Ultrasound-Guided External Oblique Intercostal Plane Block for Postoperative Analgesia in Laparoscopic Sleeve Gastrectomy: A Prospective, Randomized, Controlled, Patient and Observer-Blinded Study.

PURPOSE: The external oblique intercostal plane (EOI) block is a novel block technique for anterolateral upper abdominal wall analgesia. The superficial nature of the external oblique intercostal plane allows it to be easily identified even in patients with obesity. The aim of this study was to test the hypothesis that EOI block would reduce IV morphine consumption within 24 h after laparoscopic sleeve gastrectomy. MATERIALS AND METHODS: Patients were randomly assigned to one of two groups: EOI block group and control group. The patients in the EOI block group received ultrasound-guided bilateral EOI block with a total of 40 ml 0.25% bupivacaine after anesthesia induction. The patients in the control group received no intervention. Postoperatively, all the patients were connected to an intravenous patient controlled analgesia (PCA) device containing morphine. The primary outcome of the study was IV morphine consumption in the first postoperative 24 h. RESULTS: The median [interquartile range] morphine consumption at 24 h postoperatively was significantly lower in the EOI block group than in the control group (7.5 [3.5 to 8.5] mg vs 14 [12 to 20] mg, p = 0.0001, respectively). Numerical rating scale (NRS) scores at rest and during movement were lower in the EOI block group than in the control group at 2, 6, and 12 h but were similar at 24 h. No block-related complications were observed in any patients. CONCLUSION: The results of the current study demonstrated that bilateral EOI block reduced postoperative opioid consumption and postoperative pain in patients with obesity undergoing laparoscopic sleeve gastrectomy. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT05663658.

PECS II block for cardiac implantable electronic device insertion: A pilot study.

AIM: Some truncal blocks could provide adequate surgical anesthesia and postoperative analgesia in cardiac implantable electronic devices (CIED) insertion. The aim of this study was to evaluate the feasibility of the pectoral nerves (PECS) II block for CIED insertion. METHODS: PECS II blocks were performed on the left side using the ultrasound-guided single injection technique in all patients. The primary outcome for feasibility was the percentage of the cases completed without intraoperative additional local anesthesia. Secondary outcomes were the amount of intraoperative additional local anesthetic, intraoperative opioid requirement, postoperative pain scores, first requirement for postoperative analgesia, postoperative analgesic consumption, patient satisfaction, and block-related complications. RESULTS: Of the total 30 patients, 19 (63.3%) required intraoperative additional local anesthetic. The median (IQR [range]) volume of the additional local anesthetic used was 7 (4-10 [2.5-12]) mL. Two patients needed additional IV analgesics in the first 24 h postoperatively. No statistically significant differences were determined between the patients requiring and not requiring intraoperative additional local anesthetic in respect of age, gender, duration of surgery, block performance time, and hospital stay. A total of 26 (86.6%) patients reported a high level of satisfaction with the procedure. CONCLUSIONS: PECS II block for cardiac electronic implantable device insertion provides effective postoperative analgesia for at least 24 h. Although PECS II block alone could not provide complete surgical anesthesia in the majority of the patients, when combined with supplementary local anesthetic, contributes to a smooth intraoperative course for patients.

Comparison of plasma neutrophil gelatinase-associated lipocalin (NGAL) levels after robot-assisted laparoscopic and retropubic radical prostatectomy: an observational study.

BACKGROUND AND OBJECTIVES: Patients undergoing radical prostatectomy are at increased risk of Acute Kidney Injury (AKI) because of intraoperative bleeding, obstructive uropathy, and older age. Neutrophil Gelatinase-Associated Lipocalin (NGAL) may become important for diagnosis of postoperative AKI after urogenital oncosurgery. The objective of this study was to evaluate and compare the efficacy of NGAL as a predictor of AKI diagnosis in patients who underwent Retropubic Radical Prostatectomy (RRP) and Robot-Assisted Laparoscopic Prostatectomy (RALP) for prostate cancer. METHODS: We included 66 patients who underwent RRP (n = 32) or RALP (n = 34) in this prospective, comparative, nonrandomized study. Patients' demographic data, duration of surgery and anesthesia, amount of blood products, vasopressor therapy, intraoperative blood loss, fluid administration, length of hospital stay, creatinine, and plasma NGAL levels were recorded. RESULTS: Intraoperative blood loss, crystalloid fluid administration, and length of hospital stay were significantly shorter in RALP. There was no statistically significant difference between the groups in terms of intraoperative blood transfusion. Postoperative creatinine and plasma NGAL levels were increased in both groups. The 6-h NGAL levels were higher in RRP (p = 0.026). The incidence of AKI was 28.12% in RRP and 26.05% in RALP, respectively. The NGAL level at 6 hours was more sensitive in the early diagnosis of AKI in RALP. CONCLUSION: Although postoperative serum NGAL levels were increased in both RRP and RALP, the 6-h NGAL levels were higher in RRP. RALP was associated with fewer intraoperative blood loss and fluid administration, and shorter length of hospital stay.

Comparison of the Effects of Pectoral Nerve Block and Local Infiltration Anesthesia on Postoperative Pain for Breast Reduction Surgery: A Prospective Observational Study.

OBJECTIVE: To evaluate the effects of the Pecs II block on postoperative pain in patients undergoing breast reduction surgery. MATERIALS AND METHODS: This prospective, comparative, and observational study was conducted with 53 patients, with American Society of Anesthesiologists I-II, between the ages of 18 and 65, and undergoing bilateral breast reduction surgery. The patients were divided into two groups: Pecs II block with general anesthesia (Pecs group; n = 26) and local infiltration anesthesia with general anesthesia (control group; n = 27). The patients' demographic data, duration of surgery and anesthesia, hemodynamic parameters, perioperative analgesia requirements, postoperative visual analog scale (VAS) scores (at zero, one, three, six, nine, and 12 hours postoperative), the number of patients who needed analgesia at least once, the length of the hospital stay, and block-related complications were recorded. RESULTS: There was no statistical difference in terms of the duration of surgery and anesthesia and hemodynamic parameters. Intraoperative total fentanyl consumption (128.85 ± 25.19 mcg in the Pecs group and 227.77 ± 44.58 mcg in the control group; P < .001) and postoperative analgesic requirement were significantly lower in the Pecs group (P < .001). The number of patients who needed analgesia at least once in the Pecs group was four (15.3%). Postoperative VAS scores were significantly lower (P < .001) and the length of the hospital stay was significantly shorter in the Pecs group (P < .001). No block-related complications were observed. CONCLUSION: Pecs II block with general anesthesia may significantly contribute to reducing intraoperative and postoperative analgesia requirements and provide long-lasting and more effective postoperative pain in breast reduction surgery.

The effect of different levels of pneumoperitoneum pressures on regional cerebral oxygenation during robotic assisted laparoscopic prostatectomy

Background/aim: This study aimed to evaluate the effect of low- and high-pressure pneumoperitoneum pressures applied during robotic-assisted laparoscopic prostatectomy (RALP) using near-infrared spectroscopy (NIRS) on regional cerebral oxygenation saturation (rSO2). Materials and methods: The prospective, comparative, and observational study included patients aged 18­80 years, with the American Society of Anesthesiologists (ASA) physical status I-II, who would undergo elective RALP. The patients were divided into two groups (12 mmHg of pneumoperitoneum pressure group, n=22 and 15 mmHg of pneumoperitoneum pressure group, n=23). Patients' demographic data, durations of anesthesia, surgery, pneumoperitoneum, and Trendelenburg position, intraoperative estimated blood loss, fluid therapy, urine output, hemodynamic and respiratory data, and rSO2 values were recorded at regular intervals. Results: The rSO2 values increased significantly during the pneumoperitoneum combined with steep Trendelenburg position (from t3 to t6) and at the end of the surgery (t7) in both groups, compared to the values 5 min after the onset of pneumoperitoneum in the supine position (t2) (P < 0.05), but no statistical significance was observed between the two groups. No cerebral desaturation was observed in any of our patients. Hemodynamic and respiratory parameters were preserved in both groups. The blood lactate levels were significantly higher in patients operated at high-pressure pneumoperitoneum, compared to those with low-pressure pneumoperitoneum (P < 0.05). Conclusion: We believe that low-pressure pneumoperitoneum, especially in robotic surgeries, such as robotic-assisted laparoscopic prostatectomy (RALP), can be applied safely.

Liver Transplantation and Early Culture Growth: Risk and Impact?

OBJECTIVE: Despite advances in immunosuppressive drugs, postoperative care, and surgical techniques, bacterial infections remain the most important cause of morbidity and mortality in liver transplant patients. The aim of this study is to evaluate the influence of culture results taken on the first day of admission to intensive care unit on mortality, graft rejection, mechanical ventilation duration, and length of intensive care unit stay. Our study has clinical importance because it is the first study evaluating the cultures obtained on the first day of intensive care unit stays in liver transplant patients. METHODS: Patients' demographic data, transplant type, rates of deceased and living donors, culture results, amount of blood and blood products used intraoperatively, previous hospital admission, mortality, incidence of graft rejection, mechanical ventilation duration, and length of intensive care unit stay were recorded. RESULTS: Mortality and graft rejection were 14.8% and 9%, respectively. The mortality was significantly higher in all 3 cultures and/or in only blood culture-positive patients. Graft rejection, mechanical ventilation duration, and length of intensive care unit stay were significantly higher in patients whose 3 cultures were all positive. Only body mass index had a significant effect on mortality, graft rejection, and positive culture results. CONCLUSIONS: Liver transplant patients' first postoperative day culture results were correlated with mortality, graft rejection, mechanical ventilation duration, and length of intensive care unit stay.

Effect of a new cross-linked hyaluronan gel on the staple line after sleeve gastrectomy in a rat model.

PURPOSE: To evaluate the effect of a new cross-linked hyaluronan (NCHA) gel on healing of the staple line in an experimental sleeve gastrectomy. METHODS: Eighteen rats were randomly divided into three groups. The control group (n = 6) received no medication. In the saline group (n = 6) and NCHA gel group (n = 6), saline and NCHA gel were respectively administered onto the staple line and intraperitoneally into the abdominal cavity after the standard stapling procedure. RESULTS: The fibroblast activity and collagen deposition were significantly higher in the NCHA gel group than in the control group (p = 0.00, p = 0.017) and saline group (p = 0.004, p = 0.015). The tissue hydroxyproline protein level was significantly higher in the NCHA gel group than in the control group (p = 0.041). Adhesion formation was significantly lower in the NCHA gel group than in the control and saline groups (p = 0.015, p = 0.041). CONCLUSIONS: New cross-linked hyaluronan gel could be an effective approach to improve staple line wound healing and prevent potential leakage after sleeve gastrectomy. Moreover, NCHA gel helps to prevent adhesion formation without compromising healing of the staple line.

Effect of a new cross-linked hyaluronan gel on the staple line after sleeve gastrectomy in a rat model

Abstract Purpose: To evaluate the effect of a new cross-linked hyaluronan (NCHA) gel on healing of the staple line in an experimental sleeve gastrectomy. Methods: Eighteen rats were randomly divided into three groups. The control group (n = 6) received no medication. In the saline group (n = 6) and NCHA gel group (n = 6), saline and NCHA gel were respectively administered onto the staple line and intraperitoneally into the abdominal cavity after the standard stapling procedure. Results: The fibroblast activity and collagen deposition were significantly higher in the NCHA gel group than in the control group (p = 0.00, p = 0.017) and saline group (p = 0.004, p = 0.015). The tissue hydroxyproline protein level was significantly higher in the NCHA gel group than in the control group (p = 0.041). Adhesion formation was significantly lower in the NCHA gel group than in the control and saline groups (p = 0.015, p = 0.041). Conclusions: New cross-linked hyaluronan gel could be an effective approach to improve staple line wound healing and prevent potential leakage after sleeve gastrectomy. Moreover, NCHA gel helps to prevent adhesion formation without compromising healing of the staple line.

Comparison of different methods of nasogastric tube insertion in anesthetized and intubated patients / Comparação de diferentes métodos de inserção de sonda nasogástrica em pacientes anestesiados e intubados

Abstract Background Nasogastric tube insertion may be difficult in anesthetized and intubated patients with head in the neutral position. Several techniques are available for the successful insertion of nasogastric tube. The primary aim of this study was to investigate the difference in the first attempt success rate of different techniques for insertion of nasogastric tube. Secondary aim was to investigate the difference of the duration of insertion using the selected technique, complications during insertion such as kinking and mucosal bleeding. Material and methods 200 adult patients, who received general anesthesia for elective abdominal surgeries that required nasogastric tube insertion, were randomized into four groups: Conventional group (Group C), head in the lateral position group (Group L), endotracheal tube assisted group (Group ET) and McGrath video laryngoscope group (Group MG). Success rates, duration of insertion and complications were noted. Results Success rates of nasogastric tube insertion in first attempt and overall were lower in Group C than Group ET and Group MG. Mean duration and total time for successful insertion of NG tube in first attempt were significantly longer in Group ET. Kinking was higher in Group C. Mucosal bleeding was statistically lower in Group MG. Conclusion Use of video laryngoscope and endotracheal tube assistance during NG tube insertion compared with conventional technique increase the success rate and reduce the kinking in anesthetized and intubated adult patients. Use of video laryngoscope during nasogastric tube insertion compared to other techniques reduces the mucosal bleeding in anesthetized and intubated adult patients.

Resumo Justificativa A inserção de sonda nasogástrica (NG) pode ser difícil em pacientes anestesiados e intubados com a cabeça em posição neutra. Há várias técnicas para a inserção bem-sucedida de sonda NG. O objetivo primário deste estudo foi investigar a diferença da taxa de sucesso na primeira tentativa de diferentes técnicas para inserção de sonda NG. O objetivo secundário foi investigar a diferença do tempo de inserção com o uso da técnica selecionada e as complicações durante a inserção (dobradura da sonda e sangramento da mucosa). Material e métodos 200 pacientes adultos que receberam anestesia geral para cirurgias abdominais eletivas que exigiam inserção de sonda NG foram randomicamente distribuídos em quatro grupos: grupo convencional (Grupo C), grupo com a cabeça posicionada lateralmente (Grupo L), grupo com assistência de tubo traqueal (Grupo TE) e grupo com videolaringoscópio McGrath (grupo MG). As taxas de sucesso, os tempos de inserção e as complicações foram registrados. Resultados As taxas de sucesso de inserção da sonda NG na primeira tentativa e em geral foram menores no Grupo C do que nos grupos TE e MG. As durações e os tempos totais de inserção bem-sucedida da sonda NG na primeira tentativa foram significativamente maiores no Grupo TE. Dobradura foi maior no Grupo C. Sangramento da mucosa foi estatisticamente menor no Grupo MG. Conclusão O uso de videolaringoscópio e de TE durante a inserção de sonda NG comparado com o uso da técnica convencional aumentou a taxa de sucesso e reduziu a dobradura da sonda em pacientes adultos anestesiados e intubados. O uso de videolaringoscópio durante a inserção de sonda NG em comparação com outras técnicas reduz o sangramento da mucosa em pacientes adultos anestesiados e intubados.

[Comparison of different methods of nasogastric tube insertion in anesthetized and intubated patients]. / Comparação de diferentes métodos de inserção de sonda nasogástrica em pacientes anestesiados e intubados.

BACKGROUND: Nasogastric tube insertion may be difficult in anesthetized and intubated patients with head in the neutral position. Several techniques are available for the successful insertion of nasogastric tube. The primary aim of this study was to investigate the difference in the first attempt success rate of different techniques for insertion of nasogastric tube. Secondary aim was to investigate the difference of the duration of insertion using the selected technique, complications during insertion such as kinking and mucosal bleeding. MATERIAL AND METHODS: 200 adult patients, who received general anesthesia for elective abdominal surgeries that required nasogastric tube insertion, were randomized into four groups: Conventional group (Group C), head in the lateral position group (Group L), endotracheal tube assisted group (Group ET) and McGrath video laryngoscope group (Group MG). Success rates, duration of insertion and complications were noted. RESULTS: Success rates of nasogastric tube insertion in first attempt and overall were lower in Group C than Group ET and Group MG. Mean duration and total time for successful insertion of NG tube in first attempt were significantly longer in Group ET. Kinking was higher in Group C. Mucosal bleeding was statistically lower in Group MG. CONCLUSION: Use of video laryngoscope and endotracheal tube assistance during NG tube insertion compared with conventional technique increase the success rate and reduce the kinking in anesthetized and intubated adult patients. Use of video laryngoscope during nasogastric tube insertion compared to other techniques reduces the mucosal bleeding in anesthetized and intubated adult patients.

Comparison of Transcutaneous Electrical Nerve Stimulation and Parasternal Block for Postoperative Pain Management after Cardiac Surgery.

Background. Parasternal block and transcutaneous electrical nerve stimulation (TENS) have been demonstrated to produce effective analgesia and reduce postoperative opioid requirements in patients undergoing cardiac surgery. Objectives. To compare the effectiveness of TENS and parasternal block on early postoperative pain after cardiac surgery. Methods. One hundred twenty patients undergoing cardiac surgery were enrolled in the present randomized, controlled prospective study. Patients were assigned to three treatment groups: parasternal block, intermittent TENS application, or a control group. Results. Pain scores recorded 4 h, 5 h, 6 h, 7 h, and 8 h postoperatively were lower in the parasternal block group than in the TENS and control groups. Total morphine consumption was also lower in the parasternal block group than in the TENS and control groups. It was also significantly lower in the TENS group than in the control group. There were no statistical differences among the groups regarding the extubation time, rescue analgesic medication, length of intensive care unit stay, or length of hospital stay. Conclusions. Parasternal block was more effective than TENS in the management of early postoperative pain and the reduction of opioid requirements in patients who underwent cardiac surgery through median sternotomy. This trial is registered with Clinicaltrials.gov number NCT02725229.