Investigation of the effect of ultrasonography-guided bilateral erector spinae plane block on postoperative opioid consumption and pain scores in patients undergoing hepatectomy: a prospective, randomized, controlled study

ABSTRACT BACKGROUND: There is still a debate about what constitutes effective and safe postoperative analgesia in hepatectomy surgery. Erector spinae plane (ESP) block may be an important part of multimodal analgesia application in hepatectomy surgery. OBJECTIVES: To compare the effects of ultrasound-guided bilateral erector spinae plane block combined with intravenous (iv) patient-controlled analgesia (iv PCA), in comparison with iv PCA alone, in hepatectomy surgery. DESIGN AND SETTINGS: Randomized prospective single-blinded study in a tertiary university hospital. METHODS: Fifty patients scheduled for elective hepatectomy surgery were included in the study. Patients were randomized into the ESP group or the control group. In the ESP group, bilateral ESP block was performed preoperatively and iv PCA was used. In the control group, only iv PCA was used. Numerical rating scale (NRS) scores at rest and coughing, analgesic requirements and occurrences of nausea and vomiting were recorded. RESULTS: Intraoperative and postoperative opioid consumption, rescue analgesia requirement and resting and dynamic NRS scores were significantly lower in the ESP group (P < 0.05). There was no significant difference between two groups in terms of the presence of dynamic pain after the first postoperative hour. While all patients in the control group had nausea and vomiting, 24% of the patients in the ESP group did not have nausea and vomiting. CONCLUSION: This study showed that ESP block can be used as a part of multimodal analgesia, with the benefit of reducing opioid consumption and postoperative nausea and vomiting in hepatectomy surgery. CLINICAL TRIAL REGISTRATION: ACTRN12620000466943.

Hypovitaminosis D in Children with Hashimoto’s Thyroiditis / Hipovitaminosis D en niños con tiroiditis de Hashimoto

Background: Vitamin D deficiency or insufficiency may play a role in the pathogenesis of certain autoimmune diseases. Aim: To measure vitamin D levels in children with Hashimoto’s thyroiditis (HT) (either with subclinical or marked hypothyroidism) and in healthy controls. Material and Methods: We included 68 children with HT aged 12 ± 4 years (39 females) from a pediatric outpatient clinic and 68 healthy children aged 10 ± 4 years (37 females). Calcium metabolism parameters, thyroid function tests and anti-thyroid peroxidase (anti-TPO), anti-thyroglobulin (anti-TG) and 25 hydroxy vitamin D (25OHD) levels were measured. Results: Patients were older than controls but well matched by gender distribution. Mean 25OHD levels were significantly lower in HT patients than controls (16.8 ± 9.3 and 24.1 ± 9.4 ng/mL respectively, P < 0.01). Frequency of vitamin D deficiency was 76 and 35% in HT patients and controls, respectively (P < 0.001). Conclusions: Vitamin D deficiency is more common in children with HT than healthy controls.

Antecedentes: La deficiencia o insuficiencia de vitamina D puede tener un rol en la patogenia de enfermedades autoinmunes. Objetivo: Medir niveles de vitamina D en niños con tiroiditis de Hashimoto (TH) (con hipotiroidismo subclínico o marcado) y en controles sanos. Material y Métodos: Estudiamos 68 niños con TH, de 12 ± 4 años (39 mujeres) y 68 controles sanos de 10 ± 4 años (37 mujeres). Se les midió parámetros de metabolismo de calcio, pruebas de función tiroidea, anticuerpos anti peroxidasa y anti tiroglobulina y 25 hidroxi vitamina D (25 OH vit D). Resultados: Los pacientes eran mayores que los controles pero la distribución por género era homogénea en ambos grupos. Los niveles de 25 OH vit D en pacientes y controles fueron 16,8 ± 9,3 y 24,1 ± 9,4 ng/mL respectivamente, p < 0,01. La frecuencia de deficiencia de vitamina D fue de 76 y 35% en pacientes y controles, respectivamente. Conclusiones: La deficiencia de vitamina D es más común en niños con TH.