BACKGROUND:The safety of living liver donors is the paramount priority of liver transplantation surgeons. The liver has an effective regeneration capacity. The regeneration rate of the liver remnant in living liver donors provides much information us...

Block duration,diabetes mellitus,infraclavicular brachial plexus block,postoperative pain,time-to-first pain

Background: The aim of this study was to evaluate the effect of awake video-assisted thoracoscopic surgery on postoperative pulmonary complications among patients with different risk scores using the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT). Methods: Between January 2011 and August 2021, a total of 246 patients (158 males, 88 females; mean age: 59.1±13.6 years; range, 25 to 84 years) who underwent awake video-assisted thoracoscopic surgery were retrospectively analyzed. According to the ARISCAT scores, the patients with low and intermediate scores were included in Group L (n=173), while those with high scores (n=73) were included in Group H. Sedation protocol consisted of the combination of midazolam and fentanyl with propofol infusion, if necessary. Oxygen was delivered via face mask or nasal canula (2 to 5 L/min) maintaining an oxygen saturation of >95%, and analgesia was achieved with intercostal nerve block. Demographics, operative, and postoperative data of the patients, and pulmonary complications were evaluated. Results: Demographics, operative, and postoperative data were similar between the groups. Postoperative pulmonary complications were observed in 20 (27%) patients in Group H and 29 (17%) patients in Group L without statistically significant difference (p=0.056). Surgical approaches consisted of pleural procedures (n=194) and pulmonary resection (n=52). The incidence of pulmonary complications was significantly higher in the pulmonary resection compared to non-pulmonary procedures (p=0.027). Conclusion: Awake video-assisted thoracoscopic surgery seems to be beneficial in reducing the incidence of postoperative pulmonary complications in high-risk patients as assessed with the ARISCAT.

Background: This study compares the analgesic effects and dermatomal blockade distributions of single and double injection bilateral thoracic paravertebral block (TPVB) techniques in patients undergoing reduction mammaplasty.Methods: After obtaining ethics committee approval, 60 patients scheduled for bilateral reduction mammaplasty were included in the study. Preoperatively, the patients received one of single (Group S: T3–T4) or double (Group D: T2–T3 & T4–T5) injection bilateral TPVBs using bupivacaine 0.375% 20 ml per side. All patients were operated under general anesthesia. The T3–T6 dermatomal blockade distributions on the midclavicular line were followed by pin-prick test for 30 min preoperatively and 48 h postoperatively. All patients received paracetamol 1 g when numeric rating scale (NRS) pain score was ≥ 4, and also tramadol 1 mg/kg when NRS was ≥ 4 again after 1 h. The primary endpoint was NRS pain scores at postoperative 12th h. The secondary endpoints were dermatomal blockade distributions and NRS scores through the postoperative first 48 h, time until first pain and the analgesic consumption on days 1 and 2.Results: Fifty-two patients completed the study. The NRS pain scores at 12th h were similar (right side: P = 0.100, left side: P = 0.096). The remaining NRS scores and other parameters were also comparable within the groups (P ≥ 0.05). Only single injection TPVB application time was shorter (P < 0.001).Conclusions: The single injection TPVB technique provided sufficient dermatomal distribution and analgesic efficacy with the advantages of being faster and less invasive.