Postoperative 24th Hour Research Articles

Rhomboid Intercostal Block for Analgesia of Multiple Rib Fractures in an Infant

Rhomboid intercostal block (RIB) is a novel plane block, which is thought to provide analgesia for both the anterior and the posterior hemithorax. Herein, we represent the successful usage of ultrasound-guided RIB on an infant patient to provide analgesia for multiple rib fractures and insertion of a chest tube. A 10-month-old, 8 kg, male infant was scheduled for insertion of a chest tube. The patient had right sided pneumothorax and multiple rib fractures from T4 to T8 after a car crush. Following induction of anaesthesia, he was placed in lateral decubitis position and RIB was performed with 8mL 0.125% bupivacaine. A paediatric epidural catheter was placed into the interfacial plane for post-operative intermittent local anaesthetic injection as a part of multimodal analgesia with administration of intravenous paracetamol 60 mg. The postoperative pain assessment was conducted with FLACC scale at the post-operative 10th minute, 30th minute, 1st, 2nd, 6th, 12th and 24th hours, and the Face, Legs, Activity, Cry, Consolability scale score was 2 at all time-points. Ultrasound-guided RIB provided effective analgesia for insertion of a chest tube and attenuation of pain due to multiple rib-fractures in our infant patient.

The effect of preemptive ketamine on postoperative analgesia in lower extremity surgery

Background/Aim: Preventing sensitization by an analgesic administered before a painful stimulus is the basis for preemptive analgesia. Preemptive use of pain medication prior to the application of painful stimuli results in better-controlled pain. This study aimed to compare the effects of preoperatively administered low-dose ketamine and lornoxicam on postoperative analgesia, their side effects and patient satisfaction in orthopedic operations on the lower extremities. Methods: Seventy-eight patients aged 18-70 years who were admitted for lower extremity surgery under general anesthesia were enrolled in this prospective, randomized, and double-blind study. The patients were randomly allocated to one of the three following groups: Four milliliters of physiological saline were administered to the patients in Group P, 0.15 mg kg-1 ketamine was given to the patients in Group K and 8 mg lornoxicam was administered to those in Group L, all in 4 ml of volume, intravenously, 15 minutes before anesthesia induction. Postoperative pain was evaluated at rest and during movement at 0th, 2nd, 4th, 6th, 8th, 12th, 20th and 24th postoperative hours with the Visual Analogue Scale (VAS) and the Verbal Pain Scale (VPS). Total fentanyl consumption, additional meperidine usage, side effects and patient satisfaction were recorded at these times. Results: The mean area under the VAS and VPS at rest and movement-time curves were lower in Group K compared to the other groups. Group P and Group L were comparable in terms of the area under the VAS at rest and movement-time curves, but the mean area under the VPS at rest and movement-time curves were higher in Group P compared to Group L. Total fentanyl consumption was lower in Group K than the other two groups (P=0.001). Conclusion: Low-dose ketamine administered preoperatively to patients for lower extremity surgery decreased postoperative pain scores more than lornoxicam or placebo.

Comparison of del Nido Cardioplegia vs. blood cardioplegia in adult aortic surgery: Is the single-dose cardioplegia technique really advantageous?

Background/objective: The aim of the present study was to compare the operative and early postoperative results of the use of del Nido Cardioplegia solution (dNCS) with traditional blood cardioplegia (BC) in adult aortic surgery. MethodsA retrospective single-center study was performed on 118 patients who underwent aortic surgery with cardiopulmonary bypass (CPB) between January 2016 and June 2020. Patients were divided in to two groups according to the type of cardioplegia solution used. Cardiac arrest was achieved in Group 1 (n = 65) with traditional BC and in Group 2 (n = 53) with dNCS. Operative and postoperative outcomes of the patients were compared between the two groups. ResultsPatient demographic characteristics were similar between the two groups. dNCS group showed significantly lower aortic cross-clamp (ACC) time (73.3 vs. 87.5 min, P = 0.001), cardioplegia volume (1323.9 ± 368.5 vs. 2773.8 ± 453.8 ml, P< 0.001), defibrillation rate (44.4%vs. 69.2%, P = 0.006), drainage amount (412 ± 73.2 vs. 446.9 ± 95.1 ml, P = 0.026) and inotropic support need (37% vs. 55.3%, P = 0.046). Also dNCS group had significantly lower high sensitive troponin I (hsTnI) levels at 6th (203.5 ± 68.6 vs. 275.7 ± 76.2 ng/L, P< 0.001) and 24th (253.1 ± 101 vs. 293.4 ± 80.1 ng/L, P = 0.017) postoperative hours. And dNCS group showed significantly higher hematocrit levels at 6th (25.1 ± 3.2 vs. 22.5 ± 2.5%, P< 0.001) and 24th (25.8 ± 2.7 vs. 24.6 ± 2.8%, P = 0.024) postoperative hours. Times of intensive care unit stay, durations of intuabation and hospital stay times were similar in both groups. There was no significant difference in terms of postoperative ejection fraction values (P = 0.714). ConclusionCompared with conventional BC, dNCS provided significantly shorter ACC times, reduced the need for intraoperative defibrillation, lowered postoperative hsTnI levels with comparable early clinical outcomes for adult patients undergoing aortic surgery. dNCS is a safe and efficient alternative to the traditional BC solution in adult aortic cardiac surgery.

Comparison of Postoperative Cognitive Decline Using the Mini-Mental State Examination and Montreal Cognitive Assessment After Minor Elective Surgery in Elderly.

Introduction and aimPostoperative cognitive dysfunction (POCD) is an important complication associated with increased morbidity, mortality, and reduced quality of life. Generally, studies have focused on major surgery so there is little evidence of the incidence of cognitive dysfunction in minor surgery. We aimed to compare the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) in terms of detecting cognitive decline in elderly patients after elective inguinal herniorrhaphy procedure with general or spinal anesthesia.Material and methodsThis observational study was conducted from June 2014 to March 2015 at Ankara Numune Education and Research Hospital. The type of anesthesia was determined according to the anesthesiologist’s preference who is blind to the study. Patients were grouped according to anesthesia received: general or spinal anesthesia. The MMSE and MoCA were evaluated presurgery and 24 hours after the operation.ResultsThe postoperative (24th hour) MMSE scores of patients (26.23±2.77) were significantly lower than the preoperative scores (27.17±1.93) in only the general anesthesia group (p =0.003). The postoperative (24th hour) MoCA scores (22.87±3.88 for general and 23.13±4.08 for spinal anesthesia) were significantly lower than the preoperative scores (24.32±3.19 for general and 24.35±2.84 for spinal anesthesia) in both the general and spinal anesthesia groups (p =0.000 and 0.019, respectively). The incidence of postoperative cognitive dysfunction was 32.9% using the MoCA and 15.2% using the MMSE (p=0,018).ConclusionEarly POCD is an important problem after elective minor surgeries, even with spinal anesthesia, in elderly patients. The MoCA is an alternative tool that can be more sensitive than the MMSE to identify cognitive decline in elderly patients undergoing minor surgeries under both general and spinal anesthesia.

Gynecological natural orifice transluminal endoscopic surgeries from an anesthesiologist’s perspective: A retrospective cohort study

Background/Aim: Natural orifice transluminal endoscopic surgical (NOTES) approach allows either transgastric or transvaginal access to the targeted organs by endoscopes without a skin incision. This study aimed to evaluate the intraoperative and postoperative outcomes of patients who underwent vaginally assisted NOTES (VaNOTES) for gynecological surgery. Methods: One hundred ten patients who underwent hysterectomy and/or bilateral salpingo-oophorectomy (BSO) under general anesthesia either with conventional laparoscopy (CL) or VaNOTES methods were examined. The data of the patients were obtained from the medical records retrospectively. Demographic data, perioperative hemodynamic data, Visual Analogue Scale (VAS) scores, and analgesic consumption at the 1st, 6th, and 24th postoperative hours were assessed. Results: Among all patients, the median duration of anesthesia, median operation time, and hospital stay were lower in the VaNOTES group compared to those in CL (P

Effect of peritonsillar prilocaine infiltration on post-tonsillectomy pain in pediatric population

Purpose: This study aims to evaluate the efficacy of peritonsillar prilocaine in post-tonsillectomy pain by using the Visual Analog Scale (VAS).&#x0D; Materials and Methods: A total of 40 pediatric patients were included in this study. There were 20 patients in the prilocaine group (Group 1) and 20 patients in the control group (Group 2). In Group 1, peritonsillar prilocaine infiltration was performed. In Group 2, peritonsillar saline infiltration was performed. VAS scores of at the postoperative 1st, 4th, 12th and 24th hours and on the 2nd, 3rd, 4th, 5th, 6th and 7th days were evaluated. In addition, the presence of nausea and vomiting and the number of additional doses of intravenous paracetamol administered in the first 24 hours were evaluated.&#x0D; Results: When the groups were compared, a significant reduction in post-tonsillectomy pain was observed in the prilocaine group at the 1st, 4th and 12th hours compared to the control group. There was no significant difference between the two groups in other scores. There was no significant difference between the groups for nausea and vomiting and consumption of paracetamol values.&#x0D; Conclusion: Peritonsillar prilocaine infiltration was effective in post-tonsillectomy pain at the 1st, 4th and 12th hours postoperatively. Thus, peritonsillar prilocaine infiltration can be used in post-tonsillectomy pain because it is fast and effective.

The effects of pre-emptive intravenous ibuprofen on the thiol/disulfide homeostasis and C-reactive protein level as the markers of oxidative stress and inflammation during gynecologic laparoscopy: A randomised clinical trial.

In this study, we aimed to investigate the anti-inflammatory and antioxidant effects of intravenous ibuprofen by using the C-reactive protein level and thiol/disulfide homeostasis as the oxidative stress marker. This study was conducted on 70 patients aged between 30 and 65 who were scheduled for elective laparoscopic hysterectomy. The patients were divided into two groups to receive either pre-emptive 800mg of intravenous ibuprofen plus 1000mg of intravenous paracetamol (Group IP) or only 1000mg of intravenous paracetamol as a control group (Group P). The blood samples for thiol/disulfide homeostasis were collected as follows: before induction of anesthesia (T0), before pneumoperitoneum (T1), following postdeflation and discontinuation of anesthesia (T2), and postoperative 24th hour (T3). Simultaneous blood samples for C-reactive protein (CRP) were also collected. The pre- and postoperative urea, creatinine, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) levels were measured. A total of 69 patients were included in the study. The patient's characteristics and intraoperative variables were comparable between groups (P>.05). The number of patients requiring rescue analgesia, the total amount of analgesic used, Visual Analog Scale (VAS) scores, and postoperative side effects were significantly lower in Group IP (P<.001). The decrease in native and total thiol levels at T1, T2, and T3 measurement points was significant in Group IP (P<.001). In both groups, the comparison to baseline values demonstrated no significant changes in terms of disulfide level (P>.05). The simultaneous CRP levels indicated a significant increase at the postoperative 24hour in both groups (P<.001). The difference between groups was insignificant (P>.05). There was a significant increase in urea and creatinine levels in patients of Group IP (P<.05). The pre-emptive administration of ibuprofen provided effective pain control after gynecologic laparoscopy. However, ibuprofen changed the thiol/disulfide homeostasis in favor of oxidation and had no beneficial effect in surgically induced oxidative stress.

The Effect of Intraoperative Body Temperature on Postoperative Nausea and Vomiting in Pediatric Patients

PurposePediatric patients are at greater risk for both perioperative hypothermia and postoperative nausea and vomiting (PONV). The primary aim of this study was to investigate whether there is a relationship between intraoperative body temperature and PONV in children undergoing anesthesia. The secondary aim was to investigate the relationship between PONV and intraoperative fentanyl use, age and duration of operation. DesignA prospective cohort study MethodsThe study included 80 children who were undergoing lower abdominal surgery. Body temperature was monitored after routine preoperative preparation and standard induction. Analgesic and antiemetic requirements and the presence of nausea and vomiting were assessed postoperatively on the 30th minute and the 6th, 12th and 24th hour. FindingsThe children with or without PONV were compared. At the postoperative 6th hour, the incidence of nausea was statistically significant in the children with a mean body temperature below 36°C (P = 0.044; P < 0.05). The mean duration of the surgery was statistically significant longer in the children with PONV (P = 0.001; P = 0.004; P <0.05). Mean body temperature was not statistically significant when comparing children with and without vomiting(P > 0.05). ConclusionWhile a body temperature below 36°C increases the incidence of postoperative nausea, it does not cause an increase in the incidence of vomiting. A long operation time in pediatric patients causes an increase in the incidence of PONV. Although not statistically significant, PONV is encountered more than twice as much in patients receiving intraoperative fentanyl administration.

COMPARISON OF BUPIVACAINE–FENTANYL AND BUPIVACAINE-ALFENTANIL USED INTRATHECALLY IN LAPAROSCOPIC APPENDECTOMY SURGERY

OBJECTIVE: Acute appendicitis, which is the most common cause of acute abdominal pain, is an acute inflammation of appendix vermiformis. Spinal anesthesia is one of the most used regional anesthesia technique nowadays, and it is the temporary interruption of nerve conduction by local anesthetic solution injected into the cerebrospinal fluid. In this study we created multimodal analgesia by giving various opioid agent (fentanyl and alfentanil) intrathecally with local anesthetic. The aim of this study is to compare bupivacaine-fentanyl and bupivacaine-alfentanil that are used intrathecally to create motor and sensory block.MATERIAL AND METHODS: This study was planned as a clinical study using the random sampling method in a tertiary care hospital. 50 voluntary patients who were diagnosed with appendicitis by laboratory tests and clinical diagnosis methods in the general surgery clinic were included in the study. The patients were randomly assigned into two group, Group I (10 mg hyperbaric bupivacaine (2cc) and 25 mcg fentanyl (0.5 cc)) and Group II (10 mg hyperbaric bupivacaine (2 cc) and 250 mcg alfentanil (0.5 cc)). The patients were randomly assigned into two group, Group I and Group II. Before the operation, each patient was informed about the use of the patient-controlled analgesia system and visual pain scale (VPS) for pain scoring. It was compared the postoperative analgesic needs of patients who underwent multimodal spinal anesthesia with different opiates. Sensorial block levels were measured by pinprick test every 2 minutes in the first 10 minutes and every 5 minutes in later periods. It was recorded mean arterial pressure at the beginning of the surgery at 0th minute and at 5-10-30th minutes during the surgery. In addition, mean arterial pressure and heart rate were recorded at 1-2-6-12-24th hours postoperatively.RESULTS: Postoperative first analgesic requirement time of Group I was found to be late than Group II. Postoperative 6th, 12th and 24th hours visual pain scales were found to be significantly lower in Group I than Group II. But 2nd and 6th hours heart rates were found higher in Group I than Group II.CONCLUSIONS: It was shown that the duration of analgesia was longer and postoperative first analgesia requirements time were so late in patients who were given bupivacaine–fentanyl than the patients given bupivacaine–alfentanil

Negative pressure pulmonary edema due to endotracheal tube bite in a patient who could not be placed guedel oropharyngeal airway before extubation.

Background: Acute negative pressure pulmonary edema is a complication that usually occurs shortly after extubation in patients receiving general anesthesia. It may also occur due to the bite of the endotracheal tube prior extubation.Case presentation: A 52-year-old male patient was scheduled for ventriculoperitoneal shunt operation. General anesthesia was applied. Respiratory and hemodynamic variables were stable during surgery. At the end of the surgery, anesthetic drugs were discontinued, the lumen of the endotracheal tube and oropharynx were aspirated. When oropharyngeal airway was placed the patient bit and occluded his endotracheal tube, and began exerting breathing effort. Rapid desaturation was observed and pink foamy secretion came through the endotracheal tube. Bilateral diffuse crackles were present. A chest X-ray revealed bilateral pulmonary edema. The patient was transferred to the intensive care unit, sedation was applied and volume controlled positive pressure mechanical ventilation was started. The patient was extubated at the 12th postoperative hour and sent to the ward on the third postoperative day. Discussion: The extubation plan should be done well. Aspiration and extubation should be performed either under deep anesthesia or when the patient is fully awake. Oropharyngeal airway should be placed under adequate depth of anesthesia before extubation. Although oropharyngeal airway reduces the risk of biting of the endotracheal tube and subsequent development of negative pressure pulmonary edema, it may not prevent it completely. In negative pressure pulmonary edema treatment, invasive or non-invasive mechanical ventilation may be preferred depending on the severity of obstruction and degree of hypoxia. Early diagnosis and treatment of negative pressure pulmonary edema is life-saving.

Comparison of Surgical Outcomes of Total Laparoscopic Hysterectomy and vNOTES Hysterectomy for Undescended-Enlarged Uteri

Aim This study aimed to compare the surgical outcomes of laparoscopic hysterectomy (LH) and vaginally assisted natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy procedures in women with undescended-enlarged uteri. Materials and methods This cross-sectional study was conducted with 78 women who underwent LH (48 patients) or vNOTES hysterectomy (30 patients) for benign gynecological pathologies. The dimension of the uterus, operation time, intraoperative blood loss, the presence of peri-, postoperative complications, conversion to laparotomy, pre-, postoperative hemoglobin (Hb), and hematocrit (Hct) levels, postoperative hospital stay, total dose of postoperative analgesics, VAS scores at the postoperative 6th and 24th hours, and the final pathology reports were recorded. Results There was no significant difference between LH and vNOTES hysterectomy groups regarding age (47 vs. 47.5 years, p = 0.92), parity (2 vs. 2, p = 0.74), and BMI (30.8 vs. 28.2 kg/m2, p = 0.31). The patients in the vNOTES hysterectomy group had significantly shorter durations of surgery (45 vs. 160 min) and hospitalization (48 vs. 72 h) than the LH group (p < 0.001, p < 0.001, respectively). The 24th hour VAS score was lower (VAS score 2 vs. 3, p = 0.003) in favor of the vNOTES hysterectomy group. In matched group analysis, the 24th hour VAS score (2 vs. 3, p = 0.008), operation time (45 vs. 157, p < 0.001), and hospitalization (48 vs. 72, p < 0.001) were lower in the vNOTES hysterectomy group than the LH group. Conclusion vNOTES hysterectomy provides favorable outcomes compared to conventional LH considering the shorter operation time, hospitalization, and lower 24th h VAS score.

A Comparison of Pain and Operation Time in Children Undergoing a Tonsillectomy using Different Energy Doses of Bipolar Cautery

Objective: The aim of the study is to compare the operative time and degree of post-operative pain in children who underwent a tonsillectomy using different energy doses of bipolar cautery and to specify the most appropriate energy dose. Materials and Methods: Patients included in the study were allocated to three groups with 20 in each and each group underwent the operation with 20, 30 and 40 watt energy doses of bipolar cautery. Operative time was recorded for each patient. The Wong-Baker FACES pain rating Scale (WBS) was used in the post-operative period for each patient and the pain severity of the patients was evaluated at post-operative 30th min, 1st, 6th, 24th hours and 10th day. The operative times and pain severity of the patients were compared thereafter. Results: A significant difference was not detected between the groups in which 20, 30 and 40 watt bipolar cautery was used (p&gt;0.05). A significant difference was not detected between groups with regard to pain scores at post-operative 30th min, 1st, 6th, 24th hour and 10th day (p&gt;0.05). Conclusion: We have compared groups with regard to post-operative pain and operative time according to energy dose of bipolar cautery and detected no statistically significant difference in tonsillectomies conducted with different energy doses. Therefore we consider that energy dose should be as low as possible in tonsillectomies conducted with bipolar cautery.

To drain or not to drain: the association between residual intraperitoneal gas and post-laparoscopic shoulder pain for laparoscopic cholecystectomy

Residual intra-peritoneal gas may be associated with post-laparoscopic shoulder pain (PLSP), which is a frequently and disturbance compliant after surgery. Herein, we aimed to examine whether expiring residual gas via a surgical drain reduces the frequency and intensity of PLSP in the first day after laparoscopic cholecystectomy. 448 participants were enrolled in this prospective cohort study. The incidence and severity of PLSP after surgery were recorded. Of these, the cumulative incidence of PLSP in the drain group was lower particularly at the 12th postoperative hour (18.3% vs. 27.6%; P = 0.022), 24th postoperative hour (28.8% vs. 38.1%; P = 0.039), and throughout the first postoperative day (P = 0.035). The drain group had less severe PLSP (crude Odds ratio, 0.66; P = .036). After adjustment using inverse probability of treatment weighting, the drain group also had a significant lower PLSP incidence (adjusted hazard ratio = 0.61, P < 0.001), and less severe PLSP (adjusted odds ratio = 0.56, P < 0.001). In conclusion, the maneuver about passive force to expel residual gas, surgical drain use, contributes to reduce the incidence and severity of PLSP, suggesting that to minimize residual gas at the end of surgery is useful to attenuate PLSP.

The Comparison of Surgical Outcomes following Laparoscopic Hysterectomy and vNOTES Hysterectomy in Obese Patients

Aim This study aimed to compare the surgical outcomes of total laparoscopic hysterectomy (TLH) and vaginally assisted natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy procedures in obese patients. Materials and methods This cross-sectional study was conducted with 83 obese women (BMI > 30 kg/m2) who underwent TLH (35 patients) or vNOTES hysterectomy (48 patients) for benign gynecological indications. The duration of surgery, intra/postoperative complications, intra- and postoperative hemoglobin (Hb) and hematocrit (Hct) levels, hospital stay, Visual analogue scale (VAS) scores at the postoperative 6th and 24th hours of the patients were compared. Results There was no significant difference between TLH and vNOTES groups regarding age (49 vs. 52 years, p = 0.35), parity (2 vs. 3, p = 0.17), and uterine weight (290 vs. 230 g., p = 0.13) The median BMI was 31.6 kg/m2 (30–42.2 kg/m2) in the TLH group and 31.9 kg/m2 (30–54.6 kg/m2) in the vNOTES group (p = 0.31). The vNOTES hysterectomy group had significantly shorter durations of surgery (67.5 vs. 136 min) and postoperative hospitalization than the TLH group (p < 0.05 for all comparisons). Besides, the 6th-hour (6 vs. 7, p = 0.02) and 24th-hour (4 vs. 3, p < 0.001) VAS scores were significantly lower in the vNOTES hysterectomy group. The propensity-matched group analysis showed significantly lower 6th-hour and 24th-hour VAS scores and shorter duration of surgery (80 vs. 135 min, p < 0.001) in the vNOTES hysterectomy group than the TLH group. Conclusion vNOTES is a feasible technique in obese women who require a hysterectomy and provides favorable outcomes considering the shorter duration of surgery and postoperative hospitalization and lower pain scores.

Work in progress report of a multicentre retrospective observational study to evaluate the association between the airflows and the intrapleural pressures digitally recorded after video-assisted lobectomy.

Digital chest drainage systems allow real-time and continuous monitoring and recording of air leak flow rate and intrapleural pressure (IPP) from the immediate postoperative period to the chest drainage removal. A multicentre retrospective observational analysis of consecutive patients undergoing pulmonary lobectomy for lung cancer was performed to evaluate the association between the airflow and IPP digitally recorded during the immediate postoperative period after video-assisted thoracic surgery (VATS) lobectomy for lung cancer. Here, we present a work in progress report. All patients treated with VATS lobectomies for lung cancer were included. Multiple airflow measurements and minimum and maximum IPP through the chest tubes were digitally monitored and recorded using microelectronic mechanical sensor technology. The PALs were defined as an air leak lasting >5 days from the conclusion of the surgical procedure. The cessation of air leaks was defined as an airflow <10 ml/min during 6 consecutive hours. This analysis comprised 76 patients who underwent VATS lobectomy for lung cancer. Nineteen patients (25%) showed prolonged air leaks (PAL) (≥5 days). The operative time was higher in the PAL group (mean difference = 44 min) without a statistically significant difference. Before the 7th postoperative hours, there were no statistically significant differences in IPPs. Patients with PAL showed less negative IPP in the first 24 postoperative hours. Therefore, the 7th-24th postoperative hours were critical in PAL prediction since the mechanism for PAL seems to develop after the 7th postoperative hour.

Bilateral versus unilateral erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: a randomized controlled study

IntroductionLaparoscopic cholecystectomy (LC) is the common surgical intervention for benign biliary diseases. Postoperative pain after LC remains as an important problem, with two components: somatic and visceral. Trocar entry incisions lead to somatic pain, while peritoneal distension with diaphragm irritation leads to visceral pain. Following its description by Forero et al., the erector spinae plane (ESP) block acquired considerable popularity among clinicians. This led to the use of ESP block for postoperative pain management for various operations. Materials and methodsThis study was conducted between January and June 2019. Patients aged between 18 and 65 years with an American Society of Anesthesiologists (ASA) physical status I.ÇôII, scheduled for elective laparoscopic cholecystectomy were included in the study. All the patients received bilateral or unilateral ESP block at the T8 level preoperatively according to their groups. ResultsThere was no significant difference between the groups in terms NRS scores either at rest or while coughing at any time interval except for postoperative 6th hour (p = 0.023). Morphine consumption was similar between the groups but was significantly lower in group B at 12 and 24 hours (p = 0.044 and p = 0.022, respectively). Twelve patients in group A and three patients in group B had shoulder pain and this difference was statistically significant (p = 0.011). DiscussionIn conclusion, bilateral ESP block provided more effective analgesia than unilateral ESP block in patients undergoing elective LC. Bilateral ESP block reduced the amount of opioid consumption and the incidence of postoperative shoulder pain.

The Effect of Preoperative Oral Intake of Liquid Carbohydrate on Postoperative Stress Parameters in Patients Undergoing Laparoscopic Cholecystectomy: An Experimental Study

PurposeThe aim of this study is to investigate the effects of preoperative oral intake of liquid carbohydrate on postoperative stress parameters (blood glucose, insulin resistance, cortisol, noradrenaline, and adrenaline levels) in patients who underwent laparoscopic cholecystectomy. DesignThis is an experimental study with intervention and control groups. MethodsThe sample consisted of 68 patients who underwent laparoscopic cholecystectomy (control group = 33; intervention group = 35). Twelve-hour preoperative fasting was applied to the patients in the control group in accordance with the clinical routine. Clear oral liquid carbohydrate (400 mL; 12.5 g/100 mL maltodextrin, 50 kcal/100 mL, pH 5.0) was administered to the patients in the intervention group at the preoperative second hour. Blood samples were taken from the patients at the preoperative 2nd and postoperative 2nd and 24th hours, and their blood glucose, insulin resistance, cortisol, noradrenaline, and adrenaline levels were measured. ResultsPreoperative oral intake of carbohydrate had no effect on blood glucose (P > .05) but decreased insulin resistance at the postoperative 24th hour (P = .044; intervention and control group: 3.62 ± 3.44 to 8.16 ± 12.57 respectively) and cortisol level at the postoperative 2nd hour (P = .005; intervention and control group: 15.16 ± 6.53 mg/dl to 20.14 ± 7.49 mg/dl, respectively). In all of the three measurements, we found that the noradrenaline level of the patients in the intervention group was higher than the value of those in the control group (319.80 ± 301.49 pg/mL to 211.65 ± 141.11 pg/mL [P = .450]; 361.40 ± 213.50 pg/mL to 216.13 ± 114.53 [P = .001]; 268.40 ± 164.04 pg/mL to 196.00 ± 83.33 pg/mL [P = .026], respectively). Preoperative oral intake of liquid carbohydrate had no effect on postoperative adrenaline level (P > .05). ConclusionsOral intake of liquid carbohydrate given at the preoperative 2nd hour decreased postoperative stress response through insulin resistance and cortisol.

Evaluation of Anesthetic Efficacy of 4% Articaine, 0.5% Bupivacaine and 0.5% Ropivacaine During Surgical Removal of Impacted Mandibular Third Molars: A Randomized Comparative Clinical Study.

The aim of this study was to compare the anesthetic efficacy of 4% articaine, 0.5% bupivacaine and 0.5% ropivacaine (with 1:200,000 adrenaline) during surgical removal of impacted mandibular third molars. The study included 75 patients randomly divided into three equal groups of 25 patients each. The study variables were: onset of anesthetic action, duration of surgery and anesthesia and postoperative analgesia. A visual analog scale was used to assess pain at different time intervals. Statistical analysis revealed insignificant difference among groups in terms of volume of anesthetic solution used, quality of anesthesia, surgical difficulty and duration of surgery. The mean onset time was significantly (P < 0.001) shorter for articaine (1.14min) than ropivacaine (2.18min) and bupivacaine (2.33min). However, the duration of anesthesia as well as analgesia was significantly (P < 0.001) longer for bupivacaine (483.6min and 464min) and ropivacaine (426.6min and 459min) as compared to articaine (232.8min and 191.4min), respectively. Also, on comparing three groups pain scores at 6th postoperative hour were significant (P < 0.01). Ropivacaine and bupivacaine can be safely used in patients where longer duration of surgery is anticipated.

Effect of preoperative oral liquid carbohydrate intake on blood glucose, fasting-thirst, and fatigue levels: a randomized controlled study

BackgroundThis study aimed to analyze the effects of preoperative oral intake of liquid carbohydrate on postoperative blood glucose, fasting-thirst, and fatigue levels in patients undergoing arthroscopic surgery. MethodsThis randomized controlled clinical trial enrolled 82 patients, who were scheduled to undergo arthroscopic surgery, and divided them into two groups: (1) those who consumed a carbohydrate-rich drink, and (2) those not consuming anything after midnight. Pre- and postoperative fasting-thirst (visual analog scale) and blood glucose levels were measured. Likewise, the Brief Fatigue Inventory was applied to patients 24 hours after surgery. ResultsThe mean blood glucose levels in the first postoperative hour were 90.90 ± 13.56 mg.dL-1 and 107.00 ± 15.84 mg.dL-1 in the intervention group and control group, respectively (p < 0.001). The postoperative mean thirst scores were 4.70 ± 1.59 and 6.36 ± 2.07 in the intervention group and control group, respectively (p < 0.001). Their corresponding postoperative mean fasting scores were 5.54 ± 1.76 and 5.86 ± 1.79 (p > 0.05) and the mean fatigue levels in the 24th postoperative hour were 4.80 ± 2.13 and 5.48 ± 1.46, respectively (p > 0.05). ConclusionsOral intake of liquid carbohydrate before spinal anesthesia was found to have positive effects on patients’ postoperative blood glucose and thirst levels.

Analgesic Effect of Dual Injection Technique for the Erector Spinae Plane Block in Beating Heart Coronary By-Pass Surgeries.

IntroductionVarious regional anesthesia techniques such as thoracic epidural, thoracic paravertebral block, erector spinae plane block (ESPB), parasternal intercostal blocks are used in cardiac surgery for postoperative analgesia. In our study, we investigated the analgesic efficacy of the dual injection technique of ESPB in beating heart coronary bypass surgeries.MethodsThe records of patients with coronary artery bypass (CABG) surgery in the beating heart at the VKV American Hospital between January and December 2019 were retrospectively analyzed. The data of 30 patients who met the criteria to be included in the study were analyzed. Whether any opioid use is required for maintenance of anesthesia it is recorded. The pain scores of the patients are recorded by the intensive care team and cardiovascular service nurses for the first 48 hours.ResultsThe absence of secondary responses to pain in all surgical periods, including skin incision and sternotomy, and low number of rating scale (NRS) scores in the postoperative 0- to 24-hour period show that the technique we developed can produce effective analgesia. After the 24th postoperative hour, the patients were followed up in the cardiovascular service and there was no opioid use between 24- to 48-hour period.ConclusionOur approach, in which the local anesthetic is applied by approaching the superior costa-transverse ligament (SCTL) in the ESPB, provides an effective analgesia in coronary artery bypass surgeries in the beating heart. The main purpose of our new approach is to increase the amount of local anesthetic in the paravertebral area. We recommend using our modified technique for effective analgesia after CABG surgeries.