Addition of lidocaine to bupivacaine for spinal anaesthesia compared with bupivacaine spinal anaesthesia and local infiltration anaesthesia.

BACKGROUND: Two spinal anaesthesia techniques were compared with local infiltration anaesthesia (LIA) to test the hypothesis that the addition of lidocaine to bupivacaine would decrease the spinal block's duration and provide shorter recovery to discharge. METHODS: Ninety-three patients undergoing outpatient herniorrhaphy were randomised into three groups. Spinal anaesthesia: the BL Group (bupivacaine-lidocaine) received 2 ml hyperbaric bupivacaine (10 mg) + 0.6 ml 1% lidocaine (6 mg), the BS Group (bupivacaine-saline) received 2 ml hyperbaric bupivacaine (10 mg) + 0.6 ml saline. LIA: the LIA group received plain bupivacaine + lidocaine. Resolution of the nerve blocks were compared between spinal anaesthesia groups, and post-operative pain scores, analgesic requirements, post-anaesthesia care unit (PACU) time, and discharge time were compared among all groups. RESULTS: Spinal block resolved faster in the BL group vs. the BS group: 194.8 [standard deviation (SD) 29.2] min vs. 236.8 (SD 36.5) min (P = 0.000). PACU and discharge time were shortest in the LIA group [PACU time: 108.7 (SD 27.6) min vs. 113.0 (SD 39.4) min and 151.9 (SD 43.7) min in the BL and BS groups (P = 0.000), and discharge time 108.5 (SD 29.5) min vs. 145.8 (SD 37.3) min and 177.1 (SD 32.0) min in the BL and BS groups, respectively (P = 0.000)]. Pain scores and analgesic consumption were lower, with the time to first analgesic intake being longer in the LIA group. CONCLUSION: Addition of lidocaine to bupivacaine reduced the duration of the spinal block and was associated with shorter recovery times. However, LIA provided the fastest recovery to discharge after outpatient inguinal herniorrhaphy.

Prosthetic repair of umbilical hernias in adults with local anesthesia in a day-case setting: a comprehensive report from a specialized hernia center.

BACKGROUND: Umbilical hernia is a common surgical problem. However, there seems to be a certain discrepancy between its importance and the attention it has received in the literature to date. This prospective study aimed to report a detailed analysis of prosthetic umbilical hernia repairs with local anesthesia in a day-case setting. METHODS: It was planned to enroll 100 consecutive patients who underwent an elective umbilical hernia repair with local anesthesia. Patients who required general anesthesia and simultaneous hernia repairs were excluded. The procedure including local anesthesia and intravenous sedation was explained to the patients in detail by the operating surgeons and the anesthesiologist. The following parameters were strictly recorded: gender, age, body mass index (BMI), concomitant diseases, history of hernia (primary/recurrent), size of fascial defect, duration of operation, level of intravenous sedation (light/moderate), discharge time, and complications. RESULTS: There were 54 male and 46 female patients. The mean age was 48.6 years (24-78 years). Four patients were older than 70 years of age. Forty-one patients had 84 concomitant diseases. Eleven patients had a recurrent hernia. Female patients more frequently presented with a recurrent hernia than male patients (19.6 vs. 3.7%, P = 0.009). A standard polypropylene mesh was used in the onlay position in 91 cases. In nine cases, a light mesh was placed in the preperitoneal space. A closed vacuum drain was left in situ in 37 cases. Light sedation was set in 86 cases, whereas 12 patients received a moderate sedation. Monitored anesthesia care was used in two cases. When moderate sedation was needed, a concurrent increase in lidocaine dose and total volume was recorded. There was a positive correlation between increased lidocaine use and high midazolam dose and additional propofol requirement. The mean total local anesthetic volume was 33 ml (10-63 ml). Lidocaine doses displayed a large range between the cases (70-600 mg). The mean lidocaine dose was 263.3 mg (standard deviation [SD]: 103.4). No bupivacaine was given in 19 cases, whereas the mean bupivacaine dose was 35.1 mg (0-100 mg) in 81 cases. The mean duration in the operation room was 69 min (25-150 min). It was significantly longer for recurrent hernias than primary ones (95 vs. 65 min; P = 0.0001). Higher total volume and higher lidocaine doses were required for the repair of recurrent hernias. In addition, it was observed that the longer the operation time, then the longer the lidocaine dose and the higher the total volume of local anesthetic agents. The patient satisfaction rate was 97%. The mean discharge time was 122 ± 58 min (45-420 min). Sixty-seven patients were sent home within 2 h. Early wound problems were observed in 11 patients. Small seromas and hematomas developed in six cases, and dissolved without drainage. Three superficial surgical site infections diagnosed by erythema and enduration were recorded without obvious suppuration. No recurrence was recorded after a mean follow-up of 17 months (5-41 months). One patient complained of pain at the lower edge of a standard polypropylene mesh at the third postoperative month. CONCLUSIONS: The repair of umbilical hernias with local anesthesia in a day-case setting is a good option, with low infection and recurrence rates. Most patients can be discharged early as planned. Separate doses and total volume of local anesthetic agents needed for umbilical hernia repair are clearly higher than those used in inguinal hernia repair. Patients with higher BMI, recurrent hernia, and defects larger than 3 cm may require higher local analgesic doses. The patient satisfaction is very good when the patients are provided with detailed information about day-surgery and local anesthesia.

Factors determining the doses of local anesthetic agents in unilateral inguinal hernia repair.

BACKGROUND: Today, local anesthesia is used in specialized hernia clinics in most cases. The technique for establishing local anesthesia for inguinal surgery may differ among surgeons. Few articles to date have mentioned the exact doses of local agents. This prospective study aimed to research the doses of local anesthetic agents needed in practice and determine the patient-related and other factors which affected those doses. METHODS: Three hundred consecutive patients who underwent an elective unilateral inguinal hernia repair were planned to be included in the study. Lidocaine as a short-acting, medium-lasting agent and bupivacaine 0.5% as a long-acting agent were chosen. Gender, age, body mass index (BMI), side of hernia (right/left), concomitant disease, history of hernia (primary/recurrent), type of hernia (indirect/direct), Gilbert class of hernia (1-6), size of hernia (small or medium/large or massive), hernia sac content (omentum/intestine), time shift (8 am to 4 pm/later than 4 pm), duration of operation, and institutional experience (first 150 cases vs. latter 150 cases) were recorded. RESULTS: There were 277 male and 23 female patients. The mean age was 49.73 years (range 16-83; median 50.00). The mean volume of total anesthetic agents (lidocaine + bupivacaine) was 19.79 ml (range 5.5-40; median 19.5). The mean volumes separately were 101.79 mg for lidocaine (range 30-200; median 100) and 48.12 mg for bupivacaine (range 12.5-110; median 50). The patients were discharged after a median time of 2 h postoperatively. Univariate analysis for the total dose of the two agents showed that younger age (< or =60 vs. > or =61 years), larger size of hernia, longer duration of operation (> or =61 vs. < or =60 min), recurrent hernia, hernia sac content (omentum > intestine), and higher BMI (> or =25.1 vs. < or =25.0) were significant parameters. On the other hand, BMI, recurrent hernia, size of hernia, and omentum in the hernia sac were factors that significantly affected the mean lidocaine dose. Higher BMI and recurrent hernia also caused a higher need for bupivacaine. In addition, significantly lower doses of bupivacaine was used in older patients. The significant independent parameters in the multivariate analysis were duration of operation, sac content, and BMI for lidocaine dose, whereas the duration of operation and sac content were determinative for the sum volume of the two agents. None of the recorded parameters were found to be significant for bupivacaine dose in the logistic regression. CONCLUSIONS: This prospective study showed, again, the feasibility of local anesthesia in elective inguinal hernia repair in all patient groups with different characteristics. The mean and maximum doses of local anesthetic agents were well within safety limits, even in recurrent and large hernias. Younger age, large hernias, recurrent hernias, omental mass in the hernia sac, high BMI, and duration of operation might be the factors affecting local anesthetic doses. The significant independent parameters in the multivariate analysis were duration of operation, sac content, and BMI for lidocaine dose, whereas the duration of operation and sac content were determinative for the sum volume of lidocaine and bupivacaine.

Founding the first hernia center in Turkey.

For years, centers dedicated to hernia surgery have been operating in North America and Europe. However, such centers have not been available to patients in most other countries, including Turkey. In 2006, the first Turkish center devoted to hernia surgery, the "Ankara Hernia Center", was opened. In this paper, we present general information about the center's construction, staff, practice, patient profiles, and future goals.

Occurrence of T-2 toxin in processed cereals and pulses in Turkey determined by HPLC and TLC.

The purpose of this study was to investigate the T-2 toxin level of contaminated cereal and pulse products in Turkey. T-2 toxin was detected using high performance liquid chromatography (HPLC) with UV detection at 208 nm and thin layer chromatography (TLC) was used for confirmation of the T-2 toxin-contaminated samples (> or = 1 ppm). The recovery was 93 +/- 3.3% (SD 3.29, n = 5) for chickpea spiked with a known amount of T-2 toxin (1 ppm). The detection limits for T-2 toxin for HPLC and TLC were 25 ng per injection and 50 ng per spot, respectively. A total of 50 commercially available cereal and pulse product samples, collected from markets and street bazaars, were analysed. Incidences of T-2 toxin detected in cereal and pulse products were 23.5% and 31.2%, respectively and the maximum detected amount was 1.9 ppm in a sample of dried beans. The incidence of toxin-contaminated specimens is not so low relative to the volume of specimens produced.

Determination of T-2 toxin in grain and grain products by HPLC and TLC.

The purpose of this study was to investigate the T-2 toxin contaminated grain and grain products consumed especially by Turkish population. The T-2 toxin was detected using the high performance liquid chromatography (HPLC) with UV detector at 208 nm and the identify of T-2 was further confirmed by thin layer chromatography (TLC). The recovery was 91 +/- 4.24% for corn flour fortified with the known amount of T-2 toxin (1 ppm). The detection limits of T-2 toxin for the HPLC and the TLC were 25 ng and 50 ng, respectively. A total of 30 commercially available grain and grain product samples were analyzed. Two corn flour samples were found to contain detectable levels of T-2 toxin at a level of 1.60 ppm and 4.08 ppm.