Background: Lumbar spine surgery is associated with significant postoperative pain. Interfascial plane blocks, such as erector spinae plane (ESP) and thoracolumbar interfascial plane (TLIP) blocks, can play a significant role in multimodal analgesic regimens.Methods: Sixty patients aged 18 to 60 years undergoing elective single or double-level lumbar discectomy or primary lumbar laminoplasty were recruited into this randomized double-blind study. All patients received general anesthesia and were randomly allocated to either modified TLIP (mTLIP) block (group M) or ESP block (group E). Postoperative and intraoperative fentanyl consumption, and postoperative pain scores, were recorded.Results: Total 48 h postoperative fentanyl consumption was higher in Group M (189.66 ± 141.11 µg) than in Group E (124.16 ± 80.83 µg; P = 0.031). In the first 24 postoperative hours, fentanyl consumption was higher in Group M (150.3 ± 120.9 µg) than in group E (89.9 ± 65.3 µg; P = 0.01) but was similar between groups in postoperative hours 24to 48 (39.0 ± 20.2 µg versus 34.7 ± 17.1 µg in group M and group E, respectively; P = 0.37). Additional intraoperative fentanyl requirement was 57.66 ± 21.76 µg in group M compared with 40.33 ± 21.89 µg in group E (P < 0.01). Postoperative pain scores were higher in group M than in group E at 1, 2, 4, 6, 12, and 24 hours postoperatively (P < 0.001), but similar at 48 hours (P = 0.164).
Conclusion:Compared with the mTLIP block, the ESP block was associated with lower pain scores and a small decrease in perioperative fentanyl consumption in patients undergoing lumbar spine surgeries. Both blocks could form a part of a multimodal analgesic regimen in spine surgery patients.
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Background and Aims:The preservation of recurrent laryngeal nerve (RLN) is an essential part of thyroid surgery. The various methods to test the normal functionality of vocal cords (VCs) include direct visualisation under the fiber bronchoscope, indirect laryngoscopy, laryngeal muscles electromyography, computed tomography (CT), and magnetic resonance imaging (MRI). We aimed to assess the usefulness of ultrasound (USG) in the examination of VC morphology and movement.Methods:After Institutional Ethical Committee (IEC) clearance, 65 American Society of Anesthesiologists physical status I/II patients between the age group 18 and 60 years scheduled for thyroid surgery were enrolled in this observational study. All patients underwent USG examination before, immediately after and 2 days after thyroidectomy. The vocal fold (VF) displacement velocity (VFDV) was recorded and analysed. If any VF disorder was detected, the patients underwent two additional examinations: 2 and 3 months after thyroidectomy. All the findings were correlated with those of video rhinolaryngoscope (VRL).Results:The visualisation rate of the VCs with USG was 96.9% whereas with VRL was 100%. Two patients had preoperative VC palsy that was picked up by USG and confirmed by VRL. The sensitivity and specificity of USG as a tool to detect paralysis were 100% CI = (0.34, 1.00) and 93.44% CI = (0.84, 0.97), respectively.Conclusion:USG examination can prove to be a good, noninvasive, cheap alternative to VRL in examination for functionality of VCs perioperatively.
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