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.

The effects of hydroxyurea on proinflammatory cytokine and tissue histopathology in an experimental sepsis model.

OBJECTIVE: The diagnosis and treatment of sepsis are costly to healthcare services, and it is an important disease with high mortality rates. In the pathogenesis of sepsis, for which we still cannot provide a complete cure, there is increased cytokine release and organ damage. Hydroxyurea has been shown to reduce leukocyte counts, decrease inflammatory cytokines, and limit organ inflammation in ischemia-reperfusion models. This study aimed to evaluate leukocyte counts, interleukin-1 beta (IL-1ß), IL-6, and tumor necrosis factor-alpha (TNF-α) cytokine values and organ inflammatory processes in hydroxyurea-treated rats with an experimental sepsis model. MATERIALS AND METHODS: After ethical approval, rats were randomly divided into three groups, control (n= 7), sepsis (n= 7), and hydroxyurea (n= 7). Sepsis was created using the cecal ligation and puncture (CLP) method in rats other than in the control group. Rats in the hydroxyurea group received hydroxyurea (200 mg/kg) intragastrically, and the control and sepsis groups received sterile distilled water. IL-1ß, IL-6, and TNF-α levels were measured at 0, 8, and 24 hours after CLP in all rats. Blood samples were collected at the time of sacrification 24 hours after CLP and analyzed for the complete blood count. Tissue specimens were taken for histopathologic examination. RESULTS: Cytokine levels (IL-1ß, IL-6, TNF-α), white blood cell counts, and tissue damage were increased after the sepsis model in rats. It was found that the cytokine levels at the 8th hour, white blood cell count, and brain tissue damage in the hydroxyurea group were decreased significantly compared with the sepsis group. CONCLUSIONS: Early hydroxyurea treatment in rats with sepsis decreases proinflammatory cytokine (IL-1ß, IL-6, and TNF-α) levels and thus reduces brain damage.

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.

Effect of two surgical circumcision procedures on postoperative pain: A prospective, randomized, double-blind study.

BACKGROUND: Male circumcision (MC) is one of the most commonly used surgical procedures worldwide for medical and traditional reasons. No studies have compared the postoperative pain advantages of conventional techniques (i.e., sleeve and dorsal slit). OBJECTIVE: In this prospective randomized double-blind study, we investigated the effect of two surgical techniques (i.e., sleeve and dorsal slit) on postoperative pain and emergence agitation. STUDY DESIGN: This prospective study was conducted between January and July 2013. Approval was obtained from the local Ethical Committee on 17 December 2012, 06/23 (CLINICAL TRIALS IDENTIFIER: NCT 01909765). We compared two surgical techniques (i.e., the dorsal slit incision technique (Group A) and the double incision (i.e., sleeve) technique (Group B) in 60 children who were subjected to MC surgery under general anesthesia. All children received dorsal nerve blocks with bupivacaine. The modified objective pain scale (MOPS) was used for pain assessment, and the Ramsey Sedation Scale was used for the assessment of agitation during anesthesia emergence. RESULTS: The MOPS scores were lower in Group B than in Group A in the post-anesthesia care unit and during the 4th hour post-surgery (p = 0.01 and p = 0.037, respectively). Twelve children (40%) in Group A and 23 children (76.6%) in Group B required no additional analgesia on postoperative day one (p = 0.004). The Ramsey sedation scores were lower in Group A (p = 0.018). DISCUSSION: Dorsal slit is often the primary method in cases with paraphimosis; during this procedure, the frenulum frequently cannot be preserved at the 6-o'clock position of the mucosa, because of traction applied to skin and mucosa. As a result, the frenular artery is injured. In contrast, the sleeve technique protects the frenulum and the anatomic structures of the glans. In the sleeve technique, providing hemostasis and preventing partial ischemia by protecting the frenular artery reduces postoperative pain and complications. This present study demonstrated that the sleeve technique, which preserved the frenular artery, caused less bleeding, reduced electrocautery use and less ischemia than the dorsal slit technique. The sleeve technique effectively reduces early postoperative pain and agitation after circumcision, provided that adequate postoperative analgesia has been achieved. While all variables except the employed surgical techniques were similar, Group B had advantages with respect to analgesic requirement and pain control during the first 8 h after the operation. CONCLUSION: The sleeve technique provides lower pain scores and a reduced incidence of agitation after elective MC.

Effect of ultrasound-guided intercostal nerve block on postoperative pain after percutaneous nephrolithotomy : prospective randomized controlled study.

BACKGROUND: The aim of the study was to investigate the effect of preoperative ultrasound-guided (US) intercostal nerve block (ICNB) in the 11th and 12th intercostal spaces on postoperative pain control and tramadol consumption in patients undergoing percutaneous nephrolithotomy (PCNL). METHODS: After obtaining ethical committee approval and written informed patient consent, 40 patients were randomly allocated to the ICNB group or the control group. For the ICNB group US-guided ICNB was performed with 0.5 % bupivacaine and 1/200,000 epinephrine at the 11th and 12th intercostal spaces after premedication. A sham block was performed for the control group and postoperative pain and tramadol consumption were recorded by anesthesiologists blinded to the treatment. RESULTS: Postoperative visual analog scale scores at all follow-up times were found to be significantly lower in the ICNB group than in the control group (p < 0.05). The mean 24 h intravenous tramadol consumption was 97.5 ± 39.5 mg for the ICNB group which was significantly lower than the 199.7 ± 77.6 mg recorded for the control group (p < 0.05). CONCLUSION: In PCNL with nephrostomy tube placement US-guided ICNB performed at the 11th and 12th intercostal spaces provided effective analgesia.

The effects of tramadol infiltration on wound healing in rats.

PURPOSE: Infiltration of a local anesthetic to provide postoperative analgesia is a frequently used method. However the infiltrated agents may have negative effects on wound healing. This study aimed to investigate the effects of tramadol, a weak opioid with a local anesthetic effect, on wound healing. METHODS: Wistar albino rats were used in the study. Tramadol and saline infiltration was randomly performed on the left and right backs of rats. Following a linear incision, the site was sutured. A follow-up was conducted after seven days, and the tissue samples from both locations were extracted for histopathological examinations (fibrotic index : no fibrosis 0, mild 1, moderate 2, severe 3) and hydroxyproline measurements. RESULTS: The hydroxyproline level found in the tramadol group was 0.060 +/- 0.04 ng/mg.protein. In the control group the hydroxyproline level was 0.012 +/-0.01 ng/mg.protein (p = 0.01). The fibrotic index levels in the tramadol group were higher than the control group (p < 0.001). CONCLUSION: It was concluded that tramadol infiltration in a surgical incision site has no adverse effect on wound healing.

The effects of supplementation with a mixture of arginine, glutamine, and beta-hydroxy beta-methylbutyrate on the healing of colon anastomoses.

BACKGROUND: Several researchers have investigated how wound healing is effected by supplementation with each of the following amino acids : arginine (Arg), glutamine (Glu), and beta-hydroxy beta-methylbutyrate (HMB). This research investigates how a combination of these amino acids improves the wound healing associated with anastomoses. METHODS: We tested the effects of a combination of Arg, Glu, and HMB on the healing of colon anastomoses in 50 male rats. We randomly divided the animals into two equal groups. In each animal, the cecum was transected from its midpoint to create an end-to end anastomosis. During the first postoperative week, Group 1 (G1) animals were fed standard chow, and Group 2 (G2) animals were fed standard chow plus a ready-to-use supplement that contained a mixture of Arg, Glu, and HMB. At the end of the week, all of the rats were sacrificed, and a cecum segment containing the anastomosis line was resected. Bursting pressure and tissue hydroxyproline were measured for all animals. RESULTS: The mean values for hydroxyproline were 0.0013 ng/mg protein/ml (SD +/-0.00075) and 0.034 ng/mg protein/ ml (SD +/- 0.022) for G1 and G2, respectively (p <0.0001). The mean values for bursting pressure measurements were 122.8 mmHg (SD +/- 9.4) and 192.8 mmHg (SD+/- 31) for G1 and G2, respectively (p <0.0001). Statistically significant differences between the groups in terms of both bursting pressure levels and tissue hydroxyproline levels were observed. CONCLUSION: In an animal model of colon surgery, supplementation with a combination of three amino acids seemingly benefits anastomosis healing.

Effect of magnesium sulphate on bleeding during lumbar discectomy.

We assessed the effect of magnesium on the amount of bleeding, coagulation profiles and surgical conditions during lumbar discectomy under general anaesthesia. Forty patients, of ASA physical status 1-2 and aged 18-65 years, undergoing single-level microscopic lumbar discectomy, were randomly assigned to magnesium sulphate (50 mg.kg(-1) in 100 ml saline over 10 min followed by a continuous infusion of 20 mg.kg.h(-1) ) or saline. The mean (SD) estimated blood loss was 190 (95) and 362 (170) ml in the magnesium and saline groups, respectively (mean difference = 172 ml; 95% CI 84-260 ml). The median (IQR [range]) Fromme's scale score for surgical conditions for the magnesium and saline groups were 2 (2-3 [2-3]) and 3 (2-3 [3-4]), respectively (p < 0.05). The bleeding time, haemoglobin, platelet count, prothrombin time, international normalised ratio and fibrinogen levels were similar in the two groups. The activated partial thromboplastin time was prolonged in the magnesium group immediately postoperatively and at 6 h after surgery. After the bolus of magnesium, the heart rate was higher and the mean arterial pressure lower in the magnesium group. The use of magnesium sulphate during lumbar discectomy decreases blood loss, and provides better surgical conditions without marked haemodynamic effects.