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BACKGROUND: Our aim was to observe the effects of local infiltration analgesia (LIA) or erector spinae plane block (ESPB) methods, which we applied preemptively in patients who were scheduled for surgery with a lumbotomy surgical incision and on intraoperative remifentanil consumption, and to compare the postoperative numerical rating scale (NRS), morphine demand, consumption, and pain degrees. METHODS: Sixty American Society of Anesthesiologists I to III patients aged 18 to 75 years who were due to be operated on with a lumbotomy surgical incision were included in the study. The present study was conducted via prospective, randomized controlled, double-blind trials. After the induction of standard anesthesia, LIA was applied to 30 patients and ESPB was applied to 30 patients preemptively. The dose of remifentanil consumed in the intraoperative period was measured, and the hemodynamic parameters were measured every 5 minutes. Morphine bolus treatment with the postoperative patient-controlled analgesia and rescue analgesia with paracetamol were planned for the patients. Postoperative morphine and additional analgesia consumption, NRS, hemodynamic parameters, and complications were recorded for 48 hours. RESULTS: There was no difference between the groups in terms of demographic and hemodynamic data. The mean consumption of remifentanil was measured as 455â ±â 165.23 µg in the intraoperative ESPB group and 296.67â ±â 110.59 µg in the LIA group, and a statistical difference was observed (Pâ =â .001). In the postoperative follow-ups, the ESPB group drug consumption and NRS score averages were significantly lower at all times (Pâ =â .01; patient-controlled analgesia-morphine, 41.93â ±â 14.47 mg vs 57.23â ±â 15.5 mg and additional analgesic-paracetamol: 2.1â ±â 1.06 vs 4.27â ±â 1.14 g). The mean duration of additional analgesic intake of the groups was 10.6â ±â 8.1 in the LIA group, while it was 19.33â ±â 8.87 in the ESPB group, a significant difference. The patient satisfaction questionnaire was also significantly in favor of ESPB (Pâ =â .05). CONCLUSIONS: In conclusion, it has been shown that the intraoperative LIA method is more effective in terms of remifentanil consumption and in controlling pain in operations performed with a flank incision, but the ESPB method provides longer and more effective pain control in postoperative follow-ups.
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Analgésicos Opioides , Morfina , Bloqueo Nervioso , Dimensión del Dolor , Dolor Postoperatorio , Remifentanilo , Humanos , Persona de Mediana Edad , Masculino , Dolor Postoperatorio/prevención & control , Dolor Postoperatorio/tratamiento farmacológico , Femenino , Método Doble Ciego , Adulto , Bloqueo Nervioso/métodos , Remifentanilo/administración & dosificación , Estudios Prospectivos , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/uso terapéutico , Morfina/administración & dosificación , Morfina/uso terapéutico , Anciano , Adulto Joven , Músculos Paraespinales/inervación , Adolescente , Vértebras Lumbares/cirugía , Piperidinas/administración & dosificación , Piperidinas/uso terapéutico , Analgesia Controlada por el Paciente/métodosRESUMEN
Although diclofenac (DCF) is a nonsteroidal anti-inflammatory drug that is considered safe, its chronic use and overdose may show some toxic effects. The protective effect of tyrosol (Tyr) pretreatment against DCF-induced renal damage was investigated in this study. The 32 rats used in the study were randomly divided into four groups of eight rats each. According to the data obtained, it was determined that creatinine, urea, and blood urea nitrogen (BUN) levels increased in serum samples of the DCF group. Besides, the levels of reduced glutathione (GSH) and glutathione peroxidase (GPx) activity decreased and the malondialdehyde (MDA) level increased in the kidney tissue. However, no change was observed in catalase (CAT) activity. Cyclooxygenase-2 (COX-2), nuclear factor kappa B (NF-κB), and tumor necrosis factor-alpha (Tnf-α) levels increased and nuclear factor erythroid 2-related factor 2 (Nrf-2) levels decreased. No change was detected in the level of interleukin 1 beta (IL-1ß). When the DCF+Tyr group and the DCF group were compared, it was assessed that Tyr had a curative effect on all biochemical parameters. Also, kidney damages, such as degeneration and necrosis of tubular epithelium and congestion of veins, were obviated by treatment with tyrosol in histopathological examinations. It was determined that Tyr pretreatment provided a protective effect against nephrotoxicity induced by DCF with its anti-inflammatory and antioxidant properties.
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Diclofenaco , Alcohol Feniletílico/análogos & derivados , Insuficiencia Renal , Ratas , Animales , Diclofenaco/toxicidad , Estrés Oxidativo , Riñón , Antioxidantes/farmacología , Antioxidantes/metabolismo , Glutatión/metabolismo , Antiinflamatorios/farmacologíaRESUMEN
OBJECTIVE: Postcircumcision pain in children can cause restlessness, crying and bleeding due to trauma. However, there are various methods to prevent postoperative pain, caudal and penile blocks are in the foreground. The primary objective of this study is to evaluate the effectiveness of CB and PB for the relief of postcircumcision pain. The secondary aim is to evaluate the postoperative additional analgesic requirement and side effects of these blocks. MATERIALS AND METHODS: A total of 148 children between the ages of 2 and 10 who underwent circumcision surgery were randomly assigned to two groups in terms of postoperative analgesia. 1) A group of caudal block (0,5 ml/kg %0.25 levobupivacaine) and 2) A group of penile block (0,3 ml/kg %0,25 levobupivacaine). Premedication and sedoanalgesia were standardized. The pain (FLACC Pain Score), analgesic consumption, motor block (Bromage Scale) and side effects (vomiting, hematoma, urinary retention) were assessed postoperatively for 4 hours. RESULTS: Postoperative FLACC scores were lower for caudale block group in the 1st, 3rd and 4th hours. There was no significant difference in postoperative analgesic consumption between the groups. The most common postoperative side effect was vomiting in both groups. CONCLUSION: Caudal block provided more effective analgesia than penile block in postcircumcision pain control.
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Objectives Sepsis bundle compliance is not clear. We evaluated rates of compliance with sepsis bundle protocols among health care providers in Turkey. Methods Our study was carried out retrospectively. Forty-five intensive care units (ICU) participated in this study between March 2, 2018 and October 1, 2018. Results One hundred thirty-eight ICUs were contacted and 45 ICUs agreed to participate. The time taken for the diagnosis of sepsis was less than six hours in 384 (59.8%) patients, while it was more than six hours in 258 (40.2%) patients. The median [interquartile range (IQR)] times for initial antibiotic administration, culturing, vasopressor initiation, and second lactate measurement were 120.0 (60-300) minutes, 24 (12-240) minutes, 40 (20-60) minutes, and 24 (18-24) hours, respectively. The rate of compliance with tissue and organ perfusion follow-up in the first six hours was 0%. The rates of three- and six-hour sepsis bundle protocol compliance were both 0%. The ICU mortality rates for sepsis and septic shock were 22% and 78%, respectively. The ICU mortality rates for sepsis and septic shock were 22% and 78%, respectively. Conclusions The rate of compliance with sepsis bundle protocols was evaluated in Turkey for the first time and determined to be 0%.
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INTRODUCTION: The aim of this study was to investigate the effect of perineural dexamethasone against intraneural bupivacaine. MATERIAL AND METHODS: Rats were divided into 9 groups with 6 animals in each group; Group 1 (Intraneural saline 600 µL-2ndday), Group 2 (Intraneural saline 600 µL-7th day), Group 3 (Intraneural saline 600 µL + perineural dexamethasone 0.5 mg/kg-2nd day), Group 4 (Intraneural saline 600 µL + perineural dexamethasone 0.5 mg/kg-7th day), Group 5 (Intraneural bupivacaine 10 mg/kg-2nd day), Group 6 (Intranueral bupivacaine 10 mg/kg-7th day), Group 7 (Intraneural bupivacaine 10 mg/kg + perineurald exam ethasone 0.5 mg/kg-2nd day), Group 8 (Intraneural bupivacaine 10 mg/kg + perineural dexamethasone 0.5 mg/kg-7th day), Group 9 (Control group). At the end of the application period, histopathological and immunohistochemical examinations were analyzed. RESULTS AND CONCLUSION: It was observed that caspase 3 levels significantly increased in the 5th and 6th groups compared to the 1st and 2nd groups (p < 0.01). However, in the 7th and 8th groups, these levels were similar with 1st and 2nd groups. While a significant decrease in S 100 levels was detected in group 6 (p < 0.05), a significant increase occurred in Group 8 and reached the same levels as Group 2. According to histopathological evaluation, edema, vacuolization and myelin degeneration were significantly increased in groups 5 and 6 (p < 0.05). However, in the 8th group, the mentioned data showed a significant decrease and reached the same levels as group 2. As a result, perineural dexamethasone was found to have protective effects against intraneural bupivacaine induced sciatic nerve damage.
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Anestésicos Locales , Bupivacaína , Dexametasona/uso terapéutico , Inyecciones/efectos adversos , Nervio Ciático/lesiones , Anestésicos Locales/efectos adversos , Animales , Bupivacaína/efectos adversos , RatasRESUMEN
The antioxidant and cardioprotective effects of oleuropein have been reported in several studies; however, its effect on ketamine cardiotoxicity has not been known yet. The aim of this study was to investigate the effects of oleuropein in ketamine-induced cardiotoxicity model in rats. A total of 28 male Wistar Albino rats were included in the study and they were randomly divided into four groups, each having seven rats. Group 1 (control): rats were given 1 mL of DMSO by oral gavage method for 7 days. Group 2 (ketamine): on the seventh day of the study, 60 mg/kg ketamine was administered intraperitoneally. Then, 60 mg/kg ketamine was administered intraperitoneally every 10 min for 3 h. Group 3 (oleuropein): rats were given 200 mg/kg/day oleuropein by oral gavage method for 7 days. Group 4 (oleuropein + ketamine): rats were given 1 × 200 mg/kg oleuropein by oral gavage method for 7 days. Furthermore, 60 mg/kg ketamine was administered intraperitoneally on the seventh day of the experiment. Then, 60 mg/kg ketamine was administered intraperitoneally every 10 min for 3 h. Serum cardiac marker (TnI, CK-MB and CK) levels were measured. Histopathological analysis was performed on a portion of the cardiac tissue. Cardiac tissue oxidative stress and antioxidant markers (MDA, GSH, GSH.Px and CAT), TNF-α, IL-6, NF-κB, COX-2 and Nrf-2 gene expressions, and protein conversion levels of related genes were determined. Data obtained showed that ketamine administration increased MDA (p < 0.001), TNF-α (p < 0.01), IL-6 (p < 0.01), COX-2 (p < 0.001) and NF-κB (p < 0.001) levels, as well as serum TnI (p < 0.001), CK-MB (p < 0.001) and CK (p < 0.01) levels whereas decreased GSH (p < 0.05) and Nrf-2 (p < 0.05) levels, as well as GSH-Px (p < 0.001) and CAT (p < 0.05) enzyme activities. Oleuropein administration was observed to decrease MDA, TNF-α, IL-6, COX-2, NF-κB, TnI, CK-MB and CK levels close to the control group and to increase GSH levels and GSH-Px and CAT enzyme activities close to the control group. This study showed that oleuropein administration reversed the increased oxidative stress and inflammation as a result of the use of ketamine and had protective effects on the heart.
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Antiinflamatorios/farmacología , Antioxidantes/farmacología , Cardiopatías/prevención & control , Mediadores de Inflamación/metabolismo , Glucósidos Iridoides/farmacología , Miocitos Cardíacos/efectos de los fármacos , Estrés Oxidativo/efectos de los fármacos , Animales , Cardiotoxicidad , Modelos Animales de Enfermedad , Cardiopatías/inducido químicamente , Cardiopatías/metabolismo , Cardiopatías/patología , Ketamina , Masculino , Miocitos Cardíacos/metabolismo , Miocitos Cardíacos/patología , Ratas Wistar , Transducción de SeñalAsunto(s)
Cánula , Ventilación no Invasiva , Estudios Cruzados , Máscaras , Respiración con Presión PositivaRESUMEN
Post thoracotomy chronic pain is a severe problem that affects the majority of patients and decreases the quality of life. The purpose of this study is to evaluate the long-term effects of thoracal epidural levobupivacaine and intravenous dexketoprofen analgesia formed pre-emptively on the wound site pain after major thoracotomy operations. This randomised, prospective and double-blind study was performed with 60 patients undergoing thoracic surgery. Patients were divided into three groups; Control Group (Group C), Pre-emptive Epidural Group (Group PE) and Pre-emptive Dexketoprofen + Epidural Group (Group PED). Patients in the Group C did not receive epidural analgesics and i.v. dexketoprofen before and during the operation. 10-15 ml 0.125% levobupivacaine was given to cases in Group PE pre-emptively through epidural catheter before the anesthesia induction. The cases in Group PED were given 10-15 ml 0.125% epidural levobupivacaine and 50 mg dexketoprofen with i.v. infusion pre-emptively. The VAS score was found to be lower in Group PED during postoperative 24 and 48 hours and before the discharge (P<0.05). The VAS score was similar in all groups during the first and third months (P>0.05). A statistically significant decrease was determined in the VAS score in Group PED during the sixth month, compared to the other groups (P<0.05). When the scores of Patient Satisfaction Scale (PSS) of the cases were compared, they were found to be higher in Group PED as statistically significant during the discharge period (P<0.001). Scores of PSS were higher in Group PED as statistically significant during the postoperative month 6 (P = 0.008). Combined application of pre-emptive intravenous dexketoprofen and thoracal epidural analgesia reduce the chronic post-thoracotomy pain.
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BACKGROUND: This study investigated the effects of metamizole and paracetamol on pain and oxidative stress induced by scalpel incision and carrageenan in rats. MATERIALS AND METHODS: Total of 144 rats were divided into groups of 12 animals. Six groups each were used for scalpel incision and carrageenan tests. Pain was inflicted by applying a scalpel incision or carrageenan. Pain-created groups by scalpel incision received metamizole (SIM) or paracetamol (SIP) at doses of 250 or 500 mg/kg. Pain-created groups by carrageenan received metamizole (CAM) or paracetamol (CAP) at doses of 250 or 500 mg/kg. Analgesic activity was determined by Basile Algesimeter. The COX-2 and MPO gene expressions were determined, and malondialdehyde and tGSH were measured in rat paws. RESULTS: In the scalpel incision test, pain was reduced in groups of SIM-250 and SIM-500 in the first hour by 65.2% and 91.3%, respectively, and in the third hour by 51.9% and 77.8%, respectively, compared with the SIC group. In SIP-250 and SIP-500 groups, pain was reduced in the first hour by 43% and 74%, respectively, and by 33.4% and 59.3%, respectively, in the third hour compared with the SIC group. In the carrageenan test, in groups CAM-250 and CAM-500, pain was reduced in the first hour by 72.3% and 86.1%, respectively, and by 65.8% and 71.4%, respectively, in the third hour compared with the CCG group. In groups CAP-250 and CAP-500, pain was reduced in the first hour by 52.8% and 69.4%, respectively, and by 28.6% and 25.8%, respectively, in the third hour compared with the CCG group. Metamizole inhibited COX-2 gene expression at a dose of 500 mg/kg in the carrageenan test. At doses of 250 and 500 mg/kg, metamizole reduced COX-2 and MPO gene expressions and oxidative stress induced by scalpel incision or carrageenan. But both doses of paracetamol were unable to suppress that parameters. CONCLUSIONS: Our results show that metamizole is more effective than paracetamol for treating surgical trauma-related pain, inflammation, and oxidative stress and hence may be a preferential drug to paracetamol.
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Acetaminofén/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Dipirona/uso terapéutico , Dolor Postoperatorio/tratamiento farmacológico , Acetaminofén/farmacología , Animales , Antiinflamatorios no Esteroideos/farmacología , Carragenina , Ciclooxigenasa 2/metabolismo , Dipirona/farmacología , Evaluación Preclínica de Medicamentos , Glutatión/metabolismo , Masculino , Estrés Oxidativo/efectos de los fármacos , Peroxidasa/metabolismo , Ratas WistarRESUMEN
BACKGROUND: Postoperative nausea and vomiting (PONV) is one of common complications in patients undergoing laparoscopic cholecystectomy (LC). Aim of this study was to compare the efficacy of subhypnotic (1 mg/kg/h) infusion of propofol with dexamethasone on PONV in patients undergoing LC. METHODS: A total of 120 patients were included in this randomized, double-blind, placebo-controlled study. Patients were randomly assigned to 3 groups; patients of group dexamethasone (group D) were administrated 8 mg dexamethasone before induction of anesthesia, patients of group propofol (group P) were infused to subhypnotic (1 mg/kg/h) propofol during operation and patients of group control (group C) were applied infusion of 10% intralipid. The incidence of PONV and needs for rescue analgesic and antiemetic were recorded in the first 24 h postoperatively. RESULTS: In the 0-24 h, the incidence of PONV was significantly lower in the group D and group P compared with the group C (37.5%, 40%, and 72.5%, resp.). There was no significant difference in the incidence of PONV and use of antiemetics and analgesic between group D and group P. CONCLUSION: We concluded that infusion of propofol 1 mg/kg/h is as effective as dexamethasone for the prevention of PONV during the first 24 hours after anesthesia in patients undergoing LC.
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Antieméticos/administración & dosificación , Colecistectomía Laparoscópica/efectos adversos , Dexametasona/administración & dosificación , Hipnóticos y Sedantes/administración & dosificación , Náusea y Vómito Posoperatorios/prevención & control , Propofol/administración & dosificación , Método Doble Ciego , Femenino , Humanos , Incidencia , Bombas de Infusión , Masculino , Persona de Mediana EdadRESUMEN
Elderly patients have increased risk for perioperative mortality and morbidity due to additional comorbidities, such as cardiac diseases. Regional anaesthesia techniques are usually preferred in high-risk patients due to some advantages, such as the maintenance of cardiovascular stability and early postoperative mobilisation. This case presents the anaesthetic approach in a 55-year-old male patient with low ejection fraction that underwent hip fracture surgery. In this present case, continuous spinal anaesthesia with low-dose hyperbaric bupivacaine provided safe and effective anaesthesia during surgery with minimal haemodynamic changes and adequate analgesia during the first 24 hours after surgery.
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The objective of our study is to research biochemically and histopathologically the effect of nimesulide on oxidative damage inflicted by ischemia-reperfusion (I/R) on the rat renal tissue. Twenty-four albino Wistar type of male rats were used for the experiment. The animals were divided into groups as: renal ischemia-reperfusion control (RIR), nimesulide+renal ischemia-reperfusion of 50 mg/kg (NRIR-50), nimesulide+renal ischemia-reperfusion of 100 mg/kg (NRIR-100), and sham groups (SG). In NRIR-50 and NRIR-100 groups were given nimesulide, and RIR and SG groups were given distilled water, an hour after anesthesia. Groups, except for the SG group, 1-h-ischemia and then 6-h-reperfusion were performed. In the renal tissue of the RIR group in which the malondialdehyde (MDA), myeloperoxidase (MPO), and 8-hydroxyguanine (8-OHGua) levels were measured, the COX-1 and COX-2 activities were recorded. Nimesulide at 100 mg/kg doses reduced the oxidant parameters more significantly than 50 mg/kg doses; on the other hand, it raised the antioxidant parameters. It has been shown that 100 mg/kg doses of nimesulide prevented the renal I/R damage more significantly than a dose of 50 mg/kg, which shows that nimesulide, in clinics, could be used in the prevention of I/R damage.
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Enfermedades Renales , Estrés Oxidativo/efectos de los fármacos , Daño por Reperfusión , Sulfonamidas/farmacología , Animales , Antioxidantes/farmacología , Relación Dosis-Respuesta a Droga , Riñón/patología , Enfermedades Renales/tratamiento farmacológico , Enfermedades Renales/etiología , Enfermedades Renales/metabolismo , Masculino , Malondialdehído/metabolismo , Peroxidasa/metabolismo , Inhibidores de Agregación Plaquetaria/farmacología , Prostaglandina-Endoperóxido Sintasas/metabolismo , Ratas , Ratas Wistar , Daño por Reperfusión/tratamiento farmacológico , Daño por Reperfusión/metabolismo , Factores de Tiempo , Resultado del TratamientoRESUMEN
This study investigated the effect of metyrosine against ketamine-induced cardiotoxicity in rats and compared the results with the effect of metoprolol. In this study, rats were divided into groups A, B and C. In group A, we investigated the effects of a single dose of metyrosine (150 mg/kg) and metoprolol (20 mg/kg) on single dose ketamine (60 mg/kg)-induced cardiotoxicity. In group B, we investigated the effect of metyrosine and metoprolol, which were given together with ketamine for 30 days. In group C, we investigated the effect of metyrosine and metoprolol given 15 days before ketamine and 30 days together with ketamine on ketamine cardiotoxicity. By the end of this process, we evaluated the effects of the levels of oxidant-antioxidant parameters such as MDA, MPO, 8-OHGua, tGSH, and SOD in addition to CK-MB and TP I on cardiotoxicity in rat heart tissue. The experimental results show that metyrosine prevented ketamine cardiotoxicity in groups A, B and C and metoprolol prevented it in only group C.