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.

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Objective: Erector spinae plane block (ESP) is a novel technique for postoperative pain management. Primary aim of this study is to evaluate efficacy of ultrasound -guided ESP for providing postoperative analgesia in laparoscopic cholecystectomy (LC) procedures. Methods: Forty-six ASA I-II patients aged 20-70, who were scheduled to undergo elective LC were included in the study. Patients were randomized into two groups as ESP and Control group. Patients in the ESP group received ultrasound (US)-guided ESP block with 20 ml 0.25% bupivacaine. An intravenous patient-controlled analgesia device containing morphine was provided for all the patients in both groups. Morphine consumptions at postoperative 24 th hour and postoperative numeric rating scale (NRS) scores for pain were recorded. Results: Mean morphine consumptions at postoperative 24 th hour were 7.5 mg±5.8 in the ESP group while it was 13.2±5.6 mg in the control group (p<0.01). There was also a significant difference between the groups as for NRS scores at 12 th and 24 th hours (p=0.016, p=0.003 respectively). None of the patients in the ESP group complained about shoulder pain; but in the control group 9 patients reported shoulder pain. Conclusion:This study has shown that ESP block at T8 level has reduced the opioid consumption and showed a significant analgesic effect in patients undergoing LC.

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Background/aim: Increased body mass index (BMI) and neck circumference are the two independent predictors of difficult intubation. McGrath MAC X-Blade is a videolaryngoscope specifically designed for difficult intubations. Materials and methods: Eighty patients with the American Society of Anesthesiologists (ASA) physical status I-III undergoing elective surgery requiring endotracheal intubation were enrolled in the study. Patients were divided into two groups, nonobese (BMI < 30) and morbidly obese (BMI > 35). All patients were intubated with the McGrath MAC X-Blade in both groups. View optimization and tube insertion maneuvers such as reinsertion of the device, slight removal of the device, cricoid pressure, handling force, 90° anticlockwise rotation of the tube, use of stylet, and head flexion maneuvers were recorded. Cormack-Lehane grades, insertion times, intubation, and total intubation times were recorded. The hemodynamic changes and postoperative minor complications were also recorded. Results: Body mass index, neck circumference, Mallampati scores, and ASA physical status were statistically higher in the morbidly obese group (P < 0.001 and P < 0.05). Sternomental distances were shorter in the morbidly obese (P < 0.05). Cormack-Lehane grades were comparable among the groups. The morbidly obese patients required more reinsertion attempts and cricoid pressure maneuvers during intubation than the nonobese patients (P = 0.019 versus P = 0.012, respectively). Slight removal of the device, handling force, use of the stylet, 90° anticlockwise rotation of the tube, and head flexion maneuvers were also helpful in both groups. Although device insertion times were similar between the groups, intubation and total intubation times were longer in the morbidly obese group (P = 0.009 and P = 0.034, respectively). The groups were comparable in hemodynamic changes and postoperative minor complications. Conclusion: The McGrath MAC X-Blade videolaryngoscope could safely be used both in nonobese (BMI < 30) and morbidly obese (BMI > 35) patients with the aid of some key maneuvers and with a statistically significant but clinically negligible prolongation of the intubation time.

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The quadratus lumborum block (QLB) is a unilateral facial plane block, which extends from T4 to L1 at the paravertebral space. Injecting local anesthetic between the facial plane of the quadratus lumborum muscle and the psoas major muscle provides the block of the referred dermatomes. However, the number of published studies for QLB used in various surgical procedures is limited. In this case report, we share the results of a 46-years-old ASA I female patient, who underwent open surgery for cholecystectomy and right-sided nephrectomy in the same session. After general anesthesia was induced, QLB was performed in the left lateral decubitus position. A convex probe was placed in transversely between the iliac crest and the costal margin at the midclavicular line. 20cc of 0.25% bupivacaine was injected to the facial plane between the quadratus lumborum and psoas major muscles. The surgery lasted 4 hours and completed uneventfully. In the postoperative period, the patient was provided with morphine PCA. After 24 hours, the VAS score was 0, and the total demanded morphine dose was 13 mg. This case report recommends that QLB may be an adequate choice in the postoperative pain management for patients undergoing cholecystectomy and nephrectomy.