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.

Abstract Background and objectives Laryngeal mask airways are increasingly used as supraglottic devices during general anesthesia. Ultrasonography can provide a dynamic image simultaneous to placing the supraglottic airway device. In the current study, the incidence of suboptimal laryngeal mask airway position and replacement in children was evaluated using simultaneous ultrasonographic imaging. Methods A prospective observational study was conducted on 82 patients aged 3–15 years with American Society of Anesthesiologists (ASA) physical status I or II. Patients under general anesthesia and with airway provided by a laryngeal mask airway were included. The position of the laryngeal mask airway was evaluated by ultrasonography on two planes. According to our scoring system, Grade I and Grade II were determined to indicate acceptable placement, while Grade III was determined to indicate unacceptable placement. Suboptimal laryngeal mask airway placement rates and the requirement of replacement were determined. Laryngeal mask airway placement optimized by ultrasonography was evaluated with both leak tests and a fiberoptic laryngoscope. Results The average age of the patients was 6.27 ± 4.66 years. After evaluation with ultrasonography, 65 (79.3%) of the laryngeal mask airways were found to be optimally positioned, while the position of 13 (15.9%) had to be corrected, and 4 (4.9%) had to be replaced. There was a moderate positive correlation between the ultrasonographic evaluation and leak test evaluation (p < 0.001; r = 0.628). Relocation of the laryngeal mask airway was determined to be an independent risk factor affecting the development of complications (OR = 2.961; p = 0.046; 95% Cl 2.850–30.745). Conclusion The use of ultrasonography to verify and relocate laryngeal mask airway placement is noninvasive and effective.