Analgesic efficacy of ultrasound-guided bilateral transversus abdominis plane block in children: retrospective analysis of 97 cases.

BACKGROUND: Transversus abdominis plane (TAP) block is a method for postoperative pain management. Studies on children are gradually increasing. The aim of this retrospective study was to evaluate effectiveness of TAP block on pain control, its side effects, and parental satisfaction levels in children. METHODS: Study included patients operated between January 2019 and December 2020 in Gazi University Faculty of Medicine. Total of 97 patients (35 girls, 62 boys) between 5 and 18 years who had an ultrasound guided TAP block for lower abdominal or inguinal surgery were examined retrospectively. TAP block application time, hemodynamic variables, postoperative pain scores, postoperative analgesic requirement, sex, surgical history and satisfaction levels were evaluated. RESULTS: : The average application time of TAP block was 9.48 ± 3.4 and the time between TAP block and surgical incision was 12.06 ± 6.1 min. Pain scores in postanesthesia care unit (PACU) and at the postoperative first hour decreased as the time between TAP block and surgical incision increased (p < 0.05). Girls have higher pain scores at PACU than boys (p < 0.05). Previous surgical history increased postoperative 1st hour pain scores (OR: 13.8; 95% CI 1.7-113.3; p = 0.01). There was a significant negative correlation between pain scores at PACU, postoperative 1st, 2nd, 4th, 6th, 12th and satisfaction levels (r = -0.45, r = -0.56, r = -0.60, r = -0.54, r = -0.52, r = -0,43, respectively, p < 0.05). DISCUSSION: Ultrasound-guided TAP blocks can be performed safely in children in lower abdominal surgeries. However, the efficacy of TAP block on late term postoperative pain scores is limited. Time interval between the TAP block and the incision, sex, and pain memory, as well as other factors that may improve the quality of TAP block should be considered.

Hemodynamic effects of chest-knee position: comparison of perioperative propofol and sevoflurane anesthesia.

BACKGROUND/AIM: There are limited data in the literature investigating the effects of anesthetic agents on cardiac output used in the chest-knee position. The aim of this study is to compare the effects of inhalation and total intravenous anesthesia on cardiac output in patients undergoing lumbar discectomy in the chest-knee position. MATERIALS AND METHODS: Forty patients undergoing discectomy in the chest-knee position were allocated to 2 groups. The first group (GrS, n = 20) received sevoflurane after thiopental induction, while the second group (GrP, n = 20) received propofol induction and infusion. Heart rate (HR), mean arterial pressure (MAP), peripheral oxygen saturation, cardiac output (CO), and cardiac index (CI) were recorded. RESULTS: Groups were comparable in terms of HR and MAP. The differences related to anesthetic technique and position were statistically significant within each group. Cardiac output and CI were similar between the groups. Cardiac output and CI of GrP were found to be decreased in the chest-knee position and significantly elevated in the supine position after surgery (P < 0.05). There were significant decreases in the mean CO and CI values recorded after the chest-knee position in GrP. CONCLUSION: Sevoflurane is found to be superior when compared to propofol in patients undergoing surgery in the chest-knee position in terms of perioperative hemodynamic stability. Therefore, sevoflurane may be the anesthetic of choice, especially in patients operated on in the chest-knee position with suspected hemodynamic instability.

Comparison of the effects of different percutaneous tracheotomy techniques on acute tracheal trauma.

AIM: As it can easily be performed at the bedside with minimal morbidity, percutaneous dilatational tracheotomy (PDT) is preferred over surgical tracheotomy. The aim of this study is to compare the effects of different PDT techniques on posterior tracheal wall injury. MATERIALS AND METHODS: The study was conducted at the Gazi University Laparoscopy Training Center after approval was granted by the ethics committee. After sedation with xylazine/ketamine, electrocardiography, peripheral oxygen saturation, and blood pressure were monitored. Propofol was used to achieve the desired level of sedation during the procedure. There were 16 pigs, randomly allocated into 4 groups. Multiple, single, forceps, and twist dilator techniques were performed in groups I, II, III, and IV, respectively. At the end of the course all pigs were sacrificed and tracheas were harvested for macroscopic and histopathological evaluation. RESULTS: Macroscopic evaluation revealed erythematous/hemorrhagic and ulcerative lesions on the posterior wall of all samples. Histopathological injury was observed in all samples and was similar in all groups. Procedural time was significantly longer in group I than in all other groups (P < 0.05). CONCLUSION: Although the results are conflicting, bronchoscopy-aided PDT is believed to reduce complications. In our study, PDTs were performed without bronchoscopy, and posterior wall injury was observed in all samples. Therefore, we suggest using bronchoscopy to reduce procedure-related complications and improve patient safety during PDT.