Analgesic effect of erector spinae plane block after cesarean section: A randomized controlled trial.

Background: Ultrasound-guided bilateral erector spinae plane block is also a technique for providing analgesia after a cesarean section. Aim: We hypothesized that bilateral erector spinae plane block applied from the transverse process of T9 who underwent elective cesarean section could provide effective postoperative analgesia. Patients and Methods: Fifty parturients who were scheduled to undergo elective cesarean section under spinal anesthesia were included in the study. Group SA (n = 25) was categorized as the group in which spinal anesthesia alone (SA) was performed, and Group SA+ESP (n = 25) was categorized as the group in which SA + ESP block was performed. All patients were given a solution containing 7 mg isobaric bupivacaine + 15 µg fentanyl intrathecally through spinal anesthesia. In the SA + ESP group, the bilateral ESPB was performed at level T9 with 20 ml 0.25% bupivacaine + 2 mg dexamethasone immediately after the operation. Total fentanyl consumption in 24 h, the visual analogue scale for pain, and time to the first analgesic request were evaluated postoperatively. Results: The total fentanyl consumption in 24 h was statistically significantly lower in the SA + ESP group than the SA group (279 ± 242.99 µg vs. 423.08 ± 212.55 µg, respectively, P = 0.003). The first analgesic requirement time was statistically significantly shorter in the SA group than the SA + ESP group (150.20 ± 51.83 min vs. 197.60 ± 84.49 min, respectively, P = 0.022). Postoperative VAS scores at 4th, 8th, and 12th h at rest were statistically significantly lower in group SA + ESP than in group SA (P = 0.004, P = 0.046, P = 0.044, respectively). VAS scores during the postoperative 4th, 8th, and 12th h cough were statistically significantly lower in group SA + ESP than in group SA (P = 0.002, P = 0.008, P = 0.028, respectively). Conclusion: Ultrasound-guided bilateral ESP provided adequate postoperative analgesia and significantly decreased postoperative fentanyl consumption in patients having cesarean section. Also, it has a longer analgesia time than the control group, and it has been shown to delay the first analgesic requirement.

HELLP syndrome is still a serious, life-threatening complication of pregnancy: admission of 34 women to an eastern Turkish intensive care unit.

OBJECTIVE: The transfer of the obstetric patient to the intensive care unit is considered as an indicator of maternal morbidity. The most important two indications for admittance of the obstetric patient to the intensive care unit are postpartum hemorrhage and hypertensive disorders. The purpose of this study was to determine maternal morbidity and mortality rates in patients diagnosed with hemolysis, elevated liver enzyme levels, and low platelet count (HELLP) syndrome who required intensive care. MATERIALS AND METHODS: The charts of 34 patients who were diagnosed with HELLP syndrome and treated in intensive care unit between the years 2005 - 2013 were evaluated retrospectively. RESULTS: During the study period, a total of 151 patients were diagnosed with HELLP syndrome and 34 patients were admitted to the intensive care unit. Mean age of the patients was 28.97 ± 7.26 years and there was no significant difference be- tween survivors and non-survivors (p = 0.442). There were no significant differences between survivors and non-survivors in terms of gestational age, parity, and multiparity rates (p > 0.05). There was 31.2% mortal cases and 77.8% of living cases had received regular antenatal follow-up and the difference was statistically significant (p = 0.006). 30 patients (88.2%) required invasive mechanical ven- tilation. The average Glasgow Coma Score (GCS) of patients was 6.47 ± 4.34. There were significant differences between patients who lived and who died in terms of Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA) score, and duration of invasive mechanical ventilation (p < 0.05). Twenty-two patients (64.7%) required transfusion of blood and blood products. Maternal mortality occurred in 16 patients (47%). The causes of death were: intracerebral hemorrhage in six cases, acute respiratory distress syndrome (ARDS) in three cases, disseminated intravascular coagulation (DIC) in three\cases, sepsis/multi- ple organ dysfunction syndrome (MODS) in two cases, hepatic rupture in one case, and massive pulmonary embolism in one case. Con- clusion: HELLP syndrome is still one of the most serious and life-threatening complications of pregnancy. Mortality rate can be reduced by regular antenatal follow-up and transfer of pregnant women who carry risk to the intensive care unit without delay.

Umbilical cord blood endocan levels according to the delivery mode.

PURPOSE OF INVESTIGATION: The authors aimed to evaluate the endocan levels in the umbilical cord blood regarding the delivery mode. MATERIALS AND METHODS: One hundred six women aged between 20 to 35 years, undergoing delivery at term were studied. Three groups were formed; 37 neonates born by spontaneous vaginal delivery (group 1), 34 neonates born by an elective cesarean section with the general anesthesia (group 2), and 35 neonates, born by an elective cesarean section with spinal anesthesia (group 3). In delivery, umbilical cord blood samples were collected and endocan levels were measured. RESULTS: The endocan levels of cord blood (mean ± standard deviation, ng/ml) were found to be lower in group 2 (1.21 ± 0.46) compared to group 1 (1.52 ± 0.52) (p = 0.011). Cord blood endocan levels were not different in group 1 than those of group 3 (p = 0.49). CONCLUSION: It may be concluded that cord blood endocan levels are affected by the delivery mode.

Anesthetic Management in Children with Congenital Lobar Emphysema.

BACKGROUND: The cause of congenital lobar emphysema (CLE) is unknown and characterized by hyperinflation of one or more lobes of the lung. The purpose of this retrospective study was to present the anesthetic management of children with congenital lobar emphysema (CLE) receiving treatment in our center. METHODS: Ten children underwent CLE-related surgical treatment in our center between March 1995 and August 2014. All cases were diagnosed on the basis of postero-anterior chest radiography and computerized tomography. Age, sex, preoperative clinical findings, location of lesions, surgical and anesthetic procedures, results of anesthesia and duration of hospitalization were evaluated. RESULTS: Six patients were male (60%) and four female (40%). Their ages ranged from 40 days to 6 years. Dyspnea was present in all cases and severe in four of them. Four patients had emphysema in the left upper lobe, three in the right middle lobe, one in the right upper lobe and one in the left lower lobe. All patients were extubated in the operating room and none experienced post-operative respiratory distress. Post-operative analgesia was provided via the previously placed intrapleural catheter. All the patients were extubated in the operation room. There was no post-operative mortality or morbidity. CONCLUSIONS: Anesthetic management of patients with CLE is challenging. In these patients the surgical team and -anesthetists should collaborate closely and the time between anesthesia induction and thoracotomy should be as short as possible.

Maternal and neonatal effects of adding morphine to low-dose bupivacaine for epidural labor analgesia.

AIM: Labor is one of the most painful experiences a woman may face during her lifetime. One of the most effective methods used for eliminating this pain is epidural analgesia. The aim of this study to determine the impact of adding morphine to low-dose bupivacaine epidural anesthesia on labor and neonatal outcomes, and maternal side effects. MATERIALS AND METHODS: This is a prospective randomized double-blind study comparing two regimens of anesthetic agents used for epidural anesthesia in labor. A total of 120 pregnant women were randomized into two groups with 60 subjects in each study arm. A catheter was inserted, and 0.1% bupivacaine + 2 µg/mL fentanyl in 15 mL saline were given to Group bupivacaine-fentanyl (Group BF), while 0.0625% bupivacaine + 2 µg/ml fentanyl + 2 mg morphine in 15 mL saline were given to Group bupivacaine-fentanyl-morphine (Group BFM) with no test dosing from the needle. No morphine was added to the subsequent epidural injections in Group BFM. RESULTS: The total dose of bupivacaine was significantly lower in Group BFM relative to Group BF (P = 0.0001). The visual analogu scalescores at 15, 30, and 45 min were significantly lower in Group BF compared to thosein Group BFM (P = 0.0001, P = 0.001, and P = 0.006, respectively). The second stage of labor was significantly shorter in Group BFM relative to Group BF (P = 0.027 and P = 0.003, respectively). The satisfaction with analgesia following the first dose was higher in the nonmorphine group (P = 0.0001). However, maternal postpartum satisfaction was similar in both groups. Either nausea or vomiting was recorded in eight patients in Group BFM. CONCLUSION: We believe that epidural analgesia comprised of a low-dose local anaesthetic and 2 mg morphine provides a painless labor that significantly reducesthe use of local anesthetic without changing the efficiency of the analgesic, ensuring the mother's satisfaction without leading to an adverse effect on the mother or foetus, while mildly (but significantly) shortening the second stage of labor.

Pre-school children with hydatid lung disease.

BACKGROUND: Hydatid cyst disease is a major health problem in developing countries and it usually settles in the lungs in children. This study aimed to present pre-school children with lung hydatid cysts cases that underwent surgical treatment. METHODS: The authors retrospectively investigated 42 consecutive pre-school patients who were diagnosed and surgical treated for hydatid cysts in their clinic between January 1998 and December 2011. RESULTS: Seventeen (40.5%) patients were female and 25 (59.5%) patients were male. The average age of the patients was 5.2 +/- 1.3 (between 2-7 years). The most common symptoms were cough (74%), chest pain (26.2%), and fever (26.2%). Twenty-eight cases had cysts in only one lung; in five cases, the cysts were in a single lung and the liver, in six cases, in bilateral lungs and liver, and in three cases, in bilateral lungs. The average cyst diameter was 6.2 +/- 2.4 (2-12) cm. In five cases, there were combined interventions to the right lung and liver cysts with a transdiaphragmatic approach. Nine patients with bilateral hydatid cysts underwent operations. Muscle protector thoracotomies were performed in eight cases. Cystotomy and capitonnage were applied to all lung cysts. One patient underwent a bronchoscopy for postoperative atelectasis. In one case, postoperative fever was observed. There was no postoperative mortality. Postoperative average hospital stay was 7.2 +/- 2.1 (3-13) days. CONCLUSION: Surgery is the definitive treatment for lung hydatid cysts. The most important way to protect against the adverse effects of a thoracotomy is to eliminate the routes of transmission.

The Effect of Pre-emptive Dexketoprofen Administration on Postoperative Pain Management in Patients with Ultrasound Guided Interscalene Block in Arthroscopic Shoulder Surgery.

Background: Postoperative pain is an important problem for patients undergoing shoulder surgery. Our study investigated analgesic efficacy, duration of analgesia, postoperative analgesic use and patient satisfaction with the use of preemptive intravenous dexketoprofen for interscalene block in addition to general anesthesia in arthroscopic shoulder surgery. Methods: 60 patients, scheduled for arthroscopic shoulder surgery were randomized (30 patients each) into either: - control group (Group1) or dexketoprofen group (Group 2). Patients were followed for 48 hours to compare both groups for; post-operative pain scores, effectiveness of postoperative analgesia, duration of analgesia, and analgesia consumption. Duration of postoperative sensory block of the shoulder joint was defined as time to onset of pain at the incision site. Duration of postoperative motor block of the shoulder joint was defined as time to onset of first shoulder movement. Results: While no significant difference was determined for motor block time, sensory block time was significantly longer in the dexketoprofen group (p < 0.05).VAS scores were significantly lower at all times in the dexketoprofen group (p < 0.05).Total PCA fentanyl consumption was 274.16 ± 314.89 (µg) in the dexketoprofen group, and 490.00 ± 408.98 (µg) in the control group, the difference was statistically significant (p < 0.05). No significant difference was observed between the groups' demographic and hemodynamic data. Conclusion: Pre-emptive IV dexketoprofen may be a good option for arthroscopic shoulder surgery and provides effective analgesia.

The effects of different doses of caudal morphine with levobupivacaine on postoperative vomiting and quality of analgesia after circumcision.

The study aim was to investigate the effect of three different morphine doses added to levobupivacaine 0.125% for caudal analgesia after circumcision surgery in children, particularly in relation to the frequency of postoperative vomiting within the first 24 hours following surgery. Two hundred and forty patients aged 5 to 12 years undergoing circumcision were included in the study. Following induction, caudal 0.125% levobupivacaine 0.5 ml/kg was given after adding 7.5, 10 or 15 µg/kg morphine. The postoperative incidence of vomiting was 5%, 12.5% and 17.5% in the groups 7.5, 10 and 15 µg/kg morphine, respectively (P=0.012, 7.5 versus 15 µg/kg groups). Five percent of the 7.5 µg/kg group and none of the patients in the other groups required paracetamol within the first 12 hours, and there was a significantly greater need for rescue paracetamol over the 24 hours in the 7.5 group versus the 15 µg/kg group (P=0.013). Postoperative analgesic durations were long and did not differ between groups (1273±338, 1361±192 and 1426±48 minutes, respectively, P=0.08). In conclusion, because the incidence of vomiting is very low, the duration of postoperative analgesia is long and a dose of 7.5 µg/kg caudal morphine is much lower than doses previously reported to be associated with respiratory depression, this study supports the use of 7.5 µg/kg caudal morphine added to 0.125% levobupivacaine for circumcision surgery.

Prevalence of the association of subacromial impingement with subcoracoid impingement and their clinical effects.

OBJECTIVES: A prospective study to determine how commonly chronic subacromial impingement is associated with subcoracoid impingement and to evaluate clinical outcome after arthroscopic subacromial decompression (ASD). METHODS: Subacromial and coracohumeral distances were evaluated in patients with chronic shoulder pain before and after ASD, using magnetic resonance imaging and the University of California at Los Angeles (UCLA) shoulder scale and Constant-Murley shoulder assessment. RESULTS: A total of 40 patients were included in the study; patients were followed up for a mean of 27.3 months. Before ASD, 14 (35%) patients with chronic subacromial impingement also had subcoracoid impingement. In these patients, the mean coracohumeral distance was 7.18 mm (range 5.00 - 11.00 mm). After ASD, no patient had subcoracoid impingement, and the mean coracohumeral distance was significantly longer than pre-ASD, 12.85 mm (range 11.00 - 15.00 mm). The Constant-Murley shoulder assessment and UCLA shoulder scale both showed improvement after ASD. CONCLUSIONS: Chronic subacromial impingement occurred together with subcoracoid impingement in 35% of patients presenting with chronic shoulder pain. Following ASD, the coracohumeral distance increased with remission from pain.