Abstract Background: Modified thoracoabdominal nerve block through perichondrial approach is a novel fascial plane block and provides abdominal analgesia by blocking thoracoabdominal nerves. Our primary aim was to evaluate the efficacy of M-TAPA on quality of recovery and pain scores in patients who underwent laparoscopic inguinal hernia repair surgery (Trans Abdominal Pre-Peritoneal approach ‒ TAPP). Methods: Patients with American Society of Anesthesiologists (ASA) physical status I–II aged between 18 and 65 years scheduled for elective TAPP under general anesthesia were enrolled in the study. After intubation, the patients were randomized into two groups: M: M-TAPA group (n = 30) and the control group (n = 30). M-TAPA was performed with total 40 ml 0.25% bupivacaine in the M group. Surgical infiltration was performed in the control group. The primary outcome of the study was the global quality of recovery score, the secondary outcomes were pain scores, rescue analgesic demands, and adverse effects during the 24-h postoperative period. Results: The global quality of recovery scores at 24 h were significantly higher in the M group (p < 0.001). There was a reduction in the median static and dynamic NRS for the first postoperative 8 h in the M group compared to the control group (p < 0.001). The need for rescue analgesia was significantly lower in the M group compared to the control group (13 patients vs. 24 respectively, p < 0.001). The incidence of side effects was significantly higher in the control group (p < 0.001). Conclusion: In our study, M-TAPA increased patient recovery scores, and provided pain relief in patients who underwent TAPP. Register Number: NCT05199922.

Resumo Justificativa O bloqueio paravertebral torácico pode proporcionar analgesia para cirurgia torácica unilateral e está associado a um baixo índice de complicações. A síndrome de Horner (também denominada paralisia oculossimpática) é uma constelação neurológica clássica de blefaroptose ipsilateral, miose pupilar e anidrose facial devido a distúrbio da via simpática que fornece inervação para a cabeça, os olhos e o pescoço. Relato de caso Apresentamos o caso de um paciente com síndrome de Horner transitória ipsilateral após a administração de injeção única de 15 mL de levobupivacaína a 0,25% para bloqueio paravertebral torácico ao nível de T5-6 guiado por ultrassom. Conclusões Devemos considerar que mesmo um bloqueio paravertebral torácico bem-sucedido com a administração de injeção única e guiado por ultrassom pode ser complicado com a síndrome de Horner devido à distribuição imprevisível do anestésico local.

Abstract Background Thoracic paravertebral block can provide analgesia for unilateral chest surgery and is associated with a low complication rate. Horner syndrome also referred to as oculosympathetic paresis, is a classic neurologic constellation of ipsilateral blepharoptosis, pupillary miosis, and facial anhidrosis resulting from disruption of the sympathetic pathway supplying the head, eye, and neck. Case report We present a patient with an ipsilateral transient Horner syndrome after ultrasound guided single shot of 15 mL 0.25% levobupivacaine for thoracic paravertebral block at T5–6 level. Conclusions It should be kept in mind that even a successful ultrasound guided single shot thoracic paravertebral block can be complicated with Horner syndrome due to unpredictable distribution of the local anesthetic.

Resumo Justificativa: O objetivo deste estudo foi investigar a relação entre a ansiedade no período pré-operatório e os sintomas vasovagais observados durante a administração de raquianestesia a pacientes submetidos à cirurgia nas regiões perianal e inguinal. Métodos: O estudo incluiu pacientes com cirurgias agendadas para correção de hérnia inguinal, fissura anal, hemorroidas e excisão de fístula pilonidal. Foram incluídos 210 pacientes entre 18-65 anos e estado físico ASA I-II. A avaliação dos pacientes compreendeu história de tabagismo e consumo de álcool, classificação ASA e nível de escolaridade. As correlações foram avaliadas entre o número de tentativas de aplicação da raquianestesia e história de anestesia com sintoma vasovagal, nível de escolaridade, sexo, tabagismo e consumo de álcool, história anestésica e escores de ansiedade. O inventário do estado (transitório) de ansiedade, parte do Inventário de Ansiedade Traço-Estado (State Trait Anxiety Inventory - IDATE), foi usado para determinar os níveis de ansiedade dos participantes. Achados clínicos de vasodilatação periférica, hipotensão, bradicardia e assistolia observados durante a administração da raquianestesia foram registrados. Resultados: Observamos aumento dos incidentes vasovagais durante a administração da raquianestesia em casos com escores elevados de ansiedade, pacientes do sexo masculino e pacientes sem história anestésica. O nível de escolaridade e o número de punções com agulha espinhal não mostraram ter qualquer efeito sobre os incidentes vasovagais. Conclusão: Determinar as causas que desencadearam os incidentes vasovagais observados durante a aplicação da raquianestesia, fornecer boa informação ao paciente sobre a anestesia regional e promover alívio da ansiedade com tratamento ansiolítico no pré-operatório contribuirão para eliminar possíveis incidentes vasovagais.

Abstract Background: It was aimed to investigate the relationship between preoperative anxiety and vasovagal symptoms observed during the administration of spinal anesthesia in patients undergoing surgery in the perianal and inguinal regions. Methods: The study included patients with planned surgery for inguinal hernia repair, anal fissure, hemorrhoid and pilonidal sinus excision. The study included a total of 210 patients of ASA I-II, aged 18-65 years. Patients were evaluated in respect of demographic characteristics, smoking and alcohol consumption, ASA grade and educational level. Correlations were evaluated between the number of attempts at spinal anesthesia and anesthesia history with vasovagal symptoms and educational level, gender, smoking and alcohol consumption and anesthesia history with anxiety scores. The instant (transient) state anxiety inventory part of the Transient State/Trait Anxiety Inventory (State Trait Anxiety Inventory - STAI) was used to determine the anxiety levels of the participants. Clinical findings of peripheral vasodilation, hypotension, bradycardia and asystole observed during the administration of spinal anesthesia were recorded. Results: Vasovagal incidences during the administration of spinal anesthesia were seen to increase in cases of high anxiety score, male gender, and an absence of anesthesia history. Educational level and the number of spinal needle punctures were not found to have any effect on vasovagal incidents. Conclusion: The determination of causes triggering vasovagal incidents seen during the application of spinal anesthesia, better patient information of regional anesthesia implementations and anxiety relief with preoperative anxiolytic treatment will help to eliminate potential vasovagal incidents.