Bora Bilal

Quadratus Lumborum Block Versus Transversus Abdominis Plane Block in Children Undergoing Low Abdominal Surgery: A Randomized Controlled Trial

Background and Objectives Truncal blocks have a place within multimodal analgesia techniques in abdominal surgery. The quadratus lumborum block is a new abdominal truncal block used for somatic analgesia of both the upper and lower abdomen. In this prospective, double-blind, randomized study, we aimed to compare quadratus lumborum block and transversus abdominis plane block in pediatric patients undergoing lower abdominal surgery. Methods Fifty-three children undergoing unilateral inguinal hernia repair or orchiopexy surgery were randomized into 2 groups: transversus abdominis plane block and quadratus lumborum block. All blocks were performed under general anesthesia before surgery. Pain levels were assessed using an FLACC (Face, Legs, Activity, Cry, Consolability) scale. Results The study included 50 patients, after excluding 3 patients who were not eligible. The number of patients who required analgesia in the first 24 hours postoperatively was significantly lower in the quadratus lumborum block group (P < 0.05). In the quadratus lumborum block group, the postoperative 30-minute and 1-, 2-, 4-, 6-, 12-, and 24-hour FLACC scores were lower compared with those of the transversus abdominis plane block group (P < 0.05). Parent satisfaction scores were higher in the quadratus lumborum block group (P < 0.05). Conclusions The results of this study showed that in pediatric patients undergoing unilateral inguinal hernia repair or orchiopexy the quadratus lumborum block provided longer and more effective postoperative analgesia compared with the transversus abdominis plane block. Clinical Trials Registration: The trial was registered prospectively at clinicaltrials.gov (NCT02715999).

Comparison of the landmark and ultrasound methods in cesarean sections performed under spinal anesthesia on obese pregnants

Abstract Difficulties in the palpation of anatomical landmarks in pregnancy due to obesity may create problems in the regional anaesthesia. Objective of this study was to compare ultrasound examination carried out before the procedure with conventional spinal anaesthesia method with papation of bony landmarks in caesarean sections performed under spinal anaesthesia in obese pregnants. Ninety-seven obese pregnants having pre- and post-pregnancy body mass index > 30 kg/m2 were prospectively examined. Patients were randomised to two groups as landmark group (n = 49) and ultrasound group (n = 48). The needle insertion point was determined at L4–L5 level before the procedure through palpation in the landmark group and with the examination in the ultrasound. The numbers of skin punctures and needle passes, total procedure time (TPT) and spinal block occurrence time (SBOT) were recorded. TPT was significantly longer in the ultrasound than in the landmark group (p < 0.001) (8 ± 2 and 5 ± 1; respectively). Whereas SBOT values were similar (p = 0.063). The numbers of skin punctures and needle passes were significantly fewer in the ultrasound than in the landmark group (p < 0.001). We believe that, accurate determination of the needle introducing site before the procedure by viewing the vertebral structures through ultrasound examination in obese pregnants could increase the success rate.

Anaesthetic management of a patient with Michels syndrome

Michels Syndrome,whichwasfirst defined in 1978, is anuncommon syndrome seen with craniosynostosis, blepharophimosis, ptosis, epicanthus inversus, cleft lip/palate, abnormal supra umbilical abdominal wall defect and mental deficit, hearing loss, spina bifida occulta, abnormalities in the kidneys, bladder and genital system [1]. To the best of our knowledge, this is the first report in literature of the anaesthesia method used in Michels syndrome. A 4-year old boy, weighing 11 k was admitted to our clinic for surgery for bilateral undescended testes. In the physical examination on presentation, the patient with the diagnosis of Michels syndrome was determined with mental retardation, hypertelorism, previously operated cleft lip/palate, unilateral cochlear implant (Fig. 1). After obtaining written, informed consent from the parents, the patient was admitted to the operating room and a vascular route was opened in the left hand with a 22-gauge needle while sevoflurane (sevorane) was administered with inhalation. After administration of 2 mg/kg propofol and 0.1 mcg fentanyl and the disappearance of the eyelash reflex, mask ventilation was provided. A no. 2 Proseal Laryngeal Mask Airway (PLMA; Intravent Orthofix, Maidenhead, UK) was applied to the patient. By positioning the patient laterally, the coccyxwas examined. A sacral dimple was observed and as it was considered that there could be occult spina bifida, caudal block that is used as routine postoperative analgesia in our clinic, was not applied. As it was considered that there could be umbilical, abdominal wall deficit, transversus abdominis plane and quadratus lumborumblocks that are applied in lower abdominal surgery for postoperative analgesia, were not applied. Postoperative analgesia for the patient was provided with 15 mg/kg paracetamol. After the 80-min operation, the patient was woken with no problems. As Michels Syndrome is characterised by many deficits such as craniosynostosis, blepharophimosis, cleft lip/palate, hearing loss, there is a high possibility that these caseswill require surgery because of thesedeficits [1]. In operations requiring general anaesthesia, preparations must be made for difficult intubation because of facial deformities and there is insufficient information on this in literature. No reports of the anaesthesia method used in cases of Michels syndrome could be found in literature. The only casewith a similar genemutationwas a report by Fiona et al. of the anaesthesia method used with Malpeuch syndrome. Adenectomy and tonsilectomy were applied to a 4-year old patient with Malpeuch syndrome and it was reported that general anaesthesia was applied successfully and intubation was difficult [2]. The case presented here had previously undergone surgery twice, for cleft lip/palate and for a cochlear implant. There were no anaesthesia difficulties written in the patient records, and the family did not give any such information. Nonetheless, preparations were made for difficult airway.

An Assessment of the Levels of Anxiety and Depression in Patients with Recurrent Aphthous Stomatitis

Backgrounds: There is a lack of valid and reliable studies in literature on both the distinctive and ambiguous relationship between the psychological profile and the occurrence of recurrent aphthous ulcers in the individual.