Follow-up of Serum Creatine Phosphokinase Levels after Ultrasound Guided Suprainguinal Fascia Iliaca Block with Bupivacaine in Total Knee Arthroplasty Patients: An Observational, Controlled Study.

OBJECTIVE: To determine the myotoxicity of bupivacaine on muscles after suprainguinal fascia iliaca block for postoperative analgesia in total knee arthroplasty (TKA) patients through changes in serum creatine phosphokinase (CPK) levels during the perioperative period. STUDY DESIGN: Observational study. Place and Duration of the Study: Postoperative Recovery Room department of Anaesthesiology and Reanimation, Samsun University, Samsun, Training and Research Hospital, Samsun, Turkiye, between December 2022 and February 2023. METHODOLOGY: Patients undergoing for the procedure of TKA surgery were recruited. (40 controls and 42 SIFIB groups). Serum CPK levels were evaluated preoperatively, at postoperative 6th hour and 24th hour. RESULTS:  From total 82 patients, 42 of them who received SIFIB as a component of multimodal analgesia had serum CPK levels comparable to those in the control group at all time points (p>0.05). While the increase in CPK level at 6th hour relative to baseline was significant in both groups (p<0.05), only the block group demonstrated a statistically significant difference between the 6th and 24th hours (p<0.05). CONCLUSION: SIFIB administration did not result in severe bupivacaine-induced myotoxicity in comparison to the control group. SIFIB administration is a safe option when used as part of multimodal analgesia in TKA. KEY WORDS:  Bupivacaine, Creatine phosphokinase, Myotoxicity, Regional anaesthesia.

Comparison of the analgesic efficacy of the ultrasound-guided transversalis fascia plane block and erector spinae plane block in patients undergoing open inguinal hernia repair under spinal anesthesia.

BACKGROUND: Open inguinal hernia repair (OIHR) surgery is a common surgical procedure, and ultrasound guided interfascial plane blocks can also be included in current approaches to postoperative multimodal analgesia regimens. This study aimed to compare the postoperative analgesic efficacy of the erector spinae plane block (ESPB) and transversalis fascia plane block (TFPB) in patients undergoing OIHR. METHODS: This prospective, randomized, assessor-blinded comparative study was conducted in the postoperative recovery room and ward of a tertiary hospital. A total of 80 patients with American Society of Anesthesiologists physical status I-III were enrolled and allocated equally to either the ESPB or TFPB group. The patients received standard multimodal analgesia in addition to an ultrasound-guided ESPB or TFPB. During the first 24 h postoperatively, tramadol consumption was assessed and pain levels at rest and during movement were compared using numeric rating scale (NRS) scores at 1, 3, 6, 9, 12, 18, and 24 h postoperatively. RESULTS: The results showed no difference in NRS scores at any time point between the groups, except for NRS at rest in the third hour. However, tramadol consumption was lower in the TFPB group than in the ESPB group overall (88 ± 75.2 vs. 131 ± 93.7 mg, respectively; P = 0.027, mean difference: -43, 95% CI [-80.82, -5.18]). CONCLUSIONS: The TFPB leads to lower tramadol requirements in the first 24 h postoperatively than the ESPB in patients undergoing OIHR.

The Effects of Magnesium Sulphate on Integrated Pulmonary Index Scores and Propofol Consumption During Endobronchial Ultrasonography: A Retrospective Study.

Aim Our aim in this study was to investigate the effect of inhaled and intravenous (iv) magnesium (Mg) use on Integrated Pulmonary Index (IPI) score and propofol consumption in patients undergoing endobronchial ultrasonography (EBUS) procedure under sedoanalgesia. Materials and methods After obtaining the approval of the local ethics committee, the files of 96 patients aged 18-75 who underwent EBUS were reviewed retrospectively. Patients using Mg were classified as the M group, and patients not using Mg were classified as the control (C) group. IPI values, amount of propofol consumed, and intubation scores of group M and group C were evaluated. Results When the intubation score values ​​at the time of the bronchoscope passing through the vocal cords (assessment of vocal cord movement, cough reflex, and leg movement) during the EBUS procedure were compared, the intubation conditions were found to be significantly better in the M group than in the C group (p<0.05). Group M had less cough reflex than group C (p<0.05). IPI scores were significantly higher in the M group than in the C group at the 10th and 15th minutes (p<0.05). Total propofol consumption was found to be significantly lower in the M group (254.61±82.80 mg) than in the C group (321.25±90.04 mg) (p<0.05). Conclusion According to our results, the use of intravenous and inhaler Mg in addition to propofol sedation during the EBUS procedure may improve the respiratory parameters and can also significantly reduce the propofol dose.

Is Pain Perception Communicated through Mothers? Maternal Pain Catastrophizing Scores Are Associated with Children's Postoperative Circumcision Pain.

The aim of this study was to evaluate the relation of maternal pain catastrophizing score with children who underwent circumcision postoperative pain. This prospective cohort study was performed between March 2022 and March 2023 at Samsun University, Turkey. Demographic characteristics of mothers and children, mothers' education level, presence of chronic pain, and Beck Depression Inventory scores were recorded preoperatively. Pain catastrophizing was assessed by applying the pain catastrophizing scale (PCS) to the mothers of children who experienced postoperative circumcision pain. The mothers were divided into low-pain catastrophizing (Group 1) and high-pain catastrophizing (Group 2) group. A total of 197 mothers and sons participated in the study, with 86 (43.6%) in Group 1 and 111 (56.4%) in Group 2. Significant differences were found between the two groups in terms of the mothers' PCS scores (p < 0.001), education levels (p = 0.004), chronic pain scores (p = 0.022), and Beck Depression Inventory scores (p < 0.001). Our findings showed that children with high pain catastrophizing mothers experience greater postoperative pain than those with low pain catastrophizing mothers. This may be attributable to a mother's specific cognitive style for coping with pain, which is associated with the child's responses to painful experiences.

The Effect of Cold Application to the Lateral Neck Area on Peripheral Vascular Access Pain: A Randomised Controlled Study.

INTRODUCTION: Various types of vagus nerve stimulation are employed in the treatment of a range of conditions, including depression, anxiety, epilepsy, headache, tinnitus, atrial fibrillation, schizophrenia, and musculoskeletal pain. The objective of this study was to apply vagal stimulation to the neck area using standardised cold, and then analyse the level of vascular access discomfort experienced by individuals who underwent venous cannulation from the dorsal side of the hand prior to anaesthesia. MATERIALS AND METHODS: A total of 180 patients, aged 18-75, who were scheduled to undergo elective surgery, were categorised into three distinct groups: the Sham group (Group S), the Control group (Group K), and the Cold group (Group M), with each group consisting of 60 individuals. Bilateral cold application to the lateral side of the neck was performed prior to the commencement of vascular access in Group M patients, followed by the subsequent opening of vascular access. The alterations in heart rate among patients was assessed subsequent to the application of cold and following the establishment of vascular access. The participants were instructed to assess their level of vascular access pain on a numerical pain scale (NRS) ranging from 0 to 10. RESULTS: A statistically significant difference (p = 0.035) was seen when comparing the pain ratings of patients during vascular access. The study revealed that the NRS values exhibited a statistically significant decrease in Group M compared to both Group K (p = 0.038) and Group S (p = 0.048). Group M had a higher prevalence of individuals experiencing mild pain compared to other groups, and the difference was statistically significant (p = 0.029). In Group M, the average heart rate following vagal stimulation exhibited a statistically significant decrease compared to the average heart rate observed at the beginning of the study (p < 0.05). Upon comparing the original heart rate measurements with the heart rate values following vascular access, it was observed that there was an elevation in heart rate for both Group S and Group K. Conversely, Group M exhibited a decrease in heart rate after vascular access when compared to the initial heart rate values. CONCLUSIONS: In the present investigation, it was discovered that the application of cold to the neck region resulted in a drop in heart rate among the patients, which persisted throughout the process of vascular access. Furthermore, the level of pain experienced by these individuals was reduced during vascular access procedures.

Does Adding an IPACK Block to the Suprainguinal Fascia Iliaca Block Improve the Quality of Analgesia in Patients Undergoing Knee Arthroplasty under Spinal Anesthesia? A Retrospective Cohort Study.

Background and Objectives: Total knee arthroplasty (TKA) is a commonly performed orthopedic procedure, and is often accompanied by significant postoperative pain. The supra-inguinal fascia iliaca block (SIFIB), similar to an anterior lumbar plexus block, is frequently used in hip surgeries. The interspace between the popliteal artery and capsule of the posterior knee (IPACK) block is a regional anesthesia technique that targets the posterior innervation of the knee capsule. This retrospective study aimed to compare the analgesic effects of SIFIB and SIFIB + IPACK on patients undergoing TKA under spinal anesthesia. Materials and Methods: This retrospective study revealed the data collected from a tertiary hospital. Patient data were gathered for individuals who underwent unilateral TKA under spinal anesthesia during the period between 1 January 2023 and 1 September 2023. Inclusion criteria comprised patients falling within ASA class I-III, those following a standardized perioperative analgesia regimen, and individuals receiving opioids via a patient-controlled analgesia device (PCA) as part of their postoperative pain management strategy. Patients were grouped as SIFIB and SIFIB + IPACK according to the performed regional anesthesia technique. Results: In the study, the data of 88 patients in total, 61 in the SIFIB group and 27 in the IPACK group, were analyzed. The 24 h cumulative morphine consumption was similar in the SIFIB and SIFIB + IPACK groups (10.62 ± 6.58 mg vs. 12.55 ± 8.84 mg, respectively; p: 0.258). The NRS scores of the groups were similar in all time frames. Conclusions: Our study reveals that combining IPACK with SIFIB in the multimodal analgesia plan does not provide additional benefits in terms of postoperative opioid consumption and pain scores in patients undergoing unilateral THA under spinal anesthesia.

Evaluation of Postoperative Analgesic Efficacy of Ultrasound-Guided Suprainguinal Fascia Iliaca Block in Knee Arthroplasty: Prospective, Randomized, Feasibility Study.

BACKGROUND: Total Knee Arthroplasty (TKA) is one of the most commonly performed orthopedic procedures, and patients complain of severe pain in the postoperative period. The supra-inguinal fascia iliaca block (SIFIB) works as an anteriorly applied lumbar plexus block and is frequently used in hip surgeries. In this study, we evaluated the effect of SIFIB in patients undergoing TKA under spinal anesthesia. METHODS: This study is a prospective, randomized, assessor-blinded feasibility study conducted in a tertiary hospital. Eighty-six patients with ASA I-III were initially enrolled, and after exclusions, 80 patients were randomized into two equal groups (SIFIB and control groups). The standard multimodal analgesia was applied to the control group, while SIFIB was additionally applied to the block group. The study measured the morphine requirement in PCA and pain intensity using Numeric Rating Scores between the two groups. RESULTS: the 24-h cumulative morphine consumption was lower in Group SIFIB. Although there was a decrease in NRS at rest scores in the SIFIB group during some time periods, pain was moderate, and no differences in pain scores were recorded during exercise in all patients. CONCLUSIONS: In patients undergoing TKA under spinal anesthesia, a single shot of SIFIB results in a significant reduction in the amount of morphine consumed in hours. This effect was most likely related to a decrease in pain at rest in the SIFIF group.

Comparison of Pain Catastrophic Scale and Anxiety in Patients With Boxer's Fracture and Other Types of Hand Fractures.

OBJECTIVE:  The Pain Catastrophic Scale (PCS) is generally associated with high and low post-recovery satisfaction and measures the pain perception of patients in the literature. This study aims to evaluate the association of deliberate (as in a fight or anger causing punching a wall) boxer's fractures with catastrophic pain compared to accidental (as in a fall, accidental knocking it against a wall, etc.) fractures and evaluate the effect of anxiety about fracture union and functional recovery on clinical outcomes. MATERIALS AND METHODS:  A total of 62 male patients with metacarpal fractures, 31 as a result of deliberate punching (1st group) and 31 with metacarpal fractures as a result of an accident (2nd group), who applied to the emergency department or orthopedic clinic with the diagnosis of metacarpal fracture between January 2021 and October 2022, were included in the study. All patients were selected from patients who were followed up with conservative plaster/splint. The PCS scores of the patients were evaluated comparatively with the clinical results measured after at least six weeks. RESULTS:  The mean age of the patients was 30.8 (18-50) in the 1st group and 34.8 (18-64) in the 2nd Group, and no statistically significant difference was found (p=0.274). While the median PCS score was 10.5 (interquartile range {IQR}: 12.3) for the 1st group, the median PCS score was 17.5 (IQR: 14.5) for the 2nd group, and the PCS score was statistically significantly lower in group 1 (p=0.009). While the median Visual Analogue Scale (VAS) value was 0 (IQR: 0.3) for the 1st group, the median VAS value was 1 (IQR: 2.0) for the 2nd group, and the VAS score was statistically significantly lower in the 1st group (p<0.001). While the median 'quick disabilities of the arm, shoulder, and hand' (Q-DASH) value was 0 (IQR:2.3) for the 1st group, the median Q-DASH value was 3.4 (IQR:6.3) for the 2nd group, and the Q-DASH score was statistically significantly lower in the 1st group (p=0.001). No significant difference was observed between the 1st and 2nd groups in terms of grip strength values (p=0.815). CONCLUSION: The etiology of patients presenting with a boxer's fracture should be well understood, and if necessary, these patients should be treated multidisciplinary, with psychiatric help. Better satisfaction can be achieved with lower results in patients whose PCS scoring system has lost its eigenvalue.

Investigation of the analgesic efficacy of ultrasound-guided thoracolumbar interfacial plane block in vertebral surgery: A prospective randomized clinical study.

OBJECTIVES: To investigate the effect of thoracolumbar interfacial plane block (TLIP) on analgesic consumption and pain score in vertebral surgery. METHODS: All patients (64 patients undergoing vertebral surgery) were randomly allocated as Group T (patients with block, n=32) and Group C (patients without block, n=32). After surgery, patient-controlled analgesia using tramadol was administered to all patients. Pain intensity was evaluated with visual analogue scale (VAS; recovery room at 1, 2, 6, 12, and 24 hours postoperative), and as rescue analgesia, morphine was administered to patients with VAS scores of >4. In this study, total tramadol consumption, the number of patients requiring morphine, VAS score, and Quality of Recovery-40 of all patients questionnaire was evaluated. RESULTS: There were important differences between the 2 groups according to mean postoperative tramadol consumption (Group T and Group C; 180 mg [100-260] vs. 210 mg [100-300]; p=0.001) and the number of patients requiring additional analgesia (n=4; 12.5% vs. n=24; 75%, p=0.000). There were important differences between the 2 groups according to the postoperative VAS pain score (p=0.000). CONCLUSION: Ultrasound-TLIP reduces analgesic consumption and pain severity after vertebral surgery. Therefore, it is an important regional analgesia technique. CLINICALTRIALSGOV GRANT NO: NCT04548076.

The effect of head position on glottic visualization with video laryngoscope and intubation success in obese patients who are not expected to have a difficult airway: a prospective randomized clinical study.

Intubation is required to maintain anesthesia in patients who are planned to undergo surgery under general anesthesia. One of the most important steps for successful intubation is to position head and neck appropriately. Sniffing position, head extension position, and neutral head position are the most known and used head and neck positions. The aim of this study is to examine the effect of head position on glottic visualization with McGrath MAC® video laryngoscope (VL) and intubation success in obese patients who are scheduled for surgery. A total of 150 patients, 50 patients in each group, with a body mass index of 30 and above were included in the study. The patients included in the study were divided into three groups: neutral head position, head extension position and sniffing position. During the intubation with McGrath MAC® VL, the groups were compared in terms of percent of glottic opening (POGO) score, intubation duration and Intubation Difficulty Scale (IDS) score. While the POGO score was found to be statistically significantly higher in the sniffing position than in the neutral head position (p < 0.001), it was similar in the extension position. The intubation duration was found to be statistically significantly shorter in the sniffing position than in the neutral head position (p = 0.001). However, there was no statistically significant difference between sniffing and extension positions. IDS score was found to be statistically significantly higher in the neutral head position compared to the other positions (p < 0.001, p < 0.001, respectively). In addition, the IDS score was statistically significantly higher in head extension position than in sniffing position (p = 0.016). This study is a randomized controlled trial of 150 patients investigating the impact of head position on glottic visualization and intubation success in obese patients when using Macintosh-like VL. The results show that sniffing position may be favored.

[Perioperative analgesic efficacy of bilateral superficial cervical plexus block in patients undergoing thyroidectomy: a randomized controlled trial]. / Eficácia analgésica perioperatória do bloqueio bilateral do plexo cervical superficial em pacientes submetidos à tireoidectomia: estudo clínico randomizado.

INTRODUCTION: Bilateral superficial cervical plexus block (BSCPB) is a common method used for analgesia in thyroid surgery. We investigated the analgesic efficacy of bilateral superficial cervical plexus block in the intraoperative and postoperative periods. MATERIALS AND METHODS: Patients (n = 46) undergoing thyroidectomy were randomly separated into the following 2 groups: the general anesthesia group (GA; n = 23) and the general anesthesia plus BSCPB group (GS; n = 23). The intraoperative analgesic requirement (remifentanil) visual analog scale (VAS) score at multiple time points during the postoperative period (after extubation, at 15 and 30 minutes and 1, 2, 6, 12, 24 and 48 hours post operation) were evaluated. Total tramadol and paracetamol consumption as well as the amount of ondansetron used was recorded. RESULTS: The intraoperative remifentanil requirement was significantly lower in the GS Group than in the GA Group (p = 0.009). The postoperative pain scores were significantly lower in the GS Group than in the GA Group at 15 (p < 0.01) and 30 (p < 0.01) minutes and 1 (p < 0.01), 2 (p < 0.01), 6 (p < 0.01), 12 (p < 0.01) and 24 (p = 0.03) hours. The postoperative tramadol requirement was significantly lower in the GS Group than in the GA Group (p = 0.01). The number of patients that used ondansetron was significantly lower in the GS Group than in the GA Group (p = 0.004). CONCLUSION: We concluded that BSCPB with 0.25% bupivacaine reduces the postoperative pain intensity and opioid dependency in thyroid surgery patients.

Perioperative analgesic efficacy of bilateral superficial cervical plexus block in patients undergoing thyroidectomy: a randomized controlled trial / Eficácia analgésica perioperatória do bloqueio bilateral do plexo cervical superficial em pacientes submetidos à tireoidectomia: estudo clínico randomizado

Abstract Introduction: Bilateral superficial cervical plexus block (BSCPB) is a common method used for analgesia in thyroid surgery. We investigated the analgesic efficacy of bilateral superficial cervical plexus block in the intraoperative and postoperative periods. Materials and methods: Patients (n = 46) undergoing thyroidectomy were randomly separated into the following 2 groups: the general anesthesia group (GA; n = 23) and the general anesthesia plus BSCPB group (GS; n = 23). The intraoperative analgesic requirement (remifentanil) and visual analog scale (VAS) score at multiple time points during the postoperative period (after extubation, at 15 , 30 minutes and 1, 2, 6, 12, 24, and 48 hours post operation) were evaluated. Total tramadol and paracetamol consumption as well as the amount of ondansetron used was recorded. Results: The intraoperative remifentanil requirement was significantly lower in the GS Group than in the GA Group (p= 0.009). The postoperative pain scores were significantly lower in the GS Group than in the GA Group at 15 (p< 0.01), 30 (p< 0.01) minutes, and 1 (p< 0.01), 2 (p< 0.01), 6 (p< 0.01), 12 (p< 0.01) and 24 (p= 0.03) hours. The postoperative tramadol requirement was significantly lower in the GS Group than in the GA Group (p= 0.01). The number of patients that used ondansetron was significantly lower in the GS Group than in the GA Group (p= 0.004). Conclusion: We concluded that BSCPB with 0.25% bupivacaine reduces the postoperative pain intensity and opioid dependency in thyroid surgery patients.

Resumo Introdução: O bloqueio bilateral do plexo cervical superficial (BPCS) é um método comumente usado para analgesia em tireoidectomia. Avaliamos a eficácia analgésica do bloqueio bilateral do BPCS nos períodos intraoperatório e pós-operatório. Materiais e métodos: Os pacientes (n = 46) submetidos à tireoidectomia foram randomicamente separados em dois grupos para receber anestesia geral (Grupo GA; n = 23) e anestesia geral mais bloqueio bilateral do BPCS (Grupo GS; n = 23). Avaliamos a necessidade de analgésico no intraoperatório (remifentanil) e os escores VAS (Visual Analog Scale) em vários momentos no pós-operatório (após a extubação, aos 15 e 30 minutos e em 1, 2, 6, 12, 24 e 48 horas de pós-operatório). O consumo total de tramadol e paracetamol e a quantidade usada de ondansetrona foram registrados. Resultados: A necessidade de remifentanil no intraoperatório foi significativamente menor no Grupo GS do que no Grupo GA (p = 0,009). Os escores de dor pós-operatória foram significativamente menores no Grupo GS do que no grupo GA aos 15 (p < 0,01) e 30 (p < 0,01) minutos e em 1 (p < 0,01), 2 (p < 0,01), 6 (p < 0,01), 12 (p < 0,01) e 24 (p = 0,03) horas de pós-operatório. A necessidade de tramadol no pós-operatório foi significativamente menor no Grupo GS do que no grupo GA (p = 0,01). O número de pacientes que recebeu ondansetrona foi significativamente menor no Grupo GS do que no Grupo GA (p = 0,004). Conclusão: O bloqueio bilateral do BPCS com bupivacaína a 0,25% reduz a intensidade da dor pós-operatória e a dependência de opioides em pacientes submetidos à tireoidectomia.

Karnofsky Performance Scale validity and reliability of Turkish palliative cancer patients

Background/aim: Validated measures in palliative cancer patients are very important in the evaluation and management of the disease. The Karnofsky Performance Scale (KPS) has been used for many years to assess the performance status of cancer patients. The aim of this study is to determine the validity and reliability of the KPS in cancer patients receiving palliative care in Turkey. Materials and methods: Eighty patients with a cancer diagnosis who were admitted to Gaziosmanpasa University Medical Faculty Hospital Palliative Care Unit between 01.03.2016 and 01.03.2017 were included in the study. KPS, measurements from the Katz Activi-ties of Daily Living (ADL) scale, and Basic Activities of Daily Living (BADL) scale were recorded. The alpha coefficient (Cronbach) was calculated by using SPSS version 20.0. The P-value was accepted as P < 0.05 in the analysis of the data. Results: There was a positive and strong correlation between Katz ADL scale total score and KPS score (r = 0.895; P < 0.001). In ad-dition, there was a strong negative correlation between the total score of BADL scale and KPS score (r = ­0.894; P < 0.001). As for the reliability of the scale scores, Cronbach's alpha coefficient found to be 0.720. Conclusion: KPS is a reliable scale for Turkish cancer patients in palliative care settings.

The pain colour of children with toothache in Turkish population.

BACKGROUND: Toothache is a common consequence of untreated caries, predisposed by poor oral hygiene and high caries risk. Most children expressed their pain through their parents or carers. The aim of this study was to determine the colour of pain presence and absence. METHODS: Patients aged between 4 and 14 and referred to a dentist for the first time due to toothache had a short-term pain of 1 month caused by deep cavities. The children chose paintings from the box of 24 standard colours (Crayola, Spain) and the circles were painted. Pain was rated by children on the Visual Analoge Scale. Normality and variance were tested using the one-sample Kolmogorov-Smirnov test. Associations were performed by using the Pearson correlation coefficient. Analyses were completed by using the Statistical Package for Social Sciences (SPSS Inc., Chicago, IL) version 20.0 program. RESULTS: A total of 147 patients including 78 girls (53.1%) and 69 boys (46.9%) were included in the study. The principal component analysis showed that red has the highest factor loading in children with pain, whereas yellow was the other highest one in children without pain. CONCLUSION: The presence of pain was mainly associated with red, and the absence of pain was associated with yellow in Turkish population. Description of pain with colour can be useful tool to recognize the children and to improve dentist-patient or dentist-parents communication.

An evaluation of the mourning tradition, the "First Feast," in the context of palliative care: The possibility of incorporating cultural rituals into palliative care.

OBJECTIVE: Grief is intertwined with cultural and religious rituals that are highly appreciated in the quality standards of palliative care. Here, we aimed to investigate whether a cultural mourning ritual, the "First Feast," can be used by palliative care teams to ease the grief response of the deceased patient's relatives. METHOD: A questionnaire with 23 questions about the prevalence of the First Feast tradition, the content, the pros and cons, and whether it would be useful for the grieving relatives of deceased patients was prepared and given to the palliative care patients' relatives. The data were evaluated using the chi-square test. RESULT: A total of 427 participants were enrolled in the study; 60.7% were female and the mean age was 36 (±13.4). A total of 76.8% of the participants were from the Tokat region and 77.8% (n = 332) performed the First Feast tradition. A significant difference was observed among participants with Tokat origins and non-Tokat origins in terms of awareness of the tradition (84.8% and 69.7%, respectively; p = 0.001). Ninety-one percent of the participants acknowledged that the tradition helped to ease the grief response of the relatives. SIGNIFICANCE OF RESULTS: The First Feast, a mourning tradition performed in Tokat and other parts of Turkey, might be a useful auxiliary method for palliative care teams to help grieving families.

A randomized placebo-controlled study of aromatherapy for the treatment of postoperative nausea and vomiting.

OBJECTIVE: The purpose of this study was to compare the aromatherapy treatment effects on PONV patients using ginger, lavender and rose oils and a placebo. DESIGN: A randomized 4-armed placebo controlled study. SETTING: Gaziosmanpasa University, School of Medicine, Health Research and Application Center. INTERVENTION: The total of 184 patients were randomized into 4 groups: Aromatherapy with lavender essential oil (Lavender group), with rose essential oil (Rose group), with ginger essential oil (Ginger group) or with pure water (Placebo group). MAIN OUTCOME MEASURES: Postoperative nausea (0-3 Likert type; 0=no nausea, 1=some, 2=a lot, 3=severe) and vomiting scores (0-3 Likert type; 0=no vomiting, 1 = 1 time, 2 = 2 or 3 time, 3 = 4 times and up) and antiemetic medication requirement. RESULTS: The nausea scores at 15 min were statistically significantly different between the groups (p = 0.00). The postoperative nausea scores improved in 20 (43.5%) subjects in the placebo group, 38 (82.6%) subjects in the lavender group, 22 (47.8%) subjects in the rose group and 30 (65.2%) subjects in the ginger group (p = 0.00). There were statistically significant differences between the groups with regard to the vomiting and antiemetic drug requirements (p = 0.00). CONCLUSION: The aromatherapy can be used as an alternative or complementary method for managing PONV. Specifically, the ginger and lavender essential oils were superior to the rose oil and pure water for the aromatherapy treatments. However, further studies with larger sample sizes are necessary to confirm these results.

Comparison of Ultrasound-Guided Supraclavicular and Interscalene Brachial Plexus Blocks in Postoperative Pain Management After Arthroscopic Shoulder Surgery.

BACKGROUND: The interscalene brachial plexus block (ISBB) is an effective procedure for minimizing postoperative opioid consumption and pain following arthroscopic shoulder surgery. The ultrasound (US)-guided supraclavicular brachial plexus block (SCBB) seems to be an alternative technique for arthroscopic shoulder surgery. However, evidence is lacking regarding the impact of SCBB on postoperative pain management and recovery after arthroscopic shoulder surgery. The aim of this study was to compare the effects of SCBB with ISBB in terms of postoperative pain and quality of recovery after arthroscopic shoulder surgery. METHODS: A total of 62 adult patients scheduled for arthroscopic shoulder surgery under general anesthesia were randomized into 2 groups to receive either ISBB (IB group, n = 31) or SCBB (SB group, n = 29) with 20 mL of 0.25% bupivacaine under US guidance. Assessments included postoperative pain scores, additional analgesic requirement, timing of the first analgesic requirement, Quality of Recovery-40 (QoR-40) scores, block characteristics, and side effects. RESULTS: No significant differences were found between the 2 groups for pain scores (P = 0.34), timing of first analgesic requirement (P = 0.30), additional analgesic requirement (P = 0.34), or QoR-40 scores (P = 0.13). The block characteristics regarding procedure time (P = 0.95), block failure, and onset time of sensory blockade (P = 0.33) were similar. Horner's syndrome occurred in 8 patients in the IB group and 1 patient in the SB group (P = 0.015). CONCLUSIONS: This study showed that US-guided SCBB is as effective as ISBB in reducing postoperative pain and improving the quality of recovery for arthroscopic shoulder surgery.

Evaluation of the perfusion index according to the visual analog scale in postoperative patients.

OBJECTIVES: To evaluate the possible value of the perfusion index (PI) as a tool for pain assessment. Methods: This prospective, observational study was performed with 89 patients underwent surgery with general anesthesia. The patients with visual analog scale (VAS) greater than 3 were grouped as M1, and patients with VAS≤3 and performed morphine were grouped as M2. After surgery patients with VAS greater than 3 were given 2mg morphine. Patients with VAS greater than 3 were given increments of intravenous morphine (2 mg) at 20 minute intervals until VAS less than 3. The correlation and difference between PI and VAS score values were evaluated before and after analgesic administration. Results: Significant changes were found in both PI values and VAS scores between M1 and M2 groups (2.80±0.77, 3.97±0.94, p less than 0.001; 6.60±1.20, 2.74±0.46, p less than 0.001) Despite no correlation was found between PI values and VAS scores of M1 and M2 groups, weak negative correlation was detected between differences in PI values and VAS scores among groups (r=-0.255, p=0.016). Conclusion: Perfusion index is a parameter that can be used in the assessment of postoperative pain and responses to analgesics.

The effect of patient positions on perfusion index.

BACKGROUND: The optimal position for surgery is one in which the patient is provided the best possible surgical intervention and put at minimum risk. Different surgical positions may cause changes in tissue perfusion. This study investigates the relationship between surgical patient positions and perfusion index. METHODS: A sample of 61 healthy individuals with no peripheral circulatory disorders, chronic diseases, or anemia was included in this study. Participants held six different positions: supine, prone, 45-degree sitting-supine, 45-degree supine with legs lifted, Trendelenburg (45-degrees head down), and reverse Trendelenburg (45-degrees head up). Perfusion index values were then measured and recorded after individuals held their positions for five minutes. RESULTS: Participants' perfusion index values were affected by different body positions (p < 0.05). Perfusion index was lowest in the sitting position (4.5 ± 2.5) and highest in individuals with Trendelenburg position (7.8 ± 3.8). CONCLUSION: Different body positions can cause changes in tissue perfusion. This should be considered in patient follow-up along with the perfusion index.