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.

Merve Sena Baytar, Canan Yılmaz, Derya Karasu, and Çağdaş Baytar. Korean J Pain 2021;34:234-40. https://doi.org/10.3344/kjp.2021.34.2.234

Introduction: The aim of this study was to compare the postoperative analgesic effects of ultrasound-guided quadratus lumborum block-2 (QLB-2) and quadratus lumborum block-3 (QLB-3) after cesarean section (C/S) under general anesthesia. Method: This was a prospective, randomized, double-blind study. A total of 143 term pregnant women with American Society of Anesthesiologists II status, who were scheduled for elective C/S under general anesthesia were randomly separated into QLB-2 and QLB-3 groups. After surgery under standardized general anesthesia, QLBs were performed with 0.3 mL.Kg^-1 0.25% bupivacaine in both groups. Patient-controlled analgesia (PCA) devices were used for additional analgesia. The primary outcomes were pain scores evaluated at 0, 2, 6, 12, and 24 hours. In addition, PCA demands, actual delivered tramadol doses, rescue analgesic requirements, anesthesia time, and patient satisfaction were recorded. Results: A total of 104 patients were analyzed statistically. Pain scores were statistically lower in the QLB-3 group at 2, 6, 12, and 24 hours postoperatively (P = .001). Anesthesia time was longer in the QLB-3 group. Patients who received QLB-3 block demonstrated significantly fewer PCA demands and lower consumption of tramadol (P = .003). Moreover, the first analgesic requirement time was longer along with higher patient satisfaction. In addition, all procedures were performed without any complications and side effects due to PCA were negligible. Conclusions: This study demonstrated that, although both QLBs were safe and reliable, QLB-3 provides more effective analgesia and patient satisfaction than QLB-2 in C/S.

The serratus posterior superior intercostal plane block (SPSIPB) is a newly described truncal block. This study aimed to compare the effects of SPSIPB with conventional methods on postoperative opioid consumption and pain scores within 24 h postoperatively. This randomized controlled trial included 60 patients aged 18–65 years with an American Society of Anesthesiologists Physical Status of I–III. Patients were randomly assigned to either the SPSIPB or the control group. The primary outcome was cumulative opioid consumption within the first 24 h postoperatively. Secondary outcomes included resting and dynamic Numerical Rating Scale (NRS) pain scores, Quality of Recovery (QoR)-15 questionnaire scores, intraoperative remifentanil consumption, and the incidence of postoperative nausea and vomiting. Total tramadol consumption was significantly lower in the SPSIPB group during the first 12 h and at the end of the 24th hour postoperatively compared with the control group (p < 0.05). The dynamic NRS score at 0 h postoperatively was lower in the SPSIPB group (p = 0.001), whereas no significant differences in NRS scores were observed at other time-points. The postoperative QoR-15 scores were significantly higher in the SPSIPB group compared with the control group. Furthermore, the SPSIPB group had significantly lower intraoperative remifentanil consumption (p = 0.003). Nausea and vomiting were more frequent at 12 and 24 h postoperatively in the control group compared with the SPSIPB group. Serratus posterior superior intercostal plane block significantly reduced opioid use, and improved recovery quality after oncoplastic breast surgery. NCT06225908, registered at ClinicalTrials.gov.

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. The questionnaire comprising 20 questions was administered to 115 research assistants who worked at different specialities in our hospital. 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 from anaesthesiology and reanimation participated at a significantly higher rate than other departments (76.9%), in terms of training programs regarding local anaesthetics. While the most popular answers about early toxicity symptoms were anaphylaxis (12.7%) and arrthymia (12.7%), late toxicity was hepatotoxicity (10.8%). However, 87.9% of participants had never encountered local anaesthetic toxicity. The great majority of participants had never heard of lipid therapy (67.4%), and those who were aware had heard it from their trainers (52.2%). Although lipid solution was available in our hospital, only 8.4% of participants knew this. We believe that additional training programs regarding local anaesthetics and toxicity are needed.

Background and Objectives: This study aimed to determine whether there is a relationship between preoperative fasting time, fasting blood glucose (FBG), and postoperative emergence delirium (ED) in pediatric patients undergoing MRI under sedation. Materials and Methods: 110 pediatric patients were included in the study. Preoperative fasting (solid-fluid) time and FBG were recorded. The development of ED in the patients who underwent MRI under sedation was evaluated with the pediatric anesthesia emergence delirium (PAED) value for 30 min every 5 min in the recovery room. PAED score of ≥10 was grouped as having ED, and a PAED score of 0.05). There was a weak positive correlation between the fasting time and the 0th, 5th, and 10th minute PAED score (r = 0.225; p = 0.018, r = 0.195; p = 0.041, r = 0.195; p = 0.041). There was a weak positive correlation between the solid food fasting time and the PAED score at the 0th, 5th, 10th, 15th, and 20th minutes (r = 0.382; p < 0.001, r = 0.357; p < 0.001, r = 0.345; p < 0.001, r = 0.360; p < 0.001, r = 0.240; p < 0.001). There was a weak positive correlation between thirst time and the PAED score at the 0th, 5th, and 10th minutes (r = 0.222; p = 0.020. r = 0.192; p = 0.045, r = 0.199; p = 0.037). The incidence of ED at any time was 34.5%. Conclusions: Prolonged fasting time, solid food fasting time and thirst time are risk factors for developing postoperative ED in children undergoing MRI under sedation.