Turkish journal of anaesthesiology and reanimation最新文献

Objective: With the regional anaesthetic technique used for brachial plexus block, the phrenic nerve (C3-C5) can be blocked due to its anatomical proximity to the brachial plexus and the effect of a significant volume of local anaesthetic deposited near the nerve roots. The goal of this study was to compare the incidence of hemi-diaphragmatic paralysis (HDP) following infraclavicular and supraclavicular approaches for brachial plexus block, using a low-volume local anaesthetic.

Methods: A total of 60 patients were enrolled in this study: 30 patients were assigned to the supraclavicular brachial plexus block group, and 30 patients were assigned to the infraclavicular brachial plexus block group. Under aseptic precautions and ultrasound guidance, both groups received 20 mL of 0.5% bupivacaine. The diaphragmatic excursion was measured using ultrasound before the block and 2 hours afterward in the postoperative care unit. A reduction in excursion of more than 75% compared with pre-block values was considered complete paralysis, whereas a reduction of 25-75% was considered partial paralysis.

Results: Infraclavicular brachial plexus block (3.33%) had a lower incidence of HDP compared with supraclavicular brachial plexus block (36.66%). The complications in both groups were not significant, and there was no need to use general anaesthesia.

Conclusion: The incidence of phrenic nerve palsy in the supraclavicular and infraclavicular brachial plexus groups was low, with a lower incidence of HDP in the infraclavicular group.

Enhanced recovery after surgery (ERAS) is a set of methods that provide early recovery with a multimodal approach in the perioperative care pathway. ERAS protocols are widely used worldwide in major surgery to improve surgical outcomes and require multidisciplinary collaboration. Using ERAS protocols means better pain management, earlier mobilization, improved oral nutrition, shorter hospital stays, and cost-effectiveness. ERAS protocols were introduced into renal transplant programs quite late. Transplantation patients are challenging and should be well prepared and followed up for ERAS. This review article highlights preoperative, intraoperative, and postoperative important points for preparing patients for renal transplantation for early recovery.

Objective: Modified thoracoabdominal nerve block with a perichondrial approach (M-TAPA) provides effective analgesia in the anterior and lateral thoracoabdominal regions. Previous studies have shown the efficacy of M-TAPA in laparoscopic surgery. The primary aim of this study was to investigate the efficacy of M-TAPA block in patients undergoing open major abdominal surgery.

Methods: This study was designed as a prospective, randomized, single-blind, controlled study. A total of 43 patients were included in the study. In group M-TAPA, the block was performed bilaterally at the end of the surgery. Local wound infiltration was performed on the control group. Postoperative analgesia was provided with patient-controlled intravenous morphine. When numeric rating scale (NRS) pain scores exceeded 4, rescue analgesia with tramadol was administered. The primary outcome of this study was to compare the 24-hour total morphine consumption. The secondary outcomes included comparing pain scores, rescue analgesia requirements, and patient satisfaction.

Results: Regarding our primary outcome, median morphine consumption during the first 24 hours was lower in the M-TAPA group [16 (14-18)] than in the control group [24.5 (19.5-27)] (P < 0.01, 95% confidence interval: -9, 42 and -3.01). Additionally, NRS scores were significantly lower and patient satisfaction was significantly higher in the M-TAPA group. The need for rescue analgesics in the first 24 hours was comparable among the study groups.

Conclusion: The M-TAPA block is an effective abdominal wall block that can be considered part of multimodal analgesia in open major abdominal surgery.

Glutaric aciduria type 1 (GA-1) presents unique challenges for anaesthetists. This case report discusses anaesthesia management in a pregnant woman with GA-1 undergoing cesarean delivery. Based on a cautious consideration of potential complications, combined spinal-epidural anaesthesia was preferred in this case. Maintenance of normoglycemia, normothermia, low-protein diet, carnitine supplementation, and proper hydration were prioritized. A healthy baby was delivered without complications. This case underscores the importance of comprehensive preoperative assessment and individualized anaesthesia strategies for achieving optimal outcomes in pregnant patients with GA-1. The cautious management of anaesthesia-related risks is important to ensure patient safety and decrease stress responses. Neuraxial anaesthesia and analgesia may be advantageous in specific cases.

Objective: Analgesia management following breast surgery is a critical concern. The erector spinae plane block (ESPB) is a regional anaesthesia technique that is frequently used for analgesia after breast surgery. However, there is no consensus on the volume. Therefore, the aim of this study was to compare ESPB performed using 20 mL vs. 30 mL.

Methods: The study included 43 female patients with American Society of Anesthesiologist class I-II physical status. Participants were randomized into two groups: 20 mL ESPB and 30 mL ESPB. Ibuprofen (400 mg) 3x1 was ordered, and a fentanyl patient-controlled analgesia device was attached intravenously to the participants. If the pain score was ≥4, meperidine (0.5 mg kg^-1) was administered.

Results: Postoperative fentanyl use was similar between the groups. There was no difference in the amount of rescue analgesic use between the groups. The static and dynamic numerical rating scores were similar between the groups. No statistical difference was noted in terms of nausea, vomiting, or itching between the groups.

Conclusion: A similar analgesic effect is achieved by performing ESPB using 20 or 30 mL of local anaesthetic at the same concentration.

Peripheral artery disease (PAD) is quite prevalent, and its incidence will increase with aging of population. Pain is a key diagnostic feature of symptomatic PAD and has been linked to disease progression and poor quality of life. Symptom improvement is of utmost importance in PAD; therefore, optimal and comprehensive pain therapy is mandatory. However, the management of acute pain in PAD remains challenging due to the lack of high-quality evidence, the complex pathophysiological mechanisms of pain, and the high comorbidity of patients. On the other hand, inadequate pain control leads to several pathophysiological deviations, such as the aggravated neuroendocrine stress response, which may be detrimental in patients with PAD. Experts suggest that the management of acute pain in patients with vascular diseases should be oriented toward the underlying pathophysiological mechanisms of each modality and should follow a multifactorial approach. Although the exact pain pathways in PAD are still poorly understood and more probably multifactorial, they may be key to an effective, individualized, patient-centered, multimodal pain strategy. The aim of this review was to provide a holistic, beyond-opioids, individualized multimodal pain approach for patients with PAD.

Objective: Successful endotracheal intubation is a key step in advanced airway management. The gold standard confirmation for successful endotracheal intubation is end-tidal carbon dioxide (etCO₂) monitoring, although recent studies suggest that ultrasound can also be used. In this study, we explored the time-sensitive early recognition of successful endotracheal intubation by comparing ultrasound and etCO₂ monitoring.

Methods: The study included 104 patients who were posted for elective surgery under general anaesthesia requiring endotracheal intubation. The time from removal of the face mask to ultrasound visualization of flutter in the trachea was compared with that of the appearance of six consecutive capnography waveforms following endotracheal intubation.

Results: Ultrasound was a faster tool for recognizing successful endotracheal intubation [(21.63±7.38) seconds] compared with capnography [(40.62±7.93) seconds].

Conclusion: eCO₂ requires more time for 6 continuous waveforms to confirm successful intubation and has a false positive rate. Supplementing the gold standard etCO₂ with ultrasound is faster and reliable in patients with low pulmonary blood flow without needing positive pressure ventilation, such as during cardiopulmonary resuscitation, in high-risk emergency intubations, such as in trauma, or in difficult airways where intubation can be confirmed in real time. Ultrasound is a reliable and faster tool for the early identification of successful endotracheal intubation than end-tidal carbon dioxide.

Objective: The neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) are indicators of postoperative inflammatory response. Low-dose ketamine has analgesic and anti-inflammatory properties. Inguinal hernia surgery is associated with a higher incidence of chronic pain.

Methods: Sixty patients aged 18-60 years; American Society of Anesthesiologists status I and II who were scheduled for laparoscopic inguinal hernia surgery were included. After the induction of general anaesthesia, a ketamine 0.5 mg kg^-1 bolus, followed by a 0.2 mg kg^-1 h^-1 infusion (group K) or saline bolus and infusion (group S) was administered until the end of the surgery. Blood samples were collected at various time intervals. Fentanyl requirement, hemodynamics, verbal analog scale (VAS), emergence delirium, recovery, postoperative nausea and vomiting, and chronic pain were recorded.

Results: Median (interquartile range) NLR was 4.63 times increased at 2 hours postoperatively from the baseline in group S [2.07 (1.72-2.79) to 7.91 (5.74-14.7)] as compared to 2.53 times increase in group K [1.85 (1.4-2.61) to 5.45 (2.89-7.61)] (P=0.02). The increase in median PLR from baseline to 2 hours postoperatively was greater in group S (2.98 times) than in group K (1.94 times) (P=0.02). The NLR and PLR were comparable on POD1 between the groups. Fentanyl requirement was significantly higher in group S compared to Group K both intraoperatively, (P=0.01) and two hours postoperatively (P=0.047). More patients had chronic pain and VAS scores in group S than in group K (13 vs 5, P=0.05).

Conclusion: Low-dose ketamine reduces postoperative inflammatory response, decreases perioperative opioid requirement, and reduces incidence of chronic pain after laparoscopic inguinal hernia surgery with no significant side effects.

Objective: We intended to research the efficacy of pericapsular nerve group (PENG) block performed with preoperative ultrasonography (USG) in patients who underwent hip fracture repair under spinal anaesthesia and whether it affects the success of spinal anaesthesia.

Methods: The files of 100 patients were analysed, and 60 patients were enrolled in the study. The patients were assigned into two groups: Group P (n = 30) consisted of patients who underwent USG-guided PENG block before the start of surgery and the control group (Group C; n = 30) consisted of patients in whom tramadol infusion was initiated. All patients received 10 mg IV bolus tramadol as rescue analgesia when numeric rating scale (NRS)>3. From the files of the patients, before PENG block application, after PENG block application, during positioning before spinal anaesthesia, the NRS values at the time of the patient's discharge from the operating room and at 2^nd, 4^th, 12^th and 24^th hour NRS values, spinal anaesthesia duration and number of attempts, and perioperative total tramadol consumption were obtained.

Results: In group P, NRS values were found to be significantly lower after PENG block application, during positioning before spinal anaesthesia, and at the postoperative discharge, 2^nd, 4^th, 12^th and 24^th hours. In addition, group P had a lower duration of spinal anaesthesia, a lower number of spinal anaesthesia attempts and a lower total perioperative tramadol consumption.

Conclusion: The results demonstrated that preoperative PENG block facilitated positioning for spinal anaesthesia, shortened the application time, increased the first-attempt success rate, decreased pain scores, and reduced the need for postoperative opioids.