Meliha Erman

Comparison of two different techniques for brachial plexus block: infraclavicular versus axillary technique

Background:  Brachial plexus block via the axillary approach is problematic in patients with limited arm mobility. In such cases, the infraclavicular approach may be a valuable alternative. The purpose of our study was to compare axillary and infraclavicular techniques for brachial plexus block in patients undergoing arm or forearm surgery.

In Vitro Effects of Opioids on Pregnant Uterine Muscle

Opioids are often used for obstetric analgesia. Ideal obstetric analgesia is attained with optimal pain relief and minimal risk for the parturient. Therefore, investigators in the present study explored the effects of different opioids on the myometrium of pregnant rats. Myometrial strips were exposed to increased concentrations of fentanyl (10-8 M to 10-6 M), alfentanil (10-8 M to 10-4 M), remifentanil (10-8 M to 10-4 M), and meperidine (10-8 M to 10-4M). Decreased contractile activity was observed in myometrial strips isolated from pregnant rats at cumulative concentrations of fentanyl, alfentanil, remifentanil, and meperidine. The amplitude of contractions was reduced with increasing concentrations of opioids; this effect was statistically significant at a concentration of 10-4 M. When administered at higher concentrations, opioids may decrease contractions in pregnant rat myometrium.

Comparison of epidural and combined spinal-epidural analgesia in the management of labour without pain.

The effects of combined spinal–epidural analgesia (CSEA) and epidural analgesia (EA) were studied in 50 healthy parturients randomly allocated to receive bupivacaine plus fentanyl either epidurally, or intrathecally and epidurally. Significant differences from baseline values were seen in systolic blood pressure at all time-points except for 4 h in the EA group and at 3 and 4 h in the CSEA group. Significant differences from baseline values were seen in diastolic blood pressure at 1, 2, 3 and 4 h in the EA group, whereas no significant differences from baseline were seen in the CSEA group. Pain scores in both groups were significantly decreased compared with baseline and all scores, except at 2h, were significantly lower in the CSEA group compared with the EA group. The duration of labour and total amount of drugs used were significantly decreased and cervical dilatation was faster with CSEA compared with EA. In conclusion, CSEA was associated with more rapid onset of analgesia and faster progress in cervical dilatation compared with EA, and can be used safely for labour analgesia.

The comparative effect of single dose mivacurium during sevoflurane or propofol anesthesia in children.

Background:  We aimed to randomly compare intubating conditions, recovery characteristics and neuromuscular effects of single dose of mivacurium (0.2 mg·kg−1) during sevoflurane vs. propofol anesthesia in 60 healthy children, undergoing inguinal surgery.

The effect of intra-articular neostigmine, tramadol, tenoxicam and bupivacaine on postoperative pain

Objctive: The present study, investigates the analgesic effects and complications of intra-articular neostigmine, tramadol, tenoxicam and bupivacaine on postoperative pain in patients undergoing day case knee arthroscopy. Subjects: Group 1 received 0.5 mg neostigmine, Group 2 received 100 mg tramadol, Group 3 received 20 mg tenoxicam, Group 4 received 20 ml 0.5% bupivacaine (control) in 20 ml normal saline intra-articularly at the end of the surgery. All patients had the same anaesthetic technique. Patients were observed in the recovery room with respect to pain scores, haemodynamic changes and postoperative analgesia at 1, 2 and 4 h postoperatively. Analgesic therapy in the recovery room was managed with 25 mg bolus doses of meperidine when the patients had visual analosue scale (VAS) scores higher than three points. The patients were discharged from hospital with a prescription for diclofenac 75 mg to be used as required. They were asked to complete their pain measures at 24 h and record their analgesic consumption. Results: There were no significant differences among the study groups regarding pain scores, haemodynamic changes, the first analgesic requirement time and complications. All patients in our study had adequate postoperative analgesia without any severe complication. Conclusion: Intra-articular administration of neostigmine, tramadol, tenoxicam or bupivacaine is a simple and effective postoperative analgesic technique after outpatient arthroscopic knee procedures.

Intrathecal Ropivacaine versus Ropivacaine plus Fentanyl for Out-patient Arthroscopic Knee Surgery

We evaluated the effects of low-dose intrathecal ropivacaine with or without fentanyl for arthroscopic knee surgery. Fifty patients were randomized in equal groups to receive an intrathecal solution (3 ml) containing either 10 mg isobaric ropivacaine or 8 mg isobaric ropivacaine plus 25 μg fentanyl. Complete motor blockade occurred in 22 patients (88%) in both groups. The time taken to reach sensory blockade to T10 and total motor blockade was shorter in the ropivacainetreated group, but differences were not statistically significant. The duration of sensory and motor blockade was shorter in the ropivacaine plus fentanyl-treated group. The cephalad spread of sensory blockade was higher with ropivacaine than with ropivacaine plus fentanyl. We conclude that although 25 μg fentanyl added to 8 mg ropivacaine provided shorter motor and sensory blockade durations than 10 mg ropivacaine alone, small doses of ropivacaine plus fentanyl can be used safely for arthroscopic knee surgery.

The effects of intraperitoneal tramadol, tenoxicam and bupivacaine on pain relief after laparoscopic gynecological procedures

Abstract Purpose: Patients undergoing laparoscopic procedures may experience postoperative pain. We conducted a randomized, double-blinded, placebo-controlled trial to evaluate the effectivenesses of peritoneal tramadol as an opioid analgesic, tenoxicam as an anti-imflammatory drug and bupivacaine as a local anesthetic. Methods: Patients were randomly assigned to one of four groups of 20 patients each. Group A received 50 mg tramadol (in 20 ml volume with 0.9% saline), group B received 20 mg tenoxicam (in 20 ml volume with 0.9% saline), group C received 20 ml 0.9% saline and group D received 50 mg bupivacaine HCl in 20 ml volume (10 ml 0.5% bupivacaine with 10 ml 0.9% saline) after surgery. Pain was assessed using a visual analog scale and a verbal rating scale at 30 and 60 min, and 2 and 4 h after surgery. Results: Pain intensity and analgesic requirements were significantly less in the group receiving intraperitoneal tramadol, tenoxicam and bupivacaine compared to placebo group. The pain scores of tenox...

The histopathological effects on rats of ultracaine, lidocaine, and bupivacaine after intravesical application

Abstract Aim: Local anesthetics have been administered in the bladder for many years. This technique provides only superficial bladder anesthesia and analgesia. This procedure may be an alternative to traditional methods of spinal, epidural or general anaesthesia. Methods: At the begining of the study, 40 rats were randomly divided into four groups. An intravesical catheter was inserted and 1 ml saline (control group) or the drugs 2% ultracaine in group 2, 2% lidocaine in group 3 and 0.5% bupivacaine in group 4 were administered intravesically. The vesical mucosal injury was evaluated macroscopically and microscopically. The data were analyzed with chi-squared and Fishers chi-squared tests. Results: There were no statistically significant differences in lynfoid folliculi, vascular proliferation, mast cell infiltration, squamous metaplasy or inflammatory infiltrations between groups 2, 3 and 4. Eosynophyl infiltration was seen in all cases of group 2 and was more pronounced than in the other groups (p < 0...