Method Of Regional Anesthesia Research Articles

Regional anesthetics: traditions and innovations

The wide implementation of different regional anesthesia techniques is also actual in pediatric anesthesiology. Using modern methods of regional anesthesia (RA) and modern local anesthetics is a new level in development of pediatric anesthesiology. This article is about advantages of regional pediatric anesthesia in intra- and post-surgery pain management and analgesia. We analyse the techniques of spinal and epidural anesthesia, as well as their varieties such as unipolar spinal block and caudal anesthesia, compare their advantages and disadvantages. Some more techniques such as paravertebral block, TAP-block are considered as an alternative to epidural anesthesia. Methods and possibilities of ilioinguinal, iliohypogastric and TAP-blocks are also mentioned here. The use of the above-mentioned methods allows to reduce the use of narcotic analgesics and hypnotics and, as a consequence, reduces their systemic effects on the child’s body. These methods are safer for use, since they allow you to plan a safe anesthetic for each child and minimize complications.

A Comparison of Two Methods of Regional Anesthesia

Category: Other Introduction/Purpose: Poorly controlled post-operative pain is a common cause of patient dissatisfaction. With future emphasis on value-based medicine, optimization of cost-effectiveness and patient satisfaction is critical. Popliteal and saphenous nerve blocks are routinely use in foot and ankle orthopaedic surgery and have become the gold standard for immediate post-operative analgesia. Traditionally a single long-acting local anesthetic agent is utilized which achieves analgesia for 6-24 hours. Recent evidence has shown that multimodal anesthesia with combined anesthetic agents remains effective for a longer duration compared to single-medication nerve blocks. The purpose of this study is to determine if patients undergoing foot and ankle surgery safely benefit from multi-modal compared with traditional single-medication nerve blocks. Methods: This was a two-armed, prospective, randomized, double-blinded study. The study population consisted of 70 patients from a single institution undergoing foot and ankle surgery by two fellowship-trained orthopaedic foot and ankle surgeons. 34 patients received a local anesthetic only popliteal and saphenous nerve block (Bupivacaine) and the other 36 patients received a triple additive nerve block (Dexamethasone, Clonidine, and Buprenorphine) in addition to Bupivacaine. Pre- and Post-operative assessments were performed to determine VAS pain scores, numbness, duration of anesthesia, patient satisfaction with analgesia, and oral pain medication use. Results: Triple additive (TA) nerve block mean duration to onset of pain was longer than for single agent (LA) nerve blocks (40.2 hrs vs 24.3 hrs respectively). Time to complete block resolution was also longer for the TA nerve blocks (82.3 hours) compared to LA blocks (38.7 hrs). 17/34 TA block patients had residual numbness at 1 week compared to 5/36 LA block patients. However, by 3 months there was no difference (8/34 TA and 7/36 LA). There was no significant difference in VAS scores or patient satisfaction rates at 1 week or 3 months. 7/34 TA block patients required narcotic refills compared to 6/36 LA block patients. There was no significant difference in complications between the groups. Conclusion: Triple agent nerve blocks give a longer duration of effective postoperative analgesia compared to single agent blocks. There was a higher rate of lingering numbness in the triple agent blocks at one week but not at 3 months. Patient satisfaction was very high for both groups regardless of their VAS pain scores. Triple agent nerve blocks demonstrate equivalent safety compared with single agent nerve blocks.

Ultrasound-guided posterior quadratus lumborum block for postoperative pain after laparoscopic cholecystectomy: A randomized controlled double blind study

Study objectiveLaparoscopic techniques are commonly used in surgical operations of the gallbladder. There are very few regional anesthesia methods used to achieve this goal. We aimed to investigate the effect of ultrasound-guided posterior quadratus lumborum block (QLB), administered bilaterally on pain scores after laparoscopic cholecystectomy operations. DesignProspective, double blind, randomized controlled clinical trial. SettingSingle-institution, tertiary hospital. Patients60 patients underwent laparoscopic cholecystectomy were included in the study. InterventionsPatients were randomized to either Group B (intravenous patient-controlled analgesia (IV PCA) + posterior QLB with 0.3 ml/kg 0.25% bupivacaine; n = 30) or Group S (IV PCA + posterior QLB with 0.3 ml/kg 0,9% saline; n = 30). MeasurementsPostoperative pain (during rest) was evaluated at the 30th minute, 2nd, 6th, 12th, and 24th hours using the VAS scores. Postoperative activity pain was also evaluated with VAS at the 2nd, 6th, 12th, and 24th hours. Postoperative 6th, 12th, and 24th hour follow-up results were recorded to identify the quantity of tramadol use. Secondary outcomes included the Ramsey sedation scale (RSS), side effect profile, and additional analgesic use. Main resultsThe VAS scores between the two groups were found to be statistically significantly lower in Group B (p < 0.001). The mean values of the quantity of tramadol use at the 6th, 12th, and 24th hours were found to be statistically significantly lower in Group B (p < 0.001). There was no statistically significant difference in the rate of side effects (p = 0.309) and RSS (p = 0.505) outcomes between the groups. ConclusionsAs a result of this study, we think that posterior QLB administered for pain palliation after laparoscopic cholecystectomy operation is an effective analgesia technique.

Ultrasound-Guided Combined Interscalene-Cervical Plexus Block for Surgical Anesthesia in Clavicular Fractures: A Retrospective Observational Study.

Objective We aim to report our experiences regarding the implementation of the ultrasound-guided combined interscalene-cervical plexus block (CISCB) technique as a sole anesthesia method in clavicular fracture repair surgery. Materials and Methods Charts of patients, who underwent clavicular fracture surgery through this technique, were reviewed retrospectively. We used an in-plane ultrasound-guided single-insertion, double-injection combined interscalene-cervical plexus block technique. During the performance of each block, the block areas were visualized by using a linear transducer, and the needles were advanced by using the in-plane technique. Block success and complication rates were evaluated. Results and Discussion 12 patients underwent clavicular fracture surgery. Surgical regional anesthesia was achieved in 100% of blocks. None of the patients necessitated conversion to general anesthesia during surgery. There were no occurrences of acute complications. Conclusions The ultrasound-guided combined interscalene-cervical plexus block was a successful and effective regional anesthesia method in clavicular fracture repair. Prospective comparative studies would report the superiority of the regional technique over general anesthesia.

Spinal anesthesia is safe in laparoscopic total extraperitoneal inguinal hernia repair. A retrospective clinical trial.

IntroductionLaparoscopic total extraperitoneal (TEP) inguinal hernia repair is an effective and safe method for the treatment of inguinal hernia. There are very few studies on regional anesthesia methods in TEP surgery.AimTo compare TEP inguinal hernia repair performed when the patient was treated under spinal anesthesia (SA) with that performed under general anesthesia (GA).Material and methodsAll total of 80 patients were studied between December 2015 and March 2017. Hyperbaric bupivacaine and fentanyl were used for SA, to achieve a sensorial level of T3. Propofol, sevoflurane, rocuronium, fentanyl, and tracheal intubation were used for GA. Intraoperative events related to SA, surgical times, intra- and postoperative complications, and pain scores were recorded.ResultsThe mean operative time in the SA TEP group was 70.2 ±6.7 min, which was significantly longer than the mean operative time in the GA TEP group of 67.2 ±6.2 min (p < 0.038). The mean pain scores in the SA TEP group were 0.23 ±0.42 at the first hour, 1.83 ±0.64 at 6 h and 1.28 ±0.45 at 24 h. These scores were significantly lower than the corresponding scores of 5.18 ±0.84 (p < 0.001), 2.50 ±0.55 (p < 0.001) and 1.58 ±0.55 in the GA TEP group. Generally, patients were more satisfied with SA than GA (p < 0.004).ConclusionsSpinal anesthesia TEP is significantly less painful in the early postoperative period, leading to earlier ambulation than GA TEP. Additionally, SA TEP results in significantly less need for analgesics and better patient satisfaction results. SA TEP seems to be a better alternative than the existing GA TEP.

КРИТЕРИИ ОЦЕНКИ ЭФФЕКТИВНОСТИ ВЫСОКОЙ СПИНАЛЬНОЙ АНЕСТЕЗИИ ПРИ ОПЕРАЦИЯХ НА ВЕРХНЕМ ЭТАЖЕ БРЮШНОЙ ПОЛОСТИ

In recent years, the frequency of application of regional anesthesia methods, and especially in economically developed countries, has progressively increased. This paper presents the experience of high spinal anesthesia during operations on the upper part of the abdominal cavity in 112 patients. We have developed and proposed a method of simultaneous high spinal anesthesia, with the development of high neuromuscular block to the level of the first and second thoracic vertebrae. By its simplicity and technique, as well as by maintenance high spinal anesthesia is close to epidural analgesia, but unlike that it provides adequate, long-lasting and high level of pain relief of the abdominal organs. Compared to traditional methods of pain relief high spinal anesthesia reduces the risk of thromboembolic complications, decreases the amount of blood loss, reduces risk of developing complications from respiratory and cardiovascular systems, reduces the duration of postoperative paresis of the intestine. The use of high spinal anesthesia during operations on the upper part of the abdominal cavity is the method of choice. This type of anesthesia has advantages over other types of pain relief, and is better tolerated by patients. The proposed technique of regional anesthesia - high spinal anesthesia - has broad prospects for use in clinical practice.

Surgical stress response following hip arthroplasty regarding choice of anesthesia and postoperative analgesia

Background/Aim. Significant surgical stress response consisting of hormonal, metabolic and inflammatory changes can be initiated by the hip replacement surgery. Appropriate choice of anesthesia and postoperative analgesia should provide diminution of surgical stress response and may reduce number of perioperative complications. Surgical stress response after peripheral nerve blocks has not been studied extensively in patients who underwent hip replacement. The aim of the study was to investigate whether continuous lumbar plexus block can significantly reduce surgical stress response in comparison to other types of postoperative analgesia – continuous epidural analgesia and intravenous patient controlled analgesia (PCA) with morphine. Methods. Prospective study included 60 patients, scheduled for total hip arthroplasty. The patients were randomized into 4 groups: group CNB (central nerve block - epidural), group PNB (Peripheral nerve block - lumbar plexus block), SAM (Spinal anesthesia- PCA (anesthesia) morphine) and GAM (General anesthesia + PCA with Morphine). Serum levels of cortisol, thyroid hormones (T3, T4) and thyroid stimulating hormone (TSH), insulin, glucose and C-reactive protein (CRP) were measured in all groups – preoperatively, as well as 4 h, 12 h and 24 h after surgery. Results. The study showed that average serum cortisol levels were significantly lower 4 h after the operation in the groups where methods of regional anesthesia were performed intraoperatively (SAM, CNB, PNB); (F = 19.867; p < 0.01). Groups with postoperative continuous catheter analgesia (CNB, PNB) had significantly lower serum cortisol levels 12 h after the operation (F = 8.050; p < 0.01). The highest serum insulin levels were detected 4 h postoperatively in the CNB and PNB group, while the lowest were in the GAM group (F = 5.811; p < 0.05). Twelve hours after the operation, the lowest values of insulin were measured in the SAM group (F = 5.052; p < 0.05), while 24 h postoperatively, the lowest values were found in the SAM and GAM group (F = 6.394; p < 0.05). T3, T4 and TSH levels showed slight reduction in comparison to preoperative values without statistical significance. Blood glucose levels were significantly different among the groups 4 h after surgery with the highest values recorded in the GAM group and the lowest ones in the SAM group (F = 10.084; p < 0.01). On the other hand, 12 h after the operation significant rise in blood glucose levels was detected in the SAM group (F = 7.186; p < 0.01) Levels of CRP increased remarkably 12 h and 24 h after the surgery, but without significant difference among the groups. Conclusion. Administration of postoperative analgesia using continuous lumbar plexus block following hip arthroplasty reduces significantly stress response in comparison to postoperative PCA with morphine and has comparable effects on hormone release to epidural analgesia. Spinal anesthesia provides the best diminution of surgical stress response in the early postoperative period in comparison with other types of intraoperative analgesia.

Continuous spinal anesthesia for elderly patients with cardiomyopathy undergoing lower abdominal surgeries

BackgroundAnesthetic management, of patients with cardiomyopathy with reduced systolic function, is challenging and may be associated with high mortality. Continuous epidural anesthesia (CEA) is generally accepted as the routine method of regional anesthesia for vascular surgery of the lower limb.Continuous spinal anesthesia (CSA) has been reported to be more rapid in action, with good sensory and motor block, fewer hemodynamic disturbance and side effects when compared to continuous epidural anesthesia (CEA), and single dose spinal anesthesia (SDSA).Patients and methodsForty adult patients with depressed systolic function (EF 45% or less) scheduled for lower abdominal surgeries were subjected to our study. Under full aseptic precautions subarachnoid space was accessed in the setting position by an epidural needle at L3–4 and 2 ml of hyperbaric bupivacaine (10 mg) was injected into subarachnoid space, then an epidural catheter was inserted in the subarachnoid space for 3 cm. Anesthesia was maintained by Top up doses of plain bupivacaine 0.5% 1.2 ml.ResultThere were no differences in demographic characteristics of patients, procedure’s duration, and ASA physical status classification. There were no significant changes in hemodynamics throughout the procedure. Hypotension occurred in 5% of patients, bradycardia occurred in 10% of patients and arrhythmia occurred in 2.5% of patients. There were no postoperative ECG changes and postoperative Troponin was negative. There was no postoperative Neurological deficit or Post dural puncture headache.ConclusionWe can conclude that, CSA was effective and safe technique for patients with cardiomyopathy undergoing lower abdominal surgeries.

Lumbar Disc Surgery with Epidural Anesthesia: Review of 700 Cases.

Lumbar disc surgery can be performed under general anesthesia or regional anesthesia methods. There are long-standing discussions between neurosurgeons, orthopedic surgeons and anesthesiologists concerning the use of epidural anesthesia in lumbar surgery. The results of this study's 700 lumbar disc surgery cases operated with epidural anesthesia in our clinic between September 2006 and December 2011 will contribute to these discussions. This study included 700 patients underwent lumbar disc surgery with epidural anesthesia, which consisted of 388 males (55%) and 312 females (45%). Forty-two of these cases had recurrence disc herniation and only 11 of 42 cases were operated in our department. Eleven of 700 cases had dural injury and were repaired intraoperatively by primary sutures and tissue sealants. Infection of the incision site developed in six patients, who healed with appropriate antibiotic treatment with no problems. In addition to those 700 cases, 22 patients received general anesthesia in which we started with epidural anesthesia. Microdiscectomies were performed in 578 of 700 cases, and open surgery in 122 cases. This study showed that epidural anesthesia seems more advantageous for some patients since it does not have some of the risks that general anesthesia bears.

REGIONAL ANESTHESIA CONTINUOUS BRACHIAL PLEXUS BLOCK WITH ULTRASONOGRAPHY GUIDANCE

Background: Regional anesthesia has an anti-inflammatory effect that blockade the C-fiber hence reduced cytokine production and blocked the activity of the sympathetic nerve fibers. Postoperative pain caused primarily by tissue inflammation and activity of the C-fibers in the manner of reduced the production of cytokines, regional anesthesia may limit the inflammatory response after surgery and severity of postoperative pain. Methods: This study is a clinical experimental study with randomized pre and post test control group design. A total of 24 samples were recruited in this study divided into two groups each consisting of 12 samples. The first group was given regional anesthesia method of continuous brachial plexus block with ultrasound guidance and the second group with general anesthesia method. T-test or Mann Whitney continued multivariate linear regression analysis was performed to analyze the differences in treatment and not because of differences in the initial values with significance level of p<0.05. Results: This study reports that the mean decreased levels of IL-6 postoperatively in 1stgroup is 29.8 lower than in 2ndgroup and it is statistically significant p< 0.05. There was an increase of IL-10 mean levels from preoperative to postoperatively with significance level of p<0.05 in both groups. Declined in the mean levels of PAF postoperatively in 1st group 1.3 lower than 2nd group and it was statistically significant p<0.05. The declined of postoperative VAS in 1st group is 3.1 lower than 2nd group and it is statistically significant p< 0.05, and it also contained the pure effect of PAF levels against value of VAS that any increased 1ng/ml levels of PAF then an increase in the value of 0.18 cm VAS and this was statistically significant p<0.05. Selection of this anesthesia technique in orthopedic antebrachii surgery provides better inflammatory response and improved clinical outcomes.

Perioperative management of Parkinson's disease

Several studies have demonstrated the serious impact of surgeries on patients with Parkinson's disease (PD). In addition, PD is a risk factor for postoperative complications and prolonged hospital stays. Discontinuation of anti-Parkinsonian drugs due to surgery causes an exacerbation of Parkinsonism and sometimes Parkinsonism-hyperpyrexia syndrome (PHS). Therefore, surgeries involving patients with PD require careful perioperative management. During the preoperative period, cooperation among neurologists, surgeons, and anesthesiologists is imperative. Administration of the same oral anti-Parkinsonian drug regimen that was prescribed during home care is important. Methods of both general and regional anesthesia should be chosen based on general health status and symptoms of Parkinsonism and agents should be selected with due consideration of their possible interaction with anti-Parkinsonian drugs. In patients with PD showing autonomic disturbance, changes in blood pressure and body temperature should be monitored. During the postoperative phase, postoperative pain, aspiration pneumonia, ileus, and psychotic symptoms should be managed, taking into consideration the interactions between anti-Parkinsonian drugs and therapeutic agents. Currently, new anti-Parkinsonian drugs, such as rotigotine and apomorphine are available for patients with PD requiring parenteral treatment. It is important that medical experts share awareness about perioperative problems and their management in patients with PD.

State of the art and perspectives in non-intubated thoracic surgery.

Non-intubated thoracic surgery (NITS) entails procedures performed through regional anesthesia methods in awake or mildly sedated, spontaneously ventilating patients. The rationale is the avoidance of side-effects of intubated general anesthesia and maintenance of more physiologic muscular, neurologic, and cardiopulmonary status in order to reduce the procedure-related traumas, fasten recovery and optimize outcomes. Preliminary reports including some randomized studies have suggested optimal feasibility of several surgical procedures including management of pleural effusion, of spontaneous pneumothorax, wedge resection of undetermined pulmonary nodules, lung volume reduction surgery (LVRS) for severe emphysema and anatomical lung resection for lung cancer treatment. So far more widely accepted indications for NITS include easy-to-perform procedures as well as surgical management of patients with significant risks for intubated general anesthesia. On the other hand, the adoption of NITS for major procedures such as anatomic lung resections and LVRS is still controversial. Further detailed investigation including further randomized trials is expected to help define indications, advantages and limitations of NITS, which might represent excellent ultra-minimally invasive strategies of treatment to be reliably offered in the near future to an increasing number of patients.

Single dose spinal analgesia: Is it a good alternative to epidural analgesia in controlling labour pain?

ObjectivesRegional anaesthesia is considered the optimal technique for obstetric patients; nevertheless, the optimal method of regional anaesthesia for delivery remains to be determined. In our study we investigate the safety, efficacy and cost benefits of single-dose spinal analgesia in comparison with epidural analgesia during labour.Study designIn our study women in advanced labour were randomly allocated into two equal groups using a computer-generated randomization table, one group (spinal group = S group) were given 3.75 mg hyperbaric bupivacaine +25 μg fentanyl with 0.75 ml saline, the other group (Epidural group = E group) were given 4 ml bupivacaine with 4 ml saline and 1 ml (50 μg) fentanyl pain intensity was recorded by the parturient on a visual analogue scale. The quality of pain relief was also rated with a verbal score directly after delivery. Side effects, such as hypotension, Pruritus, sedation, nausea and motor block were noted. Obstetric parameters were followed and recorded, Apgar score were noted, and all the results were compared in the two groups.ResultsOnset of sensory block (detected by pin-prick test) was early (4.4 ± 1.5 min vs 12.5 ± 2.3 min, p < 0.001) and duration of sensory block was longer (120.4 ± 15.6 vs 103.2 ± 18.3 min, p < 0.001) in S group compared to E group, time to reach maximum dermatome level of sensory block (T10) was shorter in S than E group (8.3 ± 2.4 min vs 22.4 ± 5.7 min, p < 0.001), two segment regression occur late in S group compared to E group(75.6 ± 12.5 min vs 66.3 ± 9.4 min, p < 0.001). Visual analogue scores after 5, 15, 30, 60, 90, 120 and 150 min were lower in S group compared to E group, all the previous result is statically significant (p < 0.001). 88% of the parturients in S group vs 60% in E group scored the analgesic quality as excellent, the mean duration of analgesia (Mean ± SD) was longer in S group compared to E group. 8% of parturients in S group vs 14% of parturients in E group had hypotension. Motor block, sedation and nausea were 2–6% in both groups. Pruritus was seen in 60% in E group vs 25% in spinal one. No caesarean section was performed. Vacuum extraction was done in 15% vs 25% among S group and E group respectively. Oxytocin augmentation was needed in 48% vs 62% of the parturients among S group and E group respectively. Faetal heart rate disturbances following the spinal block were seen in 2 cases. Apgar score were high and no neonate had Apgar score <7 in both group. The overall cost was lower in S group compared to E group.ConclusionsBased on the results of our study we concluded that single dose spinal analgesia is a good alternative to epidural analgesia in controlling labour pain i.e. spinal compared to epidural is more easy performed, faster, less expensive, and provide effective analgesia.

Paravertebral blockade – Underrated method of regional anesthesia

Abstract Introduction Paravertebral blockade (PVB) is an old, frequently forgotten and underrated method of regional anesthesia, with relatively few possible complications and an easy technique to perform. Aim The aim is to describe anatomy of paravertebral space (PVS), present history of PVB, its mechanism of action, indications and contraindications, techniques, with particular emphasis on identifying the PVS with the use of ultrasound and advantages of its use in various clinical situations. Material and methods This work was based on the available literature and the experience of the authors. Results and discussion Mechanism of action of PVB that includes somatic and sympathetic nerve blocks at a specific level, and requirements for its effectiveness and safety that rely on identification of anatomical landmarks, pressure differences, use of nerve stimulator, performed during thoracic surgery procedures, under visual control and ultrasound-guided, as a safe and accurate method with relatively the lowest number of complications, determines the use of this technique in the treatment of postoperative pain in certain clinical situations, as well as in breast surgery and hernia repair. Complications and adverse effects, including very rare, such as Harlequin syndrome, compared with complications of epidural anesthesia, confirm usefulness of this method of regional anesthesia. Conclusions (1) PVB is a technically simple and relatively easy to learn technique of regional anesthesia, with low incidence of complications and contraindications. (2) It may be successfully used in breast surgery, hernia repair, as well as in surgical debridement and revision of small, superficial thoracic wounds, in case of herpes zoster, rib fractures, bruised liver and several other clinical situations. (3) Its principal use is management of postoperative pain in thoracic surgery, where it should be used more often as an alternative to epidural anesthesia which entails multiple complications and is considered the gold standard in certain abdominal or breast surgeries. (4) The best quality of PVB is provided with placement of the catheter under direct vision during thoracotomy.

Anaesthesia Techniques for Caesarean Operations: Retrospective Analysis of Last Decade

The technique of anaesthesia in caesarean sections is selected according to the patient's clinical presentation, experience of the anaesthesist and the patient's wishes. The purpose of this study was to evaluate the anaesthesia methods employed in our clinic in the last decade (2003-2012). Records of caesarean operations performed between 2003-2012 in the Anaesthesia department of Atatürk University Medical Faculty and stored in the hospital computer system were examined. The annual distribution of methods of anaesthesia in operations was analysed. During 2003-2012, 9049 caesarean operations were performed in our clinic. General anaesthesia was used in 45% of operations and regional anaesthesia in 54%. Whereas the rate of regional anaesthesia in 2003 was 34%, this increased to 69% in 2012. The most commonly used method of regional anaesthesia was spinal anaesthesia (34%) in 2003, and spinal anaesthesia (41%) and combined spinal-epidural anaesthesia (27%) in 2012. The most commonly used anaesthesia technique for caesarean operations in our clinic between 2003-2012 was spinal anaesthesia. The most widely used regional anaesthetic method in our clinic was spinal anaesthesia. A significant increase in the use of the combined spinal-epidural anaesthetic technique occurred in the last two years of the study period.

Alternative Methods of Anesthesia for the Repair of Open-Globe Injuries: Ophthalmologists’ Perspective

Open-globe injury which is defined as a a full thickness defect in the cornea and/or sclera is a common cause of visual loss. It is an ocular emergency and surgical repair should be performed as early as possible in order to restore the structural and functional integrity of the eye. Anesthesia plays a vital role for the success of the surgery for open-globe injuries. Numerous issues must be considered for the selection of anesthesia technique. General anesthesia is the gold standard method of anesthesia and regional anesthesia has conventionally been considered to be contraindicated in patients with open-globe injuries. However, local anaesthetic techniques such as sub-tenon, topical, intracamaral, peribulbar and retrobulbar anesthesia are started to become popular for the surgery of openglobe injuries for selected patients. The aim of the present review is to describe and discuss the ophthalmologists’ perspective related to the alternative methods of anesthesia for the repair of open-globe injuries.

The comparison of levobupivacaine in continuous or single dose spinal anesthesia for transurethral resection of prostate surgery

BackgroundThe aim of the study is to compare the efficacy of levobupivacaine induced continuous spinal anesthesia (CSA) versus single dose spinal anesthesia (SDSA) in patients who are planned to undergo transurethral prostate resection. MethodsSixty years or older, ASA I–II or III, 50 patients were included in the study. 12.5mg 0.5% levobupivacaine were administered intrathecally in SDSA group. In CSA group, initially 2mL of 0.25% levobupivacaine were administered through spinal catheter. In order to achieve sensory block level at T10 dermatome, additional 1mL of 0.25% levobupivacaine were administered through the catheter in every 10min. Hemodynamic parameters and block characteristics were recorded. Preoperative and postoperative blood samples of the patients were drawn to determine plasma cortisone and plasma epinephrine levels. ResultsCSA technique provided better hemodynamic stability compared to SDSA technique particularly 90min after intrathecal administration. The rise in sensory block level was rapid and the time to reach surgical anesthesia was shorter in SDSA group. Motor block developed faster in SDSA group. In CSA group, similar anesthesia level was achieved by using lower levobupivacaine dose and which was related to faster recovery. Although, both techniques were effective in preventing surgical stress respond, postoperative cortisone levels were suppressed more in SDSA group. ConclusionCSA technique with 0.25% levobupivacaine can be used as a regional anesthesia method for elderly patients planned to have TUR-P operation.

Sezeryan operasyonlarında rejyonel anestezi komplikasyonlarının değerlendirilmesi

Aim: We aimed to evaluate the complications of regional anesthesia techniques in caesarean operations. Material and Methods: Patients who underwent caesarean operation managed with regional anesthesia between January 2010 and January 2011 were included in this study. Demographic data, regional anesthesia method, position during approach, number of attempts, patient feelings during local anesthetic injection, dermatomal level, and complications were recorded. The results were analyzed and presented for each regional anesthesia technique. Results: A total of 425 were performed in the study period. Totally 269 caesarean sections under regional anesthesia were included in this study. Caesarean sections were performed at a rate of 1.5 % in patients below 20 years of age, 91.1 % in 20-34 years of age and 7.4 % in over the age of 35 years. Specifically, spinal anesthesia, epidural anesthesia, and combined spinal-epidural anesthesia were applied to 236, 9, and 24 patients, respectively. Spinal anesthesia was the most frequently applied regional anesthesia technique in this study. The most common sensation during local anesthetic injection was feeling of warmth at a rate of 54.6 %. Post dural puncture headache was observed at a rate of 6.3 % (n=15), and backpain 8.8 % (n=21) in the spinal anesthesia group. Neurological complications occurred in 2 patients. Discussion: The present study revealed that the complication rates of regional anesthesia techniques in our university had consistent results with the current literatures.

Retrograde Laryngeal Block: A New Technique for Awake Intubation Compared With Conventional Regional Airway Block

Introduction: Retrograde laryngeal block is a new technique that blocks complete supraglottic and glottic area by introducing cath- eter retrograde from trachea to these regions. Methods and Materials: This is a clinical trial conducted on two groups each containing 15 patients, who were candidate for awake intubation. The first group (A) underwent conventional method of airway block, by multiple injections of local anesthetic. The second group (B) underwent retrograde laryngeal block as a new method of regional airway anesthesia. In this method the catheter is inserted from cricothyriod membrane through a flexible guide wire, and then local anesthetic drug will be administered by direct vi - sion of tip of the catheter by employing glide scope. The catheter has three separate orifices; each will stay on distinct area of either supraglottic and glottis area which can be adjusted at any level through this area that is considered to be blocked. Result: Both groups had hemodynamic stability during performing block. In group A we had two incidences of laryngospasm due to pain of multiple needle insertion; in group B we had no incidence of laryngospasm (P=0.1). In group A we had 5 patients with partial airway block which needed further intervention during awake intubation but in group B all the cases had complete and perfect airway block (P=0.001). Patients comfort was better in group B with single injection than group A with multiple injections (P=0.005). Discusion: The advantage of this method is single injection and high quality of block performance in comparison with the other technique. It can be conducted for the patients with neck pathologies that make conventional airway block impossible. Conclussion: This method can be applied in patients with neck pathologies that make conventional block impossible.

Comparative evaluation of two different volumes of lidocaine in intravenous regional anesthesia

BackgroundThis study was conducted to compare low concentration-high volume intravenous regional anesthesia (IVRA) method with local anesthetic method in upper extremity surgery in terms of efficiency and adverse effects.Material/MethodsThirty-nine patients were divided into 2 groups; the first group received a 2% concentration of 12–15 mL lidocaine (Group 1) and the second group received a 0.5% concentration of 30–50 mL lidocaine (Group 2). Intraoperative hemodynamic data of patients (systolic blood pressure, diastolic blood pressure, mean blood pressure, heart rate, and peripheral oxygen saturation- SpO2) was recorded before and after anesthesia at 1, 5, 10, 15, 20, and 40 minutes.ResultsThe intergroup and intragroup comparisons did not reveal any significant differences in hemodynamic data. The onset time of sensorial block was shorter and the regression time of sensorial block was longer in Group 1 than Group 2. Group 1 had shorter onset time of motor block and longer regression time of motor block than Group 2. There were no significant differences between the study groups in terms of the time of tourniquet and postoperative analgesia time.ConclusionsIVRA technique applied with 2% concentration and volume of 12–15 mL lidocaine may be suggested as a safe option.