Background. The aim of this study was to compare the effectiveness of ultrasound-guided (USG) subcostal transversus abdominis plane (TAP) block and quadratus lumborum (QL) block as preventive analgesia methods after laparoscopic cholecystectomy. Methods. A total of 120 patients, 18–75 years of age, were separated into 2 groups preoperatively. Patients in group TAP (n = 60) received 0.3 ml/kg bupivacaine with USG bilateral subcostal TAP block; patients in group QL (n = 60) received 0.3 ml/kg bupivacaine with USG bilateral QL block. Patients were assessed 24 h postoperatively, and pain scores, time to first analgesia requirement, total analgesia dose, and postoperative complications during the first 24 h were recorded. Results. Fifty-three patients in group TAP and 54 in group QL were ultimately evaluated. No statistically significant difference was found in at rest and dynamic visual analog scale scores between the groups. There was also no statistically significant difference between the groups with regard to total analgesia consumption. Although the duration of anesthesia was significantly longer in group QL, no statistically significant difference was found in the duration of surgery between the groups (p<0.05). Conclusions. Results of this study demonstrated that USG subcostal TAP and QL blocks similarly reduced postoperative pain scores and analgesia consumption, with high patient satisfaction. However, subcostal TAP block could be considered preferable to QL block because it can be applied easily and in a shorter time.

Amaç: Lokal anestezikler uygun yoğunlukta verildiklerinde, uygulama yerinden başlayarak sinir iletimini geçici olarak bloke ederler. Toksisitede kardiyovasküler sistem depresyonu, solunum arresti, koma, konvülsiyonlar, bilinç kaybı, kas seğirmesi, görme bozukluğu, baş dönmesi, sersemlik ve dilde uyuşma görülebilir. Toksisite tedavisinde ise hava yolu kontrolü sağlanması, konvülsiyon gibi oluşabilecek semptomların tedavisi ve %20 lipid solüsyonu kullanılmaktadır. Bu çalışmanın amacı yaygın olarak kullanılan lokal anestezikler ve toksisitesi hakkında araştırma görevlilerinin bilgilerini incelemek ve lokal anestezikler hakkında farkındalığı arttırmaktır.Yöntemler: Hastanemizde farklı branşlarda çalışmakta olan 115 araştırma görevlisine 20 sorudan oluşan anket formu verildi. Bulgular:Yüz iki (%88,6) katılımcı anketi tamamladı. Katılım-cıların yaş ortalaması 28,73 idi. En çok %15,8 oranında Acil Tıp Kliniği ankete katıldı. Katılımcıların %40,6'sı 2-5 yıldır araştırma görevlisi idi. Katılımcıların %44,4'ü lokal anestezikleri hergün kullanmakta iken %70,3'ü bu konu ile ilgili hiçbir eğitim almamıştı. Anesteziyoloji ve Reanimasyon Kliniği araştırma görevlileri diğer kliniklerden anlamlı olarak yüksek oranda (%76,9) lokal anestezikler ile ilgili eğitim almıştı. Lokal anestezik toksisitesinde erken dönem bulgular ile ilgili soruya anafilaksi (%12,7), aritmi (%12,7) ve geç klinik bulgular ile ilgili soruya hepatotoksisite (%10,8) cevabı en çok verildi. Katılımcıların %87,9'u daha önce lokal anestezik toksisitesi hiç görmemişti. Lokal anestezik toksisitesinde %20 lipid kullanımını katılımcıların %67,4'ü duymamış-tı. %20 lipid kullanımını duyan katılımcılar (%52,2) ise uzmanlarından duymuşlardı. Hastanemizde %20 lipid solüsyonu olmasına rağmen %8,4 katılımcı bunu biliyordu. Sonuç:Özellikle lokal anestezik toksisitesi hakkında ek eğitim programı ile bu eksikliklerin giderilmesi gerektiğini düşünüyoruz. Anahtar kelimeler: Lokal anestezik, toksisite, anketObjective: Cardiovascular system depression, respiratory arrest, coma, convulsions, loss of consciousness, muscle twitching, blurred vision, vertigo, dizziness and numbness of the tongue can be seen in local anaesthetic toxicity. Treatment includes 20% lipid solutions, airway control, symptomatic treatment for arrhythmia and convulsions. The aim of this study is to present the knowledge of research assistants, who used local anaesthetics in daily practice, regarding these medications and toxicity treatment and to raise awareness. Methods:The questionnaire comprising 20 questions was administered to 115 research assistants who worked at different specialities in our hospital. Results:One hundred and two (88.6%) research assistants answered the questionnaire. Participants' mean age was 28.93 years. Most of them were from the Emergency Department (15.7%). A total of 40.6% of participants worked for 2-5 years at their departments. Local anaesthetics were used in daily practice for 44.4% of them, but 70.3% of them had not been educated about local anaesthetics. Research assistants ...

Background Various truncal block techniques with ultrasonography (USG) are becoming widespread to reduce postoperative pain and opioid requirements in video-assisted thoracoscopic surgery (VATS). The primary aim of our study was to determine whether the USG-guided serratus anterior plane block (SAPB) is as effective as the thoracic paravertebral block (TPVB) in VATS. Our secondary aim was to evaluate patient and surgeon satisfaction, block application time, first analgesic time, and length of hospital stay. Methods Patients in Group SAPB received 0.4 mL/kg bupivacaine with a USG-guided SAPB, and patients in Group TPVB received 0.4 mL/kg bupivacaine with a USG-guided TPVB. We recorded the pain scores, the timing of the first analgesic requirement, the amount of tramadol consumption, and postoperative complications for 24 hours. We also recorded the block application time and length of hospital stay. Results A total of 62 patients, with 31 in each group (Group SAPB and Group TPVB) completed the study. Between the two groups, there were no significant differences in rest and dynamic pain visual analog scale scores at 0, 1, 6, 12, and 24 hours after surgery. The total consumption of tramadol was significantly lower in the TPVB group ( P = 0.026). The block application time was significantly shorter in Group SAPB ( P < 0.001). Conclusions An SAPB that is applied safely and rapidly as a part of multimodal analgesia in patients who undergo VATS is not inferior to the TPVB and can be an alternative to it.

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ÖZ Amaç: Yoğun bakım ünitemizde son iki yıl içinde açtığımız perkütan dilatasyonel trakeostomileri retrospektif olarak değerlendirmeyi amaçladık. Gereç ve Yöntem: Hastanemiz anesteziyoloji ve reanimasyon kliniği yoğun bakım ünitesinde Mayıs 2015-Mayıs 2017 yılları arasında perkütan trakeostomi (PT) açılan hastalar retrospektif olarak değerlendirildi. On sekiz yaş üstü hastalar çalışmaya dahil edildi. Cerrahi olarak açılan trakeostomiler çalışmaya dahil edilmedi. Bulgular: Yüz otuz iki hasta incelendi. Yaş ortalaması 66,61±17,84 olan hastaların %56,1'i erkekti. Yatış tanılarına bakıldığında en sık neden nörolojik nedenler idi. Hastaların entübe kaldıkları süre 16,51±8,32 gün ve yoğun bakımda toplam yatış süresi 61,43±49,37 gün olarak bulundu. PT işlemine bağlı komplikasyon gelişen hasta sayısı 17 (%12,9) idi. İşlem sırasında en çok görülen komplikasyon hipoksemi ve akut kanama, sonrasında görülen en sık komplikasyon deri altı amfizem ve minör kanama olarak saptandı. Sonuç: Perkütan dilatasyonel trakeostomi işlem sırasında ciddi komplikasyonlara yol açabilen bir yöntemdir.

Aim: To determine effect of ultrasound-guided serratus anterior plane block (SAPB) on intraoperative opioid consumption in patients undergoing oncoplastic breast surgery under general anesthesia. Methods: This study was conducted as a prospective, randomized controlled trial. Forty-four patients enrolled, aged 18 to 75 years with American Society of Anesthesiologists physical status I to III, undergoing elective oncoplastic breast surgery. Patients were randomly allocated to receive SAPB with 20 mL of 0.25% bupivacaine + general anesthesia (group SAPB) or only general anesthesia (group control). The primary outcome was assessing the effect of SAPB on intraoperative remifentanil consumption. Patients were assessed for emergence time, hemodynamic parameters, doses of rescue drugs used to control hemodynamic parameters, and duration of stay in the recovery room. Results: Preoperative SAPB with 0.25% bupivacaine reduced intraoperative opioid consumption (851.2 ± 423.5 vs 1409.7 ± 756.1 µg, P = .019). Emergence time was significantly shorter in group SAPB (6.19 ± 1.90 minutes) compared to group control (9.50 ± 2.39 minutes; P < .001). There were no significant differences in the doses of rescue drugs used for systolic blood pressure and heart rate between the groups. Conclusions: Preoperative SAPB with bupivacaine reduced intraoperative opioid consumption and shortened emergence time and duration of stay in the recovery unit, and hemodynamic stability was maintained without block-related complications.

Background: The aim of this prospective, randomized, controlled study was to evaluate the analgesic effect of US-guided Pectoral (PECS) I blocks on postoperative analgesia after TIVAP insertion. Methods: A hundred-twenty patients were included in this study. The patients were divided into two groups: Group PECS and Group INF (infiltration). A total 0.4 mL kg−1 0.25% bupivacaine was injected to below the middle of the clavicle in the interfascial space between the pectoralis major and minor muscles for PECS-1. The skin and deep tissue infiltration of the anterior chest wall was performed with 0.4 mL kg−1 0.25% bupivacaine for INF group. Tramadol and paracetamol consumption, visual analog scale pain scores were recorded at 0, 1, 4, 12, and 24 h postoperatively. Results: The use of the PECS in TIVAP significantly decreased the amount of paracetamol used in the first 24 h postoperatively ( p < 0.001). There was a statistically significant difference in the number of tramadol rescue analgesia administered between the groups ( p < 0.001) There was no significant difference between the groups in terms of the VAS scores at 0 and 24 h. However, VAS scores at 1, 4, and 12 h were found to be significantly lower in patients who underwent PECS than in those who received infiltration anesthesia ( p < 0.001). Conclusions: This study shows that US-guided PECS-1 provides adequate analgesia following TIVAP insertion as part of multimodal analgesia. The PECS-1 significantly reduced opioid consumption.