ABSTRACT BACKGROUND: There is still a debate about what constitutes effective and safe postoperative analgesia in hepatectomy surgery. Erector spinae plane (ESP) block may be an important part of multimodal analgesia application in hepatectomy surgery. OBJECTIVES: To compare the effects of ultrasound-guided bilateral erector spinae plane block combined with intravenous (iv) patient-controlled analgesia (iv PCA), in comparison with iv PCA alone, in hepatectomy surgery. DESIGN AND SETTINGS: Randomized prospective single-blinded study in a tertiary university hospital. METHODS: Fifty patients scheduled for elective hepatectomy surgery were included in the study. Patients were randomized into the ESP group or the control group. In the ESP group, bilateral ESP block was performed preoperatively and iv PCA was used. In the control group, only iv PCA was used. Numerical rating scale (NRS) scores at rest and coughing, analgesic requirements and occurrences of nausea and vomiting were recorded. RESULTS: Intraoperative and postoperative opioid consumption, rescue analgesia requirement and resting and dynamic NRS scores were significantly lower in the ESP group (P < 0.05). There was no significant difference between two groups in terms of the presence of dynamic pain after the first postoperative hour. While all patients in the control group had nausea and vomiting, 24% of the patients in the ESP group did not have nausea and vomiting. CONCLUSION: This study showed that ESP block can be used as a part of multimodal analgesia, with the benefit of reducing opioid consumption and postoperative nausea and vomiting in hepatectomy surgery. CLINICAL TRIAL REGISTRATION: ACTRN12620000466943.

Background: we investigated the relationships between thyroid function and obesity severity, metabolic syndrome (MS) and MS components in 260 obese children and adolescents 10-17 years of age. Objectives: we aimed to determine the association of thyroid functions with obesity severity and the components of metabolic syndrome (MS) in pediatric obese patients. Methods: only obese children and adolescents were included, and divided the obese children into three groups according to body mass index (BMI)-SDS quartiles. The first quartile was group 1, the second and third quartiles were group 2, and the fourth quartile was group 3. Group 3 indicated severe obesity. The modified WHO criteria adapted for children were used to diagnose MS. We assessed anthropometric data and serum biochemical parameters, including the lipid profile and fasting glucose (FG), insulin, thyroid-stimulating hormone (TSH), free thyroxine (fT4), and free triiodothyronine (fT3) levels. Blood pressure (BP) was measured with a standard digital sphygmomanometer. The homeostasis model assessment of insulin resistance was calculated to determine insulin resistance (IR). Results: TSH level was significantly higher in obese children with MS than that in the others (p = 0.045). Mean TSH level was not different among the BMI-SDS groups (p = 0.590). TSH levels and the fT3/fT4 ratio were not different in children with dyslipidemia, IR or hypertension (p = 0.515, 0.805, 0.973, 0.750, 0.515, and 0.805, respectively). Discussion: obesity severity does not affect TSH level or the fT3/fT4 ratio in obese children and adolescents. IR is in close relationship with TSH level. Elevated TSH level is a risk factor for MS.

Antecedentes: hemos investigado las relaciones entre la función tiroidea y la severidad de la obesidad, el síndrome metabólico (MS) y los componentes del MS en 260 niños y adolescentes obesos de entre 10 y 17 años de edad. Objetivos: pretendemos determinar la asociación de las funciones tiroideas con la severidad de la obesidad y los componentes del síndrome metabólico (MS) en pacientes pediátricos obesos. Métodos: solo se incluyeron niños y adolescentes obesos, y se dividió a los niños obesos en tres grupos según los cuartiles de índice de masa corporal (BM). El primer cuartil fue el grupo 1, el segundo y tercer cuartil fueron el grupo 2, y el cuarto cuartil fue el grupo 3. El grupo 3 indicó obesidad severa. Los criterios WHO modificados adaptados para los niños se utilizaron para diagnosticar MS. Evaluamos los datos antropométricos y los parámetros del suero bioquímico, incluyendo el perfil lípido y los niveles de glucosa en ayunas (FG), insulina, hormona estimulante del tiroides (TSH), tiroxina libre (fT4) y triyodotironina libre (fT3). Se midió la presión sanguínea (BP) con un esfigmomanómetro digital estándar. La evaluación del modelo de homeostasis de la resistencia de la insulina se calculó para determinar la resistencia a la insulina (IR). Resultados: el nivel de TSH fue significativamente mayor en niños obesos con MS que en los demás (p = 0,045). El nivel medio de TSH no fue diferente entre los grupos BMI (p = 0,590). Los niveles de TSH y la proporción fT3/ fT4 no fueron diferentes en niños con dislipidemia, IR o hipertensión (p = 0,515; 0,805; 0,973; 0,750; 0,515 y 0,805, respectivamente). Discusión: la severidad de la obesidad no afecta al nivel de TSH ni a la proporción fT3/fT4 en niños y adolescentes obesos. La IR está en relación directa con el nivel de TSH. El nivel elevado de TSH es un factor de riesgo para el MS.