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Öğe Acetaminophen reduces acute and persistent incisional pain after hysterectomy(Edizioni Luigi Pozzi, 2018) Koyuncu, Onur; Hakimoglu, Sedat; Ugur, Mustafa; Akkurt, Cagla; Turhanoglu, Selim; Sessler, Daniel; Turan, AlparslanOBJECTIVE: Acetaminophen is effective for acute surgical pain, but whether it reduces persistent incision pain remains unknown. We tested the primary hypothesis that patients given perioperative acetaminophen have less incisional pain three months after surgery. Our secondary hypotheses were that patients randomized to acetaminophen have less postoperative pain and analgesic consumption, and better functional recovery at three months. METHODS: 140 patients having abdominal hysterectomy were randomly assigned to: 1)intravenous acetaminophen (4 g/day for 72 postoperative hours); or, 2) saline placebo. The primary outcome was incisional pain visual analog scale (VAS) at three months after surgery. The secondary outcomes were (1, 2) postoperative VAS scores while laying and sitting and (3) total patient-controlled intravenous tramadol consumption during the initial 24 hours, (4) DN4 questionnaires and (5) SF-12 at three months after surgery. RESULTS: The persistent incisional pain scores at three months were significantly lower in acetaminophen (median [121, Q3]: 0 [0, 01) as compared with saline group (0 [0, 1]) (P = 0.002). Specifically, 89%, 9%, and 2% of acetaminophen patients with VAS pain score at three months of 0, 1, and 2 or more, as compared with 66%, 23%, and 10% in the saline group (odds ratio: 2.19 (95% CI: 1.33, 3.59), P = 0.002). Secondly, postoperative pain scores both laying and sitting were significantly lower in the acetaminophen group. Acetaminophen group had significantly better DN4 score and mental health related but not physical health related quality of life. CONCLUSIONS: Our results suggest that acetaminophen reduces the risk and intensity of persistent incisional pain. However, there are other mechanisms by which acetaminophen might reduce persistent pain.Öğe Assessment of the perioperative period in civilians injured in the Syrian Civil War(Elsevier Science Inc, 2015) Hakimoglu, Sedat; Karcioglu, Murat; Tuzcu, Kasim; Davarci, Isil; Koyuncu, Onur; Dikey, Ismail; Turhanoglu, SelimBackground: Wars and its challenges have historically afflicted humanity. In Syria, severe injuries occurred due to firearms and explosives used in the war between government forces and civilians for a period of over 2 years. Materials and methods: The study included 364 cases, who were admitted to Mustafa Kemal University Hospital, Medicine School (Hatay, Turkey), and underwent surgery. Survivors and non-survivors were compared regarding injury site, injury type and number of transfusions given. The mortality rate found in this study was also compared to those reported in other civil wars. Results: The mean age was 29 (3-68) years. Major sites of injury included extremities (56.0%), head (20.1%), abdomen (16.2%), vascular structures (4.4%) and thorax (3.3%). Injury types included firearm injury (64.4%), blast injury (34.4%) and miscellaneous injuries (1.2%). Survival rate was 89.6% while mortality rate was 10.4%. A significant difference was observed between mortality rates in this study and those reported for the Bosnia and Lebanon civil wars; and the difference became extremely prominent when compared to mortality rates reported for Vietnam and Afghanistan civil wars. Conclusion: Among injuries related to war, the highest rate of mortality was observed in head-neck, abdomen and vascular injuries. We believe that the higher mortality rate in the Syrian Civil War, compared to the Bosnia, Vietnam, Lebanon and Afghanistan wars, is due to seeing civilians as a direct target during war. (C) 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.Öğe Chemotherapy Related Angioedema Reply(Aves, 2015) Hakimoglu, Sedat; Tuzcu, Kasim; Davarci, Isil; Karcioglu, Murat; Kurt, Raziye; Dikey, Ismail[Abstract Not Available]Öğe Colonoscope incarceration in an inguinal hernia: a complication of colonoscopy(Georg Thieme Verlag Kg, 2015) Tas, Adnan; Oruc, Cem; Olmez, Sehmus; Sahan, Mustafa; Ugur, Mustafa; Hakimoglu, Sedat; Demir, Mehmet[Abstract Not Available]Öğe Comparison between ultrasound-guided sciatic-femoral nerve block and unilateral spinal anaesthesia for outpatient knee arthroscopy(Sage Publications Ltd, 2013) Davarci, Isil; Tuzcu, Kasim; Karcioglu, Murat; Hakimoglu, Sedat; Ozden, Raif; Yengil, Erhan; Akkurt, Cagla OzbakisObjective To compare unilateral spinal anaesthesia (USA) and ultrasound-guided combined sciatic-femoral nerve block (USFB) in ambulatory arthroscopic knee surgeries in terms of haemodynamic stability, nerve block quality, bladder function, adverse events and time-to-readiness for discharge (TRD). Methods Patients undergoing ambulatory arthroscopic knee surgery were randomly assigned to one of two groups. The USA group received 2ml (10mg) of 0.5% levobupivacaine and the USFB group received a 25ml mixture consisting of 10ml of 2.0% lidocaine, 10ml of 0.5% levobupivacaine and 5ml of saline (15ml for the femoral and 10ml for the sciatic nerve block). Preparation time (PT), surgical anaesthesia time (SAT), operation time, total anaesthesia time, time-to-first spontaneous urination, time-to-first analgesia, TRD, adverse events and patient satisfaction were recorded. Results A total of 40 patients were enrolled in the study (n=20 per group). PT, SAT, total anaesthesia time and time-to-first analgesia were significantly shorter in the USA group than the USFB group; time-to-first spontaneous urination and TRD were significantly longer in the USA group than the USFB group. Conclusions USFB provided sufficient duration of sensory blockade and it reduced the TRD and the rate of adverse events.Öğe Comparison of sugammadex and neostigmine-atropine on intraocular pressure and postoperative effects(Elsevier Taiwan, 2016) Hakimoglu, Sedat; Tuzcu, Kasim; Davarci, Isil; Karcioglu, Murat; Tuzcu, Esra Ayhan; Hanci, Volkan; Aydin, SuzanDuring surgery, changes in intraocular pressure (IOP) can be observed resulting from several factors, such as airway manipulations and drugs used. We aimed to investigate the effects of sugammadex and neostigmine on IOP, hemodynamic parameters, and complications after extubation. Our study comprised 60 patients, aged 18-65 years, with a risk status of the American Society of Anesthesiologists I-II who underwent arthroscopic surgery under general anesthesia. The patients were randomly assigned into two groups. At the end of the surgery, the neuromuscular block was reversed using neostigmine (50 mu g/kg) plus atropine (15 mu g/kg) in Group 1, and sugammadex (4 mg/kg) in Group 2. Neuromuscular blockade was monitored using acceleromyography and a train-of-four mode of stimulation. IOP was measured before induction and at 30 seconds, 2 minutes, and 10 minutes after extubation. A Tono-Pen XL applanation tonometer was used to measure IOP. This showed that elevation in IOP of patients reversed using sugammadex was similar to that recorded in patients reversed using neostigmine-atropine. When heart rate was compared, there was a significant difference between basal values and those obtained at 30 seconds and 10 minutes after extubation in the neostigmine-atropine group. Extubation time (time from withdrawal of anesthetic gas to extubation) was significantly shorter in the sugammadex group (p = 0.003) than in the neostigmine -atropine group. The postextubation IOP values of the sugammadex group were similar to the neostigmine-atropine group. Extubation time (time from withdrawal of anesthetic gas to extubation) was significantly shorter in the sugammadex group (p = 0.003) than in the neostigmine-atropine group. Copyright (C) 2016, Kaohsiung Medical University. Published by Elsevier Taiwan LLC.Öğe Comparison of the postoperative effects of the erector spinae plane block and local infiltration analgesia in patients operated with lumbotomy surgery incision: Randomized clinical study(Lippincott Williams & Wilkins, 2024) Hakimoglu, Sedat; Ozdemir, Taner; Comez, Mehmet Selim; Urfali, Senem; Yildirak, Ekrem; Gorur, Sadik; Turhanoglu, SelimBackground:Our aim was to observe the effects of local infiltration analgesia (LIA) or erector spinae plane block (ESPB) methods, which we applied preemptively in patients who were scheduled for surgery with a lumbotomy surgical incision and on intraoperative remifentanil consumption, and to compare the postoperative numerical rating scale (NRS), morphine demand, consumption, and pain degrees.Methods:Sixty American Society of Anesthesiologists I to III patients aged 18 to 75 years who were due to be operated on with a lumbotomy surgical incision were included in the study. The present study was conducted via prospective, randomized controlled, double-blind trials. After the induction of standard anesthesia, LIA was applied to 30 patients and ESPB was applied to 30 patients preemptively. The dose of remifentanil consumed in the intraoperative period was measured, and the hemodynamic parameters were measured every 5 minutes. Morphine bolus treatment with the postoperative patient-controlled analgesia and rescue analgesia with paracetamol were planned for the patients. Postoperative morphine and additional analgesia consumption, NRS, hemodynamic parameters, and complications were recorded for 48 hours.Results:There was no difference between the groups in terms of demographic and hemodynamic data. The mean consumption of remifentanil was measured as 455 +/- 165.23 mu g in the intraoperative ESPB group and 296.67 +/- 110.59 mu g in the LIA group, and a statistical difference was observed (P = .001). In the postoperative follow-ups, the ESPB group drug consumption and NRS score averages were significantly lower at all times (P = .01; patient-controlled analgesia-morphine, 41.93 +/- 14.47 mg vs 57.23 +/- 15.5 mg and additional analgesic-paracetamol: 2.1 +/- 1.06 vs 4.27 +/- 1.14 g). The mean duration of additional analgesic intake of the groups was 10.6 +/- 8.1 in the LIA group, while it was 19.33 +/- 8.87 in the ESPB group, a significant difference. The patient satisfaction questionnaire was also significantly in favor of ESPB (P = .05).Conclusions:In conclusion, it has been shown that the intraoperative LIA method is more effective in terms of remifentanil consumption and in controlling pain in operations performed with a flank incision, but the ESPB method provides longer and more effective pain control in postoperative follow-ups.Öğe Cost-Conscious of Anesthesia Physicians: An awareness survey(Professional Medical Publications, 2015) Hakimoglu, Sedat; Hanci, Volkan; Karcioglu, Murat; Tuzcu, Kasim; Davarci, Isil; Kiraz, Hasan Ali; Turhanoglu, SelimObjective: Increasing competitive pressure and health performance system in the hospitals result in pressure to reduce the resources allocated. The aim of this study was to evaluate the anesthesiology and intensive care physicians awareness of the cost of the materials used and to determine the factors that influence it. Methods: This survey was conducted between September 2012 and September 2013 after the approval of the local ethics committee. Overall 149 anesthetists were included in the study. Participants were asked to estimate the cost of 30 products used by anesthesiology and intensive care units. Results: One hundred forty nine doctors, 45% female and 55% male, participated in this study. Of the total 30 questions the averages of cost estimations were 5.8% accurate estimation, 35.13% underestimation and 59.16% overestimation. When the participants were divided into the different groups of institution, duration of working in this profession and sex, there were no statistically significant differences regarding accurate estimation. However, there was statistically significant difference in underestimation. In underestimation, there was no significant difference between 16-20 year group and >20 year group but these two groups have more price overestimation than the other groups (p=0.031). Furthermore, when all the participants were evaluated there were no significant difference between age-accurate cost estimation and profession time-accurate cost estimation. Conclusion:Anesthesiology and intensive care physicians in this survey have an insufficient awareness of the cost of the drugs and materials that they use. The institution and experience are not effective factors for accurate estimate. Programs for improving the health workers knowledge creating awareness of cost should be planned in order to use the resources more efficiently and cost effectively,Öğe The development of ventricular fibrillation due to etomidate for anesthetic induction: a very rare side effect, case report(Elsevier Science Inc, 2014) Karcioglu, Murat; Davarci, Isil; Kirecci, Nuray; Akcay, Adnan Burak; Turhanoglu, Selim; Tuzcu, Kasim; Hakimoglu, SedatBackground and objectives: Ventricular fibrillation occurring in a patient can result in unexpected complications. Here, our aim is to present a case of ventricular fibrillation occurring immediately after anesthesia induction with etomidate administration. Case report: A fifty-six-year-old female patient with a pre-diagnosis of gallstones was admitted to the operating room for laparoscopic cholecystectomy. The induction was performed by etomidate with a bolus dose of 0.3 mg/kg. Severe and fast adduction appeared in the patient's arms immediately after induction. A tachycardia with wide QRS and ventricular rate 188 beat/min was detected on the monitor. The rhythm turned to VF during the preparation of cardioversion. Immediately we performed defibrillation to the patient. Sinus rhythm was obtained. It was decided to postpone the operation due to the patient's unstable condition. Conclusion: In addition to other known side effects of etomidate, very rarely, ventricular tachycardia and fibrillation can be also seen. To the best of our knowledge, this is the first case regarding etomidate causing VF in the literature. (C) 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.Öğe THE EFFECT OF LOW-FLOW VERSUS HIGHFLOW ANESTHESIA ON POSTOPERATIVE COGNITIVE FUNCTIONS IN GERIATRIC PATIENTS UNDERGOING TUR-P SURGERY(Turkish Geriatrics Soc, 2024) Unal, Ekin Anil; Comez, Mehmet Selim; Demirkiran, Hilmi; Koyuncu, Onur; Hakimoglu, Sedat; Urfali, SenemIntroduction: This paper investigates the effect of low -flow anesthesia applications on postoperative cognitive function in geriatric age group (>= 65 years old) patients who underwent elective transurethral resection of the prostate surgery. Materials and Method: A total of 98 patients aged 65 and over who underwent elective transurethral resection of the prostate surgery under general anesthesia between December 2021 and November 2022 in Hatay Mustafa Kemal University Research Hospital's Department of Anesthesiology and Reanimation were included in the study. The patients were subjected to a mini mental test the day before the operation and postoperatively at six hours, one day, three days, and seven days. Visual analogue scale scores were evaluated at 3, 6, 12, 24, 48, and 72 hours. The data obtained were compared between the patient groups who underwent low -flow (1 L/min, n: 49) and high flow (4 L/min, n: 49) anesthesia. P< 0.05 was considered statistically significant. Results: A comparison between the postoperative 6thhour, 1st day, 2nd day, 3rd day, and 7th day mini mental testing scores of the low -flow anesthesia and high flow anesthesia groups did not exhibit any notable variations (p: 0.668, 0.785, 0.745, 0.705, respectively). The visual analogue scale scores of the cases at 3, 6, 12, 24, 48, and 72 hours did not differ statistically according to the type of flow applied (p: 0.316, 0.925, 0.651, 0.548, 0.624, 0.466, respectively). Conclusion: It is thought that low -flow anesthesia can be applied safely, but it does not have a significant effect on cognitive functions compared to high flow anesthesia.Öğe Effectiveness of sub-Tenon's block in pediatric strabismus surgery(Elsevier Science Inc, 2015) Tuzcu, Kasim; Coskun, Mesut; Tuzcu, Esra Ayhan; Karcioglu, Murat; Davarci, Isil; Hakimoglu, Sedat; Aydin, SuzanBackground and objectives: Strabismus surgery is a frequently performed pediatric ocular procedure. A frequently occurring major problem in patients receiving this treatment involves the oculocardiac reflex. This reflex is associated with an increased incidence of postoperative nausea, vomiting, and pain. The aim of this study was to investigate the effects of a sub-Tenon's block on the oculocardiac reflex, pain, and postoperative nausea and vomiting. Methods: Forty patients aged 5-16 years with American Society of Anesthesiologists status I-II undergoing elective strabismus surgery were included in this study. Patients included were randomly assigned into two groups by using a sealed envelope method. In group 1 (n=20), patients did not receive sub-Tenon's anesthesia. In group 2 (n=20), following intubation, sub-Tenon's anesthesia was performed with the eye undergoing surgery. Atropine use, pain scores, oculocardiac reflex, and postoperative nausea and vomiting incidences were compared between groups. Results: There were no significant differences between groups with regard to oculocardiac reflex and atropine use (p> 0.05). Pain scores 30 min post-surgery were significantly lower in group 2 than in group 1 (p< 0.05). Additional analgesic needed during the postoperative period was significantly lower in group 2 compared to group 1 (p< 0.05). Conclusions: In conclusion, we think that a sub-Tenon's block, combined with general anesthesia, is not effective and reliable in decreasing oculocardiac reflex and postoperative nausea and vomiting. However, this method is safe for reducing postoperative pain and decreasing additional analgesia required in pediatric strabismus surgery. (c) 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.Öğe The effects of nitrous oxide on vascular endothelial growth factor (VEGF) and its soluble receptor 1 (VEGFR1) in patient undergoing urological surgery(Professional Medical Publications, 2014) Hakimoglu, Yasemin; Can, Murat; Hakimoglu, Sedat; Mungan, Ayca Gorkem; Acikgoz, Sereften; Yildirim, Nuran Cikcikoglu; Mungan, Necmettin AydinObjective: Anesthesia and surgical intervention, leads to the development of systemic inflammatory response. The severity of the inflammatory response depends on the pharmacological effects of anesthetic agents and duration of anesthesia. Objective of the study was to investigate the effect of nitrous oxide on VEGF and VEGFR1 levels in patients undergoing surgery. Methods: Forty-four patients undergoing elective urological surgery were included in the study. Anesthesia maintenance was provided with 1-2 MAC sevoflurane, O-2 50%, N2O 50% in 4L/m transporter gase for group 1 (n = 22) and 1-2 MAC sevoflurane, O-2 50%, air 50% in 4L/m transporter gase for group 2 (n = 22) Venous blood samples for the measurement of VEGF and VEGFR1 were taken before the induction of anaesthesia, 60 minutes of anesthesia induction, at the end of anaesthesia and 24 hours after operation. In statistical analysis Bonferroni test and analysis of variance at the repeated measures were used Results: In the postoperative period serum VEGF levels had decreased significantly in both group whereas VEGFR1 did not show a significant change. Conclusions: Nitrous oxide showed significant effect on angiogenic parameters. Further detailed studies are required to evaluate the effect of nitrous oxide.Öğe Intraoperative Ephedrine Allergy in a Patient Who Received Chemotherapy and Perioperative Hypersensitivity Reactions(Aves, 2015) Hakimoglu, Sedat; Tuzcu, Kasim; Davarci, Isil; Karcioglu, Murat; Kurt, Raziye; Dikey, IsmailAnaesthesia represents a specific set-up in respect to pharmacology, and during this time, early hypersensitivity reactions or anaphylaxis may occur in patients who are exposed to a great number of foreign substances. Intravenous ephedrine (5 mg) was applied to a 37-year-old patient due to the development of intraoperative hypotension in a total abdominal hysterectomy operation. After application, hyperaemia was seen in the track of the intravenous catheter of that extremity. Approximately 15 minutes later, urticarial plaques were observed extensively in the abdomen and in both extremities. Methylprednisolone (100 mg+ 100 mg) and pheniramine (45.5 mg) were given with an increasing infusion rate of intravenous crystalloid. The patient was extubated without any problem and removed to the recovery unit for observation. After the total disappearance of lesions at postoperative 60 minutes and because of the stability of vital signs, the patient was removed to the service. In the follow-up of surgery, no complication developed, and the patient was discharged on postoperative day 2.Öğe Perioperative Anaesthetic Approach in a Homozygous Sickle Cell Anaemia Patient with Frequent Pain Crises(Aves, 2014) Tuzcu, Kasim; Karcioglu, Murat; Davarci, Isil; Hakimoglu, Sedat; Akkucuk, SeckinSickle cell disease (HbS) is a haemolytic anaemia characterized by the formation of abnormal haemoglobin. In patients with sickle cell disease, high rates of erythrocyte generation, degradation, and hyperbilirubinemia increase the risk for cholelithiasis. Previous studies have found that the incidence of cholelithiasis is 70% in adult patients. In sickle cell disease, decreased oxygen concentration leads to the sickling of erythrocytes by causing aggregation and polymerization. Sickle erythrocytes can have devastating effects on many vital organs by causing microvascular occlusion. In patients with sickle cell anaemia, anaesthetic technique, anaesthetic agents, and surgical trauma may cause additional risk. In this case report, we present a perioperative anaesthetic approach in the laparoscopic cholecystectomy of a patient with HbS, elevated liver function tests, and frequent pain crises.Öğe Preoperative management of sickle cell patients with hydroxyurea(Medi+World Int, 2015) Helvaci, Mehmet Rami; Hakimoglu, Sedat; Sariosmanoglu, Mehmet Oktay; Kardas, Suleyman; Bahar, Beray; Filoglu, Merve; Deler, Ibrahim UgurBackground: We tried to understand whether or not there are some beneficial changes of health parameters with hydroxyurea in sickle cell diseases (SCDs) cases. Methods: All SCDs cases were enrolled, and a hydroxyurea therapy was initiated. Results: We studied 337 patients, totally. Hydroxyurea was well-tolerated with a majority of patients (80.1%). Mean number (10.3 versus 1.7 crises per year, p<0.000) and mean severity of painful crises decreased, significantly (7.8 versus 2.2, p<0.001). Although body weight and mean hematocrit (Hct) value increased, white blood cell (WBC) and platelet (PLT) counts and total and direct bilirubin and lactate dehydrogenase (LDH) levels decreased, significantly (p<0.000 for all). On the other hand, there were avascular necrosis of bones in 18.9%, leg ulcers in 12.7%, pulmonary hypertension in 11.5%, chronic renal disease in 8.3%, coronary heart disease in 7.7%, digital clubbing in 6.5%, stroke in 6.5%, exitus in 5.3%, chronic obstructive pulmonary disease in 4.7%, and cirrhosis in 3.2% of the patients. Conclusion: SCDs are chronic inflammatory disorders initiating at birth. Hydroxyurea decreases frequency and severity of painful crises, WBC and PLT counts, and total and direct bilirubin and LDH levels, and it increases body weight and Hct value, all of which indicate a decreased inflammatory process in patients. Thus elective surgical procedures should be performed after a few months of treatment with hydroxyurea in non-users. By this way, beside decreased requirement of blood transfusions, perioperative morbidity and mortality will also be lowered due to decreased inflammatory process on capillary endothelium all over the body.Öğe Strategies to Prevent Postoperative Nausea and Vomiting(Kare Publ, 2020) Koyuncu, Onur; Urfali, Senem; Hakimoglu, Sedat; Tasdogan, A. MuhittinNausea and vomiting seen within the post-operative recovery room or 24 hours following the operation remain one of the most common complications in the postoperative period. Nausea and vomiting decrease the patient's postoperative satisfaction, which may lead to complications, such as aspiration of gastric contents, dehydration, electrolyte imbalance, hemorrhage, it may also bring about economic losses, prolongs recovery time and length of hospital stay. Therefore, in the preoperative process, it is very important to investigate the risks correctly for each patient concerning postoperative nausea and vomiting and to identify and apply risk-reducing pharmacological and non-pharmacological treatment methods. In this review, the importance of postoperative nausea and vomiting, risk factors, strategies to reduce risks and the treatment algorithm used in prophylaxis are presented.Öğe Successful Management of Aluminium Phosphide Poisoning Resulting in Cardiac Arrest(Aves, 2015) Hakimoglu, Sedat; Dikey, Ismail; Sari, Ali; Kekec, Leyla; Tuzcu, Kasim; Karcioglu, MuratAluminum phosphide has high toxicity when it is ingested, and in case of contact with moisture, phosphine gas is released. Aluminum phosphide poisoning causes metabolic acidosis, arrhythmia, acute respiratory distress syndrome and shock, and there is no specific antidote. A 17-year-old male patient was referred to our hospital because of aluminum phosphide poisoning with 1500 mg of aluminum phosphide tablets. The patient's consciousness was clear but he was somnolent. Vital parameters were as follows: blood pressure: 85/56 mmHg, pulse: 88 beats/min, SpO(2) : 94%, temperature: 36.4 degrees C. Because of hypotension, noradrenaline and dopamine infusions were started. The patient was intubated because of respiratory distress and loss of consciousness. Severe metabolic acidosis was determined in the arterial blood gas, and metabolic acidosis was corrected by sodium bicarbonate treatment. In addition to supportive therapy of the poisoning, haemodialysis was performed. Cardiac arrest occurred during follow-ups in the intensive care unit, and sinus rhythm was achieved after 10 min of cardiopulmonary resuscitation. The patient was discharged after three sessions of haemodialysis on the ninth day. As a result, haemodialysis contributed to symptomatic treatment of aluminum phosphide poisoning in this case report.Öğe Three blocks, including Pericapsular Nerve Block (PENG) for a femoral shaft fracture pain(Elsevier Science Inc, 2019) Koyuncu, Onur; Hakimoglu, Sedat; Polat, Sibel Tugce; Kara, Merve Yazici[Abstract Not Available]Öğe Transversus Abdominis Plane Block Following Cesarean Section: A Prospective Randomized Controlled Study Comparing the Effects on Pain Levels of Bupivacaine, Bupivacaine plus Dexmedetomidine, and Bupivacaine plus Dexamethasone(Mdpi, 2024) Urfali, Senem; Hakimoglu, Sedat; Turhanoglu, Selim; Koyuncu, OnurBackground: The transversus abdominis plane (TAP) block is providing effective postoperative analgesia in patients undergoing cesarean section (CS). This study aims to evaluate and compare the effects on pain levels of bupivacaine alone versus bupivacaine combined with dexmedetomidine and bupivacaine combined with dexamethasone in ultrasound-guided TAP block for postoperative pain after CS. Material and Method: In this randomized controlled trial, 120 patients with American Society of Anesthesiologists (ASA) physical status I and II scheduled for elective cesarean section under spinal anesthesia were randomly divided into three groups. At the end of the surgery, an ultrasound-guided TAP block was performed on all patients: bupivacaine 0.5% (Group B), bupivacaine 0.5% + dexmedetomidine (1 mu g/kg) (Group BD), and bupivacaine 0.5% + dexamethasone (4 mg) (Group BDx). Postoperatively, all patients were evaluated at 0, 1, 4, 8, 16, and 24 h for visual analog scores VASs, tramadol consumption, complications, and patient satisfaction. A p value of < 0.05 is statistically significant. Results: At 0 h, VASs in the sitting and supine positions were significantly higher in the BDx group (0.85 +/- 1.61 and 0.85 +/- 1.36, respectively) compared to the B group (0.05 +/- 0.32 in both positions) and the BD group (0.15 +/- 0.48 in both positions) (p = 0.005 and p = 0.001, respectively). At the 24th hour, VASs in the sitting and supine positions were significantly lower in the BDx group (1.7 +/- 1.2 and 1.43 +/- 1.05) compared to the B group (2.3 +/- 0.68 and 2.2 +/- 0.72) and the BD group (2.57 +/- 1.01 and 2.28 +/- 0.78) (p = 0.005 and p = 0.001, respectively). At 0 h, the tramadol requirement was highest in the BDx group at 12.5%, while it was not required in the B and BD groups (p = 0.005). At 0 h, the rate of nausea and vomiting was highest in the BDx group at 17.5%, compared to 2.5% in the BD group and 0% in the B group (p = 0.003). Patient satisfaction scores were higher in the dexamethasone group compared to the other groups. This was significant between Group B and Group BDx (p = 0.009 < 0.05). Conclusions: Adding dexmedetomidine or dexamethasone to bupivacaine in ultrasound-guided TAP blocks reduces postoperative pain and increases patient satisfaction after cesarean sections. Dexamethasone, due to its delayed onset but extended duration, achieves lower pain scores and higher satisfaction. Further research is necessary to confirm these findings.Öğe Venous involvement in sickle cell diseases(E-Century Publishing Corp, 2016) Helvaci, Mehmet Rami; Gokce, Cumali; Sahan, Mustafa; Hakimoglu, Sedat; Coskun, Mesut; Gozukara, Kerem HanBackground: Sickle cell diseases (SCDs) cause an accelerated atherosclerotic process in whole body. We tried to understand whether or not there is an additional venous involvement in the SCDs. Methods: As one of the significant endpoints of the SCDs, cases with chronic obstructive pulmonary disease (COPD) and without were collected into the two groups. Results: The study included 427 patients (220 males). There were 71 patients (16.6%) with COPD. Mean age of patients was significantly higher in the COPD group (32.8 versus 29.8 years, P=0.005). The male ratio was significantly higher in the COPD group, too (78.8% versus 46.0%, P<0.001). Smoking (35.2% versus 11.2%, P<0.001) and alcohol (7.0% versus 1.9%, P<0.01) were also higher among the COPD cases. Beside these, priapism (14.0% versus 2.8%, P<0.001), cirrhosis (8.4% versus 3.3%, P<0.05), leg ulcers (23.9% versus 12.0%, P<0.01), digital clubbing (25.3% versus 6.7%, P<0.001), coronary heart disease (23.9% versus 13.7%, P<0.05), chronic renal disease (15.4% versus 7.0%, P<0.01), and stroke (16.9% versus 8.1%, P<0.01) were all higher among the COPD cases. Although deep venous thrombosis and/or varices and/or telangiectasias of the lower limbs were also higher among them, the difference was nonsignificant (11.2% versus 5.0%, P>0.05) probably due to small sample size of the COPD group. Conclusion: SCDs are chronic catastrophic processes on vascular endothelium particularly at the capillary level, and terminate with accelerated atherosclerosis induced end-organ failures in early years of life. Beside the accelerated atherosclerotic process, venous involvement may also be common in the SCDs.
