Feyhan Ökten

The effect of intra-articular levobupivacaine on shoulder cartilage at different doses - experimental study

BACKGROUND AND OBJECTIVES In this study it was aimed to examine the histological and morphometric effects on cartilage structure of intra-articular application of levobupivacaine to the shoulder joint. METHODS In twenty New Zealand adult male rabbits, 35 shoulders were used for the study and prepared in 5 groups of 7. These groups were defined as Groups L1, L2, L3 and L4 which were right shoulders administered with 0.25% and 0.5% levobupivacaine, Group C which were left shoulders as the control group and Groups S1 and S2 which were left shoulders administered with 0.9% saline. On the 2nd and 15th days the animals were killed, the glenohumeral joints were evaluated macroscopically then cartilage samples were taken. These samples were evaluated with Mankin score, and histomorphometrically by measuring the thickness of the cartilage between the superficial cartilage layer and the tidemark and the thickness of calcified cartilage between the tidemark and the subchondral bone. RESULTS Macroscopically, on the 15th day the joint fluid was seen to have reduced in all the groups. After microscopic evaluation, the highest Mankin score (mean: 3.14±2.1/14) was in the L4 group (15th day 0.5% levobupivacaine) and was found to be statistically significant (p<0.05). No statistically significant difference was determined between the other groups. CONCLUSIONS Histologically, as the highest Mankin score was in the L4 group, this indicates that in a single intra-articular injection of levobupivacaine a low concentration should be selected. LEVEL OF EVIDENCE Level 5, animal study.

Comparison of Effects of Calcium Channel Blockers and Beta Blockers on Tourniquet-Induced Hypertension During Intravenous Regional Anesthesia

ABS TRACT Objective: To investigate the efficacy of calcium channel and beta blockers for controlling tourniquet induced blood pressure increase in patients undergoing carpal tunnel operations with intravenous regional anesthesia (IVRA). Material and Methods: Files of patients who have been operated under IVRA in orthopedics clinics between January 2009 and January 2010 were retrospectively investigated. A total of 312 patients, 164 patients with carpal tunnel syndrome and 148 patients with trigger finger have been operated under IVRA. Out of 164 patients who have been operated due to carpal tunnel syndrome, 50 patients in which either calcium channel blockers or beta blockers were used for treatment of critical blood pressure increase after tourniquet inflation and in which whole data were obtained, were included to the study.The patients with systolic blood pressure above to 150 mmHg following tourniquet inflation and in which bolus dose of calcium channel blocker 10 mg (Group I) or beta blocker 0.5 mg/kg (Group II) have been administered by intravenous route constituted the study groups. The ages of the patients, onset of sensorial block, duration of sensorial block, surgery and tourniquet durations, and the tourniquet pressures were recorded from the patient files. Results: There was no difference between groups in terms of demographical variables and hemodynamic parameters (p<0.05). The efficacy of both calcium channel and beta blockers for controlling tourniquet-induced hypertension were similar (p<0.05). Conclusion: Although both calcium channel blockers and beta blockers were found to be equally effective in treatment of tourniquet-induced hypertension, there is need of large scale prospective studies in this subject.

Preemptive Segmental Epidural Levobupivacaine Administration and Wound Infiltration Following Posterior Fusion Surgery: A Case Serie

ABS TRACT Objective: The current study aimed to provide intraoperative smooth wake-up test and postoperative effective analgesia by segmental epidural analgesia and wound infiltration in patients undergoing posterior fusion surgery. Material and Methods: Fifteen ASA I-II adolescent patients aged 11-16 undergoing posterior fusion and instrumentation were included to the study. After general anesthesia with standard intravenous anesthesia, epidural catheter was inserted to all patients in lateral decubitus position. Following confirmation of the place of the catheter under scopy, initially 3-4 ml of prepared mixture was administered from the catheter and then the catheter was retracted and during retraction, 1-2 mL of the mixture was given to each segment. Neuromonitorization was achieved with motor evoked potential (MEP). Postoperative pain was evaluated with visual analogue scale (VAS). Paracetamol infusion and nonsteroidal antiinflammatory analgesics were given for routine postoperative pain management. Intravenous patient-controlled analgesia with morphine was prepared to be given in case of VAS score higher than 40. Results: In all patients effective analgesia was achieved for postoperative 24 hours. No side effects and hemodynamic impairment were observed. The highest pain scores were obtained at the postoperative 12th hour and during movement. There was no requirement for morphine patient controlled anesthesia (PCA) as VAS values were lower than 40. The sleep quality of patients and the patient satisfaction were very good in all patients. Conclusion: Segmental epidural analgesia with a preoperatively placed epidural catheter and wound infiltration is a simple and reliable method for effective pain control in posterior fusion and instrumentation surgery in patients with adolescent idiopathic scoliosis.