The efficacy of transversus abdominis plane block for postoperative analgesia in laparoscopic cholecystectomy cases: a retrospective evaluation of 515 patients.

OBJECTIVE: To compare patients that received intravenous (i.v.) analgesics with those that received transversus abdominis plane (TAP) block for pain relief after laparoscopic cholecystectomy. METHODS: This retrospective study enrolled patients that had undergone laparoscopic cholecystectomy and divided them into two groups: the i.v. analgesic group (controls; group A) and the TAP block group (group T). Data retrieved from the medical records included postoperative visual analogue scale (VAS) pain scores, duration of intensive care unit (ICU) stay, total hospital stay, additional analgesic requirements and the occurrence of nausea and vomiting. RESULTS: A total of 515 patients were included (group A, n = 247; group T, n = 268). Postoperative VAS pain scores at 0, 2, 4 and 6 h and the need for additional analgesics were significantly lower in group T than in group A. Postoperative VAS pain scores at 12 and 24 h were significantly higher in group T than in group A. Postoperative nausea and vomiting were significantly lower in group T than in group A. The rate of ICU admission in group T was significantly lower than in group A. CONCLUSIONS: Effective postoperative analgesia can be achieved with TAP block and undesirable effects can be reduced.

Effects of ozone preconditioning on recovery of rat colon anastomosis after preoperative radiotherapy.

BACKGROUND: Anastomotic leakage is a devastating complication of colorectal surgery. Neoadjuvant radiotherapy for colorectal cancer can affect the mechanical and biochemical parameters of anastomotic healing. It has been reported that ozone increases antioxidant enzyme activity and stimulates adaptive processes to oppose the pathophysiologic conditions mediated by reactive oxygen species (ROS). OBJECTIVES: The objective of this study was to investigate the effect of controlled administration of ozone on the healing of anastomosis and the activation of antioxidant enzymes in the colon after radiotherapy. MATERIAL AND METHODS: Rats (n = 48) were randomly assigned to the following groups: control groups (1 and 2), saline-treated and irradiated (IR) groups (3 and 4) and ozone oxidative preconditioning (OOP) and IR groups (5 and 6). Rats were exposed to whole-body IR (6 Gy) after pretreatment with either saline or ozone. Rats in groups 1, 3 and 5 were euthanized on postoperative day 3, whereas those in groups 2, 4 and 6 were euthanized on postoperative day 7. The anastomoses were performed on day 7 post-IR. The anastomotic segment was resected to measure hydroxyproline (HPO) content, myeloperoxidase (MPO) activity and malondialdehyde (MDA) concentration and for histopathological evaluation. RESULTS: The mean bursting pressure of the groups that underwent radiotherapy was lower than that of the control groups (p < 0.001). In groups 5 and 6, the tissue HPO concentrations were higher than those in groups 3 and 4. Although mean values for MPO activity in groups 5 and 6 were higher than those in groups 3 and 4, the differences were not significant. Regarding oxidative damage markers, MDA concentrations were significantly lower in group 5 than those in group 3. CONCLUSIONS: In this experimental model, OOP exerted favorable effects on colon anastomotic healing after radiation exposure.

Evaluation of the open and laparoscopic appendectomy operations with respect to their effect on serum IL-6 levels.

BACKGROUND: Postoperative serum inflammatory cytokine levels are thought to reflect the magnitude of surgical stress. Cytokine interleukin-6 (IL-6) is an early marker of systemic inflammatory response and tissue damage. This study evaluated levels of IL-6 after open and laparoscopic appendectomy to compare the degree of surgical stress associated with these procedures. METHODS: IL-6 levels were measured pre- and postoperatively in the plasma of 200 consecutive patients with a diagnosis of acute appendicitis. After preoperative randomization, 100 patients underwent open appendectomy, and 100 patients underwent laparoscopic appendectomy. RESULTS: Preoperative concentrations of IL-6 were 65.22±4.76 pg/mL in the open appendectomy group and 65.73±6.34 pg/mL in the laparoscopic appendectomy group (p=0.752). Postoperative levels were 105.28±16.14 pg/mL and 76.11±16.18 pg/mL, respectively (p<0.05). CONCLUSION: Lower postoperative serum IL-6 levels suggest that laparoscopic surgery is associated with lower degree of surgical stress. Laparoscopic appendectomy has significant advantage over open appendectomy due to more rapid postoperative recovery.

Effect of erythropoietin on liver regeneration in an experimental model of partial hepatectomy.

BACKGROUND AND AIM: The liver shows remarkable regeneration ability after damage or resection. The main stimulant for hepatic regeneration is resection. Erythropoietin (EPO), which was initially used for anemia therapy, is today known as a general tissue protector owing to its anti-inflammatory, anti-oxidant, anti-apoptotic, and angiogenic properties. This study aims to investigate the effect of systemically administered EPO on liver regeneration after partial hepatectomy. METHODS: Forty-eight male Wistar albino rats were randomly split in two groups A and B consisting of 24 rats each. Standard 70% hepatectomy was performed on the rats in group A. The same surgical procedure was performed on the rats in group B, and they were additionally administered 3000 U/kg/subcutaneous EPO. The rats were sacrificed 24, 48, and 72 h after resection. The groups were compared in terms of biochemical, morphological, and histopathological parameters. RESULTS: The biochemical results showed that the administration of EPO decreased aspartate aminotransferase levels significantly (p < 0.05) at 24 h after hepatectomy. A comparison of the groups in terms of relative liver weight showed that EPO-treated groups exhibited a statistically significant increase (p < 0.05) for all three time periods. Histopathology results showed that in the EPO-treated groups, the mitosis index at 48 and 72 h, double nuclei cell number at 72 h, and proliferating cell nuclear antigen ratio at 48 h showed a significant increase (p < 0.05). CONCLUSION: Our study showed that systemically administering high-dose EPO increases regeneration by affecting the biochemical, morphological, and histopathological parameters after liver resection.

The effect of erythropoietin on anastomotic healing of irradiated rats.

AIM: The aim of the present study is to evaluate the possible protective effects of erythropoietin (EPO) on anastomotic wound healing after preoperative radiotherapy according to its pleiotropic mechanism of action. METHODS: Thirty-two male Wistar albino rats were randomized into four groups containing eight rats each: ANAS group, standard resection plus anastomosis; RT+ANAS group, radiation plus standard resection plus anastomosis; ANAS+EPO group, standard resection plus anastomosis plus EPO; RT+ANAS+EPO, radiation plus standard resection plus anastomosis plus EPO. All animals were sacrificed by cardiac puncture, and anastomotic healing was measured by bursting pressure, hydroxyproline (OHP) levels, myeloperoxidase (MPO) activity and histopathological evaluations. Malondialdehyde (MDA), tumor necrosis factor-alpha (TNF-α), and matrix metalloproteinase-9 (MMP-9) were also measured in serum specimens. RESULTS: OHP levels in the RT+ANAS + EPO group were significantly increased compared with other groups (p < .05). In contrast, MPO activity in the RT+ANAS+EPO group was significantly decreased compared with other groups (p < .05). Serum MDA levels were found to be decreased in the ANAS+EPO and RT+ANAS+EPO groups (p < .05). Group comparisons demonstrated that bursting pressure was significantly higher in EPO treated rats (p < .05). The histopathology results revealed that EPO treatment improves anastomotic wound healing though decreased necrosis and inflammatory cell infiltration and increased fibroblast activity. CONCLUSION: The findings of the present study indicate that EPO contributes to wound healing and the strength of colon anastomosis following radiation due to its antioxidant and anti-inflammatory effects, but further studies are needed to explore the significance of these effects.