Ahmet Murat Yayik

Effects of single-dose preemptive intravenous ibuprofen on postoperative opioid consumption and acute pain after laparoscopic cholecystectomy.

Background: Although studies involving intravenous (IV) ibuprofen are still limited, it has been shown to have a potential role in the treatment of postoperative pain. The primary objective of this study was to investigate the effects of preemptive IV ibuprofen on postoperative 24 hour opioid consumption and postoperative pain in patients undergoing laparoscopic cholecystectomy. Methods: Following ethical committee approval, 60 patients aged 18 to 65, American Society of Anesthesiology (ASA) I–II, and scheduled for laparoscopic cholecystectomy were included in this prospective, randomized, double-blinded study. Patients were randomly divided into 1 of 2 groups. The control group (n = 30) received 100 mL saline solution 30 minutes before surgery, while the ibuprofen group (n = 30) received 400 mg IV ibuprofen in 100 mL saline. The same general anesthesia protocol was applied in both groups, and all operations were performed by the same surgeon using the same technique. Postoperative analgesia was assessed using a visual analogue pain scale (VAS) with active and passive movements. Twenty-four hour postoperative fentanyl consumption with patient-controlled analgesia and additional analgesia requirements were recorded. Postoperative analgesia was established with 1000 mg paracetamol once every 6 hours and patient-controlled IV fentanyl. Results: Compared with the control group, VAS scores in the IV ibuprofen group were statistically lower at postoperative 30 minutes and 1, 2, 4, 8, 12, and 24 hours (P < 0.001). Twenty-four hour opioid consumption was statistically significantly higher in the control group compared to the ibuprofen group (553.00 ± 257.04 and 303.33 ± 132.08 &mgr;cq, respectively, P < 0.001). Additional analgesia use was statistically significantly higher in the control group than in the ibuprofen group (14/30 vs 5/30, respectively, P < 0.001). The rates of nausea and vomiting were higher in group control than in group ibuprofen (13/30 vs 5/30, respectively, P = 0.024). Other side-effects were similar between the groups. Conclusion: A preemptive single dose of IV ibuprofen in laparoscopic cholecystectomy reduced postoperative opioid consumption in the 1st 24 hours by 45%. It generated lower pain scores in the postoperative period compared with placebo.

Ultrasonography-guided modified thoracolumbar interfascial plane block: a new approach

To the Editor, A recent study published by Hand et al. described an ultrasonography-guided thoracolumbar interfascial plane (TLIP) block. This block involves injecting local anesthetics between the multifidus and longissimus muscles at the third lumbar vertebral level to block the dorsal rami of thoracolumbar nerves. Hand et al. made the injection between the multifidus and longissimus muscles by positioning the block needle at a 30 angle from the skin and advanced it from a lateral to medial direction (Figure). Herein, we describe our TLIP modification where we inject the anesthetics between the longissimus and iliocostalis muscles after having advanced the needles at a 15 angle in a medial to lateral direction. Our modified method has several advantages.

Efficacy of ultrasound-guided modified thoracolumbar interfascial plane block for postoperative analgesia after spinal surgery: a randomized-controlled trial

To the Editor, Surgery of the lumbar spine is characterized by diffuse and severe postoperative pain. Pre/postoperative oral opioids, gabapentinoids, nonsteroidal antiinflammatory drugs, and intraoperative ketamine are frequently included in multimodal analgesia for spinal surgery, while regional anesthetic techniques such as neuraxial anesthesia, paravertebral blocks, and local anesthetic infiltration of the wound are less frequently used. Interfascial plane blocks have the potential to provide long-lasting postoperative analgesia and reduce opioid consumption while minimizing the motor block associated with neuraxial and plexus blocks. The thoracolumbar interfascial plane (TLIP) block, first described by Hand et al., targets the dorsal roots of the thoracolumbar nerves by depositing local anesthetic at the level of third lumbar vertebra between the multifidus and longissimus muscles. We modified Hand’s TLIP technique by injecting between the longissimus and iliocostalis muscles. We believe this is simpler to perform and reduces the risk of neuraxial puncture. The aim of this study was to investigate the effect of the modified TLIP block on postoperative opioid consumption and pain scores in patients undergoing spinal surgery. The study was registered with ClinicalTrials.gov (NCT03079076). Following approval by the Ataturk University Medical Ethics Board (Erzurum, Turkey, 24.10.2016/7) written, informed consent was obtained from 40 patients, aged 1865 yrs, American Society of Anesthesiologists physical status I-III, scheduled for twoor three-level posterior lumbar instrumentation surgery. Patients were randomly assigned to control or TLIP groups using a computer software program. Those in the control group (n = 20) received bilateral ultrasound-guided injections of 2 mL 0.9% saline subcutaneously; those in the TLIP group (n = 20) received ultrasound-guided bilateral modified TLIP block with 20 mL 0.25% bupivacaine as described here. A successful block was defined as loss of cold sensation in the T7-L1 dermatomes 20 min after block application. All patients received a standardized anesthetic and following surgery were offered patient-controlled analgesia (PCA) using fentanyl. The PCA was programmed with a 25-lg bolus and ten-minute locked time, without basal infusion, and continued for 24 hr. The primary outcome was fentanyl consumption at 24 hr. Secondary outcomes included visual analogue pain scores on arrival to the postanesthesia care unit, then at one, two, four, eight, 12, and 24 hr after surgery. Requests for supplementary analgesia and the occurrence of nausea and vomiting were also recorded. The primary outcome was compared using an unpaired Student’s t test. Visual analogue scale scores over time were compared with repeated measurements analysis of A. Ahiskalioglu, MD (&) O. Doymus, MD K. Selvitopi, MD H. A. Alici, MD Department of Anaesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey e-mail: aliahiskalioglu@hotmail.com

Excisão de lipoma axilar gigante em paciente acordado sob bloqueio do plano serrátil

the American Society of Echocardiography. J Am Soc Echocardiogr. 2013;26:567--81. 6. Holm JH, Frederiksen CA, Juhl-Olsen P, Sloth E. Perioperative use of focus assessed transthoracic echocardiography (FATE). Anesth Analg. 2012;115:1029--32. 7. Schnobrich DJ, Olson AP, Broccard A, Duran-Nelson A. Feasibility and acceptability of a structured curriculum in teaching procedural and basic diagnostic ultrasound skills to internal medicine residents. J Grad Med Educ. 2013;5:493--7. 8. Ramsingh D, Rinehart J, Kain Z, et al. Impact assessment of perioperative point-of-care ultrasound training on anesthesiology residents. Anesthesiology. 2015;123:670--82. 9. Hahn RT, Abraham T, Adams MS, et al. Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr. 2013;26:921--64. Fábio de Vasconcelos Papa a,b,c

O bloqueio contínuo do quadrado lombar tipo 3 fornece analgesia pós‐operatória efetiva para cirurgia do quadril

INTRODUCTION Hip surgery is a major surgery that causes severe postoperative pain. Although pain during rest is usually considerably reduced mobilization is important in terms of thromboembolic complications. The quadratus lumborum block is a regional analgesic technique that blocks T6-L3 nerve branches. This block may provide adequate analgesia and reduce opioid consumption after hip surgery. CASE REPORT We performed continuous quadratus lumborum type 3 block in two patients who underwent hip arthroplasty. Postoperative 24-h pain scores, local anesthetic consumptions on patient-controlled analgesia and additional analgesic requirement were recorded. In two patients, postoperative pain scores were less than 6 during rest and physiotherapy. Patient was mobilized in the early postoperative period without additional opioid analgesic requirement and without muscle weakness. DISCUSSION Continuous quadratus lumborum block may be used to relieve postoperative acute pain in hip surgery because it provides one-sided anesthesia without muscle weakness.

Comparison of Lidocaine and Atropine on Fentanyl-Induced Cough: A Randomized Controlled Study

ABSTRACT Objective of the Study: Fentanyl and atropine are drugs used for analgesia during induction and for premedication, respectively. The aim of this study was to observe the effect of atropine used for premedication on cough developing in association with fentanyl use during anesthesia induction. Methods: This was a single-blind, prospective, multi-arm, parallel, randomized clinical trial involving 120 patients between ages 3 and 15 years undergoing general anesthesia. Patients were randomized into three groups: a control group (Group C), an atropine group (Group A), and a lidocaine group (Group L). Results: Incidence of cough was 45% (n = 16) in Group C, 16% (n = 6) in Group A, and 16% in Group L (n = 6) (p = 0.009). Cough was moderate in two cases in Group A and in two in Group L, and mild in all others in these groups. In Group C, cough was mild in seven cases, moderate in six, and severe in two. Conclusion: We determined that premedication with atropine suppressed the incidence and severity of fentanyl-induced cough during induction of general anesthesia. We think that, due to its antimuscarinic effect, atropine is as effective as lidocaine as a premedication.

A new described mechanisms of intestinal glandular atrophy induced by vagal nerve/Auerbach network degeneration following subarachnoid hemorrhage: The first experimental study

Stress ulcers is a trouble complication of subarachnoid hemorrhage (SAH). Although gastrointestinal ulcerations may be attributed to increased HCL secretion in SAH; the exact mechanism of that complication has not been investigated definitively. We studied if vagal network degeneration may cause intestinal atrophy following SAH. Study was conducted on 25 rabbits, with 5 control group (Group-A), 5 SHAM group (Group-B), and 15 SAH group via injection of autologue blood to cisterna magna. Seven animals followed for seven days (Early Decapitated-Group-C) and eight animals followed 21 days (Late Decapitated-Group-D). The vagal nodosal ganglia (NGs), Auerbach plexuses and goblet cells of duodenums were examined by current stereological methods and compared statistically. The mean numbers of degenerated axon density/mm2 of gastric branches of vagal nerves was 8 ± 2, 34 ± 11, 189 ± 49 and 322 ± 81 in the Group A, B, C, and D respectively. The mean numbers of degenerated neuron density/mm3 of NGs was 5 ± 2, 54 ± 7, 691 ± 87 and 2930 ± 410 in the Group A, B, C, and D respectively. The mean numbers of degenerated Auerbach neurons 2 ± 1, 4 ± 1, 12 ± 3 and 27 ± 5/mm3 in the Group A, B, C, and D respectively. The mean numbers of degenerated goblet cells/mm3 were 4.3 ± 1.02, 11.5 ± 0.26, 143 ± 26 and 937 ± 65 Group A, B, C, and D respectively. Statistical analysis showed that vagal network ischemia could cause intestinal bleeding and so atrophy in SAH progression. Statistical analyses of groups were; Group-D/Group-A < 0.001, Group-D/Group-B < 0.005, Group-C/Group-A < 0.005. Undiscovered effect of ischemic vagal network injuries should be regarded as a major cause of stress ulcerations following SAH which has not been mentioned in the literature.

Ultrasound-guided versus conventional injection for caudal block in children: A prospective randomized clinical study

STUDY OBJECTIVE The aim of this study was to compare the efficacies of ultrasound guided sacral hiatus injection and conventional sacral canal injection performed for caudal block in children. DESIGN Randomized controlled clinical trial. SETTING Operating rooms of university hospital of Erzurum, Turkey. PATIENTS One hundred-thirty four children, American Society of Anesthesiologists I-II, between the ages of 5 and 12, scheduled for elective phimosis and circumcision surgery. INTERVENTIONS Patients assigned to two groups for ultrasound guided caudal block (Group U, n=68) or conventional caudal block (Group C, n=66). Caudal solution was prepared as 0.125% levobupivacaine plus 10mcg/kg morphine (total volume: 0.5ml/kg), and was administered to both groups. MEASUREMENTS The block performing time, the block success rate, the number of needle puncture, the success at first puncture and the complications were recorded. MAIN RESULTS The block performing time and the success rate of block were similar between Group U and Group C (109.96±49.73s vs 103.17±45.12s, and 97% vs 93%, respectively p>0.05). The first puncture success rate was higher in Group U than in Group C (80% vs 63%, respectively p=0.026). No significant difference was observed between the groups with regard to the number of needle punctures (p=0.060). The rates of vascular puncture and subcutaneus bulging were higher in Group C than in Group U (8/66 vs 1/68, and 8/66 vs 0/68, respectively p<0.05). CONCLUSIONS Despite the limitations in central neuroaxial anesthesia we recommend the use of ultrasound since it reduces the complications and increases the success rate of first puncture in pediatric caudal injection.

The comparison of ultrasonography guided transversus abdominis plane block and wound infiltration for pediatric inguinal hernia repair: Randomised clinical study

Objective: Postoperative analgesic effect of transversus abdominis plane (TAP) block in patients undergoing abdominal surgery has been debatable. The aim of this study was to compare the analgesic effect of ultrasound guided TAP block and wound infiltration in pediatric patients undergoing inguinal herniorrhaphy. Methods: After ethical board approval, 60 children between 3 and 8 years of age undergoing unilateral inguinal hernia repair were randomized to TAP block (Group TAP, n=30) or to wound infiltration (Group infiltration, n=30). Group TAPB received ultrasoundguided TAP block with 0.25% bupivacaine 0.5 ml/kg and Group C received wound infiltration with 0.25% bupivacaine 0.5 ml/kg before surgery. Pain scores (Wong-Baker Faces), parental satisfication, block complications and additional analgesia requirements were recorded. Results: Compared with the infiltration group, the pain scores were statistically lower in the TAPB group during the first 12 hours (p<0.05). The additional analgesia requirement was statistically lower in the TAPB group than Group infiltration group (10/30 vs 18/30 respectively, p=0.038). Parental satisfaction was statistically higher in the Group TAPB than Group infiltration (p<0.001). Conclusion: Despite the postoperative effect of TAP block is debatable; ultrasoundguided TAP block reduces postoperative pain after pediatric inguinal hernia repair compared to wound infiltration.

Clinical Outcomes and Mortality Analysis of Patients with COPD Admitted to an Intensive Care Unit: Retrospective Analyses of Five-Year Data

Received: 16.06.2016 Accepted: 26.07.2016 1Sabuncuoğlu Şerafeddin Training Hospital, Department of Anesthesia 2Ataturk University, School of Medicine, Department of Anesthesiology and Reanimation 3Palandöken State Hospital, Department of Anesthesia 4Harakani State Hospital, Department of Anesthesia Yazışma adresi: Ali Ahıskalıoğlu, Ataturk University, School of Medicine, Department of Anesthesiology and Reanimation, Erzurum e-mail: aliahiskalioglu@hotmail.com GİRİŞ