Can Aksu

Comparison of ProSeal LMA with Supreme LMA in paediatric patients.

Supreme laryngeal mask airway (S‐LMA) has been improved in recent years, but comparative studies with a sizeable number of paediatric patients are limited in number. In this study, oropharyngeal leak pressures (OLPs) were compared between S‐LMA and ProSeal laryngeal mask airway (P‐LMA) in paediatric patients.

Survey on Postoperative Hypothermia Incidence In Operating Theatres of Kocaeli University

OBJECTIVE Hypothermia is a common problem in anaesthetized patients and an important risk factor for mortality and morbidity. Our aim was to identify the incidence of hypothermia in our operating theatres. We also aimed to find the circumstances to which hypothermia could be related. METHODS After obtaining the ethics committee approval and informed patient consent, patients with operation times longer than 30 minutes were included into the study for a one month period. Demographical data of the patients, type and duration of surgeries, temperatures measured pre and postoperatively from the tympanic membrane with an infrared thermometer were recorded. Temperatures below 35°C were accepted as hypothermia. RESULTS A total number of 564 patients were enrolled to the study (305 women and 259 men). The ages of patients varied from 1 month to 84 years (mean 38.5±20.7). Hypothermia incidence was calculated as 45.7%. When the factors related to hypothermia were considered, age, type and duration of surgery and amount of fluids administered were found to be significant contributors to the development of hypothermia (p<0.05). CONCLUSION Postoperative hypothermia is a common problem in our clinic. Therefore, we suggest that temperature monitoring and patient warming should be a routine procedure during anaesthesia management.

Ultrasound guided erector spinae plane block reduces postoperative opioid consumption following breast surgery: A randomized controlled study

STUDY OBJECTIVE To evaluate the analgesic effect of ultrasound-guided erector spinae plane (ESP) block in breast cancer surgery. DESIGN Randomized controlled, single-blinded trial. SETTING Operating room. PATIENTS Fifty ASA I-II patients aged 25-65 and scheduled for elective breast cancer surgery were included in the study. INTERVENTIONS Patients were randomized into two groups, ESP and control. Single-shot ultrasound (US)-guided ESP block with 20 ml 0.25% bupivacaine at the T4 vertebral level was performed preoperatively to all patients in the ESP group. The control group received no intervention. Patients in both groups were provided with intravenous patient-controlled analgesia device containing morphine for postoperative analgesia. MEASUREMENTS Morphine consumption and numeric rating scale (NRS) pain scores were recorded at 1, 6, 12 and 24 h postoperatively. MAIN RESULTS Morphine consumption at postoperative hours 1, 6, 12 and 24 decreased significantly in the ESP group (p < 0.05 for each time interval). Total morphine consumption decreased by 65% at 24 h compared to the control group (5.76 ± 3.8 mg vs 16.6 ± 6.92 mg). There was no statistically significant difference between the groups in terms of NRS scores. CONCLUSIONS Our study findings show that US-guided ESP block exhibits a significant analgesic effect in patients undergoing breast cancer surgery. Further studies comparing different regional anesthesia techniques are needed to identify the optimal analgesia technique for this group of patients.

Ultrasonography-guided penile block for adult penile surgery

To the Editor, Although penile nerve block (PNB) both blind and ultrasound (US)-guided has been established for clinical use, studies have focused more on children than adults. The analgesic effect of US-guided PNB in adult patients undergoing penile surgery has yet to be demonstrated. We report here its advantages in a randomized, blinded, clinical study. After ethics committee permission (KOU KAEK 2013/ 117) and informed written consent, we enrolled 40 adult patients (20-60 yr, American Society of Anesthesiologists physical status I-II) scheduled for elective penile surgery (malleable prosthesis implant). Patients were randomized (sequentially numbered, opaque, sealed envelopes) to either spinal anesthesia ? PNB (PNB) or spinal anesthesia alone (control) groups (20 patients per group). In a pilot study on ‘‘spinal only’’ patients, the mean (SD) 24 hr postoperative morphine consumption was 28 (8) mg. For 90% power and an alpha error of 0.05, the sample size needed to detect a 30% difference was 18 subjects per group. With the patient in the lateral decubitus position, spinal anesthesia (25 G Quincke; B. Braun, Melsungen Germany) consisting of hyperbaric bupivacaine 10 mg with fentanyl 25 lg was used. Penile nerve block was subsequently performed using a high-frequency linear probe placed vertically over the pubic symphysis at the base of the penile shaft. Sagittal views identified the penile shaft, corpus cavernosum, inferior ramus of the pubic bone, and Scarpa’s fascia. Using an out-of-plane approach under real-time US guidance, the block needle (Ultraplex, 22G; B. Braun, Melsungen, Germany) was advanced until it perforated Scarpa’s fascia with a ‘‘pop.’’ Then, 20 mL of 0.25% bupivacaine was injected in fractionated doses, with intermittent aspiration. For all patients, postoperative analgesia was provided with patient-controlled analgesia (morphine 1 mg bolus, eight-minute lockout, maximum 6 mg hr). A pain nurse blinded to the anesthesia care performed postoperative follow-up. Pain (dynamic) was assessed at one, six, 12, and 24 hr postoperatively using a visual analogue scale (VAS), where 0 = no pain and 10 = worst imaginable pain. The presence of nausea and vomiting were recorded at the same time intervals. Patient-controlled analgesia morphine consumption and the incidence of nausea and vomiting during the first 24-hr postoperative period were also recorded. The Mann-Whitney U-test was used for comparison of VAS scores and morphine consumption between the two groups. The incidence of nausea and vomiting was compared using Fisher’s exact test. Anesthesia for both groups provided sufficient analgesia for the mean (SD) duration of surgery [PNB, 114 (45) min; control, 108 (38) min). The VAS scores and postoperative morphine consumption, however, were lower in the PNB group than in the control group at every time interval Y. Gürkan, MD A. Kuş, MD Department of Anesthesia, Kocaeli University Hospital, Kocaeli, Turkey

[Our ultrasound-guided paravertebral block experiences in thoracic surgery].

OBJECTIVES Ultrasound-guided thoracic paravertebral block (TPVB) may be employed for postoperative analgesia in thoracic surgery. In application of TPVB, single injections, multiple injections or catheter techniques may be used. In this paper we present our experiences with ultrasound-guided TPVB in thoracic surgery patients for postoperative analgesia. METHODS Patients undergoing thoracic surgery and on whom ultrasound-guided TPVB was performed for postoperative analgesia from January 2012 to March 2013 in our clinic were analyzed retrospectively. Demographic data, block technique, complications and 1st, 6th, 12th and 24th hour VAS scores were recorded. RESULTS A total of 18 patients had TPVB. Single injection was administered to 9 patients, multiple injections to 5, and catheters to 4. While statistically insignificant, 1st hour VAS scores were found to be greater than 3 in the single injection and catheter groups. CONCLUSION Similarly to multiple injection and continuous TPVB administration, ultrasound-guided single injection TPVB provides effective 24-hour postoperative analgesia.

Changing trends and regional anesthesia practices in Turkey

OBJECTIVES Introduction of ultrasound into regional anesthesia (RA) practice has resulted in important changes and developments in RA. These developments have had a major influence on the way of practice and choice of blocks. The purpose of this study was to present the most recent instruments used in RA and clinical applications in our country. METHODS A questionnaire consisting of 10 questions were distributed to the participants of the National RA Congress in 2011. Besides demographic data, RA techniques used and the method of nerve location was questioned. Participants were asked whether they were satisfied with their training in RA and if they participated in a RA course. RESULTS A total of 95 participants filled out the forms. Spinal anesthesia was the most commonly performed technique. Peripheral nerve blocks constitute only 12% of RA practice. Axillary block was the most commonly performed peripheral nerve block technique. The most commonly used nerve localization methods were nerve stimulation and ultrasound. The majority of the participants (58%) were not satisfied with their RA training and half (50%) participated in a course for continuing medical education. CONCLUSION Nerve stimulation is the most performed method, whereas US is increasingly becoming popular. The most commonly performed blocks are central neuroaxial blocks. All in all, there is still room for improvement in RA training.