Aǧrı : Ağrı (Algoloji) Derneği'nin Yayın organıdır = The journal of the Turkish Society of Algology
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Randomized Controlled Trial
[Effects of a thoracic paravertebral block on postoperative analgesia in patients undergoing modified radical mastectomy].
Following mastectomy, 50% of patients have chronic postoperative pain. Studies have shown that a paravertebral block is an effective method of analgesia as well as anaesthesia. The aim of this study is to compare postoperative pain values and opioid consumption after a single dose of 150 mg levobupivacaine with a thoracic paravertebral block in patients undergoing mastectomy. ⋯ A paravertebral block with a single dose of 150 mg levobupivacaine before general anaesthesia in patients undergoing modified radical mastectomy and axillary lymph node dissection decreases postoperative pain values and the need for analgesics during the postoperative 24 hours.
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A major advantage of ultrasound (US) has been reduction in the amount of local anaesthetic (LA) needed for successful blocks. Reduced LA requirement reduces the risk of LA toxicity when multiple blocks are to be done for surgery of more than one extremity in the same patient. The 38-year-old female was scheduled for elective surgery of polydactilia in her right foot and syndactili in her right hand. ⋯ Surgery was performed uneventfully on both extremities. This is the first case report in the literature in which multiple blocks were applied to two different extremities, the leg and arm. In conclusion, our case report is a good example of multiple blocks in different extremities being performed successfully and safely according to US guidance and using low doses of local anaesthetics.
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Recent advances in surgical and anesthetic techniques have facilitated general anesthesia and surgical possibilities in the higher-risk patient group. Although general anesthesia is the only preferred approach for breast surgery, there have been many clinical trials about breast surgery that has been achieved with regional anesthesia techniques. It is known that regional anesthesia application decreases the preoperative stress, postoperative morbidity and mortality. ⋯ Regional anesthesia techniques like high thoracic epidural anesthesia, cervical epidural anesthesia and paravertebral block have been applied successfully in mastectomy operations. Combined thoracic epidural anesthesia-interscalene block technique may also be a good alternative to general or cervical, high thoracic epidural anesthesia. We aimed herein to present a case who underwent successful mastectomy and axillary dissection under combined thoracic epidural anesthesia-interscalene block.
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Introduction of ultrasound into regional anesthesia (RA) practice has resulted in important changes and developments in RA. These developments have had a major influence on the way of practice and choice of blocks. The purpose of this study was to present the most recent instruments used in RA and clinical applications in our country. ⋯ Nerve stimulation is the most performed method, whereas US is increasingly becoming popular. The most commonly performed blocks are central neuroaxial blocks. All in all, there is still room for improvement in RA training.
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Case Reports
[The epidural blood patch technique for the management of headache due to spontaneous intracranial hypotension].
Spontaneous intracranial hypotension is a clinical entity characterized by orthostatic headache, low CSF pressure and specific cranial imaging techniques. Headache can be accompanied by the symptoms such as tinnitus, vertigo, diplopia, nausea and vomiting. ⋯ Epidural blood patch should be planned for the treatment of patients with no reduction of the complaints following conservative treatment. In this case report, we have discussed the diagnostic methods of spontaneous intracranial hypotension and the importance of an epidural blood patch for its treatment in the light of the literature.