NCT02589015.

Background and Objectives: Percutaneous nephrolithotomy (PCNL) is a minimally invasive procedure for removing kidney stones, but patients still suffer from moderate postoperative pain. The aim of this study is to evaluate the perioperative analgesic effect of ultrasound-guided subcostal transversus abdominis plane (TAP) block performed before PCNL procedure. Materials and Methods: Patients scheduled for elective PCNL were randomized into two groups: Group TAP and Group IV. General anesthesia was induced with propofol, fentanyl, and rocuronium and maintained with sevoflurane, fentanyl, and rocuronium. Unilateral ultrasound-guided TAP block was performed with total of 30 mL volume of local anesthetic solution (20 mL bupivacaine 0.125% plus 10 mL lidocaine 1%) after intubation but before surgery to the Group TAP patients. Paracetamol 1 g was given to the Group IV. Tramadol 100 mg and morphine IV-patient-controlled analgesia were applied to both groups. Perioperative fentanyl consumption, postoperative verbal analog scale (VAS), morphine consumption, and additional analgesic drug requirement were assessed. Chi square with Yates correction and Mann-Whitney U tests were used for statistical analysis. Results: Eighty patients were assessed for enrollment. One patient developed septicemia at the recovery room so data of 79 patients were collected for statistical analysis. Total morphine consumption at 48th hour after the surgery was lower at Group TAP (p = 0.022). Perioperative fentanyl consumption was lower at Group TAP (p < 0.001). Additional analgesic requirement and VAS were comparable between groups. Conclusions: Preemptive unilateral ultrasound-guided subcostal TAP block decreases perioperative fentanyl and postoperative total morphine consumption in PCNL patients compared to IV analgesic management.

Background: Various techniques are used to detect intraoperative bleeding points in thyroid surgery. We aimed to assess the effect of increasing peak airway pressure to 30, 40 and 50 cm H 2 O manually in detecting intraoperative bleeding points. Methods: One hundred and 34 patients scheduled for total thyroidectomy were included to this prospective randomised controlled clinical study. We randomly assigned patients to increase peak airway pressure to 30, 40 and 50 cm H 2 O manually intraoperatively just before surgical closure during hemostasis control. The primary endpoint was the rate of bleeding points detected by the surgeon during peak airway pressure increase. Results: The rate of detection of the bleeding points was higher in 50 cm H 2 O Group than the other two groups (15.9 vs 25.5 vs 40%, P = 0.030), after pressure administration, the HR, SpO 2 , and P peak were similar between groups (P = 0.125, 0.196, 0.187, respectively). The median duration of the bleeding point detection after the pressure application was 21.82 s in 30 cm H 2 O, 25 s in 40 cm H 2 O, and 22.50 s in 50 cm H 2 O groups. Postoperative subcutaneous hematomas or hemorrhages requiring surgery were not seen in any patient. Conclusions: Manually increasing peak airway pressure to 50 cm H 2 O during at least 22.50 s may be used as an alternative way to detect intraoperative bleeding points in thyroid surgery. Clinical trial registration: NCT03547648. Registered 6 June2018

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