Introduction Recently, regional anesthesia techniques have been replaced by peripheral nerve blocks in the management of perioperative pain. Because of the widespread use of ultrasonography, it has been reported that peripheral nerve blocks showed similar analgesic efficacy with favorable rates of side effects when compared to central blocks. Central nerve blocks are often used in combination with general anesthesia for pediatric surgery in order to reduce general anesthetic requirements, opioid use, postoperative pain, nausea and vomiting, and risk of anesthetic neurotoxicity, particularly in young patients [1-4]. Caudal epidural block (CEB) is a well-established and commonly performed neuraxial technique for providing intraoperative and postoperative analgesia in pediatric patients scheduled for lower abdominal perineal surgical interventions [5-6]. Although the efficacy and safety of CEB are fairly high [7], the associated complications such as inadvertent dural puncture, unwarranted motor blockade of lower limbs, and disturbance of bladder function [8] might limit its use. Undoubtedly, introduction of ultrasonography into anesthesia practice has led to an increase in practice of peripheral nerve blocks. Ultrasonography guidance has significantly facilitated the practice of regional nerve blockades [9]. There has been a growing interest in ultrasound-guided transversus abdominis plane (TAP) block as an alternative and valid postoperative analgesic method in pediatric patients undergoing lower abdominal surgery [10]. Quadratus lumborum block (QL block) is a new abdominal and truncal block used for providing somatic Background/aim: Despite different regional anesthesia techniques used to provide intraoperative and postoperative analgesia in pediatric patients, the analgesic effectiveness of peripheral nerve blockades with minimal side effect profiles have not yet been fully determined. We aimed to compare the efficacy of ultrasound-guided transversus abdominis plane (TAP) block, quadratus lumborum (QL) block, and caudal epidural block on perioperative analgesia in pediatric patients aged between 6 months and 14 years who underwent elective unilateral lower abdominal wall surgery. Materials and methods: Ninety-four patients classified under the American Society of Anesthesiologists physical status classification system as ASA I or ASA II were randomly divided into 3 equal groups to perform TAP, QL or Caudal epidural block using 0.25% of bupivacaine solution (0.5 ml kg −1). Results: Postoperative analgesic consumption was highest in the TAP block group (P < 0.05). In the QL block group, Pediatric Objective Pain Scale (POAS) scores were statistically significantly lower after 2 and 4 h (P < 0.05). The length of hospital stay was significantly longer in the caudal block group than the QL block group (P < 0.05). Conclusion: We suggest that analgesia with ultrasound-guided QL block should be considered as an option for perioperative analgesia in pediatric patients undergoing lower abdominal surgery if the expertise an...

Study Design. Prospective randomized comparative (controlled) study. Objective. Management of the severe postoperative back pain followed the major spinal surgeries remains a challenge. The search is going on to find simple, efficient, and reliable perioperative analgesia with low side effects. We aimed to investigate the efficacy of intraoperative freehand erector spinae plane block (ESBP) after spinal surgeries. Summary of Background Data. A few case reports and randomized controlled studies demonstrated the analgesic efficacy of ESPB in spinal surgeries. Up-to-date, no randomized controlled studies investigated the effectiveness of ESPB on spinal instrumentation surgeries. Methods. We randomly divided 56 consecutive adult patients who underwent posterior spinal instrumentation and fusion for spondylolisthesis into two groups. The study (ESPB) group (n = 28) received intraoperative freehand bilateral ESPB with a 20-mL mixture solution of 0.25% bupivacaine and 1.0% lidocaine equally divided into all operating levels. In the control group (n = 28), 20 mL physiological saline was injected. Postoperatively, we ordered 1 g paracetamol thrice/day, besides patient-controlled analgesia pumps with morphine. We performed a postoperative evaluation with a visual analog scale (VAS), morphine consumption, ESPB-related adverse effects, and postoperative length of hospital stay (PLOS). Results. Morphine consumption was significantly higher in the controls within the first postoperative 24-hour 44.75 ± 12.3 mg versus 33.75 ± 6.81 mg in the ESPB participants (P < 0.001). Except for postoperative 24th-hour VAS (P = 0.127), all postoperative VAS scores recorded at all time-points were significantly higher in the controls (P < 0.05). In control individuals, the first analgesic demand time was shorter, and PLOS was longer (P < 0.001). Patient satisfaction was significantly higher in the ESPB group. We observed no significant difference regarding postoperative complications. Conclusion. Intraoperative ESPB as a part of multimodal analgesia was effective. For posterior instrumented patients with spondylolisthesis, it can relieve postoperative backache and reduce opioid consumption. Level of Evidence: 1

ObjectiveTo evaluate the added role of T1-weighted (T1w) gadolinium ethoxybenzyl diethylenetriamine penta-acetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance cholangiography (MRC) compared with T2-weighted MRC (T2w-MRC) in the detection of biliary leaks.MethodsNinety-nine patients with suspected biliary complications underwent routine T2w-MRC and T1w contrast-enhanced (CE) MRC using Gd-EOB-DTPA to identify biliary leaks. Two observers reviewed the image sets separately and together. MRC findings were compared with those of surgery and percutaneous transhepatic cholangiopancreatography. The sensitivity, specificity and accuracy of the techniques in identifying biliary leaks were calculated.ResultsAccuracy of locating biliary leaks was superior with the combination of Gd-EOB-DTPA-enhanced MRC and T2w-MRC (P < 0.05).The mean sensitivities were 79 % vs 59 %, and the mean accuracy rates were 84 % vs 58 % for combined CE-MRC and T2w-MRC vs sole T2w-MRC. Nineteen out of 21 patients with biliary-cyst communication, 90.4 %, and 12/15 patients with post-traumatic biliary extravasations, 80 %, were detected by the combination of Gd-EOB-DTPA-enhanced MRC and T2w-MRC images, P < 0.05.ConclusionsGd-EOB-DTPA-enhanced MRC yields information that complements T2w-MRC findings and improves the identification and localisation of the bile extravasations (84 % accuracy, 100 % specificity, P < 0.05). We recommend Gd-EOB-DTPA-enhanced MRC in addition to T2w-MRC to increase the preoperative accuracy of identifying and locating extravasations of bile.Key Points• Magnetic resonance cholangiography (MRC) does not always detect bile leakage and cysto-biliary communications.• Gd-EOB-DTPA-enhanced MRC helps by demonstrating extravasation of contrast material into fluid collections.• Gd-EOB-DTPA-enhanced MRC also demonstrates the leakage site and bile duct injury type.• Combined Gd-EOB-DTPA-enhanced and T2w-MRC can provide comprehensive information about biliary system.• Gd-EOB-DTPA-enhanced MRC is non-invasive and does not use ionising radiation.

Objectives:To investigate whether electrolyte levels measured by using blood gas analyzers (ABG) and auto-analyzers (AA) are equivalent and can be used interchangeably.Methods:This observational prospective study was conducted in 100 patients admitted to the Intensive Care Unit, Adnan Menderes University School of Medicine, Aydin, Turkey, between March and August 2014. Samples for both AA and ABG analyzers were collected simultaneously from invasive arterial catheters of patients. The electrolyte levels were measured by using 2 methods.Results:The mean sodium level measured by ABG was 136.1±6.3 mmol/L and 137.8±5.4 mmol/L for AA (p=0.001). The Pearson’s correlation coefficient was 0.561 (p<0.001). The Bland-Altman 95% limits of agreement were -9.4 to 12.6 mmol/L. The mean potassium levels measured by ABG was 3.4±0.7 mmol/L and AA was 3.8±0.7 mmol/L (p=0.001). The Bland-Altman comparison limits were -0.58 to 1.24 and the associated Pearson’s correlation coefficient was 0.812 (p<0.001).Conclusion:The results of the 2 analyzing methods, in terms of sodium, were not equivalent and could not be used interchangeably. However, according to the statistical analyses results, by including, but not blindly trusting these findings, urgent and vital decisions could be made by the potassium levels obtained from the BGA, but a simultaneous follow-up sample had to be sent to the central laboratory for confirmation.

ÖzAmAÇ: Organ bağışı ve nakliyle ilgili sosyal farkındalık dünya çapında önemli bir sağlık sorunudur. Bu konuda sağlık personeli ve öğrencilerinin yeterli bilgisinin olması gerekmektedir. Çalışmada, sağlık personeli ve öğrencilerin bu konudaki bilgi ve düşüncelerinin araştırılması amaçlandı. GEREÇ ve YÖNTEmlER:Çalışmaya 415 sağlık personeli ve 320 öğrenci katıldı. Veri toplamak için, organ bağış ve nakil anketi kullanıldı.BUlGUlAR: Katılımcıların yaş ortalaması 25,08 ± 6,82 yıl idi. Tüm katılımcıların %43,5'i tıp öğrencileri, %34,8'i hemşireler, %9,7'si hasta bakıcı, %7,6'sı doktorlar ve %4,4'ü temizlik personeliydi. Çalışmaya katılanların %10,3'ünün organ bağışı kartı vardı ve katılımcıların %44,4'ü organlarını bağışlamayı kabul etti. SONUÇ:Sağlık personeli organ bağışı konusunda net bir görüş ve yeterli bilgiye sahip değildi. Sağlık çalışanlarının farkındalıklarını sağlamak amacıyla, eğitici-bilgilendirici sempozyumların organize edilmesi gerektiği bu çalışmada ortaya konmuştur. İyi bir organizasyon ve takım çalışmasıyla organ vericilerinin sayısının artırılması, organ naklinde arzu edilen hedefe ulaşmayı sağlayacaktır.ANAhTAR SÖzcüklER: Tıp öğrencileri, Organ nakli, Beyin ölümü, Bilgi ABSTRAcT OBJEcTIVE: Social consciousness regarding organ donation and transplantation is an important health care problem worldwide. Medical staff and students must have adequate knowledge about this subject. The aim of this study was to investigate the knowledge and thoughts of staff and students about this topic. mATERIAl and mEThODS: A total of 415 medical staff and 320 students participated in the study. The organ donation and transplantation knowledge level survey was used for data collection. RESUlTS:The average age of the participants was 25.08±6.82 years. 43.5% of all participants were medical students, 34.8% were nurses, 9.7% were patient sitters, 7.6% were doctors, and 4.4% were cleaning staff. An organ donation card had been obtained by 10.3% of the study participants and 44.4% of the participants accepted to donate their organs.cONclUSION: Health care workers did not have a clear view and sufficient knowledge regarding organ donation. Educational, informative and thought-provoking symposia should be organized to enable comprehensive awareness in health care workers. The desired goal in organ transplantation may be achieved by increasing the number of organ donors and this can only be possible through good organization and teamwork.