No abstract

Pain management significantly reduces mortality by aiding in the effective elimination of secretions after thoracic surgery. We present two cases requiring emergency surgical intervention due to major trauma. Both patients were provided pain control with an intrathoracic approach of the paravertebral block performed by a sterile-clothed anesthetist with a single-shot 20 ml injection of 0.25% bupivacaine from the inner surface to the superior costo-transverse ligament (SCTL). After extubation, the measured VAS score was no higher than 3–4, and the patients could breathe and cough comfortably. The intrathoracic approach may be an effective method to implement for postoperative acute pain.

General anaesthesia has a priority in surgical interventions of clavicle; however, regional techniques may come to the fore in the presence of increased risk factors due to possible airway problems. The innervation of the clavicle region is very complex and has not been fully described; therefore, only a limited number of different regional anaesthesia approaches should be considered. Here, we present the management of a clavicle fracture with a combination of an interscalene block and deep cervical plexus block in a patient with severe maxillo-facial trauma and diaphragmatic hernia due to combat injury. A 35-year-old male admitted to the emergency room as a war-wounded patient had suffered maxillofacial trauma and an unstable clavicle defect during the Syrian Civil War. A diaphragmatic hernia was also detected during examination. The patient underwent operation with regional anaesthesia of the clavicle under spontaneous respiration. With standard monitoring and premedication, interscalene block and deep cervical plexus block were performed under ultrasound guidance with a mixture of 0.25% bupivacaine (20 mL) and 0.5% lidocaine (10 mL). In the perioperative period, the patient's vital signs remained stable. The patient had no pain during the surgery. We suggest that the combination of interscalene block and deep cervical plexus block is an efficient option for management of clavicle fracture in patients with multiple comorbidities.

Modified approaches are emphasized to make the traditional IVRA method more reliable and effective. We aimed to compare two different concentrations used with temporary tourniquet application in addition to the IVRA method for reducing local anesthetics amount in hand and wrist surgeries. Material and methods: After the approval of Gaziantep University Ethics Committee had been obtained, observation forms of patients with ASA physical score I-II who had undergone elective orthopedic upper extremity surgery were reviewed retrospectively. The patients were divided into two groups according to the concentration of 150 mg of lidocaine in saline. The patients were administered 150 mg lidocaine in 15 ml (Group 15, n:29) and 20 ml (Group 20, n:26) saline. Patients were enrolled into groups in a random and a blind fashion, and after the exclusion criteria were assessed, twenty patients from each group were evaluated. Demographic data, the classification of operation time, the peri-operative follow-up values, the sedoanelgesia consumption needs and the postoperative patient satisfaction scores were compared. Results: Demographic data were similar in both groups. The tourniquet time was 40.75±14.71 minutes in Group 15 and 38.25±9.77 minutes in Group 20 (p=0.531). Sedation start time was 23.18±9.02 in Group 15 (n=11) and 26.53±6.57 minutes in Group 20 (n=13) (p=0.304). Tourniquet pain time was 46.66±2.88 in group 15 (n=3) and 50.00±7.07 minutes in group 20 (n=2) (p=0.624). No statistically significant difference was found between the alltime classifications, hemodynamic values, peri-operative sedoanalgesia consumptions, and the patient satisfaction scores between the groups (p>0,05). A continuous increase in sedoanalgesic consumption amount with time was observed. None of the patients had signs of local anesthetic toxicity. Conclusion: We suppose that the plasticity inherent to the IVRA may be optimized by alternative adaptations to be used for decreasing the amount of local anesthetic to safer levels and for reducing the risk of related side effects.

ESPB that has axial and sagittal spreads allows it to be as effective as the central blocks. Although its effectiveness on postoperative thorax analgesia has been vastly reported, the number of studies on its use in combination with other blocks for sedation purposes in the management of breast surgery anesthesia is limited. We present the anesthetic management of a patient for accessory breast tissue surgery by using ESPB block from T1. We observed that the effect of ESPB on skin incision and skin-related tissue retractions was limited while postoperative pain control was sufficiently managed by the skin infiltration with ESPB.