The results show that US guidance is more effective in maintenance of successful ICB than neurostimulation guidance alone and a reduction of LA doses even to 70% of conventionally used doses seems possible with US guidance. This article is published in English.

This study aimed to determine the appropriate anesthetic technique for patients who underwent amputation due to peripheral vascular disease. The anesthetic technique to be applied during lower extremity amputations in geriatric patients with limited functional capacity may be important in terms of clinical outcomes and mortality rates. Patients aged older than 65 years who had undergone major lower extremity amputation were retrospectively evaluated. The patients were divided into 2 groups: regional anesthesia (RA) and general anesthesia (GA). Demographic characteristics, comorbidities, medications used, anesthesia technique, the durations of anesthesia and surgery, need for blood transfusion, 30-day mortality, postoperative cardiac and pulmonary complication rates were recorded from the medical records of the patients. Among the 441 patients, 244 had received RA, while 197 had received GA. The average length of stay in the hospital was longer in the GA group (P ¼ 0.001). The use of antiplatelet drugs (P ¼ 0.001) and the number of transfusions were higher (P ¼ 0.045) in the GA group. No

Objectives. The aim of the study was to compare adductor canal block and femoral nerve block in the postoperative analgesia of patients undergoing elective arthroscopic knee surgery with respect to opioid use and Visual Analogue Scale (VAS), which is a unidimensional measurement of pain intensity. Methods. The study was designed and conducted prospectively between April 2016 and November 2016 in a tertiary care hospital but the results were evaluated retrospectively. Prior to the induction of general anesthesia for knee surgery, (the first) 20 consecutive patients underwent femoral nerve block, and (the second) 20 consecutive patients received adductor canal block. Patients receiving adductor canal block for analgesia were referred to as Group A and patients receiving femoral nerve block for analgesia were defined as Group F. Pain was evaluated using the VAS score.The results were compared statistically. Results. Both the femoral nerve block and adductor canal block groups showed similar results in terms of VAS and opioid use (p < 0.05). Conclusion. In the postoperative analgesia of patients undergoing elective arthroscopic knee surgery, no difference was found between adductor canal block and femoral nerve block in terms of opioid use and VAS scores.Eur Res J 2018

Background: Thoracic paravertebral block (TPVB) is an analgesic method recommended in the enhanced recovery after surgery (ERAS) protocol and proven successful in thoracoscopic surgery. The study aimed to investigate whether the erector spinae plane block (ESPB) administered single-injection in uniportal videoassisted thoracoscopic surgery (VATS) can be an alternative to TPVB as an analgesic method.Methods: In this study, American Society of Anesthesiologists (ASA) physical status class I-II-III patients aged between 18-70 years who underwent thoracoscopic wedge resection surgery were analyzed retrospectively; 136 patients in the ESPB group and 114 patients in the TPVB group were included in the study. Postoperative cumulative morphine consumption numerical rating scale (NRS) scores were compared at 1, 6, 12, and 24 hours after surgery at rest and during coughing between the groups. Also, rescue analgesia requirements, postoperative nausea, vomiting and other complications were evaluated. Results:The mean cumulative morphine consumption in the postoperative 24 hours was 20.06 mg in the ESPB group and 11.35 mg in the TPVB group. A statistically significant difference was observed between groups in terms of total morphine consumption in the postoperative 24 hours (P<0.001). NRS score was significantly lower in the TPVB group at postoperative 6th and 24th hours during coughing (P=0.003 and P=0.034, respectively) and at 24th hour at rest (P=0.008) than ESPB group. Median NRS scores at rest were low (<4) in both groups. There was no significant difference between the groups in terms of postoperative pulmonary complications as atelectasis and length of hospital stay (LOS) (P=0.643 and P=0.867 respectively).Conclusions: Ultrasound (US)-guided single-injection TPVB provided superior analgesia in patients undergoing single-port VATS than ESPB. In addition to this, TPVB showed more opioid sparing by reducing morphine consumption.

Background and Aims: During the coronavirus disease 2019 (COVID-19) pandemic, health care workers are at a high risk of infection from aerosols. In this study, we compared the ease of using the aerosol box (AB) with the traditional method during internal jugular vein cannulation attempts (IJVCA). Methods: The study included 40 patients with COVID-19 who required central venous catheterisation during treatment in the ward. The patients were randomly allocated to one of the two protective equipment (PPE) groups and then randomly assigned to one of the five anaesthesiologists with at least 5 years of experience. Group P and A had both PPE and AB used, whereas Group P included patients where PPE was used alone. The physicians completed a survey after performing the procedure to evaluate the use of the AB. Results: The preparation for the procedure and procedure durations were observed to be statistically longer in Group P and A ( P = 0.002 and P = 0.001, respectively). The first attempt in Group P and A was unsuccessful in six patients, whereas the first attempt in Group P was unsuccessful in only two patients ( P = 0.235). Anaesthesiologists described difficulty with manipulation during the procedure, discomfort using the box, and resulting cognitive load increase in Group P and A. Conclusion: The IJVCA procedures were faster and easier and had greater satisfaction for physicians when the AB was not used. Also, the high complication rate, including carotid artery punctures and disruption of sterility and PPE, albeit not statistically significant, has clinical implications. Therefore, we do not recommend the use of ABs for IJVCA.

No abstract

Background and objectives: Preoperative anxiety is an enormous feeling of fear that is seen in all patients undergoing surgery. The severity of anxiety may vary depending on the type of surgery and anesthesia to be performed. The aim of this study is to compare the effects of brachial plexus blocks and general anesthesia methods on preoperative anxiety levels in patients who will undergo orthopedic upper-extremity surgery and to determine the factors affecting anxiety. Materials and Methods: After randomization, the Amsterdam Preoperative Anxiety and Knowledge Scale (APAIS) questionnaire was applied to the patients to determine the preoperative anxiety level, and then anesthesia was applied according to the anesthesia type determined. Pain scores (1, 8, 16, and 24 h) and total opioid consumption of the patients were recorded postoperatively. Results: The APAIS score of the patients in the general anesthesia (GA) group was significantly higher (p = 0.021). VAS score medians at 1, 4, and 8 h postoperatively were found to be significantly higher in the GA group (p < 0.001, p < 0.001 and p = 0.044, respectively). Conclusions: USG-guided BPB may cause less anxiety than GA in patients who will undergo elective upper-extremity surgery. However, these patients have moderate anxiety, although it is more associated with advanced age, female gender, and education level.

Amaç: Bu çalışmada üst extremite cerrahisinde brakiyal pleksus sinir bloklarının postoperatif ağrı skorlarına etkisinin belirlenmesi amaçlanmıştır. Yöntemler: Retrospektif gözlemsel yapıdaki bu araştırma, Ocak 2015-Eylül 2018 tarihleri arasında, bir eğitim ve araştırma hastanesinde kaydı tutulan ağrı ve hasta takip formlarıyla gerçekleştirildi. Çalışmada için, elektif şartlarda, tek taraflı üst ekstremite cerrahisi geçiren ve postoperatif analjezi amacı ile brakial pleksus sinir bloğu uygulanan 18-80 yaş aralığında, Amerikan Anestezi Uzmanları Derneği (ASA) I, II ve III risk grubunda, rejyonel anestezi ve ağrı takip formları tam olan hastalar geriye dönük tarandı. Kriterlere uyan 180 hasta çalışmaya dahil edildi. Veri toplama aracı olarak hasta ve ağrı takip formu, Pinprick testi ve Modifiye Edilmiş Broomage skalası kullanıldı. Verilerin analizinde, Kolmogorov-Smirnov testi, çarpıklık ve basıklık, frekans (n), yüzde (%), ortalama ve standart sapma, minimum-maksimun değerleri, Wilcoxon testi, eşleştirilmiş t-testi, Indipendent t-testi, Kruskall-Wallis H testi ve Pearson korelasyon analizi kullanıldı. Bulgular: Blok türü ile ağrı duyusu ve motor bloğun geri dönüş zamanı ve Pinprick testi sonucunun negatifleşme zamanı arasında anlamlı farklılık bulunmadı. İnfraklaviküler blok uygulanan hastalarda, motor bloğun geri dönüş zamanının, interskalen ve supraklaviküler blok uygulanan hastalara göre anlamlı derecede daha geç olduğu saptandı (p=0,035). Ağrı duyusunun geri dönüş zamanı ile motor blok ve Pinprick testi sonucunun negatifleşme zamanı arasında pozitif yönde zayıf düzeyde anlamlı ilişki bulundu. Ağrı duyusunun geri dönüş zamanı ile kullanılan bupivakain miktarı arasında pozitif yönde çok zayıf düzeyde anlamlı ilişki bulundu. Buna karşın motor bloğun geri dönüş zamanı ile Pinprick testi sonucunun negatifleşme zamanı arasında pozitif yönde yüksek düzeyde anlamlı ilişki bulundu. Sonuç: Uygulanan blok türünün postoperatif dönemde algılanan ağrı duyusunun geri dönüş zamanı üzerinde etkili olmadığı bulunmuştur. Araştırma uygulanan blok türlerinin sayısı, yaş, ASA grubu, anestezik ilaç türü ve miktarı gibi değişkenler dengelenerek, daha geniş bir örneklem grubuyla tekrarlanmalıdır. Anahtar Kelimeler: Brakiyal pleksus bloğu, interskalen blok, infraklavikular blok, suprakilavikular blok, ağrı Objective: The aim of this study was to examine the effect of brachial plexus nerve blocks in postoperative pain scores in upper extremity surgery.Methods: This retrospective research design was conducted with the pain and patient follow-up forms, which were registered in a training and research hospital between January 2015 and September 2018. Patients underwent unilateral upper extremity surgery under elective conditions with different clinical diagnoses were included in the study. A total of 180 patients in the 18-80 age group and in the American Society of Anesthesiologists (ASA) I, II and III risk group who had no missing information in the pain and patient follow-up form were included in the study. Data was collected using the p...