Erector spinae plane block in chronic pain: a retrospective study.

Patients with various aetiology of pain who underwent erector spinae plane block at different levels were evaluated at the tertiary Algology clinic. Visual analog scale (VAS) values were recorded before the block; 30 min, two weeks, and two months after the block. Medical records of fifteen patients have been obtained. The average VAS decreased from 7 ± 1 to 5 ± 3 in the second month when compared to the values before block (p < 0.01). ESP block can be an option for chronic pain in postsurgical pain syndrome and myofascial pain management.

Comparison of dexmedetomidine and remifentanil infusion in geriatric patients undergoing outpatient cataract surgery: a prospective, randomized, and blinded study.

Dexmedetomidine is an α2 agonist and remifentanil is a short-acting µ opioid agonist. We aimed to compare the dexmedetomidine and remifentanil infusions used for conscious sedation in geriatric patients undergoing outpatient cataract surgery in terms of sedation quality, side effects, and surgeon satisfaction. Eighty patients were allocated into two groups as per the administration of dexmedetomidine (dexmedetomidine group) and remifentanil (remifentanil group) infusion in this randomized, prospective, double-blinded study. In dexmedetomidine group (n = 40), after a loading of 1 µg/kg dexmedetomidine in 10 minutes, 0.4 µg/kg/h infusion was administered. In the remifentanil group (n = 40), remifentanil at a dose of 0.05 µg/kg was administered for 10 minutes, and then 0.05 µg/kg/min infusion was continued. Observer Assessment Warning/Sedation Scale values evaluating sedation quality were lower in the dexmedetomidine group than in the remifentanil group, although it was not statistically significant (P > 0.05). Bispectral Index values evaluating sedation quality were lower in the dexmedetomidine group according to the remifentanil group (P < 0.05). The dexmedetomidine group had lower Verbal Rating Scale and Visual Analogue Scale scores evaluating pain intensity compared with the remifentanil group (P < 0.05). The nausea Visual Analogue Scale values evaluating the severity of postoperative nausea in the dexmedetomidine group were lower than those in the remifentanil group (P < 0.05). The surgeon satisfaction was found to be greater in the dexmedetomidine group compared with the remifentanil group (P = 0.015). In geriatric patients, the targeted sedation and analgesia levels were achieved more easily with dexmedetomidine infusion, without hemodynamic and respiratory side effects, compared to remifentanil infusion.

Treatment of patients with neuropathic pain and provision of drug information by clinical pharmacists

Abstract Patient's satisfaction with healthcare services has an influence on pain management, which can be improved by patient education. Therefore, this study was aimed at identifying primary care health service opportunities in the treatment of neuropathic pain and assessing patients' satisfaction with the provision of drug information by clinical pharmacists. This was a cross- sectional, prospective study conducted at a pain unit during March-May 2017. Patients aged >18 years; diagnosed with neuropathic pain; and who used amitriptyline, gabapentin, pregabalin, or duloxetine were included. They were verbally informed about drug treatment by a clinical pharmacist, and their satisfaction was evaluated after 1 month. In all, 90 patients were included. The median duration for which the patients experienced pain until hospital admission was 3.6 years; furthermore, this duration was longer among women (p < 0.05). However, the median time to seeking advice from doctors was 3 months. The patients (15.6%) were less likely to admit pain unit initially and 46.7% had visited different units before being admitted to a pain unit. More than 95% of the patients indicated that they had received information from a pharmacist at a clinic and were satisfied with the provision of information (median duration, 8.5 min). Thus, the involvement of pharmacists in multidisciplinary pain management may help improve health- related outcomes at hospitals and/or in community care settings

An evaluation of cancer patients' opinions about use of opioid analgesics and the role of clinical pharmacist in patient education in Turkey.

Background Patients' potential misconceptions and concerns about using opioids are among the primary causes of patient-related barriers that may lead to failure in pain management. These barriers can be eliminated through educational interventions, thus achieving better pain management. Objective The aim of this study was to assess patients' beliefs about opioids, reduce the impact of patient-related barriers through educational intervention by a clinical pharmacist, and improve patients' adherence to opioid analgesic treatment. Setting The study was conducted in the Hacettepe University Training and Research Oncology Hospital, Department of Algology in Ankara, Turkey. Method A prospective study conducted between September, 2018 and May, 2019. Patients were included who had been diagnosed with cancer, had been prescribed opioid analgesics, and who attended the pain unit during the period this study was conducted. Patients' beliefs about opioids were assessed using the Beliefs about Medicine Questionnaire (BMQ) right before and 1 month after an educational intervention was provided by a clinical pharmacist. Also, patients' adherence to the opioid regimen was assessed using a validated Self-Report Measure of Adherence questions in Turkish. Main outcome measure The mean scores of the BMQ Necessity Subscale and Concern Subscale, and a level of adherence to opioid treatment. Results Sixty patients who met the inclusion criteria were included and follow-up was completed with 38 patients. Although an increase was detected in the total score of the Necessity subscale after provision of education (p = 0.398), a statistically significant (p < 0.001) decrease was found in the total score of the 'Concern' subscale, which suggests that patients believe the benefits of opioids outweigh the risks. The patients' pain scores were decreased (p = 0.004); furthermore a significant increase was found in the adherence scores (3.16-3.55) (p = 0.027), and a high level of adherence was observed among the patients in the post-education assessment (p = 0.021). Conclusion The integration of a clinical pharmacist into the pain management team may have a positive impact on the patients' knowledge, concerns and misconceptions about opioids, which may improve adherence and effective pain management in cancer treatment.

Effect of melatonin on the daytime sleepiness side-effect of gabapentin in adults patients with neuropathic pain / Efeito da melatonina sobre o efeito colateral de sonolência diurna da gabapentina em pacientes adultos com dor neuropática

Abstract Background and objectives: Gabapentin is an antiepileptic drug. Widely used for the management of neuropathic pain. Although it is known to be well tolerated, somnolence and dizziness are the most frequent adverse effects. In this study, we aimed to evaluate the effect of melatonin on daytime sleepiness side effect of gabapentin, sleep quality and pain intensity of patients with neuropathic pain. Methods: Patients suffering from "neuropathic pain" and planed to receive gabapentin therapy were randomly divided into two groups. Group 1 received melatonin 3 mg and gabapentin 900 mg orally, group 2 received matching placebo capsule and gabapentin 900 mg. The Epworth Sleepiness Scale, the Pittsburgh sleep quality index for assessment of sleep quality and Verbal Rating Scale were completed at the 0th, 10th and 30th days of treatment. Additive analgesic drug requirements were recorded. Results: Eighty patients were enrolled to the study; age, gender, ratio of additive analgesic consumption, baseline Epworth Sleepiness Scale, Pittsburg Sleep Quality index and Verbal Rating Scale scores were similar between the groups. Epworth Sleepiness Scale scores, Pittsburgh sleep quality index scores and Verbal Rating Scale scores in Group 1 were significantly lower than group 2 at the 10th day of treatment (p = 0.002, p = 0.003, p = 0.002 respectively). At the 30th day of treatment, Epworth Sleepiness Scale scores and Verbal Rating Scale scores were significantly lower in Group 1 (p = 0.002, p = 0.008 respectively). However, Pittsburgh sleep quality index scores did not significantly differ between the groups (p = 0.0566). Conclusions: Melatonin supplementation rapidly and significantly improved daytime sleepiness side-effect of gabapentin, however sleep quality of the patients with neuropathic pain was similar between groups.

Resumo Justificativa e objetivos: Gabapentina é um agente antiepiléptico, amplamente utilizado para o tratamento da dor neuropática. Embora conhecida por ser bem-tolerada, sonolência e tontura são os seus efeitos adversos mais frequentes. Neste estudo, nosso objetivo foi avaliar o efeito da melatonina sobre o efeito colateral de sonolência diurna da gabapentina, a qualidade do sono e a intensidade da dor em pacientes com dor neuropática. Métodos: Os pacientes que sofriam de "dor neuropática" e com prescrição para receber terapia com gabapentina foram divididos aleatoriamente em dois grupos. O Grupo 1 recebeu 3 mg de melatonina e 900 mg de gabapentina por via oral, o Grupo 2 recebeu uma cápsula de placebo correspondente e 900 mg de gabapentina. A escala de sonolência de Epworth (ESS), o índice de qualidade do sono de Pittsburgh para avaliação da qualidade do sono (PSQI) e a escala de avaliação verbal (VRS) foram aplicados nos dias 0, 10 e 30 de tratamento. A necessidade de medicamentos analgésicos adicionais foi registrada. Resultados: Oitenta pacientes foram incluídos no estudo; idade, sexo, quantidade de analgésico adicional consumida e os escores basais de ESS, PSQI e VRS foram semelhantes entre os grupos. Os escores ESS, PSQI e VRS do Grupo 1 foram significativamente menores que os do Grupo 2 no décimo dia de tratamento (p = 0,002, p = 0,003, p = 0,002, respectivamente). No trigésimo dia de tratamento, os escores ESS e VRS foram significativamente menores no Grupo 1 (p = 0,002, p = 0,008, respectivamente). No entanto, os escores PSQI não diferiram significativamente entre os grupos (p = 0,0566). Conclusões: A suplementação de melatonina melhorou de forma rápida e significativa o efeito colateral de sonolência diurna da gabapentina, mas a qualidade do sono dos pacientes com dor neuropática foi semelhante entre os grupos.

[Effect of melatonin on the daytime sleepiness side-effect of gabapentin in adults patients with neuropathic pain]. / Efeito da melatonina sobre o efeito colateral de sonolência diurna da gabapentina em pacientes adultos com dor neuropática.

BACKGROUND AND OBJECTIVES: Gabapentin is an antiepileptic drug. Widely used for the management of neuropathic pain. Although it is known to be well tolerated, somnolence and dizziness are the most frequent adverse effects. In this study, we aimed to evaluate the effect of melatonin on daytime sleepiness side effect of gabapentin, sleep quality and pain intensity of patients with neuropathic pain. METHODS: Patients suffering from "neuropathic pain" and planed to receive gabapentin therapy were randomly divided into two groups. Group 1 received melatonin 3mg and gabapentin 900mg orally, group 2 received matching placebo capsule and gabapentin 900mg. The Epworth Sleepiness Scale, the Pittsburgh sleep quality index for assessment of sleep quality and Verbal Rating Scale were completed at the 0th, 10th and 30th days of treatment. Additive analgesic drug requirements were recorded. RESULTS: Eighty patients were enrolled to the study; age, gender, ratio of additive analgesic consumption, baseline Epworth Sleepiness Scale, Pittsburg Sleep Quality index and Verbal Rating Scale scores were similar between the groups. Epworth Sleepiness Scale scores, Pittsburgh sleep quality index scores and Verbal Rating Scale scores in Group 1 were significantly lower than group 2 at the 10th day of treatment (p=0.002, p=0.003, p=0.002 respectively). At the 30th day of treatment, Epworth Sleepiness Scale scores and Verbal Rating Scale scores were significantly lower in Group 1 (p=0.002, p=0.008 respectively). However, Pittsburgh sleep quality index scores did not significantly differ between the groups (p=0.0566). CONCLUSIONS: Melatonin supplementation rapidly and significantly improved daytime sleepiness side-effect of gabapentin, however sleep quality of the patients with neuropathic pain was similar between groups.

Effect of magnesium sulfate on anesthesia depth, awareness incidence, and postoperative pain scores in obstetric patients. A double-blind randomized controlled trial.

OBJECTIVES: To assess the effects of magnesium on the depth of anesthesia and to determine the effects of magnesium on incidence of awareness and postoperative pain after caesarean section.  Methods: The study was designed as a double-blind, controlled, randomized study and conducted in Hacettepe University Hospital, Ankara, Turkey  between January 2015 and March 2016. A total of 100 pregnant healthy women who were between 17 and 41 years old, ASA II, and scheduled for an elective cesarean section with general anesthesia were included in the study. After induction, sevoflurane was used for maintenance in Group S and desflurane in Group D (control groups). At Group S-M and Group D-M (study groups), magnesium infusion was started with sevoflurane and desflurane anesthesia respectively. Minimum alveolar concentration of sevoflurane and desflurane were kept constant. Bispectral index scores (BIS), fentanyl consumption and postoperative visual analogue scale (VAS) values were recorded. All of the patients had been followed-up for awareness until the postoperative first year. Results: Demographic variables of the patients were similar. BIS values were significantly higher in control groups throughout the operation (p less than 0.001). No significant difference was detected for intraoperative fentanyl consumption and awareness incidence. VAS values were significantly lower in study groups (p less than 0.05). Conclusion: Magnesium infusion provided significantly lower intraoperative BIS values and lower postoperative VAS scores. We believe that magnesium can be useful as an adjuvant to general anesthesia.

Comparison of the effects of patient controlled analgesia (PCA) using dexmedetomidine and propofol during septoplasty operations: a randomized clinical trial.

INTRODUCTION: Septoplastical surgery to correct septum deviation can be performed under either local or general anesthesia. During local anesthesia, sedation helps to provide minimum anxiety/discomfort. Our aim was to evaluate the effects of patient-controlled analgesia using dexmedetomidine and propofol on sedation level, analgesic requirement, and patient satisfaction. STUDY DESIGN: A prospective, randomized-parallel clinical study. METHODS: Fifty patients undergoing septoplastical surgery at our university hospital were randomized into two groups. A nasopharyngeal cotton tampon soaked in 0.25 % adrenaline solution was placed, and 1 mg midazolam and 1 mcg/kg fentanyl were applied 5 min before the injections of a surgical local anesthetic. Loading dose was 0.5 mg/kg propofol (Group I) and 1 mcg/kg dexmedetomidine (Group II). The sedation was sustained by a bolus dose of 0.2 mg/kg and continuous basal infusion dose of 0.5 mg/kg/h propofol in Group I, or by a bolus dose of 0.05 µg/kg and continuous basal infusion dose of 0.4 mcg/kg/h dexmedetomidine in Group II. The primary outcomes were patient satisfaction via patient-controlled anesthesia and analgesic demand. Secondary outcomes were sedation level of patients under local anesthesia. RESULTS: In Group II, SpO2 levels were significantly higher than in Group I. Intraoperative and postoperative analgesic requirements were lower in Group II than in Group I. There were no statistically significant differences in patient satisfaction, hemodynamic parameters, nausea and vomiting between the two groups. CONCLUSION: Dexmedetomidine can be used safely as an analgesic and sedation drug in septoplastic surgery.

Comparison of efficacy of prophylactic ketamine and dexmedetomidine on postoperative bladder catheter-related discomfort.

OBJECTIVES: To compare the effects of prophylactic ketamine and dexmedetomidine on postoperative bladder catheter-related discomfort/pain in patients undergoing cystoscopy. METHODS: This prospective study was conducted on 75 American Society of Anesthesiologists (ASA) I-II patients between 18-75 years of age and undergoing cystoscopy between November 2011 and June 2012 at Hacettepe University Hospital, Ankara, Turkey. Patients were randomly assigned to one of the 3 groups to receive 1 µ/kg dexmedetomidine, 250 µ/kg intravenous ketamine, or normal saline. All patients were questioned regarding probe-related discomfort, patient satisfaction, and pain at the end of the operation 0 (t0) and 15 (t1), 60 (t2), 120 (t3), and 360 (t4) minutes postoperatively. Evaluations were performed in person at the  post-anesthesia care unit, or in ambulatory surgery rooms, or by phone calls. RESULTS: Pain incidence in the dexmedetomidine and ketamine groups (p=0.042) was significantly lower than that in the control group (p=0.044).The sedation scores recorded at t0 in the dexmedetomidine and ketamine groups (p=0.004) were significantly higher than that of the control group (p=0.017).Patient groups were similar regarding the rate of hallucinations experienced at t1, no patients experienced hallucinations at t2, t3, or t4. Significantly more patients experienced hallucinations at t0 in the ketamine group than in the dexmedetomidine group (p=0.034) and the control group (p=0.005).  CONCLUSION: Dexmedetomidine and ketamine had similar analgesic effects in preventing catheter-related pain; however, dexmedetomidine had a more acceptable side effect profile. To identify the optimal doses of dexmedetomidine and ketamine, more large-scale interventional studies are needed.

Comparison of propofol and midazolam on patients undergoing spinal surgery with intraoperative wake-up test: randomized clinical trial / Comparação de propofol e midazolam em pacientes submetidos à cirurgia de coluna vertebral com teste de despertar no intraoperatório: estudo clínico randomizado

BACKGROUND AND OBJECTIVES: Instrumentation in correction operations for spinal deformities carries a 0.5-5% risk of injuring the spinal cord. The wake-up test is used for early detection of these injuries. In this study we compared the effects of propofol and midazolam during wake-up test in scoliosis surgery. METHODS: Thirty patients were randomly assigned as group P and group M. Anesthesia was induced with propofol 2.5 mg kg-1 for group P or midazolam 0.5 mg kg-1 for group M with remifentanil 0.5 µg kg-1 and cisatracurium 0.15 mg kg-1 for both groups. At the maintenance of anesthesia O2/air and infusions of remifentanil and cisatracurium were used. In group P, propofol 6-10 mg kg-1 h-1 and in group M, midazolam 0.5 mg mg kg-1 were preferred. Approximately 15 min before the wake-up test, all drugs were discontinued. At the wake-up test, anesthesiologist asked the patients to open their eyes and squeeze his/her hand at every 30 s until the patients responded. Then patients were told to wiggle their toes. Hemodynamic parameters, time of eye-opening, appropriate movement upon verbal command were evaluated. BIS frequency throughout the operation was recorded. RESULTS: The eye opening time was 9 ± 2.15 min in group P and 7 ± 3.15 min in group M. Motor movement time was 12 ± 2.55 min in group P and 21.25 ± 3.93 min in group M. CONCLUSION: Propofol provided better wake-up conditions and conducted a better neurologic assessment within the same BIS values than midazolam.

JUSTIFICATIVA E OBJETIVOS: A instrumentação em cirurgias de correção de deformidades da coluna vertebral tem risco de 0,5 a 5% de lesionar a medula espinhal. O teste de despertar é usado para a detecção precoce dessas lesões. Neste estudo comparamos os efeitos de propofol e midazolam durante o teste de despertar em cirurgia de escoliose. MÉTODOS: Trinta pacientes foram designados de forma aleatória para os grupos P e M. A anestesia foi induzida com propofol (2,5 mg kg-1) no grupo P ou midazolam (0,5 mg kg-1) no grupo M, com remifentanil (0,5 µg kg-1) e cisatracúrio (0,15 mg kg-1) em ambos os grupos. A manutenção da anestesia foi feita com O2/ar e infusões de remifentanil e cisatracúrio. Nos grupos P e M, respectivamente, doses de propofol (6-10 mg kg-1 h-1) e de midazolam (0,5 mg mg kg-1) foram preferidas. Aproximadamente 15 min antes do teste de despertar, todos os medicamentos foram interrompidos. No teste de despertar, o anestesiologista pedia ao paciente que abrisse os olhos e apertasse sua mão a cada 30 s até que o paciente respondesse. Depois, o paciente era solicitado a mexer os dedos dos pés. Os parâmetros hemodinâmicos, o tempo de abertura dos olhos e o movimento apropriado sob comando verbal foram avaliados. A frequência do BIS foi registrada durante toda a cirurgia. RESULTADOS: O tempo de abertura dos olhos foi de 9 ± 2,15 min no grupo P e de 7 ± 3,15 min no grupo M. O tempo de movimento motor foi de 12 ± 2,55 min no grupo P e de 21,25 ± 3,93 min no grupo M. CONCLUSÃO: Propofol proporcionou melhores condições de despertar e possibilitou uma melhor avaliação neurológica dentro dos mesmos valores do BIS que midazolam.

Comparison of propofol and midazolam on patients undergoing spinal surgery with intraoperative wake-up test: randomized clinical trial.

BACKGROUND AND OBJECTIVES: Instrumentation in correction operations for spinal deformities carries a 0.5-5% risk of injuring the spinal cord. The wake-up test is used for early detection of these injuries. In this study we compared the effects of propofol and midazolam during wake-up test in scoliosis surgery. METHODS: Thirty patients were randomly assigned as group P and group M. Anesthesia was induced with propofol 2.5 mg kg(-1) for group P or midazolam 0.5 mg kg(-1) for group M with remifentanil 0.5 µg kg(-1) and cisatracurium 0.15 mg kg(-1) for both groups. At the maintenance of anesthesia O2/air and infusions of remifentanil and cisatracurium were used. In group P, propofol 6-10 mg kg(-1)h(-1) and in group M, midazolam 0.5 mg mg kg(-1) were preferred. Approximately 15 min before the wake-up test, all drugs were discontinued. At the wake-up test, anesthesiologist asked the patients to open their eyes and squeeze his/her hand at every 30s until the patients responded. Then patients were told to wiggle their toes. Hemodynamic parameters, time of eye-opening, appropriate movement upon verbal command were evaluated. BIS frequency throughout the operation was recorded. RESULTS: The eye opening time was 9 ± 2.15 min in group P and 7 ± 3.15 min in group M. Motor movement time was 12 ± 2.55 min in group P and 21.25 ± 3.93 min in group M. CONCLUSION: Propofol provided better wake-up conditions and conducted a better neurologic assessment within the same BIS values than midazolam.

THE EFFECTS OF LISTENING TO THE MOTHER'S HEARTBEAT ON THE DEPTH OF ANAESTHESIA IN CHILDREN.

BACKGROUND: The present study aimed to evaluate the effects of listening to the mother's heartbeat and womb sounds on the depth of anaesthesia in children. METHODS: The present study included 40 children scheduled for minor surgery under general anaesthesia, with an American Society of Anaesthesiologists (ASA) status of 1 to 2. Anaesthesia was induced with sevoflurane, and maintained with sevoflurane and oxygen in nitrous oxide. Patients were randomly divided into two groups. The children in Group I were made to listen to recordings of their mothers' heartbeat and womb sounds via earphones during anaesthesia induction, while those in Group II were made to listen to ambient noise via earphones. The music was turned off when the inhalational anaesthetics were discontinued. Intraoperative monitoring included electrocardiogram (ECG) recordings, heart rate (HR), oxygen saturation, non-invasive systolic blood pressure (SBP) and diastolic blood pressure (DBP), bispectral index system (BIS), end-tidal (ET) sevoflurane, ET N2O, ET CO2, and SaO2. RESULTS: In Group I, there was a significant decrease in bispectral index (BIS) values over time (p < 0.05). Although blood pressure and heart rate were lower in Group I, no significant differences between the groups were detected. While the duration of extubation was shorter in Group I, overall, there was no significant difference between the groups. CONCLUSION: We found that children exposed to recordings of their mothers' heartbeat and womb sounds in addition to music had lower BIS values under anaesthesia, which indicates deeper anaesthesia levels.

[Comparison of propofol and midazolam on patients undergoing spinal surgery with intraoperative wake-up test: randomized clinical trial]. / Comparação de propofol e midazolam em pacientes submetidos à cirurgia de coluna vertebral com teste de despertar no intraoperatório: estudo clínico randomizado.

BACKGROUND AND OBJECTIVES: Instrumentation in correction operations for spinal deformities carries a 0.5-5% risk of injuring the spinal cord. The wake-up test is used for early detection of these injuries. In this study we compared the effects of propofol and midazolam during wake-up test in scoliosis surgery. METHODS: Thirty patients were randomly assigned as group P and group M. Anesthesia was induced with propofol 2.5mgkg(-1) for group P or midazolam 0.5mgkg(-1) for group M with remifentanil 0.5µgkg(-1) and cisatracurium 0.15mgkg(-1) for both groups. At the maintenance of anesthesia O2/air and infusions of remifentanil and cisatracurium were used. In group P, propofol 6-10mgkg(-1)h(-1) and in group M, midazolam 0.5mgmgkg(-1) were preferred. Approximately 15min before the wake-up test, all drugs were discontinued. At the wake-up test, anesthesiologist asked the patients to open their eyes and squeeze his/her hand at every 30s until the patients responded. Then patients were told to wiggle their toes. Hemodynamic parameters, time of eye-opening, appropriate movement upon verbal command were evaluated. BIS frequency throughout the operation was recorded. RESULTS: The eye opening time was 9±2.15min in group P and 7±3.15min in group M. Motor movement time was 12±2.55min in group P and 21.25±3.93min in group M. CONCLUSION: Propofol provided better wake-up conditions and conducted a better neurologic assessment within the same BIS values than midazolam.

All about ketamine premedication for children undergoing ophtalmic surgery.

Ketamine is a non-barbiturate cyclohexamine derivative which produces a state of sedation, immobility, analgesia, amnesia, and dissociation from the environment. One of the most important advantages of ketamine premedication is production of balanced sedation with less respiratory depression and less changes in blood pressure or heart rate. As its effects on intracranial pressure, the possible effect of ketamine on intraocular pressure has been controversial overtime. In this study, we aimed to demostrate all the advantages and possible side effects of ketamine premedication in 100 children with retinablastoma undergoing ophthalmic surgery. All the children were premedicated with ketamine 5 mg kg(-1) 15 minutes before the examination orally and peroperative complications, reaction to intravenous catheter insertion, need for additive dose and intraocular pressures of children were recorded. We showed that ketamine administration orally is a safe and effective way of premedication for oncologic patients undergoing examination under general anaesthesia. The incidence of agitation, anxiety at parental separation and reaction to insertion of intravenous catheter was very low while adverse side effects were seen rarely. Intraocular pressure which is very important for most of the ophthalmic surgery patients remained in normal ranges.

Intraoperative esmolol infusion reduces postoperative analgesic consumption and anaesthetic use during septorhinoplasty: a randomized trial / Infusão intraoperatória de esmolol reduz o consumo pós-operatório de analgésicos e o uso de anestésico durante a septorrinoplastia: estudo randômico / La infusión intraoperatoria de esmolol reduce el consumo postoperatorio de analgésicos y el uso de anestésico durante la septorrinoplastia: estudio aleatorizado

Background and objectives: Esmolol is known to have no analgesic activity and no anaesthetic properties; however, it could potentiate the reduction in anaesthetic requirements and reduce postoperative analgesic use. The objective of this study is to evaluate the effect of intravenous esmolol infusion on intraoperative and postoperative analgesic consumptions as well as its effect on depth of anaesthesia. Methods: This randomized-controlled double blind study was conducted in a tertiary care hospital between March and June 2010. Sixty patients undergoing septorhinoplasty were randomized into two groups. History of allergy to drugs used in the study, ischaemic heart disease, heart block, bronchial asthma, hepatic or renal dysfunction, obesity and a history of chronic use of analgesic or β-blockers were considered cause for exclusion from the study. Thirty patients received esmolol and remifentanil (esmolol group) and 30 patients received normal saline and remifentanil (control group) as an intravenous infusion during the procedure. Mean arterial pressure, heart rate, and bispectral index values were recorded every 10min. Total remifentanil consumption, visual analogue scale scores, time to first analgesia and total postoperative morphine consumption were recorded. Results: The total remifentanil consumption, visual analogue scale scores at 0, 20 and 60 min, total morphine consumption, time to first analgesia and the number of patients who needed an intravenous morphine were lower in the esmolol group. Conclusions: Intravenous infusion of esmolol reduced the intraoperative and postoperative analgesic consumption, reduced visual analogue scale scores in the early postoperative period and prolonged the time to first analgesia; however it did not influence the depth of anaesthesia. .

Justificativa e objetivos: Esmolol é conhecido por não ter atividade analgésica e propriedades anestésicas; porém, pode potenciar a redução da necessidade de anestésicos e reduzir o uso de analgésicos no pós-operatório. O objetivo deste estudo foi avaliar o efeito da infusão de esmolol por via intravenosa sobre o consumo de analgésico durante os períodos intraoperatório e pós-operatório, bem como seu efeito sobre a profundidade da anestesia. Métodos: Este estudo randômico, controlado e duplo-cego foi conduzido em um hospital terciário entre março e junho de 2010. Foram randomicamente divididos em dois grupos 60 pacientes programados para serem submetidos à septorrinoplastia. História de alergia aos medicamentos usados no estudo, isquemia cardíaca, bloqueio cardíaco, asma brônquica, insuficiência hepática ou renal, obesidade e história de uso crônico de analgésicos ou β-bloqueadores foram os critérios de exclusão. Trinta pacientes receberam esmolol e remifentanil (grupo esmolol) e 30 receberam soro fisiológico e remifentanil (grupo controle) via perfusão intravenosa. Pressão arterial média, frequência cardíaca e valores do índice bispectral foram registrados a cada 10 minutos. Consumo total de remifentanil, escores da escala visual analógica, tempo para a primeira analgesia e consumo total de morfina no pós-operatório foram registrados. Resultados: O consumo total de remifentanil, os escores da escala visual analógica nos minutos 0, 20 e 60, o consumo total de morfina, o tempo para a primeira analgesia e o número de pacientes que precisaram de morfina intravenosa foram menores no grupo esmolol. Conclusões: Esmolol em infusão intravenosa reduziu o consumo de analgésicos tanto no intraoperatório ...

Justificación y objetivos: El esmolol se conoce porque no posee actividad añalgésica ni propie-dades anestésicas; sin embargo, puede potenciar la reducción de la necesidad de anestésicos y disminuir el uso de analgésicos en el postoperatorio. El objetivo de este estudio fue evaluar el efecto de la infusión de esmolol por vía intravenosa sobre el consumo de analgésico durante los períodos intraoperatorio y postoperatorio, como también su efecto sobre la profundidad de la anestesia. Métodos: Este estudio aleatorizado, controlado y doble ciego fue llevado a cabo en un hospital terciario entre marzo y junio de 2010. Sesenta pacientes programados para someterse a la septorrinoplastia fueron aleatoriamente divididos en 2 grupos. El historial de alergia a los medicamentos usados en el estudio, isquemia cardíaca, bloqueo cardíaco, asma bronquial, insuficiencia hepática o renal, obesidad e historial de uso crónico de analgésicos o ß-bloqueantes, fueron los criterios de exclusión del estudio. Treinta pacientes recibieron esmolol y remifenta-nilo (grupo esmolol) y 30 pacientes recibieron suero fisiológico y remifentanilo (grupo control), vía perfusión intravenosa durante el procedimiento. La presión arterial media, frecuencia cardíaca y valores del índice biespectral fueron registrados cada 10 min. Se registraron el consumo total de remifentanilo, puntuaciones de la escala visual analógica, tiempo para la primera analgesia y el consumo total de morfina en el postoperatorio. Resultados: El consumo total de remifentanilo, las puntuaciones de la escala visual analógica en los minutos 0, 20 y 60, el consumo total de morfina, el tiempo para la primera analgesia y el número de pacientes que necesitaron morfina intravenosa fueron menores en el grupo esmolol. Conclusiones: El esmolol en infusión intravenosa ...

[Intraoperative esmolol infusion reduces postoperative analgesic consumption and anaesthetic use during septorhinoplasty: a randomized trial]. / Infusão intraoperatória de esmolol reduz o consumo pós-operatório de analgésicos e o uso de anestésico durante a septorrinoplastia: estudo randômico.

BACKGROUND AND OBJECTIVES: Esmolol is known to have no analgesic activity and no anaesthetic properties; however, it could potentiate the reduction in anaesthetic requirements and reduce postoperative analgesic use. The objective of this study is to evaluate the effect of intravenous esmolol infusion on intraoperative and postoperative analgesic consumptions as well as its effect on depth of anaesthesia. METHOD: This randomized-controlled double blind study was conducted in a tertiary care hospital between March and June 2010. Sixty patients undergoing septorhinoplasty were randomized into two groups. History of allergy to drugs used in the study, ischaemic heart disease, heart block, bronchial asthma, hepatic or renal dysfunction, obesity and a history of chronic use of analgesic or ß-blockers were considered cause for exclusion from the study. Thirty patients received esmolol and remifentanil (esmolol group) and 30 patients received normal saline and remifentanil (control group) as an intravenous infusion during the procedure. Mean arterial pressure, heart rate, and bispectral index values were recorded every 10min. Total remifentanil consumption, visual analogue scale scores, time to first analgesia and total postoperative morphine consumption were recorded. RESULTS: The total remifentanil consumption, visual analogue scale scores at 0, 20 and 60min, total morphine consumption, time to first analgesia and the number of patients who needed an intravenous morphine were lower in the esmolol group. CONCLUSIONS: Intravenous infusion of esmolol reduced the intraoperative and postoperative analgesic consumption, reduced visual analogue scale scores in the early postoperative period and prolonged the time to first analgesia; however it did not influence the depth of anaesthesia.

Effect of preoperative consumption of high carbohydrate drink (Pre-Op) on postoperative metabolic stress reaction in patients undergoing radical prostatectomy.

AIM: To investigate the effects of oral carbohydrate solution consumed until 2 h before the surgery in the patients that would undergo open radical retropubic prostatectomy on postoperative metabolic stress, patient anxiety, and comfort. METHOD: A total of 50 adult patients, who were in ASA I-II group and would undergo open radical retropubic prostatectomy, were included in the study. While Group 1 = CH (n = 25) received oral glucose solution, Group 2 = FAM (n = 25) was famished starting from 24:00 h. Blood glucose, insulin, and procalcitonin levels of the patients were recorded, and the patients completed state-trait anxiety inventory (STAI) test, which reflects the anxiety level of the patients, both before surgery and on the postoperative 24th hour. In order to evaluate patient comfort, senses of hunger, thirst, nausea, and cold were assessed in the morning prior to the surgery. RESULTS: No difference was observed between the two groups in terms of demographic data and insulin resistance levels (p > 0.05). Comparing with the preoperative levels, insulin resistance showed statistically significant elevation in both groups (p < 0.05). Procalcitonin levels were similarly increased in both groups in the postoperative period (p < 0.05). Preoperative and postoperative STAI state scores were similar in both groups (p > 0.05). With regard to preoperative patient comfort, sense of hunger was present in lesser number of subjects and at lower level in Group 1 (p < 0.05). CONCLUSION: Preoperative consumption of high carbohydrate drink (Pre-op) decreases insulin resistance and enhances patient comfort leading to lesser sense of hunger and thirst in the preoperative period in open radical retropubic prostatectomies.

The analgesic efficacy of intra-articular acetaminophen in an experimental model of carrageenan-induced arthritis.

BACKGROUND: Acetaminophen is one of the most common drugs used for the treatment of pain and fever. OBJECTIVES: To examine the effects of intra-articular (IA) acetaminophen on carrageenan-induced arthritic pain-related behaviour and spinal c-Fos expression in rats. METHODS: The present study was performed using 20 Sprague Dawley rats. Forty microlitres of IA 0.9% NaCl was injected in the control group, and 40 µL of IA carrageenan was injected in the carrageenan group. One hour after carrageenan injection, 400 µg of IA acetaminophen was injected in the IA acetaminophen group, and 400 µg of intraperitoneal (IP) acetaminophen was injected in the IP acetaminophen group. One day before injection, and 4 h and 8 h after injection, diameters of both knee joints, motility of the rat, paw loading and joint mobility were assessed. After the rats were euthanized, L3 and L4 spinal segments were excised for c-Fos assessment. RESULTS: IA acetaminophen decreased both the severity and distribution of c-Fos expression. IP acetaminophen decreased only the distribution of c-Fos expression. IA acetaminophen decreased knee diameter at 8 h. IA and IP acetaminophen increased rat motility and paw loading scores. Joint mobility scores of IP acetaminophen were similar to saline at 8 h. CONCLUSIONS: Results of the present study indicate an analgesic and/or possible anti-inflammatory effect of IA acetaminophen and provide further evidence on the efficacy of systemic acetaminophen injection in reducing arthritic pain.

Effects of dexmedetomidine on succinylcholine-induced myalgia in the early postoperative period.

OBJECTIVE: To determine the effects of dexmedetomidine on the incidence of fasciculation and myalgia, and to evaluate changes in creatine kinase levels due to succinylcholine administration. METHODS: Sixty patients undergoing direct laryngoscopy were enrolled in this study carried out in the Department of Anesthesiology and Reanimation, Hacettepe University, Ankara, Turkey between January and March 2010. Patients were allocated blindly to 3 anesthesiologists. In the dexmedetomidine group (group D) (n=30), dexmedetomidine 1ug/kg was administered intravenously over 10 minutes before the intubation. In the control group (group C) (n=30), the same volume of normal saline was administered. Laryngoscopy was performed one minute after administration of succinylcholine. Dexmedetomidine infusion was continued until the end of surgery. Fasciculation and myalgia at the postoperative thirtieth minute, and creatine kinase levels before the induction of anesthesia and at the postoperative 24th hour, and adequacy of relaxation for intubation were recorded. RESULTS: The severity and incidence of fasciculation were better in group D than group C (p=0.025). Intubating conditions were better in the dexmedetomidine group (p=0.011). At the thirtieth minute, the incidence and severity of myalgia were significantly higher in group C (p=0.014). Postoperative creatine kinase levels increased significantly compared with their base-line levels in both groups (p=0.022 in group D and p=0.017 in group C). Creatine kinase level elevation was higher in group C (p=0.03). CONCLUSION: Dexmedetomidine infusion before and after succinylcholine administration may be useful in diminishing the incidence of succinylcholine-induced myalgia in the early postoperative period. Routine use of dexmedetomidine cannot be recommended, but further research is needed with a larger number of patients.