Bilge Karslı

Comparison of Transcutaneous Electrical Nerve Stimulation and Parasternal Block for Postoperative Pain Management after Cardiac Surgery

Background. Parasternal block and transcutaneous electrical nerve stimulation (TENS) have been demonstrated to produce effective analgesia and reduce postoperative opioid requirements in patients undergoing cardiac surgery. Objectives. To compare the effectiveness of TENS and parasternal block on early postoperative pain after cardiac surgery. Methods. One hundred twenty patients undergoing cardiac surgery were enrolled in the present randomized, controlled prospective study. Patients were assigned to three treatment groups: parasternal block, intermittent TENS application, or a control group. Results. Pain scores recorded 4 h, 5 h, 6 h, 7 h, and 8 h postoperatively were lower in the parasternal block group than in the TENS and control groups. Total morphine consumption was also lower in the parasternal block group than in the TENS and control groups. It was also significantly lower in the TENS group than in the control group. There were no statistical differences among the groups regarding the extubation time, rescue analgesic medication, length of intensive care unit stay, or length of hospital stay. Conclusions. Parasternal block was more effective than TENS in the management of early postoperative pain and the reduction of opioid requirements in patients who underwent cardiac surgery through median sternotomy. This trial is registered with Clinicaltrials.gov number NCT02725229.

Effects of Parasternal Block on Acute and Chronic Pain in Patients Undergoing Coronary Artery Surgery

Background. Sternotomy causes considerable postoperative pain and postoperative pain management encompasses different analgesic regimens. In this study, we aimed to investigate the effect of peroperative parasternal block with levobupivacaine on acute and chronic pain after coronary artery bypass graft surgery. Materials and Methods. A total of 81 patients undergoing coronary artery bypass graft surgery were included in this study. Patients were randomly allocated by opening an envelope to receive either parasternal block with pharmacologic analgesia (group P; before sternal wire placement: sternotomy and mediastinal tube sites were infiltrated with local anesthetics) or pharmacologic analgesia alone (group C) for postoperative pain relief. All patients received intravenous tramadol with patient-controlled analgesia at the end of the surgery. Demographic characteristics, vital signs, tramadol consumption, analgesic intake, and intensity of pain with a visual analogue scale were recorded for each patient. Six months after surgery, the patients’ type of chronic pain was evaluated using the Leeds Assessment Neuropathic Symptoms and Signs pain scale questionnaire. Results. Patients who received parasternal block experienced less pain and needed less opioid analgesic (125.75 ± 28.9 mg in group P vs 213.17 ± 61.25 mg in group C) for 24 hours postoperatively (P < .001). There was no significant difference in nociceptive and neuropathic pain between the groups. Conclusion. Parasternal block had a benefical effect on the management of postoperative acute pain and decreased opioid consumption after surgery but had no significant effect in chronic post surgical pain.

Beckwith-Wiedemann Sendromlu Hastada Anestezi Yönetimi

Beckwith-Widemann sendromu (BWS) neonatal periyotta yaklasik 13700 canli dogumda 1 gorulur. Bu sendrom makroglossi, omfalosel, viseromegali, gigantism, neonatal hipoglisemi gibi bircok anomaliler icerir. Havayolu yonetimini makroglossinin sebep olabilecegi zor ventilasyon ve endotrakeal entubasyonun komplike hale getirmesi beklenir. Bu yuzden anestezi induksiyonu oncesi zor havayolu hazirligi dusunulmelidir. BWS’da diger bir problemde postoperatif analjezidir. Cunku opioid kullanimi solunumu deprese edebilkirken, nonsteroid antiinflamatuar ilaclarda kanamaya yol acabileceginden postoperatif analjezi yonetimi dikkatlice planlanmalidir. Biz buyuk bir dile sahip, adenotonsillektomi ameliyati yapilacak 8 yasinda Beckwith-Widemann sendromlu hastada anestezi yonetimini sunduk