No abstract

No abstract

The traditional method to evaluate adequacy of the block for surgery is based on loss of sensory response to stimuli, which requires patient cooperation. Several methods have been described for objective assessment of the nerve block. The aim of the study was to investigate whether perfusion index (PI), a measure of peripheral perfusion from a pulse oximetry finger sensor, is a reliable and objective method for assessing the adequacy of infraclavicular blockade and to describe the time course of PI changes once peripheral nerve block has been achieved during surgery. The study was performed on patients scheduled for elective hand, wrist and forearm surgery under infraclavicular brachial plexus block. The pulse oximetry sensor was affixed to a finger ipsilateral to the side of the infraclavicular block for continuous measurement of PI. The average PI and the average percent change in PI from baseline, at 10, 20 and 30 min from the administration of the block were calculated. Baseline values of PI ranged from 0.6 to 4.7 % in 44 patients for whom infraclavicular block was effective and 1.8 to 2.4 % in 2 patients for whom infraclavicular block failed. Differences were not significant (p = 0.60). In the effective infraclavicular block group, PI rose continuously during the 30-min observation period. At 10 min, PI increased by (mean ± standard deviation) 120 ± 119 % from baseline. At 20 and 30 min, perfusion index increased by 133 ± 125 % and 155 ± 144 % from baseline. All changes from baseline were significant (p < 0.01). The perfusion index is a predictor of infraclavicular block success. The largest changes in PI occur 30 min after the block administration but significant changes in PI were detected 10 min after administration. Perfusion index monitoring may provide a highly valuable tool to quickly evaluate the success of regional anesthesia of the upper extremity in clinical practice.

Arterial cannulation with ultrasound (US) guidance increases the success rate and reduces complications. US-guided vascular access has two main approaches: long axis in-plane (LA-IP) and short axis out-of-plane (SA-OOP) approaches. The purpose of this study was to compare performance time and possible complications between two techniques. After obtaining ethics committee approval and informed patient consent, a prospective and randomized trial was conducted at ASA I-III, patients between the ages of 20-70 years. 108 patients were scheduled for radial arterial cannulaton in patients undergoing elective surgery under general anesthesia. Patients were divided into two groups as LA-IP and SA-OOP approaches with sealed envelope randomized method. After induction of anesthesia, the distance between skin-to-artery and the diameter of radial artery in US-imaging was recorded. The successful cannulation time, the number of attempts, potential complications such as thrombosis, edema, vasospasm, hematoma and posterior wall puncture were recorded. Demographic and hemodynamic parameters were similar in two groups. The diameter and the depth of artery were also similar in both of groups. Cannulation time was shorter in LA-IP Group compared to SA-OOP (24 ± 17 s vs. 47 ± 34 s respectively, p < 0.05). The arterial cannulation by LA-IP approach increased the rate of cannula-insertion success at the first attempt (76 %) compared to SA-OOP approach (51 %). Posterior wall damage during arterial cannulation were found in 30 patients with SA-OOP Group (56 %) and 11 patients with LA-IP Group (20 %), (p < 0.05). In our study, the use of LA-IP approach during US-guided radial artery cannulation has higher success rate at first insertion. We also found LA-IP approach results in shorter cannulation time and decreased the incidence of complications.

Objectives: Due to the complex breast innervation, postoperative analgesia after breast surgery is a challenge for the anesthesiologists. The erector spinae plane block (ESPB) is a newly defined promising technique for this purpose. The main purpose of this study was to evaluate the analgesic efficacy of the ultrasound-guided ESPB in breast surgery, monitoring its effect on the postoperative opioid consumption. Methods: Fifty female patients, who were scheduled to undergo elective breast surgery, with the American Society of Anesthesiology physical score I-II, and aged between 25 and 70 years, were included into the study. Patients were randomized into two groups, as the ESPB and the control group. All patients in the ESPB group received a bi-level (T2-T4) ultrasound-guided ESPB with 20 ml 0.25 % bupivacaine (10 ml for each level) preoperatively. An intravenous patient-controlled analgesia device for the postoperative analgesia was given to all patients. The numeric rating scale (NRS) scores for pain and postoperative morphine consumptions were recorded at the 1 st , 6 th , 12 th , and 24 th hour postoperatively. Results: Postoperative morphine consumption was significantly lower in the ESPB group compared to the control group at the postoperative 6 th , 12 th , and 24 th hour (p<0.001 for each time interval). The morphine consumption at the 24-hour was reduced by 75%. There was no significant difference in the NRS scores (median NRS values were 2, 1, 0, 0, and 2, 2, 1, 1, respectively). Conclusion:Our study has shown that a significant opioid-sparing analgesic effect in patients undergoing breast surgery could be achieved with a US-guided bi-level ESP block.