Posterior Quadratus Lumborum Block or Thoracolumbar Interfascial Plane Block and Postoperative Analgesia after Spinal Surgery: A Randomized Controlled Trial.

INTRODUCTION: The management of postoperative pain following lumbar disc herniation (LDH) surgery is crucial for the quality of recovery. The effectiveness of multimodal analgesia plans increases when interfascial plane blocks are included. This study sought to compare the analgesic efficacy of preoperative ultrasound-guided TLIP (thoracolumbar interfascial plane) blocks and posterior QLBs (quadratus lumborum blocks) in patients undergoing LDH surgery. METHODS: Patients undergoing elective LDH surgery under general anesthesia were randomized into two groups: thoracolumbar interfascial plane block (Group T) and posterior quadratus lumborum block (Group Q). Block applications were performed 30 min before anesthesia induction. In the postoperative period, analgesia control was provided with a patient-controlled analgesia device. The patients' 24 h cumulative opioid consumption was examined. Pain scores were evaluated in the 0th, 3rd, 6th, 9th, 12th, and 24th hours. RESULTS: The mean 24 h cumulative morphine consumption for patients was statistically insignificant when Groups T and Q were compared (9.14 ± 7.03 mg vs. 8.66 ± 6.58 mg, p = 0.788). Pain scores at rest and during movement as well as morphine consumption were similar between groups in the 0th, 3rd, 6th, 9th, 12th, and 24th hours (p > 0.05). CONCLUSIONS: The study determined that the utilization of TLIP blocks and posterior QLBs prior to anesthesia induction yielded comparable outcomes in terms of reducing postoperative analgesic consumption and enhancing the efficacy of multimodal analgesia in individuals undergoing single-distance lumbosacral spine surgery under general anesthesia.

Effects of Cerebral Ischemia on Levels of Vascular Endothelial Growth Factor (VEGF) and Its Soluble Receptors: A Possible Link to Angiogenesis in Arteriovenous Malformations.

AIM: To investigate the levels of vascular endothelial growth factor (VEGF) in the brain, and its soluble forms, namely sVEGFR1 and sVEGFR2, levels in the plasma of rats after cerebral ischemia. MATERIAL AND METHODS: Rats were divided into three groups as follows: Group 1: Sham-operated group, Group 2: Complete occlusion of the right carotid artery, Group 3: Complete occlusion of the right carotid artery and temporary occlusion of the left carotid artery for 10 min. Blood samples were collected on days 0 and 10 prior to the sacrification to measure the sVEGFR1 and sVEGFR2 levels. On day 10, animals were sacrificed, and brain tissue was collected to analyze VEGF expression. RESULTS: Postoperative sVEGFR1 levels reduced significantly in Group 3, while it remained stable in other groups. sVEGFR2 levels did not change in any group. Although VEGF staining scores in the groups that underwent ischemia procedures increased compared to group 1, no significant differences were observed. CONCLUSION: Decreased levels of sVEGFR1 can be a mechanism contributing to angiogenesis in arteriovenous malformations by increasing the levels of VEGF available to bind membrane-bound VEGFRs.

Comparison of TachoComb and TissuDura in Terms of Adverse Effects and Complications in Duraplasty in Rats.

AIM: To compare two synthetic graft materials, TachoComb®, a fibrin sealant composed of collagen, fibrinogen, thrombin and aprotinin and TissuDura®, a collagen-based biomatrix. MATERIAL AND METHODS: Thirty Sprague?Dawley rats were randomly divided into three groups with 10 animals in each group. A dural defect was created on the left parietal bone of each animal, and the dural defect was repaired using either TachoComb® (TachoComb group) or TissuDura® (TissuDura group). Sham animals did not receive any dural graft. After 21 days of follow-up, the brain was dissected, and inflammation, oedema, gliosis and foreign body reaction in the bone and parenchymal tissue were investigated histopathologically. RESULTS: The TachoComb group showed significantly greater inflammation, gliosis and parenchymal foreign body reaction compared with the sham group. By contrast, the TissuDura group had significantly lower gliosis and insignificantly less inflammation in the bone and parenchymal foreign body reaction compared with the TachoComb group. CONCLUSION: In conclusion, our results suggest that TissuDura® may be considered more biocompatible than TachoComb® in duraplasty.