This study aims to evaluate the efficacy of ultrasound (US)-guided peripheral nerve blocks in postoperative analgesia after pediatric orthopedic tumor surgery. This retrospective study included 108 children (64 boys, 44 girls, mean age 10.23 years; range, 2 to 18 years) who were performed orthopedic tumor surgery under general anesthesia. The children were divided into two groups as those who were performed nerve block for postoperative pain control (group 1, n=54) and those who were performed intravenous analgesic (group 2, n=54). In group 1, nerve blocks were performed with bupivacaine 0.25%. In group 2, intraoperative acetaminophen 15 mg/kg was performed intravenously. Postoperative visual analog scale (VAS) scores, time to pain onset, nausea, vomiting, total analgesic consumption in 24 hours, and complications were recorded at first, second, sixth and 24th hours. Visual analog scale scores were higher in group 2 than group 1 at first, second, and sixth hours, but were not different at 24th hour. Mean time to pain onset was 10.2 hours in group 1 and 1.8 hours in group 2 (p<0.05). Mean time to pain onset and VAS values at first, second, sixth and 24th hours did not differ between nerve block types. Nausea and vomiting rates were not different between groups 1 and 2 (18.51% and 16.66%, respectively; p=0.4). Total analgesic consumption in 24 hours was higher in group 2 compared to group 1 (1.7 and 0.07 mg/kg, respectively; p<0.05). Pain-free periods extending up to 10 hours provided by US-guided peripheral nerve blocks may help recovery while reducing postoperative analgesic use and their side effects.

Objectives To identify postoperative residual symptoms of carpal tunnel syndrome (CTS) and to investigate the effectiveness of gabapentin in the treatment of residual symptoms. Materials and methods Of a total of 412 patients who underwent surgery for CTS in four centers over a four-year period, 14 who had residual symptoms after CTS release and did not receive gabapentin (Group A) and 14 patients with postoperative residual symptoms and received gabapentin were included in this retrospective study. Postoperative residual symptoms were defined as persistent nocturnal numbness and tingling with or without occasional daytime pain. Tinel's and Phalen's tests were performed for the diagnosis of residual symptoms. Functional Severity Score (FSS), Symptom Severity Score (SSS), and Visual Analog Scale (VAS) were used to evaluate functional outcomes, severity of symptoms, and numbness and sleep quality, respectively at six and 12 weeks postoperatively. Results There was no statistically significant difference in the mean postoperative FSS (p=0.845) and VAS-numbness scores (p=0.367) between the groups. However, there was a statistically significant difference in the mean postoperative SSS (p=0.025) and VAS-sleep quality scores (p<0.001) between the groups. Conclusion Gabapentin treatment can be a treatment of choice for residual symptoms after CTS surgery and clinical improvement can be achieved owing to its relieving effect, particularly in nocturnal symptoms of patients having neuropathic pain.

Joint Diseases and Related Surgery (JDRS), the official journal of the Turkish Joint Diseases Foundation, is an international, peer-reviewed, immediate open access journal. All published articles in JDRS has been free for everyone, without embargo, since 1990.

In this study, we aimed to compare axillary brachial plexus block using the two-injection and four-injection techniques assisted with ultrasonography (USG) and nerve stimulator in patients operated for carpal tunnel syndrome with articaine. To evaluate which technique is more effective, we compared the onset time, effectiveness, and duration of block procedures, patient satisfaction, adverse effect of the drug, and complication rates of the motor and sensory blocks. Sixty patients were randomly divided into two groups. A mixture of physiologic serum added to articain with NaHCO3 (30 mL) was injected into the patients' axilla in both the groups. After the blockage of the musculocutaneous nerve in both the groups, the median nerve in the two-injection group and the median nerve, ulnar nerve, and radial nerve in the four-injection group were blocked. In brachial plexus nerves, sensorial blockage was evaluated with pinprick test, and motor block was evaluated by contraction of the muscles innervated by each nerve. The adverse effects and complications, visual analog scale (VAS) values during the operation, and post-operative patient satisfaction were recorded. Sufficient analgesia and anaesthesia were achieved with no need for an additional local anaesthetics in both the groups. Furthermore, additional sedation requirements were found to be similar in both the groups. A faster rate and a more effective complete block were achieved in more patients from the four-injection group. In the two-injection group, the block could not be achieved for N. radialis in one patient. All other nerves were successfully blocked. Whereas the blockage procedure lasted longer in the four-injection group, the VAS values recorded during the blockage procedure were higher in the four-injection group. No statistical difference was found with regard to patient satisfaction, and no adverse effects and complications were observed in any group. Although the multi-injection method takes more time, it provides faster anaesthesia and more complete blockage than the two-injection method used with articain. The two-injection method can also be used in specific surgery such as for carpal tunnel syndrome, as an alternative to multi-injection method.

Patient positioning (Trendelenburg vs. supine) may alter hemodynamics. This study aimed to compare the effects of position changes on cardiac parameters and vital signs in patients undergoing major abdominal cancer surgery, performed either laparoscopically or via open techniques, using esophageal Doppler monitoring (ODM) for intraoperative fluid management. After obtaining ethics committee approval, 80 patients who underwent major abdominal cancer surgery between November 2021 and November 2022 using ODM were retrospectively identified from the records of the Anesthesiology Clinic. These patients were analyzed based on whether they underwent open or laparoscopic procedures. Demographic information, vital signs, amount of blood loss, type and volume of administered fluids, as well as cardiac parameter measurements obtained with the ODM device in both the supine and Trendelenburg positions (> 45°), were examined. The ODM device recorded the following parameters: cardiac output (CO), flow time corrected (FTc), peak velocity (PV), and stroke distance (SD). The study aimed to determine whether there were significant variations in these parameters between the open and laparoscopic surgical approaches. The demographic characteristics of the patients were similar in both the supine and Trendelenburg positions. The mean duration of surgery was 163 ± 30 min in the open surgery group and 153 ± 29 min in the laparoscopic surgery group (p = 0.137). The average amount of blood loss was 495 ± 280 ml in the open surgery group and 310 ± 240 ml in the laparoscopic group (p = 0.034). There was no significant difference in net fluid balance between the two groups (open surgery: 388 ± 60 ml; laparoscopic surgery: 473 ± 21 ml; p = 0.107). Continuous fluid monitoring revealed no changes in cardiac parameters during position changes in either group. However, an increase in mean arterial pressure was observed in the Trendelenburg position, regardless of the type of surgery (p = 0.003, p = 0.014, p < 0.05). The findings of this study are consistent with the existing literature, indicating that patient positioning did not alter cardiac parameters. We conclude that preservation of intravascular volume may reduce changes in cardiac parameters that could be caused by the Trendelenburg position or pneumoperitoneum. Continuous non-invasive hemodynamic monitoring may help ensure that positional changes do not adversely affect cardiac parameters. NCT06293391 and registration on 06 November 2024.

Aim: During transurethral resection of bladder tumor (TUR-BT), adductor muscle spasms in varying degrees can be seen due to stimulation of obturator nerve if the tumor is in the inferolateral localization. This can cause some serious complications such as bladder perforation. We aim to show the effectiveness of obturator nerve block (ONB) to avoid the adductor muscle spasm in general anesthesia applied with laryngeal mask (LMA) without using muscle relaxant according to the spinal anesthesia method. Methods: The study has been designed prospectively and observationally. A total of 64 patients who underwent TUR-BT were divided into two groups. Group I consisted of 30 patients in whom TUR-BT was performed under general anesthesia without muscle relaxant + ONB. Group II consisted of 31 patients in whom TUR-BT was performed under spinal anesthesia + ONB. Intraoperative adductor spasm, the severity of adductor response, and surgeon satisfaction were recorded. Results: Median values of adductor muscle strengths were found to be higher in Group I (p < 0.05). There was no statistically significant relationship between the anesthetic method and adductor spasm (p = 0.110). Of patients in Group I, 13.4% showed moderate or severe adductor response, whereas the ratio was 0% in Group II (p = 0.015). Surgeon satisfaction was similar in both groups (p = 0.363). Conclusions: Obturator spasm was not different in both anesthesia techniques. General anesthesia without muscle relaxant combined with ONB was found effective to prevent adductor muscle spasms as the spinal anesthesia in TUR-BT operations. It has been concluded that surgical complications can be reduced via general anesthesia without the muscle relaxant method, although surgeons' satisfaction did not alter. General anesthesia and obturator block applications with the help of LMA without muscle relaxants can be preferred in short-term TUR-B operations where spinal anesthesia is not desired.