Additional Analgesic Requirements Research Articles

Evaluation of Ultrasound-Guided Erector Spinae Plane Block and Oblique Subcostal Transversus Abdominis Plane Block in Laparoscopic Cholecystectomy: Randomized, Controlled, Prospective Study.

Background:Oblique subcostal transversus abdominis plane block (OSTAP) is a recently described regional anesthetic technique used in upper abdominal surgeries such as laparoscopic cholecystectomy (LC). Erector spinae plane block (ESPB) has also been reported for postoperative analgesia in LC.Aim:We aimed to compare the effectiveness of OSTAP and ESPB in providing postoperative analgesia in patients undergoing these surgeries.Setting and Design:This study was designed as a double-blinded, prospective, randomized, efficiency study in a tertiary university hospital, postoperative recovery room, and ward.Materials and Methods:A total of 72 patients were recruited and 60 patients were randomized into three equal groups (ESPB, OSTAP, and control group). Pain intensity between groups was compared using Numeric Rating Scale (NRS) scores. In addition, consumption of paracetamol and tramadol and additional rescue analgesic requirement were measured. Standard multimodal analgesia was performed in all groups, while ESPB block was also performed in Group ESPB and OSTAP block was also performed in group OSTAP.Statistical Analysis Used:Descriptive statistics were expressed as mean ± standard deviation. Independent t-test, Mann–Whitney U-test, Chi-square test, Fisher's exact test, Shapiro–Wilk test, one-way ANOVA, and post hoc Tukey's analysis were used for statistical analysis.Results:NRS was lower in block groups during the first 3 h. There was no difference in NRS scores at other hours. Analgesic consumption and rescue analgesic requirement were lower in groups ESPB and OSTAP when compared to those of control group. Block groups were similar.Conclusion:Bilateral ultrasound-guided ESPB and OSTAP performed at the end of LC lead to akin analgesia requirement and improve the quality of multimodal analgesia.

Preemptive intravenous ibuprofen application reduces pain and opioid consumption following thyroid surgery

ObjectiveThe primary aim of this study was to investigate the effects of preemptive a single dose IV ibuprofen on postoperative 48 h opioid consumption and postoperative pain in patients undergoing thyroidectomy. MethodsThe study included 40 patients aged 18 to 65, scheduled for elective thyroidectomy. Patients were randomly divided into 2 groups. Control group (n = 20) received 100 mL saline solution 15 min before surgery, while study group (n = 20) received 800 mg IV ibuprofen in 100 mL saline. The same general anesthesia protocol was applied in both groups, and all operations were performed by the same surgical team using the same technique. Postoperative analgesia was assessed using a visual analogue scale (VAS) and the amount of consumption of 48 h postoperative fentanyl with patient-controlled analgesia (PCA) and additional analgesia requirements were recorded. When additional analgesia was required, 1000 mg IV paracetamol was used. ResultsVAS scores in the ibuprofen group were found lower than the control group in the all-time points (p < 0.05). Opioid consumption in the 48 h was significantly higher in the control group than the ibuprofen group (p < 0.001). Using of rescue analgesia was significantly higher in the control group than the ibuprofen group, statistically (p < 0.05). A significant difference was observed between two groups in terms of side effects of fentanyl consumption (nausea and vomiting) (p < 0.001). ConclusionTo use preemptive a single dose IV ibuprofen decreases pain scores and postoperative opioid consumption in patients following thyroidectomy. Additionally, this application increase the patient comfort reducing nausea and vomiting in early postoperative period.

Efficacy of preemptive analgesia on acute postoperative pain in children undergoing major orthopedic surgery of the lower extremities.

BackgroundChildren undergoing major orthopedic surgery of the lower extremities can experience severe postoperative pain; yet, the ideal postoperative pain management strategy is unknown. Thus, in this patient population, we investigated the effect of intraoperative epidural infusion of local anesthetic on acute postoperative pain and analgesic consumption.Patients and methodsPatients (N=50, 3–12 years) randomly received either ropivacaine 0.15% (preemptive group) or normal saline (control group) as an initial bolus of 0.2 mL/kg, followed by continuous infusion of 0.15 mL/kg/h throughout surgery. Following surgery, patient-controlled epidural analgesia with ropivacaine 0.1% was provided. The main study outcomes were the revised Face, Legs, Activity, Cry, and Consolability pain scores, epidural ropivacaine consumption, and additional analgesic requirements during the first 48 hours postoperatively.ResultsForty-seven patients completed the study, 23 in the preemptive group and 24 in the control group, respectively. The revised Face, Legs, Activity, Cry, and Consolability pain scores were significantly lower in the preemptive group only at 30 minutes after postanesthesia care unit arrival and 6 hours after surgery (median difference −1.0, 95% CI −2.0 to −1.0, P=0.001 and median difference −2.0, 95% CI −3.0 to −1.0, P=0.005, respectively). However, they were not significantly different between the groups at 12, 24, and 48 hours postoperatively. Epidural ropivacaine consumption and additional analgesic requirements throughout 48 hours postoperatively were not significantly different between the groups.ConclusionIntraoperative epidural infusion of ropivacaine did not demonstrate preemptive analgesic efficacy within 48 hours postoperatively in children undergoing extensive lower limb orthopedic surgery.

Perioperative local anaesthesia for reducing pain following septal surgery.

Septal surgery is a well-established procedure used to treat nasal obstruction due to deviation of the nasal septum, which is carried out under local or general anaesthesia. Local anaesthesia is used for postoperative pain control, but its effectiveness and safety are unclear. To assess the effectiveness of perioperative local anaesthesia for reducing pain in septal surgery and to evaluate the risk of associated complications. The Cochrane ENT Information Specialist searched the Cochrane ENT Trial Register; Central Register of Controlled Trials; Ovid MEDLINE; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 9 January 2018. Randomised controlled trials and cluster-randomised controlled trials involving adults or children (or both) who underwent septal surgery. We included studies comparing local anaesthesia versus no treatment/placebo. We also included studies comparing different types of local anaesthesia to each other (i.e. local injection, the addition of an anaesthetic agent to nasal packing, where used, and sphenopalatine ganglion block). We used the standard methodological procedures expected by Cochrane. The primary outcome was postoperative pain intensity at 12, 24 and 48 hours measured by visual analogue scale (VAS) or another pain outcome tool including numerical or verbal rating scales. Secondary outcomes were requirement for additional analgesia, duration of hospitalisation and adverse effects (postoperative bleeding and postoperative vomiting). We used GRADE to assess the quality of the evidence for each outcome; this is indicated in italics. We included seven randomised controlled trials involving 493 participants. In all studies the participants were adults undergoing septoplasty. These studies were heterogeneous and the quality of the body of evidence ranged from low to very low. Few of the studies provided reliable data for the primary outcome in this review.Local anaesthetic injection versus no treatment/placeboTwo studies (142 participants) compared local anaesthetic injection versus placebo but these studies did not report postoperative pain at 12, 24 or 48 hours. It is unclear whether local anaesthetic injection changed the risk of vomiting (odds ratio (OR) 3.10, 95% confidence interval (CI) 0.12 to 79.23; 60 participants; one study) (low-quality evidence). Neither study reported the requirement for additional analgesia, duration of hospitalisation or uncontrollable postoperative bleeding.Local anaesthetic application via nasal packing versus no packing/packing with placeboFour studies (301 participants) used nasal packing postoperatively and compared the addition of local anaesthetic to the pack versus packing with a placebo added. Compared with packing with placebo, the addition of local anaesthetic to nasal packing reduced the pain score on a VAS (ranging from 0 to 100) at 12 hours (mean difference (MD) -16.95, 95% CI -22.27 to -11.62; 151 participants; two studies; I2 = 49%) (low-quality evidence) and at 24 hours postoperatively (MD -7.53, 95% CI -9.76 to -5.29; 268 participants; four studies; I2 = 83%) (very low-quality evidence). These studies did not report postoperative pain at 48 hours. The addition of local anaesthetic to nasal packing decreased the requirement for additional analgesia (OR 0.15, 95% CI 0.07 to 0.34; 151 participants; two studies; I2 = 15%) (moderate-quality evidence). No studies reported duration of hospitalisation, postoperative vomiting or uncontrollable postoperative bleeding.No studies compared the addition of local anaesthetic to nasal packing versus no packing.Sphenopalatine ganglion block versus no treatment/placeboOne study (50 participants) compared sphenopalatine ganglion block versus no treatment but this study did not report postoperative pain, requirement for additional analgesia, duration of hospitalisation, vomiting or uncontrollable postoperative bleeding. The addition of local anaesthesia to nasal packs (if these are being used) following septal surgery may reduce postoperative pain within the first 12 hours, compared to nasal packing with a placebo added. The effect is uncertain at 24 hours because the quality of the evidence is very low. Evidence was lacking for other outcomes, including adverse effects. There is a lack of evidence about the effects of local anaesthesia added to nasal packing compared to no nasal packing. There is also a lack of evidence about the effects of local anaesthesia given by injection and the effects of sphenopalatine ganglion block.

Multimodal Enhanced Recovery After Surgery (ERAS) Program is the Optimal Perioperative Care in Patients Undergoing Totally Laparoscopic Distal Gastrectomy for Gastric Cancer: A Prospective, Randomized, Clinical Trial.

The application of ERAS protocol has widely gained acceptance after gastrointestinal surgery. Well-designed, randomized, control trials are needed to evaluate fully its safety and efficacy in the field of gastric cancer. This study aims to compare the enhanced recovery after surgery (ERAS) protocol and the conventional perioperative care program after totally laparoscopic distal gastrectomy (TLDG) in gastric cancer. Patients with gastric cancer indicated for TLDG were randomly assigned to either the ERAS group or the conventional group. The ERAS protocol included short fasting time, fluid restriction, early oral feeding, immediate mobilization, and use of epidural patient-controlled analgesia. Primary endpoint was recovery time, which was defined with the criteria of tolerable diet, safe ambulation, no requirement of additional analgesics, and afebrile state. Hospital stay, pain score, complications, and readmission rate were secondary endpoints. A total of 97 patients who underwent TLDG from October 2012 to August 2014 were enrolled (ERAS = 46, conventional = 51). The ERAS group had faster recovery time (111.6 ± 34.3 vs. 126.7 ± 30.7h; p = 0.026) and significantly less pain through postoperative days 1-4. Possible hospital stay also was faster in the ERAS group (5.0 ± 1.9 vs. 5.7 ± 1.6days, p = 0.038), but there was no difference in actual hospital stay. No difference was found in complication, and there was no mortality or readmission in both groups. ERAS is safe and enhances postoperative recovery after TLDG in gastric cancer. The trial was registered in ClinicalTrials.gov (NCT01938313).

The use of O-ring retractors at Caesarean section : A systematic review and meta analysis

O-ring retractors (Alexis/Mobius) have been shown to reduce the risk of Surgical site infection (SSI) following general abdominal surgery. The benefit at caesarean section (CS) remains to be established given the relatively high cost. ObjectivesTo assess the efficacy of O-ring retractors when used at CS. Study DesignSystematic review and meta-analysis. Electronic databases were searched from inception of each database until January 2018. No language restrictions were applied. All randomised controlled trials (RCTs) which compared the use of an O-ring retractor to routine care at CS were included. Primary outcome was SSI. Secondary outcomes were operating time, estimated blood loss, need for blood transfusion, need to exteriorise the uterus, requirement for additional postoperative analgesia and adequate operative field visualisation. Analysis was performed using Revman 5.3. Results6 RCTs were included in the qualitative synthesis and the meta-analysis. This included 1669 women. The use of O-ring retractors did not reduce the risk of SSI when used at CS RR 0.76 (95% CI 0.34–1.70). Nor did the use of O-ring retractors reduce the operating time, estimated blood loss, the need for blood transfusion or the need for additional postoperative analgesia. The use O-ring retractors did reduce the need for exteriorisation of the uterus RR 0.48 (95% CI 0.33–0.69), and did increase the rate of adequate visualisation of the operative field RR 1.05 (95% CI 1.00–1.10). In a planned subgroup analysis there was a reduction in the rate of SSI with the use of O-ring retractors in women with a BMI < 35 RR 0.34(95% CI 0.12–0.98). ConclusionThis review has shown that O-ring retractors do not reduce the incidence of the common measurable complications of CS; SSI, blood loss, need for blood transfusion and need for additional postoperative analgesia. There may be a subgroup where these retractors are useful, but present evidence does not justify their routine use at CS.

Evaluation of ultrasound-guided erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: A prospective, randomized, controlled clinical trial

Study objectiveLaparoscopic cholecystectomy (LC) is a commonly performed minimally invasive procedure that has led to a decrease in procedure-related mortality and morbidity. However, LC requires analgesia that blocks both visceral and somatic nerve fibers. In this study, we evaluated the effectiveness of Erector Spinae Plane Block (ESPB) for postoperative analgesia management in LC. DesignSingle-blinded, prospective, randomized, efficiency study. SettingTertiary university hospital, postoperative recovery room & ward. Patients36 patients (ASA I-II) were recruited in two equal groups (block and control group). Following exclusion, 30 patients were included in final analysis. InterventionsStandard multimodal analgesia was performed in Group C (control) while ESPB block was also performed in Group B (block). MeasurementsPain intensity between groups were compared using Numeric Rating Scores (NRS). Also, tramadol consumption and additional rescue analgesic requirement were measured. Main resultsNRS was lower in Group B during the first 3 h. There was no difference in NRS scores at other hours. Tramadol consumption was lower in Group B during the first 12 h. Less rescue analgesia was required in Group. ConclusionBilateral ultrasound guided ESPB leads to effective analgesia and a decrease in analgesia requirement in first 12 h in patients undergoing LC.

Canine ovariectomy by hybrid or total natural orifice transluminal endoscopic surgery: technical feasibility study and pain assessment.

To compare technical feasibility, surgical time, surgical complications, and postoperative pain in ovariectomy (OVE) by hybrid and total natural orifice transluminal endoscopic surgery (NOTES). Prospective randomized clinical trial. Sixteen healthy and sexually intact bitches. Dogs were randomly assigned to the hybrid NOTES group (HNG; n = 8) and the total NOTES group (TNG; n = 8) to compare surgical time, pain scores and complications. Pain was assessed by using the visual analog scale (VAS) and the Melbourne pain scale (MPS). Surgical time did not differ between the experimental groups (HNG = 46.3 ± 18.5 minutes, TNG = 54.6 ± 31.1 minutes). Exteriorization of the ovaries through the vaginal wound was the major difficulty. Complications were minor in both groups and occurred intraoperatively only in the HNG, and in both groups post operatively. No dogs required rescue analgesia in the intraoperative or postoperative period. There were no differences in VAS or MPS scores between the groups for any surgical times except for the VAS assessment at 72 hours after extubation (HNG = 1.1 ± 0.3, TNG = 0.7 ± 0.4, P = .0221). Both NOTES techniques were comparable for canine OVE, with no requirement for additional analgesia in the postoperative periods. It was not possible to determine whether there was a clear advantage of one technique rather than the other. The minimally invasive techniques proposed for laparoscopic OVE are feasible for dogs with low pain scores and low rates of complications for both groups.

Feasibility of single-incision laparoscopy for ruptured ectopic pregnancies with hemoperitoneum

Background: The aim of this study was to compare single-incision laparoscopic surgery (SILS) and conventional laparoscopy in ectopic pregnancies accompanied by severe hemoperitoneum.Material and methods: The main outcome measures were duration of surgery, intraoperative bleeding quantity, complications, post-operative pain scores, additional analgesic requirements, and length of hospital stay.Results: A total of 53 women, 28 in the conventional laparoscopy group and 25 in the SILS group, participated in the study. There were no differences in demographic characteristics between the two groups. There were no differences in terms of variables including gestational week, beta human chorionic gonadotropin (βhCG) levels, and operation time. No intraoperative complications were observed in either group. The groups exhibited no significant differences regarding additional analgesic requirements or postoperative pain scores. However, pain at the sixth postoperative hour was lower in the SILS group. This effect was not observed at 12 and 24 hours.Conclusion: SILS appears to be effective and safe for the treatment of ruptured ectopic pregnancies accompanied by hemoperitoneum.

Comparison of Single Incision and Conventional Laparoscopic Surgery for Surgical Sterilization

Objective: To compare the intraoperative characteristics and postoperative pain levels of single incision and conventional laparoscopic surgeries performed for surgical sterilization.Study Design: A single center prospective observational study was conducted to compare the conventional and single incision laparoscopic (SIL) partial salpingectomies performed for surgical tubal sterilization. In total of 110 women, 62 in the conventional laparoscopy and 48 in the SILS group participated in the study. The main outcome measures were peritoneal entry time, total operation time, amount of bleeding, intraoperative complications, post-operative pain scores, additional analgesic requirements, and length of hospital stay. Statistical analysis was accomplished using the chi-square test or Mann Whitney U test, where appropriate.Results: Demographical findings did not differ between the two groups (p&gt;0.05). Similarly, total operation time, rates of intraoperative complications, conversion to laparotomy, length of hospital stay, pre and postoperative hematocrit levels were not significantly different between the groups. Peritoneal entry time was shorter in the SIL group (7.1 min. vs. 4.8 min., p&lt;0.001). Additional analgesic requirements, postoperative pain scores in the recovery room and at 6th, 12th, and 24th hours were not different between the groups (p&gt;0.05).Conclusion: SILS seems a safe and feasible alternative to conventional laparoscopy for surgical tubal sterilization.Keywords: Partial salpingectomy, Tubal ligation, Contraception, Surgical sterilization, Single Incision Laparoscopy

Does preemptive gabapentin modulate cytokine response in total knee arthroplasty? A placebo controlled study.

Gabapentin, as a structural analogue of γ-aminobutyric acid, has been investigated to provide pain relief in the early postoperative period following various surgical interventions. The objective of this study was to investigate whether preemptive oral administration of gabapentin 800 mg can reduce postoperative pain and modulate the inflammatory cytokine response in comparison to placebo in patients undergoing total knee arthroplasty under general anesthesia. Fifty-two patients were randomly divided into 2 groups before surgery, either to receive peroral gabapentin 800 mg or placebo drug, 1 h before surgery. All patients had general anesthesia with endotracheal intubation, in a standardized fashion, by the same anesthetist. Thirty min before completion of surgery, intramuscular diclofenac sodium 75 mg was administered. Following extubation, visual analogue pain scale (VAS) scores and additional analgesic requirements were recorded at 15 min at post-anesthesia care unit (PACU), and at 4th and 24th h postoperatively. Plasma levels of interleukin 6 (IL-6), and tumor necrosis factor R (TNF-R) were measured at predetermined time points (T0 1 h before administration of gabapentin, T1 at postoperative the 4th h mark, and T2 at postoperative at the 24th h mark). The VAS scores at postoperative 4th h were significantly higher in placebo and gabapentin groups compared with VAS scores at PACU and at 24th h. The groups did not differ in terms of additional analgesic requirements. In gabapentin group, IL-6 levels at T1 and T2 were significantly lower in comparison to values measured in placebo group at the same time points. This difference was not significant in TNF-R levels between the groups. Though preemptive oral gabapentin administration did not reduce postoperative pain and analgesic requirements in total knee arthroplasty surgery, it attenuated IL-6 production on the first postoperative day.

Comparative study of ultrasound-guided paravertebral block versus intravenous tramadol for postoperative pain control in percutaneous nephrolithotomy

BackgroundPercutaneous nephrolithotomy (PCNL) is a minimally invasive surgical procedure for renal calculi, and nephrostomy tubes lead to postoperative pain after PCNL. Regional techniques (e.g., epidural analgesia and peripheral blocks) and opioids are applied for postoperative pain treatment. The aim of this study was to compare effectiveness of ultrasound-guided paravertebral block (PVB) and tramadol on postoperative pain in patients who underwent PCNL.MethodFifty-three patients were included in this prospective randomized study. The patients were allocated into two groups: the PVB group (group P, n = 26) and the tramadol group (group T, n = 27). All patients were administered standard general anaesthesia. Ultrasound-guided PVB was performed at the T11- L1 levels using 0.5% bupivacaine for a total dose of 15 mL in group P. Patients in group T were intravenously administered a loading dose of 1 mg/kg tramadol. Patients in both groups were given patient-controlled analgesia. Haemodynamic parameters, visual analogue scale (VAS) scores, side effects, and complications, tramadol consumption and additional analgesic requirements of the patients were recorded after surgery.ResultsHaemodynamic parameters were statistically similar between the groups. The VAS in group P were statistically lower than in group T. In the 24-h period after surgery, total PCA tramadol consumption was statistically lower in group P than in group T. The use of supplemental analgesic in group T was higher than in group P.ConclusionsUltrasound-guided PVB was found to be an effective analgesia compared to tramadol, and no additional complications were encountered.Trial registrationClinicalTrials.gov, NCT02412930, date of registration: March 27, 2015, retrospectively registered.

The Pattern of Contrast Dye through the Thoracic Paravertebral Catheter Does Not Predict Analgesic Efficacy after Breast Cancer Surgery: A Prospective Cohort Study

Purpose: We examined whether or not the spreading pattern of contrast dye through the catheter into the thoracic paravertebral space (TPVS) was associated with acute post-operative pain relief after breast cancer surgery. Methods: Sixty patients were recruited. After surgery, patients received thoracic paravertebral block (TPVB). The catheter was inserted within the TPVS, and radiographic contrast dye was injected through the catheter. Based on the main spreading patterns of the dye, the patients were divided into a cloud-like (spreading to the posterior compartment of the TPVS) or a longitudinal spread group (spreading to the anterior compartment of the TPVS). The primary endpoint of the study was pain intensity by numeric rating scale (NRS) and additional analgesic requirements within 12 h after surgery. Results: In 22 patients, the spread of contrast dye was not noted in the PVS. Of the 38 eligible patients, 9 patients were assigned to the cloud-like spread group, 28 patients to the longitudinal spread group and 1 patient was excluded. There were no significant differences in the NRS between the two groups both at rest and on moving. No significant differences were found in the frequency of requiring additional analgesics. Conclusions: There is no marked difference in the analgesic efficacy after breast cancer surgery based on the spread of the contrast dye to the posterior or anterior compartment of the TPVS. We should not insert the needle deeply within the TPVS, as the risk of the migration of catheters into the pleural space can be quite high.

Comparison of Ultrasound-Guided Lumbar Erector Spinae Plane Block and Transmuscular Quadratus Lumborum Block for Postoperative Analgesia in Hip and Proximal Femur Surgery: A Prospective Randomized Feasibility Study.

Study Objective:Lumbar Erector spinae Plane block (L-ESPB) is a modification of a recently described block. Both L-ESPB and Transmuscular Quadratus Lumborum block (QLB-T) have been reported to provide effective postoperative analgesia in hip and proximal femur surgery. Herein, we compare the effectiveness of L-ESPB and QLB-T in providing postoperative analgesia in patients undergoing hip and femur operations.Design:Double-blinded, prospective, randomized, feasibility study.Setting:Tertiary university hospital, postoperative recovery room and ward.Methodology:A total of 72 patients (American Society of Anesthesiology physical status classification II-III) were recruited. After exclusion, 60 patients were allocated to three equal groups (control, L-ESB and QLB-t).Interventions:Standard multimodal analgesia was performed in the control group while L-ESPB or QLB-T was performed in the block groups.Measurements:Pain intensity between groups was compared using Numeric Rating Scores. Furthermore, tramadol consumption and additional rescue analgesic requirement was measured.Results:There was no difference between demographic data or type of surgery. While there was no difference in Numeric Rating Scale (NRS) score at any hour between the block groups; NRS scores at the 1st, 3rd and 6th h, tramadol consumption during the first 12 h and total tramadol consumption, the number of patient required rescue analgesic in 24 h were significantly higher in the control group compared to both block groups.Conclusion:While L-ESPB and QLB-T have similar effect, they improve analgesia quality in patients undergoing hip and proximal femoral surgery when compared to standard intravenous analgesia regimen.

Prophylactic Midazolam For Prevention Of Post-Operative Nausea And Vomiting Following Adenoidectomy or Adenotonsillectomy

Aim: Postoperative nausea and vomiting (PONV) is a common complication after tonsillectomy. Midazolam is known to decrease postsurgical vomiting. In this study, we investigate the effect of intramuscular Midazolam on postoperative nausea vomiting in children undergoing adenoidectomy or adenotonsillectomy. Material and Method: In a randomized double-blind study, we evaluated 66 healthy children, aged 5–12 years, who underwent adenoidectomy with or without tonsillectomy. Afterwards, anesthesia was induced by inhalation of sevoflurane, rocuronium bromide 0.6 mg kg–1, and fentanyl 1 µg kg–1, and anesthesia was maintained by sevoflurane for all patients. Patients were administered subcutaneous morphine 0.1 mg kg–1 for postoperative analgesia. Patient’s in-Group II were administered intramuscular midazolam 0.1 mg kg–1. The incidence of nausea/vomiting and antiemetic requirement 0-4 h and 4-24 h post surgery was recorded. Data for postoperative vomiting were grouped into the following time periods: 0–4 and 4–24 h. Data were analyzed using a Student’s t-test and chi-squared analysis. Results: No statistically significant different was found between groups in 0-4, and 4-24 hours in terms of median VAS levels (p=0,883 and p=0,881). Although Group II had lower incidence of nausea both in 0-4 and 4-24 hours compared to Group I, there was no statistically significant difference between the groups (p=0,618 and p=0,28). There was no statistically significant difference between the groups in 0-4, and 4-24 hours in terms of median nausea VAS levels (p=0,597 and p=0,982). There was also no statistically significant difference between the groups in terms of rates of additional analgesic requirement in 24 hours, and median additional analgesic number (p=0,197 and p=0,865). Antiemetic requirement rates in 24 hours in Group II were lower at a statistically significant rate compared to Group I (p=0,027). Yet, there was no statistically significant difference between the groups in terms of median antiemetic number in 24 hours (p=0,070). Conclusion: For children undergoing tonsillectomy, intraoperative midazolam treatment does not provide a prophylaxis against postoperative vomiting.

Effects of Single-Dose Preemptive Pregabalin and Intravenous Ibuprofen on Postoperative Opioid Consumption and Acute Pain after Laparoscopic Cholecystectomy

ABSTRACTPurpose: Non-opioid medications as a part of multimodal analgesia has been increasingly suggested in the management of acute post-surgical pain. The present study was planned to compare the efficacy of the combination of pregabalin plus ıv ibuprofen. Methods: 58 patients were included in this prospective, randomized, double-blinded study. The pregabalin group (Group P, n = 29) received 150 mg pregabalin, the pregabalin plus ibuprofen group (Gropu PI, n = 29) received 150 mg pregabalin and 400mg ıv ibuprofen before surgery. Postoperative fentanyl consumption, additional analgesia requirements and PACU stay were recorded. Postoperative analgesia was performed with patient-controlled IV fentanyl. Results: VAS scores in the group PI were statistically lower at PACU, 1and 2 hours at rest, at PACU, 1, 2, 4, 12 and 24 hours on movement compared to the group P (P < 0.05). Opioid consumption was statistically significantly higher in the group P compared to the group PI (130.17 ± 60.27 vs 78.45 ± 60.40 μq, respectively, P < 0.001) and reduced in the 4th 24 hours by 55% in group PI. Rescue analgesia usage was statistically significantly higher in the group P than in the group PI (16/29 vs 7/29, respectively, P < 0.001). Four patient in the group PI did not need any opioid drug. Besides, PACU stay was shorter in the group PI than the group P (10.62 ± 2.38 vs 15.59 ± 2.11 min, respectively, P < 0.001). Conclusion: Preemptive pregabalin plus ıv ibuprofen in laparoscopic cholecystectomy reduced postoperative opioid consumption. This multimodal analgesic aproach generated lower pain scores in the postoperative period.

Relation with postpartum maternal morbidity of different types of anesthesia in preeclamptic patients

ABSTRACTObjective: The aim of this study is to investigate the effect of different anesthesia types administered to patients with preeclampsia on postoperative maternal morbidities.Methods: Medical records of pregnant women complicated with preeclampsia delivered by cesarean from January 2010 to December 2016 in our clinic were retrospectively reviewed.Results: There was not a statistically significant difference between patients receiving spinal anesthesia and general anesthesia in terms of additional parenteral analgesic requirement at postoperative period (p = 0.520). The length of stay in hospital and δHb (preoperative hemoglobin value minus postoperative hemoglobin value) were not different between spinal anesthesia and general anesthesia groups (p = 0.140 and 0.648, respectively). The rate of postoperative antihypertensive medication requirement was statistically significant in patients with severe preeclampsia who underwent general anesthesia (p = 0.009, x2 = 6.867, odds ratios = 4.276 (1.531–11.942)). The time passing to reach the first normal blood pressure level in patients with severe preeclampsia was 11.95 ± 9.11 h in patients with spinal anesthesia, 10.55 ± 4.95 h in patients with general anesthesia, and the difference was not statistically significant (p = 0.504).Conclusion: The need for antihypertensive medication is greater in patients with severe preeclampsia receiving general anesthesia. There is a need for comprehensive, prospective, and randomized controlled trials to establish the relationship between postpartum morbidity and the different types of anesthesia.

Çocuk Hastalarda İlioinguinalL/İliohipogastrik Sinir Bloğunda Bupivakain ve Levobupivakainin Postoperatif Ağrıya Etkilerinin Karşılaştırılması: Retrospektif Çalışma

Objective: Ilioinguinal/iliohypogastric (II/IH) nerve block added to general anesthesia is frequently used for postoperative analgesia in pediatric patients. We aimed to compare the postoperative analgesic effects of bupivacaine and levobupivacaine for II/IH nerve block for inguinal hernia repair in pediatric patients, which is not investigated previously. Materials and Methods: In this 2-year retrospective study, data were collected from the medical charts of patients that underwent unilateral inguinal hernia repair. Patients were included who received an II/IH nerve block with 0.2 mL/kg 0.5% of either bupivacaine (Group B) or levobupivacaine (Group L). Non-elective cases, age under 2 years and patients with multiple procedures were excluded. Demographic properties of the patients (age, weight, and sex), duration and side of surgery, pain scores, additional analgesic requirement and complications were documented. The chi-square test and the Mann-Whitney U test were used for statistical analysis. Results: In both groups, t he pain scores were not significantly different at post anesthesia care unit, 1, 2, 6 and 24th hours; nevertheless, the pain scores at 4th hour were significantly lower in Group L. Conclusion: II/IH nerve block added to general anesthesia is effective in inguinal region surgery of pediatric patients in postoperative pain control, and 0.5% levobupivacaine and bupivacaine had similar analgesic effect.

The efficacy of serratus anterior plane block in analgesia for thoracotomy: a retrospective study.

A multimodal analgesic approach is necessary for post-thoracotomy pain, which can be severe. Intravenous access, central and peripheral nerve blocks are frequently used. The aim of this study was to evaluate the efficacy of serratus anterior plane block (SAPB) in the management of post-thoracotomy pain. A total of 40 patients who underwent thoracotomy between January 2014 and January 2016 were retrospectively analyzed. The patients were divided into two groups: Group M (intravenous patient-controlled analgesia morphine; n=20) and Group S (intravenous patient-controlled analgesia morphine+SAPB; n=20). The Visual Analogue Scale (VAS) was used for pain evaluation at the 1st, 2nd, 4th, 6th, 8th, 12th and 24th postoperative hours and morphine consumption was evaluated at the 6th, 12th and 24th postoperative hours. Secondary outcomes were additional analgesic requirement, side effects, the Ramsay Sedation Scale (RSS) scores, block onset time and block level. The VAS scores and the amount of morphine consumed at the 6th, 12th and 24th hours were found to be significantly lower in Group S than in Group M (P<0.001). No statistically significant difference was found in the rate of side effects, including nausea, vomiting, pruritus, respiratory depression, bradycardia and hypotension, and RSS outcomes between the groups. Our study suggests that SAPB is an effective adjuvant treatment option for thoracotomy analgesia.

Patient-controlled analgesia with remifentanil versus alternative parenteral methods for pain management in labour.

Patient-controlled analgesia with remifentanil versus alternative parenteral methods for pain management in labour.