Abstract Background and objectives We aimed to compare the analgesic effects of both posterior (type 2) Quadratus Lumborum Block (QLB) and Transversus Abdominis Plane Block (TAPB) compared to spinal anesthesia alone for postoperative pain management in inguinal hernia repair. Methods This study enrolled 63 patients scheduled for open inguinal hernia repair. The eligibility criteria were undergoing elective unilateral inguinal hernia repair surgery, having an American Society of Anesthesiologists (ASA) physical status I, II, or III, and not suffering from any chronic pain condition. Group S patients received spinal anesthetics and no additional analgesic treatments. Group T patients received TAPB, and Group Q patients received QLB as analgesic technique in addition to spinal anesthetics. Results The pain scores at 6 hours (VAS 6) and 24 hours (VAS 24) were significantly different between groups (p < 0.01). Additionally, the sensory and motor block levels were significantly different between groups (p < 0.05). Multiple comparison tests showed that patients in Group Q had significantly higher sensory and motor block levels (p < 0.01 compared with Group S; p < 0.05 compared with Group T). Opioid consumption was significantly different between Groups Q and S (p < 0.01) after surgery. Conclusions Our findings show that both blocks are similarly effective for the management of postoperative pain compared to spinal anesthesia alone for inguinal hernia repair. We found that QLB resulted in a significant cranial spread compared to TAPB. Opioid consumption in QLB was significantly lower than that in controls but similar to that in TAPB.

Abstract Purpose: To measure the preoperative fasting durations with respect to time of the day and its effect on vital parameters and electrocardiogram in elderly patients undergoing surgery under spinal anesthesia. Methods: This study investigated 211 patients older than 60 years undergoing elective surgery under spinal anesthesia. Patients scheduled for surgery in morning hours (AM) and afternoon hours (PM) were compared. Patients fasting hours and repeated measurements of mean arterial pressure (MAP), heart rate (HR), peripheral oxygen saturation (Sp02) and the type and number of ischemic electrocardiogram (ECG) signs were recorded and compared [preoperative, zeroth, 2nd,5th,15th,30th minutes following spinal anesthesia(SA)]. Results: Mean fasting durations were 12±2.8 and 9.5±2.1 hours in AM group and 15.5±3.4 12.7±4.4 hours in PM group for foods and liquids respectively. ECG changes were significantly more frequent in PM group and body temperatures were significantly higher in AM group patients. Conclusion: Our study has shown that fasting times in our population is far longer than recommended and fasting prolonged>15 hours is related to a transiently increased cardiac stress and mild hypothermia.

Resumo Justificativa: Fornecer informação suficiente durante uma consulta pré-anestesia pode aumentar a compreensão do paciente e diminuir a ansiedade relacionada à anestesia espinhal. Investigamos o efeito do fornecimento de informação via vídeo sobre a ansiedade e satisfação em pacientes prestes a serem submetidos à anestesia espinhal. Métodos: Foram inscritos prospectivamente 198 pacientes agendados para cirurgias eletivas de pequeno porte sob anestesia espinhal. Os questionários de avaliação de estado e traço de ansiedade (State-Trait Anxiety Inventory/State e State-Trait Anxiety Inventory/Trait) e uma escala visual analógica foram usados para medir os níveis de ansiedade antes de a avaliação-padrão da anestesia ter sido iniciada. Em seguida, 100 pacientes do Grupo 1 receberam informação por escrito, verbal e via vídeo, enquanto 98 pacientes do Grupo 2 receberam apenas informação por escrito e verbal sobre a anestesia espinhal. Em seguida, todos os participantes responderam os inventários de estado e traço de ansiedade e a escala visual analógica para avaliar a ansiedade. Por fim, a escala de Likert de 5 pontos foi usada para medir a satisfação durante o período pós-operatório. Resultados: Não houve diferença nos escores dos questionários de estado e traço de ansiedade e da escala visual analógica entre os dois grupos antes do período de informação. Os escores de estado e traço de ansiedade que avaliam a ansiedade durante o período pós-informação foram diferentes em ambos os grupos: 36,5 ± 10,0 no Grupo 1 e 39,6 ± 8,6 no Grupo 2 (p = 0,033). Os escores da escala Likert de 5 pontos para medir a satisfação foram: 4,5 ± 0,6 no Grupo 1 e 3,5 ± 1,2 no Grupo 2 (p < 0,001). Conclusão: Fornecer informação via vídeo durante a consulta pré-anestésica aliviou a ansiedade e aumentou a satisfação em pacientes submetidos à anestesia espinhal.

Abstract Background: Providing sufficient information during a preanesthetic interview may help improve patient understanding and decrease anxiety related to spinal anesthesia. We investigated the effect of video-based education on anxiety and satisfaction in patients about to undergo spinal anesthesia. Methods: A total of 198 patients scheduled for minor elective surgery under spinal anesthesia were prospectively enrolled. The State-Trait Anxiety Inventory (State-Trait Anxiety Inventory/State and State-Trait Anxiety Inventory/Trait) questionnaires and visual analog scale were used to measure anxiety levels before the standard anesthesia evaluation was initiated. Then, 100 patients in Group 1 received written, verbal, and video-based education, whereas 98 patients in Group 2 received only written and verbal instructions regarding spinal anesthesia. Then all participants completed the State-Trait Anxiety Inventory/State and visual analog scale to evaluate anxiety. Finally, a 5-point Likert scale was used to measure satisfaction during postoperative period. Results: No differences were found in the State-Trait Anxiety Inventory/State, State-Trait Anxiety Inventory/Trait, or visual analog scale scores between the two groups before the information period. The State-Trait Anxiety Inventory/State scores evaluating anxiety during the post-information period were differed in both groups and they found as 36.5 ± 10.0 in Group 1 and 39.6 ± 8.6 in Group 2 (p = 0.033). The 5-point Likert scale scores to measure satisfaction were stated as 4.5 ± 0.6 in Group 1 and 3.5 ± 1.2 in Group 2 (p < 0.001). Conclusions: Providing video-based information during the preanesthetic interview alleviated anxiety and increased satisfaction in patients undergoing spinal anesthesia.

Resumo Justificativa: A incidência de complicações respiratórias no perioperatório e o tempo em sala de recuperação pós-anestesia no pós-operatório em pacientes com exposição passiva à fumaça de tabaco foram avaliados de acordo com o grau de exposição. Métodos: Foram avaliados 270 pacientes entre 18-60 anos, estado físico ASA I ou II, passivamente expostos e não expostos à fumaça de tabaco, submetidos à anestesia geral para vários procedimentos cirúrgicos eletivos. Os pacientes foram divididos em dois grupos: passivamente expostos e não expostos à fumaça de tabaco. Aqueles com exposição passiva à fumaça também foram divididos em dois grupos de acordo com o grau de exposição. Os pacientes enviados à sala de recuperação pós-anestesia (SRPA) no fim da cirurgia foram monitorados até atingir 9 ou mais no escore modificado de Aldrete. As complicações respiratórias foram avaliadas e registradas nos períodos intraoperatório e pós-operatório. Resultados: Foram incluídos 251 pacientes, dos quais 63 (25,1%) apresentaram complicações respiratórias, 11 (4,4%) complicações no intraoperatório e 52 (20,7%) complicações no pós-operatório. Houve relação significativa entre a exposição passiva à fumaça de tabaco e a alta incidência de complicações respiratórias no perioperatório e pós-operatório. O risco de complicação como tosse, dessaturação e hipersecreção aumentou de acordo com o grau de exposição. Houve relação significativa entre o grau de exposição passiva à fumaça e o tempo de permanência em SRPA. Conclusão: Os pacientes com exposição passiva à fumaça de tabaco apresentaram altas taxas de complicações respiratórias no perioperatório e prolongamento da permanência em SRPA, em comparação com os pacientes não expostos.

Abstract Background: The incidence of perioperative respiratory complications and postoperative care unit recovery time investigated in patients with passive tobacco smoke exposure according to the degree of exposure. Methods: Total 270 patients ranging in age from 18 to 60 years with the ASA physical status I or II exposed and not exposed to passive tobacco smoke received general anesthesia for various elective surgical operations evaluated for the study. Patients divided into two groups as exposed and non-exposed to passive tobacco smoke, those exposed to passive smoke are also divided into two groups according to the degree of exposure. Patients taken to the postoperative care unit (PACU) at the end of the operation and monitorized until Modified Aldrete's Scores became 9 and more. Respiratory complications evaluated and recorded in intraoperative and postoperative period. Results: A total of 251 patients were enrolled; 63 (25.1%) patients had airway complications, 11 (4.4%) had complications intraoperatively and 52 (20.7%) patients had complications postoperatively. There has been found significant relation with passive tobacco smoke exposure and high incidences of perioperative and postoperative respiratory complications. The risk of cough, desaturation and hypersecretion complications were found to be increased depending on the degree of exposure. There was significant relation between the degree of passive smoke exposure and the duration of PACU stay. Conclusion: Passive tobacco smoke exposed general anesthesia receiving patients also regarding to the degree of exposure having high rates of perioperative respiratory complications and prolongation of PACU stays when compared with unexposed patients.