A novel comparison of erector spinae plane block and paravertebral block in laparoscopic cholecystectomy.

OBJECTIVE: Erector spinae plane block is an updated method than paravertebral block, possessing a lower risk of complications. This study aimed to compare erector spinae plane and paravertebral blocks to safely reach the most efficacious analgesia procedure in laparoscopic cholecystectomy cases. METHODS: The study included 90 cases, aged 18-70 years, classified as American Society of Anesthesiologists I-II, who underwent an laparoscopic cholecystectomy procedure. They were randomly separated into three groups, namely, Control, erector spinae plane, and paravertebral block. No block procedure was applied to Control, and a patient-controlled analgesia device was prepared containing tramadol at a 10 mg bolus dose and a 10-min locked period. The pain scores were recorded with a visual analog scale for 24 h postoperatively. RESULTS: The visual analog scale values at 1, 5, 10, 20, and 60 min at rest and 60 min coughing were found to be significantly higher in Control than in paravertebral block. A significant difference was revealed between Control vs. paravertebral block and paravertebral block vs. erector spinae plane in terms of total tramadol consumption (p=0.006). Total tramadol consumption in the first postoperative 24 h was significantly reduced in the paravertebral block compared with the Control and erector spinae plane groups. CONCLUSION: Sonography-guided-paravertebral block provides sufficient postoperative analgesia in laparoscopic cholecystectomy surgery. Erector spinae plane seems to attenuate total tramadol consumption.

Comparison of the median and intermediate approaches to the ultrasound-guided sacral erector spinae plane block: a cadaveric and radiologic study.

BACKGROUND: Erector spinae plane block (ESPB) is a well-established method for managing postoperative and chronic pain. ESPB applications for the sacral area procedures are called sacral ESPBs (SESPBs). This cadaveric study aimed to determine the distribution of local anesthesia using the median and intermediate approaches to the SESPB. METHODS: Four cadavers were categorized into the median and intermediate approach groups. Ultrasound-guided SESPBs were performed using a mixture of radiopaque agents and dye. Following confirmation of the solution distribution through computed tomography (CT), the cadavers were dissected to observe the solution distribution. RESULTS: CT images of the median group demonstrated subcutaneous pooling of the radiopaque solution between the S1 and S5 horizontal planes. Radiopaque solution also passed from the sacral foramina to the anterior sacrum via the spinal nerves between S2 and S5. In the intermediate group, the solution distribution was observed along the bilateral erector spinae muscle between the L2 and S3 horizontal planes; no anterior transition was detected. Dissection in the median group revealed blue solution distribution in subcutaneous tissue between horizontal planes S1 and S5, but no distribution in superficial fascia or muscle. In the intermediate group, red solution was detected in the erector spinae muscle between the L2 and S3 intervertebral levels. CONCLUSIONS: Radiologic and anatomic findings revealed the presence of radiopaque dye in the superficial and erector spinae compartments in both the median and intermediate groups. However, anterior transition of the radiopaque dye was detected only in the median group.

Catheter use in regional anesthesia: pros and cons.

Continuous peripheral nerve blocks refer to a local anesthetic solution administered via perineurally placed catheters in an effort to extend the benefits of a single-shot peripheral nerve block. They offer several advantages in the postoperative period including excellent analgesia, reduced opioid consumption and associated side effects, enhanced rehabilitation and improved patient satisfaction. The current trend towards less invasive, one-day surgery and enhanced recovery programs may decrease the requirement of catheter use. Prolonged motor block in particular is associated with undesirable outcomes. Should we routinely use continuous peripheral nerve blocks in our daily practice? This PRO-CON debate aims at answering the question from the experts' perspectives. Fascial compartment and wound catheters are outside the scope of this debate.

A rare case of axillary Schwannoma.

Schwannoma, neurilemmoma, is well capsulated, slowly growing tumor originating from benign neoplastic Schwann cells of the peripheral nerve sheath. Due to its rarity and complex anatomical location they can pose the misdiagnosis at clinical evaluation. A total surgical excision with a safety margin was performed for 63 year-old male with the complaints of painless lump at the axillary region for 4 months and the diagnosis of axillary Schwannoma confirmed by the histopathological examination and immunohistochemistry. Although its rarity, Schwannoma should be kept in mind for the differential diagnosis of axillary masses. Its complete resection represents the cure for indicated cases. KEY WORDS: Axilla, Immunohistochemistry, Peripheral Nerve Sheath, Schwannoma.

In vitro antimicrobial activity of commonly used vasoactive drugs.

STUDY OBJECTIVE: Microbial contamination during preparation of the infusion drugs is an important issue in intensive care units. Objective of this study was to investigate in vitro antimicrobial properties of commonly used vasoactive drugs. DESIGN: Prospective study. SETTING: Clinical microbiology laboratory of a university hospital. MEASUREMENTS: Growth of the microorganisms Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, Pseudomonas aeruginosa, and Candida albicans in saline dilutions of adrenaline at 1, 10, and 100 µg/mL; noradrenaline at 1, 10, and 100 µg/mL; and dopamine at 0.1, 1, and 10 mg/mL concentrations was investigated. Each drug solution and saline were analyzed with a digital pH meter. MAIN RESULTS: Saline dilutions of adrenaline, noradrenaline, and dopamine at clinically used concentrations decreased microbial growth. The highest concentration doses of adrenaline, noradrenaline, and dopamine used in the study had significant antimicrobial effect when compared to the low and moderate doses. This effect was shown with the all microorganisms. S aureus, S epidermidis, and C albicans were more sensitive; on the other hand, E coli and P aeruginosa were more resistant against the effect of the drug dilutions. CONCLUSIONS: To limit microbial growth in case of contamination of the drug solution, it is advisable to use more concentrated dilutions of adrenaline, noradrenaline, and dopamine used in clinical practice.

The association between thenar eminence and I-gel(tm) dimensions in paediatric patients / Associação entre as dimensões da eminência tênar e I-gel(tm) em pacientes pediátricos

ABSTRACT OBJECTIVES: A practical anatomic landmark may be helpful to perform the appropriate size of the airway devices easily in paediatric patients. The aim of this study was to investigate the association between thenar eminence and I-gel dimensions in children. METHODS: After Institutional Ethics Committee approval, two hundred and seventy ASA Class I-II patients between 0 and 12 years old, who were scheduled for elective procedures under general anaesthesia not requiring tracheal intubation, were recruited to the study. The size of the I-gel selected was based on the patient's body weight according to the manufacturer's recommendation. After successful insertion of the I-gel, thenar eminence dimensions were determined. Long-axis (Th-l) was measured from junction point of the thumb to wrist curl and short-axis (Th-w) constitutes the largest portion of the thenar eminence from lateral end of the thumb to the first hand line. The manufacturer's dimensions of the I-gel which was inserted into the patients were compared with the measurements obtained from thenar eminence. RESULTS: The mean (SD) values for (Ig-w) and (Ig-l) were 2.98 cm (0.53) and 4.54 cm (0.82), and the mean (SD) values for (Th-w) and (Th-l) were 2.99 cm (0.60) and 3.88 cm (0.93), respectively. There was a statistically significant correlation between Th-w and Ig-w (r = 0.794,p < 0.001), and between Th-l and Ig-l (r = 0.820, p < 0.001). CONCLUSION: The dimensions of thenar eminence were fitted to that of the weight based size of I-gel and this anatomic landmark may be a practical tool to assess appropriate size for paediatric patients.

RESUMO OBJETIVOS: Uma referência anatômica prática pode ser útil para determinar o tamanho adequado dos dispositivos para vias aéreas em pacientes pediátricos. O objetivo deste estudo foi investigar a associação entre as dimensões da eminência tênar e do dispositivo I-gel em crianças. MÉTODOS: Após aprovação do Comitê de Ética Institucional, 270 pacientes com estado físico ASA I-II, entre 0-12 anos, programados para cirurgias eletivas sob anestesia geral, sem necessidade de intubação traqueal, foram recrutados para o estudo. A escolha do tamanho do I-gel foi baseada no peso corporal do paciente, de acordo com a recomendação do fabricante. Após a inserção bem-sucedida do I-gel, a dimensão da eminência tênar era determinada. O eixo longo (Th-l) foi medido do ponto de junção do polegar ao vinco do pulso e o eixo curto (Th-w) constitui a maior parte da eminência tênar da extremidade lateral do polegar à primeira linha da mão. As dimensões de fábrica do I-gel inserido no paciente foram comparadas com as dimensões obtidas a partir da eminência tênar. RESULTADOS: As médias (DP) dos valores para (Ig-w) e (Ig-l) foram 2,98 cm (0,53) e 4,54 cm (0,82) e as médias (DP) dos valores para (Th-w) e (TH l) foram 2,99 cm (0,60) e 3,88 cm (0,93), respectivamente. Houve uma correlação estatisticamente significativa entre Th-w e Ig-w (r = 0,794, p < 0,001) e entre Th-l e Ig-l (r = 0,820, p < 0,001). CONCLUSÃO: As dimensões da eminência tênar foram ajustadas àquelas do tamanho do I-gel baseado no peso e essa referência anatômica pode ser uma ferramenta prática para avaliar o tamanho apropriado em pacientes pediátricos.

The association between thenar eminence and I-gel™ dimensions in paediatric patients.

OBJECTIVES: A practical anatomic landmark may be helpful to perform the appropriate size of the airway devices easily in paediatric patients. The aim of this study was to investigate the association between thenar eminence and I-gel dimensions in children. METHODS: After Institutional Ethics Committee approval, two hundred and seventy ASA Class I-II patients between 0 and 12 years old, who were scheduled for elective procedures under general anaesthesia not requiring tracheal intubation, were recruited to the study. The size of the I-gel selected was based on the patient's body weight according to the manufacturer's recommendation. After successful insertion of the I-gel, thenar eminence dimensions were determined. Long-axis (Th-l) was measured from junction point of the thumb to wrist curl and short-axis (Th-w) constitutes the largest portion of the thenar eminence from lateral end of the thumb to the first hand line. The manufacturer's dimensions of the I-gel which was inserted into the patients were compared with the measurements obtained from thenar eminence. RESULTS: The mean (SD) values for (Ig-w) and (Ig-l) were 2.98cm (0.53) and 4.54cm (0.82), and the mean (SD) values for (Th-w) and (Th-l) were 2.99cm (0.60) and 3.88cm (0.93), respectively. There was a statistically significant correlation between Th-w and Ig-w (r=0.794, p<0.001), and between Th-l and Ig-l (r=0.820, p<0.001). CONCLUSION: The dimensions of thenar eminence were fitted to that of the weight based size of I-gel and this anatomic landmark may be a practical tool to assess appropriate size for paediatric patients.

[The association between thenar eminence and I-gel™ dimensions in paediatric patients]. / Associação entre as dimensões da eminência tênar e I-gel™ em pacientes pediátricos.

OBJECTIVES: A practical anatomic landmark may be helpful to perform the appropriate size of the airway devices easily in paediatric patients. The aim of this study was to investigate the association between thenar eminence and I-gel dimensions in children. METHODS: After Institutional Ethics Committee approval, two hundred and seventy ASA Class I-II patients between 0 and 12 years old, who were scheduled for elective procedures under general anaesthesia not requiring tracheal intubation, were recruited to the study. The size of the I-gel selected was based on the patient's body weight according to the manufacturer's recommendation. After successful insertion of the I-gel, thenar eminence dimensions were determined. Long-axis (Th-l) was measured from junction point of the thumb to wrist curl and short-axis (Th-w) constitutes the largest portion of the thenar eminence from lateral end of the thumb to the first hand line. The manufacturer's dimensions of the I-gel which was inserted into the patients were compared with the measurements obtained from thenar eminence. RESULTS: The mean (SD) values for (Ig-w) and (Ig-l) were 2.98cm (0.53) and 4.54cm (0.82), and the mean (SD) values for (Th-w) and (Th-l) were 2.99cm (0.60) and 3.88cm (0.93), respectively. There was a statistically significant correlation between Th-w and Ig-w (r=0.794, p<0.001), and between Th-l and Ig-l (r=0.820, p<0.001). CONCLUSION: The dimensions of thenar eminence were fitted to that of the weight based size of I-gel and this anatomic landmark may be a practical tool to assess appropriate size for paediatric patients.

Effect of topical administration of tramadol on corneal wound healing in rats.

In this study, we aimed to investigate the effects of topical tramadol administration on corneal wound healing, and examine ophthalmic structures and intraocular pressure 7 days after tramadol administration. The experiments were conducted on eight male Wistar rats (250-300 g). After ophthalmic examination, epithelial cell layers in the central cornea were wounded. Rats received 30 µL of tramadol hydrochloride in one eye (Group Tramadol) and the same volume of vehicle in the other (Group Control) every 12 h for 7 days. Both eyes were stained with fluorescein dye, photographed, and wound area was calculated every 8 h until complete healing was observed. Eye blink frequency and corneal reflex tests were measured before and after drug administrations. After 7 days, slit lamp biomicroscopy, fundoscopy, Goldmann applanation tonometry, and histological evaluation were performed. There was no difference in the corneal wound healing rates between the tramadol and control groups. Reduction in wound area over time was also similar; group-time interaction was insignificant (F = 738.911; p = 0.225). Tramadol application resulted in blinking and blepharospasm for 30 s, but vehicle did not. Corneal reflex was intact and eye blink frequency test results were similar in all measurement times in both groups. Slit lamp biomicroscopy, fundoscopy, and intraocular pressures were within normal range. Corneal cells appeared unaffected by the repeated doses of tramadol for 7 days. Topical tramadol application on the cornea did not cause any side effect, except for initial temporary blinking and blepharospasm. Corneal wound healing was not affected, either.

Segmental epidural anesthesia for percutaneous kyphoplasty:comparison with general anesthesia.

BACKGROUND/AIM: This is a feasibility study evaluating whether segmental epidural anesthesia is an alternative anesthetic approach to general anesthesia for percutaneous kyphoplasty. MATERIALS AND METHODS: After ethics committee approval was obtained, 52 ASA class I-III patients scheduled for elective, single-level percutaneous kyphoplasty were recruited. The patients were divided into two equal groups. In Group E (Group Epidural) segmental epidural anesthesia was performed using the loss of resistance technique with saline. In Group G (Group Control) general anesthesia was performed. Hemodynamic parameters, intraoperative and postoperative analgesic requirements, visual analogue scale (VAS) scores, length of stay in the postanesthesia care unit (PACU), and complications were recorded. RESULTS: Hemodynamics were similar between the two groups. Postoperative analgesic requirement was significantly higher in Group G than in Group E (P < 0.004). VAS scores were significantly lower in Group E than in Group G (P < 0.05). Time to first pain experience at the first postoperative 4 h was significantly longer and length of stay in the PACU was significantly shorter in Group E than in Group G (P < 0.001). CONCLUSION: Segmental epidural anesthesia is a safe anesthetic technique for percutaneous kyphoplasty. This technique offered advantages over general anesthesia in terms of postoperative analgesia, analgesic consumption, early recovery, and short PACU stay. Therefore, it should be considered a suitable anesthetic technique in patients undergoing single level percutaneous kyphoplasty.