Peripheral nerve blocks with the use of ultrasonography (USG) allow visualisation of both the structures and nerves and make the block administrations safe, quick, and comfortable. However, few publications concerning the minimum local anesthetic (LA) volume are capable of providing blocks. This study aimed to find the minimum effective LA volume in brachial plexus blockage administrations with an axillary approach accompanied by ultrasonography in hand, elbow, and forehand operations. Materials and MethodThe study included a total of 55 patients (classified as American Society of Anesthesiologists (ASA) I-II) who underwent hand surgery by administering USG-guided axillary brachial plexus blockage. The ulnar, median, and radial nerves were located, and the minimum effective LA volume was investigated starting with a total of 21 ml of bupivacaine 0.5%. After accomplishing the blockage, the volume was decreased by 0.5 ml for each nerve. Block administration time, block onset times, anesthesia times, and time to first analgesic requirement were recorded. ResultsThe minimum effective LA volume for each nerve was 2.5 ml for a total of 7.5 ml. In comparing block administration times, there were no differences between high or low volume groups. It was found that sensory block onset time was 17 minutes for 7.5 ml and 11 minutes for 21 ml; sensory block regression time was six hours for 7.5 ml and 10.4 hours for 21 ml, respectively. This regression was statistically significant. The first analgesic requirement was 5.8 -16.6 hours, respectively, for each group. ConclusionIn the administration of an USG-guided axillary block, sufficient anesthesia can be achieved by administering 2.5 ml of bupivacaine 0.5% for each nerve. However, it might be kept in mind that motor and sensory block onset time will be extended and regression time and time to the first analgesic requirement will be shorter with this volume. In addition, more advanced studies must be done for the determination of the optimum volume which can be used.

No abstract

In Turkey, there are few studies conducted on the retrospective evaluation of the perioperative and postoperative effects of anesthesia methods applied in patients undergoing total knee arthroplasty surgery. In this study, our aim is to test the hypothesis that regional anesthesia techniques applied in patients undergoing total knee replacement surgery provide better results than general anesthesia. Ankara Numune Training and Research Hospital Scientific Research Evaluation Commission approved this study. Medical archives and anesthesia records of 247 patients who underwent total knee arthroplasty surgery between January 01, 2012 and December 31, 2012 were retrospectively analyzed. Preoperative, intraoperative and postoperative records were kept. In terms of gender, age, smoking status, ASA level, surgery type, accompanying diseases, mean arterial blood pressure, blood donation status, complications, postoperative intensive care need, operation and discharge times, perioperative morbidity and mortality, it was found that there is no statistically significant difference between the groups studied (p> 0.05). There was a statistically significant difference between groups in terms of the amount of blood given, amount of fluid administered and heart rate (p <0.05). In our study, 247 patients who underwent total knee arthroplasty were analyzed retrospectively. We concluded that there was no significant difference in terms of perioperative morbidity and mortality between regional anesthesia applications and general anesthesia applications in patients with similar age groups and concomitant diseases. We think that more comprehensive meta-analyzes and studies are needed on this subject.