Comparison of Conventional Intensive Care Scoring Systems and Prognostic Scores Specific for Intracerebral Hemorrhage in Predicting One-Year Mortality.

BACKGROUND: Specific prognostic models for intracerebral hemorrhage (ICH) have short and simple features, whereas intensive care unit (ICU) severity scales include more complicated parameters. Even though newly developed ICU severity scales have disease-specific properties, they still lack radiologic parameters, which is crucial for ICH. AIMS: To compare the performance of the Simplified Acute Physiology Score (SAPS) III, Acute Physiology and Chronic Health Evaluation (APACHE) IV, Logistic Organ Dysfunction Score (LODS), ICH, max-ICH, ICH functional outcome score (ICH-FOS), and Essen-ICH for prediction of in-hospital and one-year mortality of patients with ICH. METHODS: A single-center analysis of 137 patients with ICH was conducted over 5 years. The performance of scoring systems was evaluated with receiver operating characteristic analysis. The independent predictors of one-year mortality were investigated with a multivariate logistic regression analysis. The SAPS-III score was calculated both in the emergency department (ED) and ICU. RESULTS: Among the independent variables, the need for mechanical ventilation, hematoma volume, the presence of intraventricular hemorrhage, and hematoma originating from both lobar and nonlobar regions were found as the strongest predictor of one-year mortality. For in-hospital mortality, the discriminative power of SAPS-II, APACHE-IV, and LODS was excellent, and for SAPS-III-ICU and SAPS-III-ED, it was good. For one-year mortality, the discriminative power of SAPS-II, APACHE-IV, LODS, and SAPS-III-ICU was good, and for SAPS-III-ED, Essen-ICH, ICH, max-ICH, and ICH-FOS, it was fair. CONCLUSIONS: Although all three ICH-specific prognostic scales performed satisfactory results for predicting one-year mortality, the common intensive care severity scoring showed better performance. SAPS-III scores may be recommended for use in EDs after proper customization.

Infraclavicular Brachial Plexus Block and Sugammadex Use in a Paediatric Patient with Wolff-Parkinson--White Syndrome.

BACKGROUND: Wolff-Parkinson-White (WPW) syndrome is a rare disease that can cause various patterns of tachyarrhythmias. The main goal of anaesthesiologists for the perioperative anaesthetic management of WPW patients must be to avoid sympathetic stimulation and prevent tachyarrhythmias. CASE: A 9-year-old male patient with a diagnosis of WPW syndrome, who underwent emergency surgery for supracondylar humerus fracture, is presented. General anaesthesia in combination with infraclavicular brachial plexus (ICBP) block was performed successfully without any complications. For the reversal of neuromuscular block, sugammadex was uneventfully used. Intraoperative sympathetic discharge due to surgical intervention was prevented with ICBP block. The ICBP block has also provided good postoperative analgesia. CONCLUSIONS: Sugammadex is a good alternative for the reversal of neuromuscular blocks to avoid the undesirable effects of cholinergic drugs. Peripheral regional blocks that require relatively large doses of local anaesthetics can be safely performed with utmost attention in paediatric WPW patients.

[The need for supplemental blocks in single versus triple injections in infraclavicular brachial plexus blocks with a medial approach: a clinical and anatomic study]. / Bloqueio complementar de nervos no bloqueio de plexo braquial infraclavicular com técnica medial de injeção única versus tripla: estudo anátomo­clínico.

BACKGROUND AND OBJECTIVES: To evaluate the single-injection and triple-injection techniques in infraclavicular blocks with an ultrasound-guided medial approach in terms of block success and the need for supplementary blocks. METHODS: This study comprised 139 patients who were scheduled for elective or emergency upper-limb surgery. Patients who received an infraclavicular blocks with a triple-injection technique were included in Group T (n=68). Patients who received an infraclavicular blocks with a single-injection technique were included in Group S (n=71). The number of patients who required supplementary blocks or had complete failure, the recovery time of sensory blocks and early and late complications were noted. RESULTS: The block success rate was 84.5% in Group S, and 94.1% in Group T without any need for supplementary nerve blocks. The blocks were supplemented with distal peripheral nerve blocks in 8 patients in Group S and in 3 patients in Group T. Following supplementation, the block success rate was 95.8% in Group S and 98.5% in Group T. These results were not statistically significant. A septum preventing the proper distribution of local anesthetic was clearly visualized in 4 patients. The discomfort rate during the block was significantly higher in Group T (p <0.05). CONCLUSION: In ultrasound-guided medial-approach infraclavicular blocks, single-injection and triple-injection techniques did not differ in terms of block success rates. The need for supplementary blocks was higher in single injections than with triple injections. The presence of a fascial layer could be the reason for improper distribution of local anesthetics around the cords.

Superior Hypogastric Plexus Blocks for Postoperative Pain Management in Abdominal Hysterectomies.

OBJECTIVE: To evaluate the efficacy of intraoperative superior hypogastric plexus (SHP) blocks on postoperative pain management in abdominal hysterectomies. MATERIALS AND METHODS: A total of 78 female American Society of Anesthesiologists grade I or II patients who underwent elective total abdominal hysterectomy for benign reasons were assessed for eligibility. After exclusion of patients who did not fulfill the inclusion criteria, 60 patients were evaluated in 2 groups: patients who had intraoperative SHP block (SHP; n=30), and patients who did not have intraoperative SHP block (No-SHP; n=30). RESULTS: There was no statistically significant difference between the 2 groups in demographic attributes, surgical duration, and length of hospital stay. Opioid requirements in both the postanesthesia care unit and gynecology ward, and nonsteroidal anti-inflammatory drug requirements in the ward were statistically significantly higher in the No-SHP group (P<0.05). Rescue analgesic times were found to be significantly longer in the SHP group (627±352.9 min; P<0.05). All visual analogue scale score assessments were found to be statistically significantly lower in the SHP group (P<0.05). No complications related to the SHP blocks were observed. CONCLUSIONS: Intraoperative SHP blocks in abdominal hysterectomies appear to be promising methods for acute postoperative pain management as part of a multimodal analgesia regimen. Although single SHP blocks provide adequate pain relief and reduce analgesic consumption, these blocks might have better results when used together with somatic nerve blocks, including abdominal wall blocks or wound site infiltrations.

Comparison of Ultrasound-Guided Transgluteal and Finger-Guided Transvaginal Pudendal Nerve Block Techniques: Which One is More Effective?

PURPOSE: Pudendal neuralgia (PN) is a painful and disabling condition, which reduces the quality of life as well. Pudendal nerve infiltrations are essential for the diagnosis and the management of PN. The purpose of this study was to compare the effectiveness of finger-guided transvaginal pudendal nerve infiltration (TV-PNI) technique and the ultrasound-guided transgluteal pudendal nerve infiltration (TG-PNI) technique. METHODS: Forty patients who underwent PNI for the diagnosis of PN were evaluated. Thirty-five of these 40 patients, who were diagnosed as PN, underwent a total of 70 further unilateral PNI. All the patients underwent PNI for twice after the first diagnostic PNI, 1 week apart. RESULTS: In the ultrasound (US)-guided TG-PNI group, the success rate was 68.8% (11 of 16) in both "pain in the sitting position" and "pain in the region from the anus to the clitoris." The success rate of blocks in the US-guided TG-PNI group was 75% (12 of 16) in terms of pain during/after intercourse. In the finger-guided TV-PNI group, the success rate was 84.2% in both "pain in the sitting position" and "pain in the region from the anus to the clitoris." The success rate of blocks in the fingerguided TV-PNI group was 89.5% (17 of 19) in terms of pain during/after intercourse. There was no statistically significant difference in the success rate of the 3 assessed conditions between the 2 groups (P>0.05). CONCLUSION: The TV-PNI may be an alternative to US-guidance technique as a safe, simple, effective approach in pudendal nerve blocks.

The need for supplemental blocks in single versus triple injections in infraclavicular brachial plexus blocks with a medial approach: a clinical and anatomic study / Bloqueio complementar de nervos no bloqueio de plexo braquial infraclavicular com técnica medial de injeção única versus tripla: estudo anátomo-clínico

Abstract Background and objectives: To evaluate the single-injection and triple-injection techniques in infraclavicular blocks with an ultrasound-guided medial approach in terms of block success and the need for supplementary blocks. Methods: This study comprised 139 patients who were scheduled for elective or emergency upper-limb surgery. Patients who received an infraclavicular blocks with a triple-injection technique were included in Group T (n = 68). Patients who received an infraclavicular blocks with a single-injection technique were included in Group S (n = 71). The number of patients who required supplementary blocks or had complete failure, the recovery time of sensory blocks and early and late complications were noted. Results: The block success rate was 84.5% in Group S, and 94.1% in Group T without any need for supplementary nerve blocks. The blocks were supplemented with distal peripheral nerve blocks in 8 patients in Group S and in 3 patients in Group T. Following supplementation, the block success rate was 95.8% in Group S and 98.5% in Group T. These results were not statistically significant. A septum preventing the proper distribution of local anesthetic was clearly visualized in 4 patients. The discomfort rate during the block was significantly higher in Group T (p < 0.05). Conclusion: In ultrasound-guided medial-approach infraclavicular blocks, single-injection and triple-injection techniques did not differ in terms of block success rates. The need for supplementary blocks was higher in single injections than with triple injections. The presence of a fascial layer could be the reason for improper distribution of local anesthetics around the cords.

Resumo Justificativa e objetivos: Avaliar as técnicas de injeção única e tripla no bloqueio infraclavicular, empregando-se acesso medial guiado por ultrassonografia, comparando-se o sucesso do bloqueio e a necessidade de bloqueios complementares. Método: O estudo incluiu 139 pacientes com indicação de cirurgia de membro superior eletiva ou de emergência. O Grupo T (n = 68 pacientes) recebeu bloqueio infraclavicular com técnica de injeção tripla e o Grupo S (n = 71), bloqueio infraclavicular com injeção única. Registrou-se o número de pacientes que necessitaram bloqueio complementar de nervo ou que apresentaram falha completa do bloqueio, o tempo de recuperação do bloqueio sensorial e as complicações precoces e tardias. Resultados: A taxa de sucesso do bloqueio infraclavicular, sem necessidade de bloqueio complementar de nervo, foi 84,5% e 94,1% para os Grupos S e T, respectivamente. No bloqueio infraclavicular foi necessário bloqueio de nervos periféricos distais em 8 e 3 pacientes dos Grupos S e T, respectivamente. Após a complementação, a taxa de sucesso do bloqueio foi 95,8% e 98,5% para os Grupos S e T, respectivamente. Os resultados não foram estatisticamente significantes. Imagem de septo impedindo a distribuição adequada do anestésico local foi claramente visualizada em quatro pacientes. A taxa de desconforto durante a realização do bloqueio foi estatatisticamente mais alta no Grupo T (p< 0,05). Conclusões: As técnicas de injeção única e tripla em bloqueio infraclavicular guiado por ultrasonografia com acesso medial não diferiram quanto à taxa de sucesso. A necessidade de bloqueio complementar foi maior com a técnica de injeção simples. A ocorrência de invólucro de fascia poderia justificar a distribuição inadequada do anestésico local ao redor dos fascículos do plexo.