Resolving Ethical Issues in the Field of Anaesthesia: A Mixed-Methods Study.

OBJECTIVE: Ethical problems related to the field of anaesthesia and reanimation are generally addressed within the scope of reanimation and intensive care medicine by overseeing the particular issues of medical ethics in the practice of anaesthesia. The existing literature shows that a very limited number of studies are found on this issue. This research aims to address this gap in the academic literature and to discuss ethical approaches to these problems. METHODS: A search was conducted to compile key themes of ethical problems. These were combined with similar themes in the limited existing literature. Next, a questionnaire consisting of 20 multiple choice and open-ended questions and two Likert scales were developed. The answers to the questionnaire were collected on-line after 2 months. RESULTS: The survey was conducted with 226 participants. 82.79% of the participants received ethics training only before graduation, and 95.40% stated that ethics training is required during their residency training. 67.80% of participants think that informed consent forms are sufficient in terms of content and readability, but 89.90% note that such forms are not read by patients. In the preoperative period, communication with patients, interaction with surgical teams, long working hours and high workload, problems in informing patients, lack of institutional support in malpractice cases, lack of authority, responsibility and rights of anaesthesiologists are the most important ethical and legal issues in the field. CONCLUSION: There are complex ethical issues in the field of anaesthesiology that should be discussed with in the frame of deficiencies in training, ethical reasoning for patient autonomy, informed consent, paternalism and professional satisfaction to shed light on potential solutions.

The efficacy of adding dexketoprofen trometamol to tramadol with patient controlled analgesia technique in post-laparoscopic cholecystectomy pain treatment.

OBJECTIVES: Pain treatment in laparoscopic cholecystectomy, which is performed in increasing numbers as an ambulatory procedure, is an important issue.Although laparoscopic cholecystectomy is regarded as an ambulatory procedure, patients are often hospitalized due to pain and this increases opioid consumption and side effects caused by opioids. This study aims at evaluating the efficacy of adding dexketoprofen trometamol to tramadol with patient controlled analgesia (PCA) in postlaparoscopic cholecystectomy pain treatment. METHODS: 40 patients in ASA I-II risk groups aged between 18-65 years were enrolled in the study and were randomized using closed envelope method. In Group TD 600 mg tramadol and 100 mg dexketoprofen trometamol, in Group T 600 mg tramadol was added to 100 ml 0.9% normal saline for PCA. 8 mg lornoxicam iv was given if VAS >40 in the postoperative period. RESULTS: There was no statistically significant difference in terms of adverse effects (hypotension, bradycardia, sedation) but in Group T 4 patients complained of nausea and 3 complained of vomiting. Opioid consumption was lower and patient satisfaction was higher in group TD. CONCLUSION: This study has shown that adding dexketoprofen trometamol to tramadol in patient controlled analgesia following laparoscopic cholecystectomy lowers VAS scores, increases patient satisfaction and decreases opioid consumption.

Levobupivacaine for postoperative pain management in circumcision: caudal blocks or dorsal penile nerve block.

OBJECTIVES: In this study, we evaluated the analgesic efficacy and adverse effect profile of levobupivacaine in caudal and DPNB in postcircumcision pediatric patients. METHODS: Sixty boys between 2-10 years of age undergoing circumcision were enrolled. The patients were divided into two groups: Group C (n=30) and Group P (n=30) were applied caudal block or dorsal penile nerve block (DPNB), respectively. Blocks were performed before surgery as a supplement to general anesthesia with 1 mL kg(-1) 0.25% levobupivacaine. Postoperative pain and sedation scores were assessed on the 10th and 30th minutes, and hours 1-6. The number of pain free patients in the first 6 hours, the duration of analgesia, time to first analgesic administration, walking, micturition, and total paracetamol demands, and length of stay were recorded. RESULTS: Demographic data were similar between groups. The number of children who spent the first 6 hours pain-free was larger in Group C than Group P (p=0.0001). The time to first analgesic (p=0.000033) and walking (p=0.004) were longer in Group C. There were 14 patients with motor block in Group C (p=0.00007). In view of AUC, FPRS, OPS and MPOPS were significantly better in Group C on the first postoperative 6 hours. CONCLUSION: Caudal block done using levobupivacaine for postoperative pain management in circumcision is more successful than penile block, however there is a significant delay in time to first walking and as might be expected there is an increased risk of motor block.

Ultrasound guided TAP block for the treatment of postoperative prolonged pain - an alternative approach.

Transversus abdominis plane (TAP) block is a relatively new regional anesthesia technique in which T7-12 intercostal nerves, ilioinguinal and iliohypogastric nerves, and cutaneous branches of L1-3 nerves are blocked between the internal oblique and transversus abdominis muscles. This technique is mostly used for the treatment of acute postoperative pain following abdominal surgery. In this case report, we evaluate the usage of TAP block in prolonged pain following upper abdominal surgery.

Intraarticular levobupivacaine or bupivacaine administration decreases pain scores and provides a better recovery after total knee arthroplasty.

PURPOSE: The aim of this prospective randomized blinded controlled study was to compare the efficacy of the two local anesthetics, intraarticular bupivacaine and levobupivacaine administration, versus control for postoperative pain control and functional recovery. Length of hospital stay, opioid consumption, and the side effects of opioids were also evaluated. METHODS: Sixty patients of American Society of Anesthesiologists class I-III undergoing elective knee arthroplasty under spinal anesthesia were randomized into three groups. Groups B (n = 20) and L (n = 20) both received 150 ml solution intraarticularly, containing 200 mg bupivacaine or 200 mg levobupivacaine combined with 0.5 mg epinephrine, respectively, at the end of the surgery. Group C (n = 20) received 150 ml saline intraarticularly. Postoperatively, all groups received injections through the intraarticular catheters in quantities of 120 mg (levobupivacaine for group L, bupivacaine for group B) and 0.5 mg epinephrine whereas group C received a saline bolus at 10 and 22 h. Patients were given tramadol by intravenous patient-controlled analgesia (PCA), and sodium diclofenac 75 mg intramuscularly was used for rescue analgesic medication. Visual analogue score (VAS) for pain at rest and during mobilization (which was defined as flexion exercise supported by physiotherapist in postoperative first 8 h and afterward a 3-m walk with walker), consumption of tramadol, side effects, and patient satisfaction were recorded until the 48th hour postoperatively. RESULTS: Area under the curve values for VAS were lower in groups B and L compared to the control, both at rest and during mobilization (first 48 h) (P = 0.032 and P = 0.029, respectively). Tramadol consumption was lower (P < 0.05), patient satisfaction as evaluated with a five-point Likert score (completely comfortable; quite comfortable; slight discomfort; painful; very painful) was higher (P = 0.03), and length of hospital stay was shorter (P = 0.03) in groups B and L compared to group C. CONCLUSION: Intraarticular bupivacaine and levobupivacaine provided better postoperative analgesia both at rest and during mobilization in total knee replacement surgery compared to control. Tramadol consumption and hospital stay were also decreased in the study groups.