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.

Ultrasound-guided erector spinae block versus mid-transverse process to pleura block for postoperative analgesia in lumbar spinal surgery.

BACKGROUND: In recent years, promising results were achieved with the use of ultrasound (US)-guided interfascial plane blocks for effective postoperative analgesia in several surgeries. Erector spina plane (ESP) block and mid-transverse to pleura plane (MTP) block are the latest techniques in this area. The aim of this prospective and randomized study was to compare the postoperative analgesic efficacy of bilateral ESP and MTP blocks in patients undergoing lumbar spinal surgery under general anesthesia (GA). METHODS: A total of 120 adult patients were included in the study and randomized into 3 groups: group ESP (n = 40), group MTP (n = 40) and group Control (n = 40). The patients in the group ESP received a bilateral block by injecting 20 ml of 0.25% bupivacaine at a vertebrae level in the mid-point of the incision before GA. The same LA was administrated bilaterally at the T12/L1 level in the group MTP. Postoperatively, a multimodal analgesic regimen including an intravenous tramadol patient-controlled analgesia (PCA), paracetamol and dexketoprofen was used in all groups. Postoperative pain was assessed using a visual analogue scale (VAS) during the first 48 postoperative hours. Pethidine was used as a rescue analgesic when VAS score was >3. Primary outcome measure was mean pain scores. Secondary outcome measures were consumption of rescue analgesic and the amount of tramadol delivered by PCA. A p < 0.05 was considered statistically significant. RESULTS: Mean VAS scores were significantly higher in the group Control than in the group MTP and group ESP at all-time points during 48 h (Control > MTP > ESP; p < 0.001). Mean VAS scores were lower in group ESP than group MTP in postoperative 12 h (p < 0.001). Rescue analgesic consumption, number of bolus demand on PCA, PCA bolus demand dose, total PCA dose, and complications related to opioid consumption were highest in control group and lowest in ESP group (Control > MTP > ESP; p < 0.001). CONCLUSION: Both ESP and MTP blocks provided effective pain relief after lumbar spinal surgery but the ESP block was superior to MTP block regarding postoperative analgesia in the first 24 h.

Comparison of alfentanil and remifentanil infusions in combination with propofol for the outpatient extra-corporeal shock wave lithotripsy.

PURPOSE: The aim of this study is to compare the efficiency of propofol+remifentanil to propofol+alfentanil in reducing pain in patients with urinary system stones undergoing outpatient Extracorporeal Shock Wave Lithotripsy (ESWL). METHODS: In this prospective study, 30 patients, ASA (American Society of Anesthesiologist) I-II, who are 18-60 years old and undergoing Extracorporeal Shock Wave Lithotripsy for urinary system stones were included. Patients were randomly selected for either propofol+remifentanil (Group PR) or propofol+alfentanil treatment (Group PA). Propofol was given at a dose 1 mg/kg, and then 5mg doses were given to maintain a BIS (Bispectral Index) level 60-70. Remifentanil (0.2 microg/kg (-1) bolus dose and later 0.02 microgkg(-1) min(-1) infusions) was given to the group PR and alfentanil (bolus dose 7 microgkg(-1) and later with 0.7 microgkg(-1) min(-1) infusions) was given to the group PA. If needed, the patients might use 10 ig remifentanil and 50 ig alfentanil bolus doses in group PR and PA using patient controlled analgesia (PCA) device. ECG, SpO2, BIS levels and arterial blood pressures were monitored and recorded. Patients were evaluated with Ramsay Sedation Level Evaluation Scale and with Modified Aldrete Scoring System during and after the procedure. VAS was given to patients to mark their pain level on this scale at the end of the procedure. RESULTS: The values at pre-induction and post- induction in each group were statistically different but difference did not exist between the PR and PA groups. CONCLUSION: We concluded that both methods may be successfully used for patients undergoing ESWL (Tab. 6, Rief. 29).

Nasogastric tube aided fiberoptic intubation through laryngeal mask airway (case report).

Burn scars in early childhood often impairs normal development of the structures of the face. Multiple reconstructive interventions contribute to airway deformity with excessive scar and contracture band formation. Such patients are the most difficult group because of the risk of difficult ventilation and intubation in anesthesiology practice. Although developments in complex airway management techniques are increased, solutions may be achieved with simple approaches. For this purpose, we report about a patient with an anticipated difficult airway who has rejected awake fiberoptic intubation. The patient was managed successfully using classical laryngeal mask airway and nasogastric tube with the guidance of fiberoptic bronchoscope under deep sedation.