The effect of pregabalin on tourniquet-induced ischemia-reperfusion injury: a prospective randomized study

Background/aim: The aim of this study was to investigate the efficacy of pregabalin on ischemia-reperfusion injuries. Materials and methods: Fifty-four patients were randomly assigned into 2 groups. A 150-mg tablet of pregabalin was given the night before and then 1 h before the operation for patients in Group P (pregabalin group, n = 27). A placebo was given to patients in Group C (control group, n = 27) at the same times. After combined spinal-epidural anesthesia was performed, venous blood samples were taken before tourniquet inflation (t1), just before tourniquet deflation (t2), and 20 min after tourniquet deflation (t3) for the analysis of total antioxidant status (TAS), total oxidant status (TOS), catalase (CAT), and ischemia-modified albumin (IMA). Results: There was no significant difference in TAS levels between the groups for the t3 period. However, the TAS in Group P was significantly higher in the t3 period than the t2 period (mean ± SD, 0.46 ± 0.1 vs. 0.38 ± 0.2 mmol of Trolox equivalent/L, respectively; P < 0.05). The CAT level in the t3 period was significantly higher in Group P than Group C (mean ± SD, 53.04 ± 32.1 vs. 35.46 ± 17.2 µmol/ formaldehyde, respectively; P < 0.05). In the t3 period, the TOS was significantly lower in Group P than Group C (mean ± SD, 11.97 ± 5 vs. 18.29 ± 9.9 pg/mL, respectively; P < 0.05). The TOS in Group P was significantly lower in the t3 period than the t2 period (mean ± SD, 11.97 ± 5 vs. 18.98 ± 10.7 pg/mL, respectively; P < 0.0001). Conclusion: Pregabalin has no marked antioxidant activity, but it contributes to the antioxidant defense system of an organism.

Post-traumatic stress disorder in mothers of children who have undergone cancer surgery.

BACKGROUND: The aim of this study was to investigate the rate of post-traumatic stress disorder (PTSD) and associated risk factors among mothers of children who underwent cancer surgery. METHOD: This cross-sectional, multi-center study included a total of 60 mothers whose children underwent major thoraco-abdominal surgery and were under follow up in the outpatient setting between February 2016 and May 2016. Clinical Data Form, Hospital Anxiety and Depression Scale (HADS), and Clinician-Administered PTSD scale were used. RESULTS: Of all participants, 13 (21.7%) were diagnosed with PTSD. These mothers had shorter duration of marriage, longer duration of hospital stay after surgery, and higher HADS scores, compared with the others without PTSD. Thoughts of guilt such as "I am being punished or tested" were more frequent in mothers with PTSD. Insomnia, irritability, concentration problems, and psychological reactivity were the most common symptoms. CONCLUSION: Post-traumatic stress disorder is a severe disorder that may worsen the daily functioning of mothers and may also have an unfavorable effect on child. It is therefore of utmost importance for clinicians to recognize PTSD and the associated risk factors in order to guide these parents.

Smartphone use habits of anesthesia providers during anesthetized patient care: a survey from Turkey.

BACKGROUND: Smartphones are used in many areas of anesthesia practice. However, recent editorial articles have expressed concerns about smartphone uses in the operating room for non-medical purposes. We performed a survey to learn about the smartphone use habits and views of Turkish anesthesia providers. METHODS: A questionnaire consisting of 14 questions about smartphone use habits during anesthesia care was sent anesthesia providers. RESULTS: In November-December 2015, a total of 955 participants answered our survey with 93.7 % of respondents responding that they used smartphones during the anesthetized patient care. Phone calls (65.4 %), messaging (46.4 %), social media (35.3 %), and surfing the internet (33.7 %) were the most common purposes. However, 96.7 % of respondents indicated that smartphones were either never or seldom used during critical stages of anesthesia. Most respondents (87.3 %) stated that they were never distracted because of smartphone use; however, 41 % had witnessed their collagues in such a situation at least once. CONCLUSIONS: According to the results of the survey, smartphones are used in the operating room often for non-medical purposes. Distraction remains a concern but evidence-based data on whether restrictions to smartphone use are required are not yet available.

The effect of pneumoperitoneum on the cross-sectional areas of internal jugular vein and subclavian vein in laparoscopic cholecystectomy operation.

BACKGROUND: Increased central venous pressure secondary to an increase in intraabdominal pressure has been reported during laparoscopic surgery. However, no study has yet determined the effect of pneumoperitoneum on cross-sectional area (CSA) of central veins by ultrasonography during laparoscopic cholecystectomy. Herein, we aimed to quantify changes in CSAs of internal jugular (IJV) and subclavian veins (SCV) by ultrasonography during this surgery. METHODS: This study included 60 ASA I-II patients scheduled for laparoscopic cholecystectomy surgery under general anesthesia. Pneumoperitoneum was performed with CO2 at 12 mmHg. The CSAs of right IJV and right SCV were measured using a 6 Mhz ultrasonography transducer in supine and neutral positions before anesthesia induction (T1), 5 min after connecting to mechanical ventilator (T2), 5 min after creation of pneumoperitoneum (T3), at the end of pneumoperitoneum (T4), and 5 min after desufflation and before extubation (T5) both at end-expiration and end-inspiration. RESULTS: The comparison of IJV CSA at inspiration showed significant increase in T3 value compared to T2 value (p < 0.001). Similarly the expiratory measurements of IJV CSA demonstrated significant increase in T3 value compared to T2 value (p < 0.001). The comparison of inspiratory CSA measurements of SCV showed significantly increased in T3 (p = 0.009) than T2 value. In expiratory measurements there was a significant increase in T3 (p = 0.032) value compared to T2. All measurements of IJV and SCV SCAs both end-inspiration and end-expiration T5 values significantly decreased compared to T4 values (p < 0.001). CONCLUSIONS: Pneumoperitoneum with an intraabdominal pressure of 12 mmHg produces significant increases in IJV and SCV CSAs during laparoscopic cholecystectomy procedure. We believe that this finding may enhance our understanding of pneumoperitoneum-induced hemodynamic changes and facilitate catheterization attempts. TRIAL REGISTRATION: Date of registration 21/07/2016, ISRCTN Registry ( No: ISRCTN15164056 , registered retrospectively).

Spinal anaesthesia at low and moderately high altitudes: a comparison of anaesthetic parameters and hemodynamic changes.

BACKGROUND: Hypoxemia caused high altitude leads to an increase and variability in CSF volume. The purpose of this prospective study was to detect the differences, if any, between moderately highlanders and lowlanders in terms of anaesthetic parameters under neuroaxial anaesthesia. METHODS: Consecutive patients living at moderately high altitude (Erzurum, 1890 m above the sea level) and sea level (Sakarya, 31 m above the sea level) scheduled for elective lower extremity surgery with spinal anaesthesia were enrolled in this study (n = 70, for each group). Same anaesthesia protocol was applied for all patients. Spinal anaesthesia was provided with hyperbaric bupivacaine 0.5 %, 9 mg (1.8 mL) in all patients. Anaesthetic characteristics and hemodynamic parameters of patients were recorded. The findings obtained in two different altitudes were compared using appropriate statistical tests. If data was not normally distributed, comparisons were determined using the Mann-Whitney U-test. Comparisons were determined using the Independent T test when data was normally distributed and Fisher's exact test was used to compare the percentage values. RESULTS: Duration of the block procedure (minutes) was significantly shorter at the sea level (14.34 ± 0.88) than at moderate altitude (20.38 ± 1.46) (P < 0.001). Motor block duration (minutes) was higher at the sea level compared to the moderate altitude (310.2 ± 104.2, 200.4 ± 103.2; respectively; P < 0.05). Also, the sensory block time (minutes) was higher at the sea level compared to moderate altitude (200.2 ± 50. minutes vs. 155.2 ± 60.7 min; respectively; P < 0.05). Moderate altitude group had significantly higher MABP values at baseline, during surgery and at postoperative 1(st) and 2nd hours than in the sea level group (P < 0.05, for all). Moderately high altitude group had lower heart rate values at baseline, during surgery and postoperative 1(st) and 2(nd) hours compared with the sea level group (P < 0.05). PDPH was seen more frequently (7.14 vs. 2.85 %; P < 0.05) at moderate altitude. CONCLUSIONS: Hemodynamic variations and more anaesthetic requirements following the spinal anaesthesia may be observed at moderately high altitudes compared to the sea level. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12614000749606 .

Optic neuritis in Turkish children and adolescents: A multicenter retrospective study.

BACKGROUND: Various etiologies may underlie optic neuritis, including autoantibody-mediated disorders described in the last decade. We re-examined demographic, clinical, laboratory features and prognostic factors in pediatric patients with autoimmune optic neuritis according to current knowledge. METHODS: Cases of pediatric ON from 27 centers in Türkiye diagnosed between 2009 and 2022 were included for retrospective evaluation. RESULTS: The study included 279 patients, 174 females and 105 males, with a female-to-male ratio of 1.65. The average age at onset was 12.8 ± 3.4 years, and mean follow-up, 2.1 years (range: 1-12.1 years). Patients <10 years old were grouped as "prepubertal" and those ≥10 years old as "others". The diagnoses made at the end of follow-up were multiple sclerosis associated optic neuritis (n = 90, 32.3 %), single isolated optic neuritis (n = 86, 31 %), clinically isolated syndrome (n = 41, 14.7 %), myelin oligodendrocyte glycoprotein antibody associated optic neuritis (n = 22, 7.9 %), and relapsing isolated optic neuritis (n = 18, 6.5 %). Predominant diagnoses were myelin oligodendrocyte glycoprotein antibody associated optic neuritis and acute disseminated encephalomyelitis associated optic neuritis in the prepubertal group and multiple sclerosis associated optic neuritis in the older group. Recurrences were observed in 67 (24 %) patients, including 28 with multiple sclerosis associated optic neuritis, 18 with relapsing isolated optic neuritis, 11 with myelin oligodendrocyte glycoprotein antibody associated optic neuritis, 8 with aquaporin-4 antibody related optic neuritis, and 2 with chronic relapsing inflammatory optic neuropathy. Recurrences were more common among female patients. Findings supporting the diagnosis of multiple sclerosis included age of onset ≥ 10 years (OR=1.24, p = 0.027), the presence of cranial MRI lesions (OR=26.92, p<0.001), and oligoclonal bands (OR=9.7, p = 0.001). Treatment in the acute phase consisted of intravenous pulse methylprednisolone (n = 46, 16.5 %), pulse methylprednisolone with an oral taper (n = 212, 76 %), and combinations of pulse methylprednisolone, plasmapheresis, or intravenous immunoglobulin (n = 21, 7.5 %). Outcome at 12 months was satisfactory, with 247 out of 279 patients (88.5 %) demonstrating complete recovery. Thirty-two patients exhibited incomplete recovery and further combination treatments were applied. Specifically, patients with relapsing isolated optic neuritis and aquaporin-4 antibody related optic neuritis displayed a less favorable prognosis. CONCLUSION: Our results suggest optic neuritis is frequently bilateral in prepubertal and unilateral in peri­ or postpubertal patients. Age of onset 10 or older, presence of oligoclonal bands, and brain MRI findings reliably predict the development of multiple sclerosis. The risk of developing multiple sclerosis increases mostly during the second and third years of follow-up. Relapsing isolated optic neuritis remains a separate group where the pathogenesis and outcome remain unclear. Investigation of predisposing and diagnostic biomarkers and long follow-up could help to define this group.

Unexpected motor block after ultrasound-guided lumbar erector Spinae plane block.

The successful use of the erector spinae plane block (ESPB) has been reported for post-operative analgesia in numerous operations due to the widespread use of local anesthetic (LA) and the blocking of the dorsal and ventral rami. ESPB has also been effective for easing lumbar back pain caused by lumbar disc herniation through a high-volume LA application to the lumbar area. While high-volume LA administration increases the effectiveness of the block, it can also cause unexpected side effects due to its coverage area. In the literature, only one study has reported on the development of motor weakness following ESPB application, in a case in which the block was performed at the thoracic level. In the present study, a 67-year-old female patient with lower back and leg pain resulting from lumbar disc herniation developed a bilateral motor block following lumbar ESPB. This is the second report of this type of case in the literature.

Probable association between mRNA COVID-19 vaccine and opsoclonus-myoclonus-ataxia syndrome.

Opsoclonus-myoclonus-ataxia syndrome (OMAS) in children is most often of paraneoplastic origin, but it can also result from infectious processes, toxic and metabolic disorders, and organic events that cause damage to the brainstem or cerebellum. Post-vaccination OMAS has also been reported. We report the case of a 15-year-old girl who developed OMAS 24 hours after her first dose of mRNA COVID-19 (BioNTech) vaccine.

Comparison of Ultrasound-Guided Erector Spinae Plane Block and Subcostal Transversus Abdominis Plane Block for Postoperative Analgesia after Laparoscopic Cholecystectomy: A Randomized, Controlled Trial.

PURPOSE: Laparoscopic cholecystectomy causes moderate to severe pain despite its minimally invasive nature. This study was performed to compare the efficacy of the bilateral erector spinae plane block (ESPB) and the subcostal transversus abdominis plane block (STAPB) under ultrasound guidance. METHODS: 64 patients were included in this prospective, randomized study. The patients were allocated into two groups as those receiving ESPB (n = 32) and those receiving STAPB (n = 32). Pain scores at rest and during movement, fentanyl requirement, postoperative walking time, and duration of hospital stay were compared. The complications which related to block were also recorded. RESULTS: In the ESPB group, the Numeric Rating Scale (NRS) scores at rest were lower at hour 0 [at the time of post-anesthetic care unit (PACU) admission] and postoperative hours 2, 4, 6, and 12 (p < 0.05). In the same group, the NRS scores at movement were lower at hours 0, 2, 4, 6, 12, and 24 (p < 0.05). In the ESPB group, the time to first analgesic need was longer (p < 0.05), intraoperative and postoperative Fentanyl requirement (p < 0.0001 for both) and PACU rescue analgesic requirement were lower (p < 0.05), the lengths of PACU and hospital stay were shorter (p < 0.0001), and unassisted walking time was shorter (p < 0.0001). There were no complications related to the block in either group. CONCLUSION: Bilateral ultrasound-guided ESPB provides superior analgesia after laparoscopic cholecystectomy surgery compared to STAPB and further reduces unaided walking time and hospital stay.

Angioedema-like presentation as the presenting finding of juvenile myositis and juvenile dermatomyositis in 2 patients.

BACKGROUND: Juvenile dermatomyositis (JDM) is the most common subtype of idiopathic inflammatory myopathies in childhood. Gottron's papules, shawl sign, periorbital heliotrope rash, and periungual telengiectasis are characteristic skin findings of the disease. Besides characteristic skin involvement, some other skin findings, such as angioedema, may be seen prior or in the course of the disease. The presence of angioedema in JDM is emphasized in this report. CASE PRESENTATIONS: We present 2 unrelated girls, aged 2 (case 1) and 12 years (case 2), who had developed symmetrical weakness in the proximal muscles, muscle pain, elevated muscle enzymes and angioedema. Both cases had abnormal muscle magnetic resonance imaging findings, suggestive of inflammatory myositis. Muscle biopsy was performed only in case 1, and major histocompatibility complex-1 expression on myofibers was shown consistent with JDM. Cases were diagnosed as probable and definite JDM, respectively. Angioedema was prominent, particularly in the lips and extremities of both cases, without laboratory evidence of C1 inhibitor deficiency or capillary leak syndrome, and absence of family history. Mast cell-mediated, acquired angioedema was the most likely diagnosis. In both cases, skin and muscle findings improved significantly with steroid treatment. CONCLUSION: We suggest that angioedema may be among the characteristic skin findings in JDM, and may be included in subsequent definitions.

The application of infraclavicular brachial plexus block with retroclavicular approach for arterio-venous fistula aneurysm.

Infraclavicular block provides adequate anesthesia to the arm, forearm, and antecubital region. There are many different approaches to infraclavicular brachial plexus block. Corocoid approach which is mostly preferred is not appropriate in some cases that needle orientation disappear. In this case report, we performed a newly defined retroclavicular approach to infraclavicular brachial plexus block and discussed in the light of information in literature. The patient who has 79 year old man, 29.36 body mass index, American Society of Anesthesiologists 3 with chronic renal failure was admitted to the operation room with complaint of aneurysmatic arteriovenous fistula in the left antecubital area. We planned the infraclavicular brachial plexus block with retroclavicular approach for better visibility of needle. The needle insertion point was posterior to the clavicle and the needle was advanced from cephalad to caudal. The block was effectuated after median nerve stimulation as the needle was advanced toward posterior of axillar artery. In our case with excess weight and life-threatening disease, it is highly reliable to perform infraclavicular block with retroclavicular approach indicated spread of local anesthetic, needle tip, and orientation without damage to nerve and vascular structures under ultrasound-guided.

Ultrasound-guided bilateral greater occipital nerve block on headache seen after endovascular treatment of ruptured or unruptured intracranial aneurysms: A case report.

Headache is a common symptom in subarachnoid hemorrhage (SAH). Often, pain control is difficult and opioid use can have a complicated effect on the patient's state of consciousness. In this study of 2 cases, opioid consumption was reduced while effective pain control of headache occurring after endovascular treatment of an intracranial aneurysm was achieved using an ultrasound-guided, bilateral greater occipital nerve (GON) block. Case 1 was a 59-year-old male patient with a Glasgow Coma Scale (GCS) of 13 who was diagnosed with Fisher scale grade 3 SAH. Coiling and stenting were performed for an anterior communicating artery aneurysm. Cerebrospinal fluid drainage was provided with a lumbar spinal catheter. Case 2 was a 55-yearold male patient with a GCS of 15 who underwent coiling of a fusiform aneurysm in the left basilar artery and stenting of the stenotic region due to a basilar artery aneurysm. After the procedure, the visual analog score (VAS) of the patients was 9 and 7, respectively, and a bilateral GON block was performed with ultrasound guidance. The VAS score of both patients decreased to 3 and did not exceed 3 during follow-up in the intensive care unit, eliminating the need for additional analgesics. A bilateral GON block provided effective analgesia and significantly reduced the need for other pain relief in both cases.

Efficacy of ultrasound-guided bilateral erector spinae plane block in pediatric laparoscopic cholecystectomy: Case series.

Postoperative opioid administration can cause various side effects, such as drowsiness, respiratory distress, postoperative nausea, and vomiting. The use of non-opioid medications as part of a multimodal analgesia method has been increasingly suggested in the management of acute postsurgical pain. Erector spinae plane block (ESPB), which is a regional anesthesia technique, blocks both visceral and somatic nerve fibers. Though it is infrequently used in young patients, presently described is a series of cases in which ESPB was successfully used in the performance of pediatric laparoscopic cholecystectomy. Ultrasound-guided bilateral ESPB was performed on 4 patients who underwent a laparoscopic cholecystectomy. An injection of 0.25% bupivacaine was administered into the interfascial area on each side in the pre-incisional period after the anesthesia induction (total anesthetic: 2.5 mg/kg). Postoperative pain control was planned at 10 mg/kg intravenous paracetamol every 8 hours. Numeric rating scale pain scores were less than 3 points in the post-anesthetic care unit, and at 1, 2, 4, 8, 12, and 24 hours. No rescue analgesic (1 mg/kg tramadol) was needed. None of the typical complications, such as drowsiness or nausea, were observed and no block-related complications were recorded. Bilateral ESPB that is a part of multimodal analgesia regimen can provide effective analgesia for pediatric laparoscopic cholecystectomy patients in the first 24 hours postoperatively.

Ultrasound-Guided versus Conventional Caudal Block in Children: A Prospective Randomized Study.

BACKGROUND: Injection to the accurate area without any complications is the main factor for the efficiencies of caudal block. The aim of this study was to compare success and the complications of conventional and ultrasound method for caudal block in children. MATERIALS AND METHODS: Two-hundred sixty-six American Society of Anesthesiologists (ASA) category 1 children aged between 6 months and 6 years undergoing hypospadias, circumcision, or both surgeries were randomly allocated two groups (Group C or Group H, n = 133). About 0.25% bupivacaine with 1/200000 adrenaline (total volume: 0.5 mL/kg) was injected after the needle was inserted into the sacral canal in Group C, or right after the needle pierced the sacrococcygeal ligament under longitudinal ultrasound view in Group H. Success rate of block, block performing time, number of needle puncture, success at first puncture, complication rate, age and weight of the patients encountering these complications were recorded. RESULTS: The success rate of block was similar between two groups (94.7% in Group C vs 96.2% in Group U, p > 0.05). Success at first puncture was higher in Group U than in Group C (90.2 vs 66.2%, respectively; p < 0.001). Number of needle puncture, blood aspiration, subcutaneous bulging, and bone contact was higher in Group C but none in Group U (p < 0.001) and these complications were occurred in children weighing < 16 kg and less younger than 6 years old. CONCLUSION: We observed that the complications were not encountered, number of needle puncture was lesser, and the success rate of first puncture was higher under ultrasound with longitudinal view.

Effects of Single-Dose Preemptive Pregabalin and Intravenous Ibuprofen on Postoperative Opioid Consumption and Acute Pain after Laparoscopic Cholecystectomy.

PURPOSE: Non-opioid medications as a part of multimodal analgesia has been increasingly suggested in the management of acute post-surgical pain. The present study was planned to compare the efficacy of the combination of pregabalin plus iv ibuprofen. METHODS: 58 patients were included in this prospective, randomized, double-blinded study. The pregabalin group (Group P, n = 29) received 150 mg pregabalin, the pregabalin plus ibuprofen group (Gropu PI, n = 29) received 150 mg pregabalin and 400mg iv ibuprofen before surgery. Postoperative fentanyl consumption, additional analgesia requirements and PACU stay were recorded. Postoperative analgesia was performed with patient-controlled IV fentanyl. RESULTS: VAS scores in the group PI were statistically lower at PACU, 1and 2 hours at rest, at PACU, 1, 2, 4, 12 and 24 hours on movement compared to the group P (P < 0.05). Opioid consumption was statistically significantly higher in the group P compared to the group PI (130.17 ± 60.27 vs 78.45 ± 60.40 µq, respectively, P < 0.001) and reduced in the 4th 24 hours by 55% in group PI. Rescue analgesia usage was statistically significantly higher in the group P than in the group PI (16/29 vs 7/29, respectively, P < 0.001). Four patient in the group PI did not need any opioid drug. Besides, PACU stay was shorter in the group PI than the group P (10.62 ± 2.38 vs 15.59 ± 2.11 min, respectively, P < 0.001). CONCLUSION: Preemptive pregabalin plus iv ibuprofen in laparoscopic cholecystectomy reduced postoperative opioid consumption. This multimodal analgesic aproach generated lower pain scores in the postoperative period.

The efficacy of ultrasound-guided type-I and type-II pectoral nerve blocks for postoperative analgesia after breast augmentation: A prospective, randomised study.

PURPOSE: The present study was planned to evaluate the efficacy and safety of ultrasound-guided Pecs I and II blocks for postoperative analgesia after sub-pectoral breast augmentation. METHODS: Fifty-four adult female patients undergoing breast augmentation were randomly divided into two groups: the control group (Group C, n=27) who were not subjected to block treatment and Pecs group (Group P, n=27) who received Pecs I (bupivacain 0.25%, 10mL) and Pecs II (bupivacain 0.25%, 20mL) block. Patient-controlled fentanyl analgesia was used for postoperative pain relief in both groups, and the patients were observed for the presence of any block-related complications. RESULTS: The 24-h fentanyl consumption was smaller in Group P [mean±SD, 378.7±54.0µg and 115.7±98.1µg, respectively; P<0.001]. VAS scores in Group P were significantly lower at the time of admission to the post-anaesthetic care unit and at 1, 2, 4, 8, 12, and 24h (P<0.001). The rates of nausea and vomiting were higher in Group C than in Group P (9 vs 2, P=0.018). Hospital stay duration was shorter in Group P than in Group C (24.4±1.2h vs 27.0±3.1h, P<0.001). No block-related complications were recorded. CONCLUSIONS: Combine used of Pecs I and II blocks provide superior postoperative analgesia in patients undergoing breast augmentation and shortens hospital stay.

Less painful ESWL with ultrasound-guided quadratus lumborum block: a prospective randomized controlled study.

Objectives: Extracorporeal shock wave lithotripsy (ESWL) has been widely used for the treatment of urinary tract stones and is usually administered as an outpatient procedure, although the vast majority of patients do not tolerate it without sedoanalgesia. The quadratus lumborum block (QLB) is a newly-defined technique for abdominal surgery. The aim of this study was to evaluate the analgesic efficacy of ultrasound-guided QLB in ESWL.Materials and methods: Forty patients, aged 18-65, with ASA physical status I-II and scheduled for ESWL were randomly assigned to Group C (control group) and Group QLB (treatment group). Group QLB received single-shot USG-guided transmuscular QLB with 10 ml of 0.5% bupivacaine and 10 ml of 2% lidocaine before a 20-min ESWL procedure. No intervention was performed on Group C. Visual analogue scale (VAS) scores, opioid consumption, patient satisfaction, ESWL and stone details were recorded.Results: VAS scores were significantly lower in Group QLB at all time intervals (p < 0.05). Fentanyl consumption during ESWL was significantly lower in Group QLB than in Group C (p < 0.001). The fragmentation success rate was significantly higher in Group QLB than in Group C (19/20 vs 14/20, respectively, p = 0.046). Patient satisfaction was also higher in Group QLB (p = 0.011).Conclusions: This study shows that QLB provided adequate analgesia for ESWL and that it reduced extra opioid consumption significantly compared to the control group.

Laparoscopic gastrostomy under awake thoracic epidural anesthesia: A successful experience.

General anesthesia is the first choice as an anesthesia method particularly for abdominal operations. However, because neuromuscular blockade induced during general anesthesia will increase atelectasis in a patient with pulmonary disease, it will also increase postoperative ventilator dependence, which will be even more apparent in cases of chronic obstructive pulmonary disease (COPD) that pose a risk, particularly for postoperative complications. Herein, thoracic epidural anesthesia (TEA) was found to be a better option for our patient with severe COPD and stage IV lung cancer, as it provided sufficient anesthesia and better postoperative care for laparoscopic gastrostomy.