Unilateral transversus abdominis plane block and port-site infiltration : Comparison of postoperative analgesic efficacy in laparoscopic cholecystectomy.

PURPOSE: To compare the analgesic efficacy of unilateral subcostal transversus abdominis plane (TAP) block with local anesthetic infiltration, applied to the port site in patients undergoing laparoscopic cholecystectomy (LC). METHODS: Group T received a unilateral subcostal TAP block, group I received a local anesthetic infiltration at port sites, and group C was the control group. Groups T and I received 20 mL 0.25% bupivacaine. Intravenous patient-controlled analgesia with tramadol was similarly applied to all groups. Postoperative pain levels during rest and cough were evaluated using a numeric rating scale (NRS). Nausea and vomiting were evaluated using postoperative nausea vomiting scores (PONV) at 1, 3, 6, 12 and 24 h and tramadol consumption was also determined. Patient satisfaction was evaluated using a Likert-type scale. RESULTS: Postoperative resting NRS scores were lower in group T than the other groups at 1 h and 12 h (p = 0.007 and p = 0.016), while NRS values during cough were statistically significant at 1 h (p = 0.004). The 24­h tramadol consumption was different: group T 229 ± 33 mg, group I 335 ± 95 mg, and group C 358 ± 66 mg (p < 0.001). The percentages of patients reporting that they would prefer the applied postoperative pain control method again were 83.3%, 62.5% and 70.8% in groups T, I and C, respectively (p = 0.118). CONCLUSION: Unilateral subcostal TAP block was superior to local anesthetic infiltration at port sites after LC, in terms of low opioid consumption. Unilateral subcostal TAP block is recommended as part of a multimodal analgesic protocol.

Effect of magnesium sulphate on bleeding during lumbar discectomy.

We assessed the effect of magnesium on the amount of bleeding, coagulation profiles and surgical conditions during lumbar discectomy under general anaesthesia. Forty patients, of ASA physical status 1-2 and aged 18-65 years, undergoing single-level microscopic lumbar discectomy, were randomly assigned to magnesium sulphate (50 mg.kg(-1) in 100 ml saline over 10 min followed by a continuous infusion of 20 mg.kg.h(-1) ) or saline. The mean (SD) estimated blood loss was 190 (95) and 362 (170) ml in the magnesium and saline groups, respectively (mean difference = 172 ml; 95% CI 84-260 ml). The median (IQR [range]) Fromme's scale score for surgical conditions for the magnesium and saline groups were 2 (2-3 [2-3]) and 3 (2-3 [3-4]), respectively (p < 0.05). The bleeding time, haemoglobin, platelet count, prothrombin time, international normalised ratio and fibrinogen levels were similar in the two groups. The activated partial thromboplastin time was prolonged in the magnesium group immediately postoperatively and at 6 h after surgery. After the bolus of magnesium, the heart rate was higher and the mean arterial pressure lower in the magnesium group. The use of magnesium sulphate during lumbar discectomy decreases blood loss, and provides better surgical conditions without marked haemodynamic effects.

Neurolytic phenol blockade of the obturator nerve for severe adductor spasticity.

BACKGROUND: In this study, we present the 3-month follow-up results of a retrospective analysis of obturator nerve (ON) phenol neurolysis performed between 2000 and 2007 in patients with adductor spasticity. METHODS: The study was performed by retrospective investigation of the clinical follow-up results of 80 ON phenol treatments in 62 patients. Neurolysis using 5-10 ml 6% phenol was applied with the guidance of fluoroscopy and a peripheral nerve stimulator. Pain, spasticity and hygiene were evaluated and the hip abduction range of motion (ROM) was measured at the end of the first week and in the first, second and third months following the intervention. RESULTS: The visual analogue scale scores decreased significantly in the first week, first month and the second month, but reached their initial values in the third month. A drastic increase in the ROM values was shown in hip abduction in the first week, first month and second month. An increase in the Ashworth Scale values was observed in the second and third months, but they did not reach their initial values. The hygiene score decreased drastically in the first week and the first and second months, but worsened in the third month. The success rate in nerve localization during ON neurolysis was 100%. CONCLUSION: ON phenol blockade with fluoroscopy and peripheral nerve stimulator guidance in patients with adductor spasticity led to a decrease in spasticity and pain with an increase in the ROM of the hip and better hygiene with an efficacy lasting for about 3 months.

C2/C3 nerve blocks and greater occipital nerve block in cervicogenic headache treatment.

In the diagnosis of cervicogenic headache, greater occipital nerve (GON), cervical nerve, minor occipital nerve, and cervical facet joint blocks are used. In our study we compared the GON and C2/C3 nerve blocks in the diagnosis and treatment of cervicogenic headache. In both cases, repeated blocks proved to have a long-lasting effect in the treatment of this disorder, with both GON and C2/C3 blocks being found to be equally effective.