The effect of ultrasound-guided serratus plane block on the quality of life in patients undergoing modified radical mastectomy and axillary lymph node dissection: a randomized controlled study.

BACKGROUND: Modified radical mastectomy (MRM) and axillary lymph node dissection (AD) are the most commonly used surgical methods in breast cancer surgery, and they are characterized by moderate to severe pain. This study aimed to investigate the effect of ultrasound-guided serratus plane block (SPB) on postoperative acute and chronic pain in patients undergoing MRM and AD. METHODS: After ethical approval, 60 patients, aged between 18-65 years, ASA I-III, underwent unilateral MRM, and AD was assigned into 2 groups. The SPB group received ultrasound-guided SPB with 30 mL 0.25% bupivacaine, and the control group received 2 mL saline injection subcutaneously. Postoperative analgesia was performed with intravenous patient-controlled analgesia and dexketoprofen trometamol. Pain scores, opioid consumption, and rescue analgesic requirements were recorded. Chronic pain and quality of life were evaluated with the Numerical Rating Scale (NRS), short form-36 (SF-36), and painDETECT. RESULTS: Compared with the control group, the visual analogue scale scores were statistically lower in the SPB group during 4 postoperative hours in post-anaesthetic care unit PACU at 1st, 2nd (P < 0.001), and 4th hour (P = 0.014). Fentanyl consumption and rescue analgesics were lower in the SPB group than in the control group (0-4 h, P = 0.001; 4-8 h, 8-12 h, 24 h; total P < 0.001). The incidence of chronic pain was 11%, and there was no statistically significant difference between control and SPB groups in terms of SF-36, NRS, and painDETECT scores measured at the first and sixth months. CONCLUSIONS: SPB demonstrated superiority versus the control group concerning acute postoperative pain parameters. However, SPB had no influence on the quality of life and did not prevent chronic postmastectomy pain.

Effects of Bupivacaine Versus Bupivacaine Plus Dexamethasone-Soaked Nasal Packing After Endoscopic Nasal Surgery.

BACKGROUND: The aim of this randomized prospective study was to investigate the postoperative analgesic effectiveness of bupivacaine versus bupivacaine plus dexamethasone-soaked nasal packing in patients scheduled for endoscopic nasal surgery. METHODS: Sixty American Society of Anesthesiologists groups I and II patients aged 18 to 65 years and scheduled for endoscopic nasal surgery were assigned into 2 groups. Group B received 8 mL 0.5% bupivacaine and 2 mL saline, and group BD received 8 mL 0.5% bupivacaine and 8 mg (2 mL) dexamethasone-soaked nasal packing. In the postoperative period, 1000 mg paracetamol was administered and repeated every 6 hours. Postoperative pain scores, additional analgesia requirements and nausea-vomiting were recorded. RESULTS: Postoperative pain scores were significantly lower in group BD than in group B at 1, 2, 4, 8, and 12 hours, and during tampon removal (P < 0.05), but there was no difference between the groups' 24-hour visual analog scale scores (P = 0.115). Postoperative additional analgesia use was statistically significantly higher in group B than in group BD (25/30 versus 13/30 respectively, P = 0.001). Postoperative nausea and vomiting was statistically higher in group B than in group BD (11/30 versus 4/30 respectively, P = 0.037). CONCLUSION: The addition of dexamethasone to bupivacaine via soaked nasal packing in endoscopic nasal surgery reduced postoperative pain scores, additional analgesia requirements, and PONV. The authors recommended a combination of bupivacaine plus dexamethasone-soaked nasal packing after endoscopic nasal surgery.

Comparison of transverse short-axis classic and oblique long-axis "Syringe-Free" approaches for internal jugular venous catheterization under ultrasound guidance / Comparação das abordagens clássica transversal no eixo curto e longitudinal oblíqua no eixo longo sem seringa para cateterização de veia jugular interna guiada por ultrassom

Abstract Background and objectives: There are different ultrasound probe positions used for internal jugular venous catheter placement. Also, in-plane or out of plane needle approach may be used for catheterization. Transverse short-axis classic approach is the most popular performed approach in literature. "Syringe-Free" is a new described technique that is performed with oblique long-axis approach. We aimed to compare performance of these two approaches. Methods: This study was conducted as a prospective and randomized study. 80 patients were included the study and allocated into two groups that were named Group C (transverse short-axis classic approach) and Group SF (oblique long-axis syringe-free approach) by a computer-generated randomization. The primary outcome was mean time that guidewire is seen in the Internal jugular vein (performing time). The secondary outcomes were to compare number of needle pass, number of skin puncture and complications between two groups. Results: Demographic and hemodynamic data were not significantly different. The mean performing time was 54.9 ± 19.1 s in Group C and 43.9 ± 15.8 s in Group SF. Significant differences were found between the groups (p = 0.006). Mean number of needle pass was 3.2 (± 2.1) in Group C and 2.1 (± 1.6) in Group SF. There were statistically significant differences between two groups (p = 0.002). The number of skin puncture was 1.6 (± 0.8) and 1.2 (± 0.5) in Group C and SF, respectively (p = 0.027). Conclusion: "Syringe-Free" technique has lower performing time, number of needle pass and skin puncture. Also, it allows to follow progress of guide-wire under continuous ultrasound visualization and the procedure does not need assistance during catheter insertion. Namely, "Syringe-Free" is effective, safe and fast technique that may be used to place internal jugular venous catheter.

Resumo Justificativa e objetivos: Há diferentes posições do probe do ultrasom que são utilizadas para a colocação de cateter em veia jugular interna. Além disso, a aproximação da agulha no plano ou fora do plano pode ser usada para o cateterismo. A abordagem transversal clássica no eixo curto é a abordagem mais popular na literatura. Sem seringa é uma nova técnica descrita, realizada com a abordagem oblíqua no eixo longo. Nosso objetivo foi comparar o desempenho dessas duas abordagens. Métodos: Este foi um estudo prospectivo e randômico. No total, 80 pacientes foram incluídos no estudo e divididos em dois grupos denominados Grupo C (abordagem transversal clássica no eixo curto) e Grupo SF (abordagem sem seringa oblíqua no eixo longo) por meio de randomização gerada por computador. O desfecho primário foi o tempo médio para a visibilização do fio-guia na veia jugular interna (tempo de execução). Os desfechos secundários foram o número de passagens da agulha, o número de punções da pele e as complicações entre os dois grupos. Resultados: Os dados demográficos e hemodinâmicos não foram significativamente diferentes. O tempo médio de execução foi de 54,9 ± 19,1 segundos no Grupo C e 43,9 ± 15,8 segundos no Grupo SF. Diferenças significativas foram observadas entre os grupos (p = 0,006). O número médio de passagens da agulha foi de 3,2 (± 2,1) no Grupo C e 2,1 (± 1,6) no Grupo SF. Houve diferença estatisticamente significativa entre os dois grupos (p = 0,002). O número de punções da pele foi de 1,6 (± 0,8) no Grupo C e 1,2 (± 0,5) C no Grupo SF (p = 0,027). Conclusão: A técnica sem seringa apresentou tempo de execução, número de passagens da agulha e número de punções da pele menores. Além disso, essa técnica permite acompanhar o progresso do fio-guia com visibilização ecográfica contínua e o procedimento não precisa de auxílio durante a inserção do cateter. Ou seja, sem seringa é uma técnica eficaz, segura e rápida que pode ser usada para a colocação de cateter em veia jugular interna.

[Comparison of transverse short-axis classic and oblique long-axis "Syringe-Free" approaches for internal jugular venous catheterization under ultrasound guidance]. / Comparação das abordagens clássica transversal no eixo curto e longitudinal oblíqua no eixo longo sem seringa para cateterização de veia jugular interna guiada por ultrassom.

BACKGROUND AND OBJECTIVES: There are different ultrasound probe positions used for internal jugular venous catheter placement. Also, in-plane or out of plane needle approach may be used for catheterization. Transverse short-axis classic approach is the most popular performed approach in literature. "Syringe-Free" is a new described technique that is performed with oblique long-axis approach. We aimed to compare performance of these two approaches. METHODS: This study was conducted as a prospective and randomized study. 80 patients were included the study and divided into two groups that were named Group C (transverse short-axis classic approach) and Group SF (oblique long-axis syringe-free approach) by a computer-generated randomization. The primary outcome was mean time that guidewire is seen in the internal jugular vein (performing time). The secondary outcomes were to compare number of needle pass, number of skin puncture and complications between two groups. RESULTS: Demographic and hemodynamic data were not significantly different. The mean performing time was 54.9±19.1s in Group C and 43.9±15.8s in Group SF. Significant differences were found between the groups (p=0.006). Mean number of needle pass was 3.2(±2.1) in Group C and 2.1(±1.6) in Group SF. There were statistically significant differences between two groups (p=0.002). The number of skin puncture was 1.6(±0.8) and 1.2(±0.5) in Group C and SF, respectively (p=0.027). CONCLUSION: "Syringe-Free" technique has lower performing time, number of needle pass and skin puncture. Also, it allows to follow progress of guide-wire under continuous ultrasound visualization and the procedure does not need assistance during catheter insertion. Namely, "Syringe-Free" is effective, safe and fast technique that may be used to place internal jugular venous catheter.