Posterior quadratus lumborum block versus posterior transversus abdominis plane block for unilateral inguinal hernia surgery.

Background: Ultrasound-guided truncal nerve blocks are increasingly used for postoperative pain relief after abdominal surgery. Aim: The aim of this prospective and randomized study was to compare posterior transversus abdominis plane block (pTAPB) with posterior quadratus lumborum block (pQLB) for postoperative analgesic efficacy in patients undergoing unilateral inguinal hernia surgery under general anesthesia (GA). Patients and Methods: A total of 90 adult patients were randomized into 3 groups: group pTAPB (n = 30), group pQLB (n = 30), and group Control (n = 30). The patients in groups pQLB and pTAPB received a unilateral block using 20 ml of 0.25% bupivacaine after the induction of GA. Intravenous (IV) tramadol patient control group analgesia (PCA) and paracetamol were used in the postoperative period as a part of the multimodal analgesic regimen in both groups. Postoperative pain was assessed using a visual analog scale (VAS) during postoperative 24 h. Dexketoprofene was used as a rescue analgesic when VAS is >3. The primary outcome measure was mean pain scores. Secondary outcome measures were consumption of rescue analgesics and the amount of tramadol delivered by PCA. P <0.05 was considered statistically significant. Results: Mean VAS scores were significantly lower in the group pQLB than group pTAPB and group Control at all-time points (pQLB < pTAPB < Control; P < 0.001). Rescue analgesic was not required in group QLB. Rescue analgesic consumption, the number of bolus demand on PCA, and total PCA dose were highest in group Control and lowest in the pQLB group (Control > pTAPB > pQLB; P < 0.001). Conclusion: It is concluded that both pQLB and pTAPB provided effective pain relief after unilateral inguinal hernia surgery. pQLB was superior to pTAPB due to lower pain scores and analgesic consumption.

Effect of favorite music on postoperative anxiety and pain.

BACKGROUND: Music is one of the most commonly used non-pharmacological interventions to reduce anxiety. It helps patients overcome emotional and physical alienation, provides comfort and familiarity in an improved environment and offers a pleasant distraction from pain and anxiety. This study aimed to evaluate the effects of listening to preoperative favorite music on postoperative anxiety and pain. MATERIAL AND METHODS: This prospective, randomized, single-blinded, controlled trial included the American Society of Anesthesiologists (ASA) I-III patients, aged 18-70 years, undergoing elective inguinal hernia surgery. Demographic data and anxiety status were recorded. Anxiety status was measured using the Spielberger state-trait anxiety inventory form 1 (STAI-1) and state-trait anxiety inventory form 2 (STAI-2). After recording baseline heart rate, blood pressure and STAI levels, patients were randomly allocated to the music group (Group M) or control group (Group C). Patients in Group M listened to their favorite music using headphones and patients in the control group received standard care. The STAI­1 was repeated after surgery and the numeric rating scale (NRS) and patient satisfaction were measured. RESULTS: A total of 117 patients were included. Demographic data, educational status, and previous surgical history were similar between the groups. Mean preoperative STAI­1 and STAI­2 scores were similar between the groups (p > 0.05). Mean postoperative STAI­1 score was significantly lower in Group M than in Group C (39 [range 35-43] vs. 41 [range 37-43], p < 0.05). Moreover, the change in the STAI score was significantly higher in Group M compared with Group C (p < 0.05). The difference of hemodynamic measurements pre-music to post-music was significant between Group M and Group C (p = 0.001). The NRS scores remained similar between the groups. Patient satisfaction score was significantly higher in Group M (p = 0.017). CONCLUSION: Listening to patient-preferred favorite music preoperatively reduced anxiety, regulated hemodynamic parameters, and improved postoperative patient satisfaction. Reduced anxiety was not associated with reduced pain.

Comparison of cervical spine motion during intubation with a C­MAC D­Blade® and an LMA Fastrach®.

BACKGROUND: This prospective randomized study compared cervical motion during intubation with a C­MAC D­Blade® and with a laryngeal mask airway LMA Fastrach®. MATERIAL AND METHODS: The participants in this study were 52 ASA I-III patients aged 18-70 years and assigned for elective cervical discectomy. The patients were randomly selected for intubation with a C­MAC D­Blade® (group V) or an LMA Fastrach® laryngeal airway (group F). Both groups received the same induction of anaesthesia. The first lateral view was X­rayed while the head and neck were in a neutral supine position and the second exposure was taken during the passage of the endotracheal tube through the vocal cords for group V and during the advance of the endotracheal tube for group F. The occiput-C1 (C0-C1), C1-C2 and C2-5 angles were measured. The angle formed by the line between the occipital protuberance and anterior process of the foramen magnum and the line between the central point of C1 spinous process and the anterior process of the foramen magnum was defined as angle A. The differences between the angles were calculated. Overall intubation success and first-pass success (success at the first attempt) were recorded. RESULTS: The change in angulations between C0-C1 during intubation was significantly lower in group F than in group V (2.780 ± 2.10 vs. 6.040 ± 4.10, p = 0.007). Before intubation, angle A was 14.40 ± 3.90 in group V and 13.80 ± 3.70 in group F (p = 0.627). During intubation, angle A was significantly smaller for group V than for group F (9.10 ± 2.40 vs. 10.70 ± 2.90, p = 0.04). The number of successful intubations were significantly higher in group V (100% of intubations were successful on the first attempt for group V, vs. 80% for group F, p = 0.023). CONCLUSION: Intubation with both a C­MAC D­Blade and a Fastrach LMA resulted in cervical motion but within safe ranges. Intubation with a C-mac D blade might be preferred because the Fastrach LMA may result in more failed intubation attempts in patients with cervical spine disorders.