RESUMO
SUMMARY OBJECTIVE: A new block, namely, modified thoracoabdominal nerves block through perichondrial approach, is administered below the costal cartilage. We sought to compare the analgesic efficacy of the modified thoracoabdominal nerves block through perichondrial approach block with local anesthetic infiltration at the port sites in an adult population who underwent laparoscopic cholecystectomy. METHODS: Patients who will undergo laparoscopic cholecystectomy were randomized to receive bilateral ultrasound-guided modified thoracoabdominal nerves block through perichondrial approach blocks or local anesthetic infiltration at the port insertion sites. The primary outcome was the total amount of tramadol used in the first 12 h postoperatively. The secondary outcomes were total IV tramadol consumption for the first postoperative 24 h and visual analog scale scores. RESULTS: The modified thoracoabdominal nerves block through perichondrial approach group had significantly less tramadol use in the first 12 h postoperatively (p<0.001). The modified thoracoabdominal nerves block through perichondrial approach group's visual analog scale scores at rest (static) and with movement (dynamic) were significantly lower compared with the port infiltration group (p<0.05). CONCLUSION: Patients who received modified thoracoabdominal nerves block through perichondrial approach block had significantly less analgesic consumption and better pain scores than those who received port-site injections after laparoscopic cholecystectomy.
RESUMO
Aim: The aim of this prospective randomized blinded study was to evaluate clinical effectiveness of three different sedation protocols [intravenous propofol vs. ketamine vs ketofol] in children scheduled for dental treatment
Methodology: Seventy five ASA I patients were enrolled; were randomly selected from 6-12 years aged children with documented high anxiety level and were randomly divided into 3 groups: ketamine treated group [Group K]- received a priming dose of 1 mg/kg, followed by continuous infusion dose of 50-60 ug/kg/min, propofol treated group [Group P] - received priming dose of 2 mg/kg, followed by continuous infusion dose of 70-90 microg/kg/min, and ketamine plus propofol treated group [ketofol] [Group KP] - which received priming dose of 0.6 mg/kg, followed by continuous infusion dose of 40-60 microg/kg/min. During the study period, vital signs of children, the level of sedation using BIS monitor and time interval needed for full recovery were recorded every 5 min. The levels of changing anxiety were measured using Children's Fear Survey Schedule - Dental Subscale [CFSS-DS] and face version of the Modified Child Dental Anxiety Scale [MCDASf]
Results: A higher complication rate was noted in ketamine treated group [p < 0.05]. Also mean time of recovery was found statistically longer in ketamine treated group [p < 0.05]. Both in KP and P groups we found similar associations between BIS values and sedation levels. In contrast there was no correlation between BIS values and sedation levels in ketamine treated group. Children's anxiety levels were significantly decreased in propofol and ketofol treated groups compared with ketamine treated group [p < 0.05]
Conclusion: During the study period no serious complication noted in both of three different sedation protocols. We found that ketamine plus propofol treatment is associated with lower complication and higher satisfaction rates in pediatric patients undergoing dental treatment