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Article ; Online: Bupivacaine combined with morphine for patient-controlled epidural analgesia after thoracotomy: high volume and low concentration vs. low volume and high concentration.

Tunç, M / Küçük, O / Ülger, G / Cirik, M Ö / Baldemir, R / Kaybal, O / Sazak, H

European review for medical and pharmacological sciences

2023 Volume 27, Issue 20, Page(s) 10041–10052

Abstract: Objective: In this prospective randomized controlled study, we aimed to evaluate the effects of the administration of equal doses of bupivacaine and morphine (BM) at high volume and low concentration (HV-LC) or low volume and high concentration (LV-HC) ... ...

Abstract	Objective: In this prospective randomized controlled study, we aimed to evaluate the effects of the administration of equal doses of bupivacaine and morphine (BM) at high volume and low concentration (HV-LC) or low volume and high concentration (LV-HC) on the number of drugs consumed, pain scores and side effects. Patients and methods: We randomized 64 patients who underwent thoracotomy into two groups. Group 1 received a solution prepared with 0.12% bupivacaine and 0.05 mg/cc morphine, administered with a basal infusion rate of 4 cc/h, a 2-cc bolus dose, and a 30-minute lockout time. Group 2 received a solution prepared with 0.48% bupivacaine and 0.2 mg/cc morphine, administered with a basal infusion rate of 1 cc/h, a 0.5-cc bolus dose, and a 30-minute lockout time. We compared patient-controlled epidural analgesia (PCEA) usage doses, pain scores, sensory and motor block, hemodynamic effects, side effects, and patient satisfaction in the postoperative periods. Results: An increase in drug consumption with PCEA was found in the first 24 hours postoperatively in Group 2 (p<0.05). Resting visual analog scale (VAS) scores were statistically significantly higher at hours 2, 28, 32, 36, 44 and coughing VAS scores were also higher at hours 2 and 20 in Group 2. Heart rates in Group 2 were lower than in Group 1 at hours 16, 24, 44 and 48 (p<0.05). The cephalic spread of the sensory block in Group 1 was more extensive (p<0.05). The groups demonstrated no significant differences regarding side effects and patient satisfaction (p>0.05). Conclusions: The HV-LC approach resulted in better analgesia, less drug consumption, and greater cephalic spread of sensory block than the LV-HC approach. Both applications were effective and safe in terms of analgesia and side effects.
MeSH term(s)	Humans ; Bupivacaine ; Morphine ; Anesthetics, Local ; Analgesia, Epidural/adverse effects ; Thoracotomy/adverse effects ; Prospective Studies ; Pain, Postoperative/drug therapy ; Pain, Postoperative/etiology ; Analgesics, Opioid ; Analgesia, Patient-Controlled
Chemical Substances	Bupivacaine (Y8335394RO) ; Morphine (76I7G6D29C) ; Anesthetics, Local ; Analgesics, Opioid
Language	English
Publishing date	2023-10
Publishing country	Italy
Document type	Randomized Controlled Trial ; Journal Article
ZDB-ID	605550-3
ISSN	2284-0729 ; 1128-3602 ; 0392-291X
ISSN (online)	2284-0729
ISSN	1128-3602 ; 0392-291X
DOI	10.26355/eurrev_202310_34184
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Article ; Online: Safety of geriatric patients undergoing endobronchial ultrasound-guided transbronchial needle aspiration with deep sedation: a retrospective study.

Tunç, Mehtap / Sazak, Hilal / Öztürk, Ayperi / Yılmaz, Aydın / Alagöz, Ali

BMC anesthesiology

2023 Volume 23, Issue 1, Page(s) 276

Abstract: Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) can be performed in a wide range, from minimal sedation to general anesthesia. Advanced age increases perioperative risks related to anesthesia and is also ... ...

Abstract	Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) can be performed in a wide range, from minimal sedation to general anesthesia. Advanced age increases perioperative risks related to anesthesia and is also associated with many pathological processes that further increase morbidity and mortality. The ideal sedation protocol for EBUS-TBNA has yet to be determined in geriatric patients. Deep sedation (DS) may increase the safety and performance of the procedure. There are limited studies evaluating the effectiveness and safety of EBUS-TBNA under DS in elderly patients. Methods: 280 patients who underwent EBUS-TBNA under DS were included in this retrospective study. 156 patients aged 65 years and over (Group 1) and 124 patients under 45 (Group 2) were compared. Demographic data, comorbidities, pulmonary function tests (PFTs), hemodynamic measurements, and peripheral oxygen saturation (SpO Results: There was no difference in body mass index, EBUS-TBNA procedure duration, and recovery time between geriatric and young patients(p > 0.05). The proportion of female patients, pre-anesthesia SpO Conclusions: The EBUS-TBNA procedure performed under DS was safe in elderly and young patients. Our study showed that the procedure and recovery times were similar in the elderly and young groups. The incidence of temporary high blood pressure during the procedure was higher in the elderly patients. The other complication rates during the procedure were similar in groups. Decreased propofol dose in the regimen using propofol alone has shown us that anesthetists are more sensitive to the administration of sedative agents in geriatric patients, taking into account comorbidities and drug interactions.
MeSH term(s)	Aged ; Female ; Humans ; Anesthesia, General ; Deep Sedation/adverse effects ; Hypertension/epidemiology ; Hypnotics and Sedatives/adverse effects ; Propofol/adverse effects ; Retrospective Studies ; Ultrasonography, Interventional ; Incidence
Chemical Substances	Hypnotics and Sedatives ; Propofol (YI7VU623SF)
Language	English
Publishing date	2023-08-16
Publishing country	England
Document type	Journal Article
ZDB-ID	2091252-3
ISSN	1471-2253 ; 1471-2253
ISSN (online)	1471-2253
ISSN	1471-2253
DOI	10.1186/s12871-023-02241-7
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Article: Unexpected difficult intubation with a double-lumen tube in a case of asymptomatic vallecular cyst.

Tunç, Mehtap / Sazak, Hilal / Baldemir, Ramazan / Alagöz, Ali

Turkish journal of anaesthesiology and reanimation

2022 Volume 49, Issue 4, Page(s) 334–337

Abstract: Vallecular cyst (VC) can cause difficult intubation. If a double-lumentube (DLT) has to be placed, difficulty in tracheal intubation becomes more complicated. The gum elastic bougie (GEB) is a widely used device for facilitating tracheal intubation ... ...

Abstract	Vallecular cyst (VC) can cause difficult intubation. If a double-lumentube (DLT) has to be placed, difficulty in tracheal intubation becomes more complicated. The gum elastic bougie (GEB) is a widely used device for facilitating tracheal intubation.However, there is not enough study with DLT to make a predictionfor success of GEB-guided intubation. Here, we aimed to describe our approach during unexpected difficult intubation due to VC in a patient required DLT insertion. We emphasize that, in case of confronting a patient with asymptomatic VC as a cause of difficult intubation, a successful DLT intubation is possible by sliding endobronchial lumen of DLT over pediatric GEB.
Language	English
Publishing date	2022-01-31
Publishing country	Turkey
Document type	Journal Article
ISSN	2667-677X
ISSN	2667-677X
DOI	10.5152/TJAR.2021.291
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Article: The Incidence of Itching in Thoracic Epidural Morphine Applications: Can Laboratory Parameters Be Effective in Predicting Itching?

Ulger, Gulay / Baldemir, Ramazan / Zengin, Musa / Sazak, Hilal / Alagoz, Ali

Cureus

2022 Volume 14, Issue 2, Page(s) e22257

Abstract: Background Epidural morphine, a powerful analgesic, also causes significant itching in patients. This study aimed to determine the incidence of thoracic epidural morphine-induced pruritus (EMIP) after thoracotomy and to investigate preoperative ... ...

Abstract	Background Epidural morphine, a powerful analgesic, also causes significant itching in patients. This study aimed to determine the incidence of thoracic epidural morphine-induced pruritus (EMIP) after thoracotomy and to investigate preoperative laboratory parameters for predicting itching in patients who received thoracic epidural morphine (TEM). Methods The patients were divided into two groups. The itching (+) group consists of patients who developed itching (n=31). The no-itching (-) / control group (n=31) was selected among patients who did not develop itching after TEM. Preoperative hemogram values, neutrophil/lymphocyte rate (NLR), platelet/lymphocyte rate (PLR), lymphocyte/monocytes rate (LMR), preoperative and postoperative alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase (ALP), gamma-glutamyl transferase values, and whether there was itching in the first 48 hours after surgery were determined. Results The incidence of thoracic EMIP after thoracotomy was 7.9%. While preoperative and postoperative ALP was found to be lower in patients with itching compared to those without itching. The cut-off value for preoperative/postoperative ALP was 84.5/53. Decreased white blood cell (WBC) could predict pruritus with a borderline statistical significance. Conclusions The incidence of EMIP after thoracotomy was lower compared to other literature data. Infusion of morphine only into the epidural area may cause a low incidence of EMIP. Laboratory parameters ALP and WBC can predict EMIP, but other hemogram parameters, NLR, LMR, and PLR cannot predict EMIP.
Language	English
Publishing date	2022-02-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.22257
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Article ; Online: Is there a correlation between preoperative neutrophil-to-lymphocyte, platelet-to-lymphocyte, and lymphocyte-to-monocyte ratios and postoperative pain in video-assisted thoracoscopic surgery?

Ülger, Gülay / Baldemir, Ramazan / Zengin, Musa / Sazak, Hilal / Alagöz, Ali

Medicine

2022 Volume 101, Issue 21, Page(s) e29472

Abstract: Abstract: Many thoracic surgery procedures are now performed with video-assisted thoracoscopic surgery (VATS). Postoperative pain is a common condition in patients undergoing VATS. In this study, we aimed to investigate whether neutrophil-to-lymphocyte ... ...

Abstract	Abstract: Many thoracic surgery procedures are now performed with video-assisted thoracoscopic surgery (VATS). Postoperative pain is a common condition in patients undergoing VATS. In this study, we aimed to investigate whether neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) are effective in evaluating postoperative pain in patients undergoing VATS.This prospective observational study was performed between March 2021 and September 2021 at a tertiary thoracic surgery center. The study included patients who had undergone elective VATS. Preoperative and postoperative NLR, PLR, LMR, hemogram values and postoperative visual analog scale (VAS) were recorded.A total of 105 patients were analyzed. A positive correlation was observed between postoperative monocyte, neutrophils and VAS resting and VAS cough levels in the early postoperative period. No significant correlation was found between preoperative and postoperative NLR, PLR, and LMR values and VAS rest and VAS cough values. When compared to the preoperative period, a negative correlation was found between the change in the postoperative LMR value and the VAS rest and VAS cough values in the early postoperative period.When compared to the preoperative period, the change in postoperative neutrophil, postoperative monocytes, and postoperative LMR values in patients undergoing VATS in thoracic surgery can be used as a guide in the objective evaluation of postoperative acute pain. It is the belief of the researchers that comprehensive new studies on this subject will contribute significantly to the determination of objective criteria in postoperative pain evaluation.
MeSH term(s)	Cough ; Humans ; Lymphocytes ; Monocytes ; Neutrophils ; Pain, Postoperative/diagnosis ; Pain, Postoperative/etiology ; Thoracic Surgery, Video-Assisted/adverse effects
Language	English
Publishing date	2022-05-27
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	80184-7
ISSN	1536-5964 ; 0025-7974
ISSN (online)	1536-5964
ISSN	0025-7974
DOI	10.1097/MD.0000000000029472
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Article ; Online: The Effect of Erector Spinae Plane Block and Combined Deep and Superficial Serratus Anterior Plane Block on Acute Pain After Video-Assisted Thoracoscopic Surgery: A Randomized Controlled Study.

Zengin, Musa / Sazak, Hilal / Baldemir, Ramazan / Ulger, Gulay / Alagoz, Ali

Journal of cardiothoracic and vascular anesthesia

2022 Volume 36, Issue 8 Pt B, Page(s) 2991–2999

Abstract: Objective: The study aimed to compare the analgesic effects of erector spinae plane block (ESPB) and a combination of the deep and superficial serratus anterior plane block (C-SAPB) methods in patients who underwent video-assisted thoracoscopic surgery ( ...

Abstract	Objective: The study aimed to compare the analgesic effects of erector spinae plane block (ESPB) and a combination of the deep and superficial serratus anterior plane block (C-SAPB) methods in patients who underwent video-assisted thoracoscopic surgery (VATS). Design: A prospective, randomized study. Setting: At a single-center, high-volume, tertiary thoracic surgery center. Participants: Adult patients undergoing VATS. Interventions: Ultrasound-guided ESPB and C-SAPB. Measurements and main results: Patients were assigned to ESPB (group 1) or C-SAPB (group 2) groups according to the analgesia protocol. All interventions were performed with single-needle insertion. Multimodal analgesia was achieved via paracetamol, dexketoprofen, and intravenous morphine for both study groups. Pain scores were assessed by the visual analog scale (VAS). Morphine consumption, rescue analgesic requirements, and side effects were recorded postoperatively for 24 hours. The primary outcome was determined as VAS scores at rest and coughing. The secondary outcomes of this study were postoperative morphine consumption and the requirement of rescue analgesics. There was no statistically significant difference between the groups in terms of VAS scores (p > 0.05). The groups also were similar in terms of demographic characteristics, side effects, morphine consumption, additional analgesic use, and duration of block procedures (p > 0.05). There also were comparable results in terms of hemodynamic variables (p > 0.05). Conclusions: Patients who underwent VATS receiving ESPB or C-SAPB had similar pain scores, opioid consumption, and side effects during the first postoperative 24 hours. At the same time, the fact that the duration of the block procedure was similar in both groups showed that multisite serratus anterior plane block can be an effective alternative method in analgesic treatment after VATS, considering that it easily can be applied. The authors here think that C-SAPB can be a good alternative to ESPB because the outcomes of both applications are similar, and C-SAPB easily can be seen and applied with ultrasound.
MeSH term(s)	Acute Pain ; Adult ; Humans ; Morphine/therapeutic use ; Nerve Block/methods ; Pain, Postoperative/drug therapy ; Pain, Postoperative/etiology ; Pain, Postoperative/prevention & control ; Prospective Studies ; Thoracic Surgery, Video-Assisted/adverse effects ; Thoracic Surgery, Video-Assisted/methods
Chemical Substances	Morphine (76I7G6D29C)
Language	English
Publishing date	2022-02-04
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial
ZDB-ID	1067317-9
ISSN	1532-8422 ; 1053-0770
ISSN (online)	1532-8422
ISSN	1053-0770
DOI	10.1053/j.jvca.2022.01.048
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Article ; Online: Comparison of the effects of one-level and bi-level pre-incisional erector spinae plane block on postoperative acute pain in video-assisted thoracoscopic surgery; a prospective, randomized, double-blind trial.

Zengin, Emine Nilgün / Zengin, Musa / Yiğit, Hülya / Sazak, Hilal / Şekerci, Sumru / Alagöz, Ali

BMC anesthesiology

2023 Volume 23, Issue 1, Page(s) 270

Abstract: Background: This prospective, randomized, double-blind trial aimed to compare the postoperative analgesic efficacy of One-Level pre-incisional erector spinae plane block (ESPB) and Bi-Level pre-incisional ESPB in patients undergoing video-assisted ... ...

Abstract	Background: This prospective, randomized, double-blind trial aimed to compare the postoperative analgesic efficacy of One-Level pre-incisional erector spinae plane block (ESPB) and Bi-Level pre-incisional ESPB in patients undergoing video-assisted thoracic surgery (VATS). Methods: This pilot trial was conducted between April 2022 and February 2023 with sixty patients. The patients were randomly divided into two groups. In One-Level ESPB Group (n = 30) block was performed at the thoracal(T)5 level with the 30 ml 0.25% bupivacaine. In the Bi-Level ESPB Group (n = 30) block was performed at T4 and T6 levels by using 15 ml of 0.25% bupivacaine for each level. In the postoperative period, 50 mg dexketoprofen every 12 h and 1 g paracetamol every 8 h were given intravenously (IV). Patient-controlled analgesia (PCA) prepared with morphine was applied to the patients. 0.5 mg/kg of tramadol was administered via IV for rescue analgesia. Visual analog scale (VAS) scores were recorded in the postoperative 1 Results: VAS scores at resting were statistically significantly higher at the 1 Conclusions: Adequate analgesia was achieved in the early postoperative period in the group treated with Bi-Level ESPB with similar morphine consumption and side effects. This may be an advantage, especially in the early postoperative period when the pain is quite intense.
MeSH term(s)	Humans ; Acute Pain/drug therapy ; Acute Pain/prevention & control ; Analgesia, Patient-Controlled ; Analgesics, Opioid ; Bupivacaine/administration & dosage ; Cough ; Drug-Related Side Effects and Adverse Reactions ; Morphine ; Nerve Block/methods ; Pain, Postoperative/drug therapy ; Pain, Postoperative/prevention & control ; Prospective Studies ; Thoracic Surgery, Video-Assisted ; Ultrasonography, Interventional
Chemical Substances	Analgesics, Opioid ; Bupivacaine (Y8335394RO) ; Morphine (76I7G6D29C)
Language	English
Publishing date	2023-08-11
Publishing country	England
Document type	Randomized Controlled Trial ; Journal Article
ZDB-ID	2091252-3
ISSN	1471-2253 ; 1471-2253
ISSN (online)	1471-2253
ISSN	1471-2253
DOI	10.1186/s12871-023-02232-8
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Article ; Online: Correction: Comparison of analgesic efficacy of different local anesthetic volumes for erector spinae plane block in thoracotomy patients; a prospective randomized trial.

Zengin, Musa / Sazak, Hilal / Baldemir, Ramazan / Ulger, Gulay / Arican, Dilara / Kaybal, Oya / Alagoz, Ali

BMC anesthesiology

2023 Volume 23, Issue 1, Page(s) 70

Language	English
Publishing date	2023-03-07
Publishing country	England
Document type	Published Erratum
ZDB-ID	2091252-3
ISSN	1471-2253 ; 1471-2253
ISSN (online)	1471-2253
ISSN	1471-2253
DOI	10.1186/s12871-023-02031-1
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Article ; Online: Comparison of analgesic efficacy of different local anesthetic volumes for erector spinae plane block in thoracotomy patients; a prospective randomized trial.

Zengin, Musa / Sazak, Hilal / Baldemir, Ramazan / Ulger, Gulay / Arican, Dilara / Kaybal, Oya / Alagoz, Ali

BMC anesthesiology

2023 Volume 23, Issue 1, Page(s) 42

Abstract: Background: Erector spinae plane block (ESPB) is a thoracic wall block that has been used frequently in recent years. It was aimed to compare the analgesic efficacy of bupivacaine in different volumes for ESPB in patients undergoing thoracotomy.: ... ...

Abstract	Background: Erector spinae plane block (ESPB) is a thoracic wall block that has been used frequently in recent years. It was aimed to compare the analgesic efficacy of bupivacaine in different volumes for ESPB in patients undergoing thoracotomy. Methods: Patients who were in the age range of 18 to 65 years, ASA I-III, had a body mass index (BMI) of 18-30 kg/m Results: Visual analog scale (VAS) resting scores, the 1 Conclusions: The results of ESPB applied with 20 ml and 30 ml of local anesthetic before the surgical incision in thoracotomy patients showed that the use of 30 ml of local anesthetic provided more effective analgesia. In addition, similar side-effect rates show that 30 ml of local anesthetic can be used safely.
MeSH term(s)	Humans ; Adolescent ; Young Adult ; Adult ; Middle Aged ; Aged ; Anesthetics, Local/therapeutic use ; Pain, Postoperative/prevention & control ; Pain, Postoperative/drug therapy ; Thoracotomy ; Prospective Studies ; Nerve Block/methods ; Bupivacaine ; Analgesics/therapeutic use ; Analgesia, Patient-Controlled ; Morphine/therapeutic use
Chemical Substances	Anesthetics, Local ; Bupivacaine (Y8335394RO) ; Analgesics ; Morphine (76I7G6D29C)
Language	English
Publishing date	2023-02-06
Publishing country	England
Document type	Randomized Controlled Trial ; Journal Article
ZDB-ID	2091252-3
ISSN	1471-2253 ; 1471-2253
ISSN (online)	1471-2253
ISSN	1471-2253
DOI	10.1186/s12871-023-02004-4
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Article ; Online: The effect of body mass index on thoracic paravertebral block analgesia after video-assisted thoracoscopic surgery; a prospective interventional study.

Zengin, Emine Nilgün / Alagöz, Ali / Yiğit, Hülya / Sazak, Hilal / Şekerci, Sumru / Zengin, Musa

BMC anesthesiology

2023 Volume 23, Issue 1, Page(s) 297

Abstract: Background: To investigate the effects of body mass index (BMI) on intensity postoperative pain in patients who underwent thoracic paravertebral block (TPVB) for postoperative analgesia after video-assissted thoracoscopic surgery (VATS).: Methods: ... ...

Abstract	Background: To investigate the effects of body mass index (BMI) on intensity postoperative pain in patients who underwent thoracic paravertebral block (TPVB) for postoperative analgesia after video-assissted thoracoscopic surgery (VATS). Methods: Patients aged 18-80 years, ASA I-III, and BMI 18-40 kg/m Results: The post-hoc test revealed that the VAS resting scores at the 4 Conclusions: Higher postoperative VAS scores with TPVB applied in obese patients and the consequent increase in additional analgesics and complications require more specific postoperative management in this patient group.
MeSH term(s)	Humans ; Thoracic Surgery, Video-Assisted ; Body Mass Index ; Prospective Studies ; Analgesia, Patient-Controlled ; Morphine ; Cough
Chemical Substances	Morphine (76I7G6D29C)
Language	English
Publishing date	2023-09-04
Publishing country	England
Document type	Journal Article
ZDB-ID	2091252-3
ISSN	1471-2253 ; 1471-2253
ISSN (online)	1471-2253
ISSN	1471-2253
DOI	10.1186/s12871-023-02264-0
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