Effects of erector spinae plane block on opioid consumption in patients undergoing hand-assisted laparoscopic donor nephrectomy: a randomized controlled trial.

BACKGROUND: The erector spinae plane block is a relatively new regional anesthesia technique that is expected to provide some benefits for postoperative analgesia. This study investigated the effects of erector spinae plane block on postoperative opioid consumption in kidney donors undergoing hand-assisted laparoscopic donor nephrectomy for renal transplantation. METHODS: Fifty-two donors scheduled for elective hand-assisted laparoscopic donor nephrectomy were randomly divided into the block (25 donors) and control (27 donors) groups. Donors in the block group received 30 mL of 0.25% bupivacaine under ultrasound guidance, whereas the control group received no block treatment. The primary outcome measure was the amount of fentanyl administered via patient-controlled analgesia at 24 h. Secondary outcomes included the duration of stay, opioid consumption in the post-anesthesia care unit, and pain scores during the recording hours. RESULTS: No significant differences were observed between the groups regarding total opioid consumption converted to intravenous morphine equivalent administered via patient-controlled analgesia (33.3±21.4 mg vs. 37.5±18.5 mg; P=0.27) and in the postanesthesia care unit (1.5±0.9 mg vs. 1.4±0.8 mg; P=0.55). The duration of stay in the postanesthesia care unit (86.3±32.6 min vs. 85.7±33.6 min; P=0.87) was similar between the groups. There was no significant difference between the groups in the postoperative donor-reported NRS pain scores (P>0.05 for all the time points). CONCLUSIONS: Preoperative erector spinae plane block is not an effective strategy for reducing postoperative pain or opioid consumption in patients undergoing hand-assisted laparoscopic donor nephrectomy. Different block combinations are needed for optimal pain management in hand-assisted laparoscopic donor nephrectomy.

Evaluation of brachial plexus stiffness in different arm and head positions by sonoelastography.

Intraoperative positioning-related nerve injuries, particularly those affecting the brachial plexus, are concerning complications believed to arise from stretching and/or compression of peripheral nerves. Although sonoelastography, a new ultrasound technology, is emerging as a valuable tool in the musculoskeletal system, its utility in evaluating peripheral nerves remains unclear. This study aimed to utilize sonoelastography to assess the brachial plexus during surgery, specifically investigating changes in its stiffness values in relation to different head and arm positions. In this prospective cohort study, bilateral brachial plexuses of 8 volunteers in 3 different positions were enrolled. Using a high-frequency linear probe, the stiffness of the brachial plexus was quantitatively measured in kilopascals (kPa) under 3 different positions: neutral, head rotated, and head rotated with arm hyperabducted. Intra-class agreement was evaluated. The stiffness of the brachial plexus was 7.39 kPa in the neutral position (NP), 10.28 kPa with head rotation, and 17.24 kPa when the head was turned, and the ipsilateral arm was hyperabducted. Significant increases were observed in stiffness values when the head was turned, whether ipsilaterally or contralaterally, and during hyperabduction of the arm while the head was turned (for all P < .001). Strong intra-class correlations were found for the measurements of stiffness values (ICC = 0.988-0.989; P < .001; Cronbach Alpha = 0.987-0.989). Sonoelastography revealed significant increases in the stiffness of the brachial plexus with various head rotations and arm positions compared to the neutral state. These findings suggest that sonoelastography could potentially serve as a valuable tool for assessing the risk of brachial plexus injury during surgery and for guiding optimal patient positioning. Further research with larger sample sizes is needed to establish definitive clinical applications.

The effect of erector spinae plane block on arterial grafts in coronary artery bypass grafting.

Background: This study aims to evaluate the sympathectomy effects of erector spinae plane block on the diameters and cross-sectional areas of the left and right internal mammary arteries and of the radial arteries. Methods: This prospective study included a total of 25 patients (14 males, 11 females; median age: 67 years; range, 23 to 75 years) who underwent erector spinae plane block categorized as the American Society of Anesthesiologists Class III and underwent off-pump coronary artery bypass grafting between June 01, 2020 and March 01, 2021. The effects of erector spinae plane block on the diameters and cross-sectional areas of the left and right internal mammary arteries and radial arteries were assessed using ultrasonography images taken both before and 45 min after the procedure, from the third, fourth, and fifth intercostal spaces for the left and right internal mammary arteries and from 3 cm proximal to the wrist for the radial arteries. Results: The diameters and cross-sectional areas of the left and right internal mammary arteries and radial arteries significantly increased compared to baseline values after the erector spinae plane block (p<0.05). There was no significant difference in the pre- and post-procedural heart rate and mean arterial pressure values (p>0.05). Conclusion: The bilateral erector spinae plane block, which was performed at the T5 level, provided vasodilatation of the left and right internal mammary arteries and radial arteries without causing any significant difference in the heart rate and mean arterial pressure. These findings indicate that the sympathetic block produced by the erector spinae plane block may facilitate better surgical conditions by preventing arterial spasms. Thus, bilateral erector spinae plane block may be a promising technique to achieve regional anesthesia for off-pump coronary artery bypass grafting.

Should we take precautions to avoid respiratory compromise while delaying CPAP resumption following transsfenoidal surgery? An alternative approach in a patient with severe obstructive sleep apnea: case report.

BACKGROUND: We describe a patient with severe obstructive sleep apnea scheduled for transsfenoidal surgery. Early postoperative use of continuous positive airway pressure (CPAP) was considered unsafe because increased risk of intracranial complications. METHODS: Aiming to bypass the upper airway obstruction and thus avoid CPAP, a 6-mm nasopharyngeal airway was introduced by the surgical team under endoscopic vision. In the postoperative period and during follow-up, patient and his family did not complain about apnea/hypopnea episodes and nasopharyngeal airway was tolerated comfortably. CONCLUSION: We recommend this technique as an alternative in obstructive sleep apnea patients undergoing transsfenoidal surgery.

[A comparison of vertical infraclavicular and coracoid approaches in forearm surgery]. / Ön kol cerrahisinde infraklaviküler ve korakoid yaklasimlarin karsilastirilmasi

OBJECTIVES: Despite several risks, infraclavicular approaches to the brachial plexus gained popularity. The present study compared success rates, block onset times, block performance times, and frequency of adverse effects of vertical infraclavicular (VIB) and coracoid blocks (CB) in patients undergoing forearm surgery. METHODS: After ethical committee approval and informed consent 40 patients undergoing forearm surgery were included. The brachial plexus was located using a nerve stimulator and an insulated pencil point needle. Thirty ml bupivacaine 0.5% was used for the block. The blocks were assessed every minute for the first 5 min, then every 5 min for 15 min and then every 15 min and at the end of the operation. RESULTS: Block onset times of both groups were similar. Higher rates of sensory block were found in group CB at the 5th, 10th, and 15th minutes of assessment. Also higher rates of motor block were found in group CB at the 5th, 10th, 15th and 30th minutes of assessment. Time to perform block was shorter in group VIB. One patient in CB group required general anaesthesia. Except two vascular punctures in group CB no other side-effects were observed. CONCLUSION: Coracapid block provided higher rates of sensorial and motor blocks in a similar onset time without serious complications. CB can be accepted as a safe and reliable alternative to VIB for forearm surgery.

Spinal anesthesia for elective cesarean section is associated with shorter hospital stay compared to general anesthesia.

OBJECTIVES: This prospective study aims to compare maternal and neonatal effects of spinal and general anesthesia for elective cesarean section. METHODS: Term parturients receiving routine spinal (Group SA, n=95) or general (Group GA, n=93) anesthesia and standard postoperative analgesia for elective cesarean section were included in this study. Operation time, incision-hysterotomy (TS-H) and hysterotomy-umbilical cord clamping (TH-U) intervals, oxytocine requirement, intraoperative fluids, ephedrine requirement, incidence of hypotension, time to first analgesic requirement (Tanalg), pethidine consumption, adverse events, time to first breastfeeding, oral food intake (TOI), flatulence (TF), defecation (TD), mobilization, and postoperative hospital stay were compared between the groups. Newborn Apgar scores, umbilical venous blood gas analysis, incidence of hypoglycemia, nutritional support, phototherapy and ventilatory support were also analyzed. RESULTS: Spinal anesthesia was associated with longer TS-H and TH-U durations, lower oxytocine requirements, higher incidence of hypotension, increased ephedrine and fluid consumption, and delayed Tanalg. Furthermore, TOI, TF, TD and postoperative hospital stay was shorter in patients given spinal anesthesia when compared with patients given general anesthesia (48h vs. 52 h, respectively; p<0.01). No difference in postoperative analgesic consumption and neonatal outcomes, except 1st min Apgar scores and umbilical blood gas analysis, was detected. CONCLUSION: Spinal anesthesia, when compared to general anesthesia shortens postoperative hospital stay with early return of gastrointestinal functions in elective cesarean section.