes of rats during different intraperitoneal gram-negative sepsis stages. Adult male Sprague-Dawley rats were divided randomly into four groups. Control group was intraperitoneally inoculated with 2 mL of pyrogene-free saline (Group I, n = 6), and the other rats received an intraperitoneal inoculum with 2 mL of saline containing 2 x 10(8) CFU of Escherichia coli. The animals were killed at time zero (Group I, n = 6), at 6th (Group II, n = 7), 12th (Group III, n = 7), and 24th (Group IV, n = 7) hour after the E. coli inoculation. Oxidative DNA damage in peripheral lymphocytes of rats was evaluated by modified comet assay (single-cell gel electrophoresis). Formamidopyrimidine DNA glycosylase (Fpg) and Endonuclease III (Endo III) were used to detect oxidized purines and pyrimidines, respectively. Total antioxidant quantification was carried out using ABTS+ (2,2'-Azino-di-[3 ethylbenzthiazoline sulphonate]) radical formation kinetics (Randox kit) in serum samples. Significant elevations of basal levels of strand breaks (SB) in Group IV were observed as compared with Group I, II, and III. There was a significant increase in Fpg sites in Group III as compared with Group I and II. However, there was no significant difference in terms of Endo III sites in any of the groups. Although the TAS was decreased with the stages of sepsis, this moderate decrease was significant in only Group IV as compared with Group I. There was no statistically significant correlation between DNA damage and TAS for any of the groups.

Can facet joint infiltrative analgesia reduce postoperative pain in degenerative lumbar disc surgery?

OBJECTIVE: Perioperative analgesia effects the postoperative course of pain. The purpose of this study was to evaluate its possible relation with the consumption of dolantine and analgesics and the facet-induced pain and postoperative pain score in degenerative disc surgery. METHODS: We employed perioperative intra- and perifacet bupivacaine infiltration technique to reduce the postoperative pain after lumbar disc surgery. The study was randomized and observer blinded enrolling 40 American Society of Anesthesiologists physical status class I-II patients scheduled for elective degenerative lumbar disc surgery. The patients were divided into two groups of 20 of which Group 1 underwent injection of bupivacaine into the subcutaneous and muscular layers around the incision site, while Group 2 underwent additional intra- and perifacetal joint infiltration. Postoperatively, the patients were provided with a programmed patient-controlled pump which was only activated on demand to infuse dolantine for the next 24 hours. In the postanesthesia care unit the delay for analgesia and the dose of dolantine used were recorded. RESULTS: There was no statistical significance between these two groups regarding postoperative visual analoque scale scores. The time before the first analgesic request was significantly longer in facet group (p= 0,006). The cumulative dolantine dose was also significantly lower in the facet group (p= 0,001). CONCLUSION: The results indicate that facet joint infiltrative analgesia may have an effect on the postoperative analgesic requirement and reduce the dolantine consumption.

Cigarette smoking and the haemodynamic response to tracheal intubation.

This study investigated the effects of smoking and gender on the haemodynamic response after tracheal intubation. Patients were assigned to one of four groups: female non-smokers, female smokers, male non-smokers and male smokers. After tracheal intubation, the highest mean (SD) increase in heart rate (30 (18) %) and rate-pressure product (40 (29) %) was seen in male smokers. The increases in heart rate and rate-pressure product in male smokers were significantly greater than those in female non-smokers, p < 0.05. The increase in rate-pressure product was significantly greater in male smokers than in male non-smokers, p = 0.022.

Can facet joint infiltrative analgesia reduce postoperative pain in degenerative lumbar disc surgery?

Objetivo. La analgesia peroperatoria influye en el curso del dolor postquirúrgico. El propósito del estudio reside en la evaluación de la posible relación entre el consumo de dolantina y otros analgésicos en el control del dolor postquirúrgico de origen facetario lumbar en la enfermedad discal degenerativa. Métodos. Empleamos peroperatoriamente infiltraciones percutáneas de bupivacaína intra y perifacetariapara reducir el dolor postoperartorio tras cirugía discal lumbar. El estudio fue randomizado y oculto al observador y se realizó sobre 40 pacientes operados de cirugía electiva por enfermedad degenerativa lumbar, con una situación general Clase I-II de la clasificación de la American Society of Anesthesiologist. Los pacientes se dividieron en dos grupos de 20 .El Grupo1 se le administró bupivacaína en el tejido subcutáneoy capas musculares. El grupo 2 recibió una inyección adicional de bupivacaína intra y perifacetaria. Durante el postoperatorio, los pacientes, dispusieron de una bomba programable de analgesia controlada, que se activó exclusivamente a demanda para infundir dolantina en las 24 horas siguientes a la operación. En la Unidad de Reanimación postquirúrgicas se recogieron las necesidades de dolantina de los distintos pacientes. Resultados. No se encontraron diferencias estadísticamente significativas entre ambos grupos en relación a los valores de la escala analógica visual. El tiempo de demanda del primer bolo analgésico fue significativamente mayor en el grupo de facetas infiltradas (p=0,006). La acumulación de las dosis de dolantina fue también significativamente inferior en el grupo de facetas infiltradas (p=0.001) Conclusión. Los resultados indican que la infiltración de la faceta articular con anestésico local puede tener un efecto positivo reduciendo las necesidades analgésicas postoperatorias de dolantina

Objective. Perioperative analgesia effects the postoperative course of pain. The purpose of this study was to evaluate its possible relation with the consumption of dolantine and analgesics and the facet-induced pain and postoperative pain score in degenerative disc surgery. Methods. We employed perioperative intra- and perifacet bupivacaine infiltration technique to reduce the postoperative pain after lumbar disc surgery. The study was randomized and observer blinded enrolling40 American Society of Anesthesiologists physical status class I-II patients scheduled for elective degenerative lumbar disc surgery. The patients were divided into two groups of 20 of which Group 1 underwent injection of bupivacaine into the subcutaneous and muscular layers around the incision site, while Group 2 underwent additional intra- and perifacetal joint infiltration. Postoperatively, the patients were provided with a programmed patient-controlled pump which was only activated on demand to infuse dolantine for the next 24 hours. In the postanesthesia care unit the delay for analgesia and the dose of dolantine used were recorded. Results. There was no statistical significance between these two groups regarding postoperative visual analoque scale scores. The time before the first analgesic request was significantly longer in facet group (p=0,006). The cumulative dolantine dose was also significantly lower in the facet group (p= 0,001). Conclusion. The results indicate that facet joint infiltrative analgesia may have an effect on the postoperative analgesic requirement and reduce the dolantine consumption