OBJECTIVE:Antagonism of the central nervous system inhibitor neurotransmitter gamma-Aminobutyric acid (GABA) or serotonergic system activation is an important factor in the pathogenesis of intrathecal morphine-induced pruritus. This study tested the hypothesis that preoperative use of ondansetron, gabapentin or mirtazapine can prevent morphine-induced pruritus.METHODS:We randomly allocated 80 patients of American Society of Anesthesiology (ASA) classification I and II physical status who were to undergo unilateral inguinal hernia or pilonidal sinus operations under spinal anesthesia into 4 equal groups. The first 3 groups received oral doses of 30 mg mirtazapine, 8 mg ondansetron, and 1200 mg gabapentin at 2 hours, 10 minutes, and 1 hour before surgery, respectively, and the fourth group was given a placebo. All patients received intrathecal injection of 15 mg of 0.5% hyperbaric bupivacaine and 0.2 mg morphine. Pruritus was evaluated at 0, 3, 6, 9, 12, and 24 hours after intrathecal morphine administration, and details of presence, onset time, duration, localization, and severity of pruritus were recorded.RESULTS:Incidence of pruritus was significantly more frequent in the placebo group compared to ondansetron, gabapentin, and mirtazapine groups (70%, 55%, 35%, and 35%, respectively). In general, onset of pruritus was between 2 and 6 hours after intrathecal morphine injection; however, onset in the gabapentin group (mean±SD: 4.75±2.7 hours; p=0.019) was delayed compared to other groups. It was observed that pruritus persisted relatively longer in the ondansetron and placebo groups (mean±SD: 6±3.08; 5.82±2.96 hours, respectively; p=0.047). No statistical determination was made regarding location of pruritus. Severity of pruritus was greater in the placebo group (p=0.0001). Necessity for antipruritic treatment was not statistically significantly different between groups.CONCLUSION:Incidence and severity of intrathecal morphine-induced pruritus decreased with use of each of all 3 drugs compared to placebo.

The beach chair position is one of the most commonly used positions in arthroscopic shoulder surgery because of its anatomical nature and easy modifiability to open surgery. Despite these advantages, thromboembolic and neurologic complications have been reported. We report a case of carotid sinus hypersensitivity due to shoulder sling pressure after arthroscopic shoulder surgery.

Aim:To evaluate the effects of morphine and fentanyl added to bupivacaine and intrathecal bupivacaine to combine spinal-epidural anaesthesia during caesarean.Methods:Forty subjects with American Society of Anesthesiologists I-II status who would have caesarean were included in the study. The subjects were divided into two groups. Group bupivacaine-fentanyl (BF) were given 0.5% bupivacaine 7.5 mg + 25 µg fentanyl and group bupivacaine-morphine (BM) received 0.5% bupivacaine 7.5 mg + 0.1 mg morphine intrathecal total 2 mL. Periods for access to T4 block, two dermatome regression of sensory block, time elapsed between the administration of the local anaesthetic and reaching Bromage scale 1, reaching the highest level of motor block, first analgesic necessity, umbilical cord clamping time, and when the operation ends were recorded. One-minute and five-minute Apgar scores, umbilical blood gas values of the newborns and the adverse effects were recorded. Results:Comparisons between the two groups show that group BM has longer periods for motor block start time, two dermatome regression time, and first anaesthetic necessity time and group BF had higher levels for motor block level at the 1 st minute and visual analog scale scores at postop 60 th minute. There was no significant difference between the groups for the adverse effects. Conclusion:Fentanyl and morphine added to intrathecal bupivacaine show similar effects in intraoperative analgesia. We Amaç: Sezaryenlerde kombine spinal-epidural anestezide intratekal bupivakain ve bupivakaine eklenen fentanil ve morfinin etkilerini değerlendirmektir.Yöntemler: Sezaryen operasyonu geçirecek Amerikan Anestezi Derneği I-II grubunda, 40 olgu çalışmaya alındı. Olgular iki gruba ayrıldı. Grup bupivakain-fentanile (BF) 7,5 mg %0,5 bupivakain + 25 µg fentanil, grup bupivakain-morfine (BM) 7,5 mg %0,5 bupivakain + 0,1 mg morfin intratekal olarak total 2 mL verildi. T4 duyusal bloğa ulaşma, duyusal bloğun iki dermatom gerileme, lokal anestezinin verilmesinden Bromage skalasının 1 olma süreleri, motor bloğun en üst skalaya ulaşma süresi, motor bloğun tamamen kaybolma süresi, ilk analjezik ihtiyacı süresi, bebeğin umblikal korda klemp konma süresi, operasyon bitim süresi kaydedildi. Olguların deri ve uterus insizyonu, periton kapatma, postoperatif 30 dakika, 60 dakika ve ağrı duydukları andaki ağrı şiddetleri ve ulaşılan en üst motor blok skalası kaydedildi. Yenidoğan birinci-beşinci dakika Apgar değerleri ve umblikal kan gazı değerleri ve yan etkiler kaydedildi. Bulgular:Gruplar arasında yapılan karşılaştırmalarda, grupların motor blok başlama zamanı, iki dermatom gerileme süresi, ilk analjezik ihtiyacı süresi grup BM'de uzun bulunurken, birinci dakika motor blok seviyesi ve postop 60 dakika visuel analog skalaları ise grup BF'de daha yüksek bulundu. Yan etkiler açısından gruplar arasında anlamlı farklılık bulunmadı.