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Öğe Blood Types and Severity of COVID-19(Eurasian Society of Family Medicine, 2021) Ozdemir, Burcu; Ozdemir, Levent; Akgunduz, Bilge; Celik, Murat; Urfali, Senem; Vicdan, Ayse SemaAim: Since blood types first appeared, their association with diseases caused by microorganisms has been further investigated with several studies for many years. The bond of blood groups described as A, B, AB, and O with coronavirus has been the research subject in many countries.We aimed to elucidate whether there was a relationship between blood types and Rh factor and contracting COVID-19 disease and disease severity. Methods: The study was designed as a retrospective case-control study. Between March 2020-February 2021, 1110 patients were included (538 cases, 572 controls). Disease severity was classified according to where patients were treated: those who were outpatients considered as “mild disease”, hospitalized in a hospital ward considered as “moderate disease”, and treated in the intensive care unit were considered as “severe disease”. Results: The number of people with blood type A was 447 (40.3%), blood type B was 197 (17.7%), blood type AB was 90 (%8), and blood type O was 376 (33.9%). There was no significant difference between the case and control groups according to the blood types. A 3.93 times increase of developing mild illness was detected compared to the control group in Rh-positive individuals. The rate of developing a severe disease was higher in females with blood type A than a mild disease, and A blood type caused the disease to be severe compared to other blood groups in females. Conclusion: We concluded that blood type A caused more severe disease than other blood types in females, and females with B blood type survived the disease as outpatients. Our study can shed light on pathophysiological investigation of the relationship between COVID-19 disease causing a pandemic with high mortality and virulence and blood types. © 2021, Eurasian Society of Family Medicine. All rights reserved.Öğe Burnout and anxiety level of healthcare professionals during the COVID-19 pandemic in Turkey(Ios Press, 2021) Dogru-Huzmeli, Esra; Cam, Yagmur; Urfali, Senem; Gokcek, Ozden; Bezgin, Sabiha; Urfali, Boran; Uysal, HakanBACKGROUND: COVID-19 has affected many countries in the world and has been known as one of the fast-spreading viruses in recent history. OBJECTIVE: Our aim is to reveal the level of anxiety and burnout, attitudes, thoughts, and behaviors of healthcare professionals about COVID-19 in Turkey. METHODS: The individuals included in the study answered seven questions containing demographic information, 27 questions determining their views and perspectives on COVID-19. Anxiety level was measured by Beck Anxiety Scale (BAI), and State Anxiety Inventory (SAT); burnout was measured by Maslach Burnout Inventory (MBT). RESULTS: We included 66 health staff (50 female, 16 male) whose mean age was 31.71 +/- 5.18 years (22-46 ranged). Twenty-two (33.3%) of the participants worked on the COVID-19 frontline while 44 (66.6%) of them worked on usual wards. We found that participants' anxiety was at a moderate level in BAI (mean: 14.00 +/- 12.66). The mean of the SAI was 49.93 +/- 13.06. MBI subscales were low. We found that there was a significant difference in BAI between COVID-19 frontline healthcare professionals and those who worked on the usual wards (p = 0.01). CONCLUSIONS: It is important to consider the level of anxiety and burnout in all healthcare professionals and to help them to protect their mental health.Öğe Characteristics of Patients with COVID-19 Pneumonia Treated with High-flow Oxygen and Non-invasive Ventilation Outside the Intensive Care Unit(Galenos Publ House, 2023) Ozdemir, Burcu; Ozdemir, Levent; Celik, Mehmet Murat; Urfali, Senem; Ozdemir, Uyesi BurcuObjective: Comparing high-flow oxygen (HFO) and non-invasive ventilation (NIV) treatment methods applied to patients hospitalized in the coronavirus disease-2019 (COVID-19) service outside the intensive care unit. Materials and Methods: Demographic characteristics, duration of hospitalization and application times, acute phase reactants, ROX index, comorbid conditions, radiological scores and results were evaluated retrospectively in patients treated with HFO (n=26) and NIV (n=23) who were hospitalized in the COVID service outside the intensive care unit of the state hospital between November 2020 and June 2021. Results: A total of 49 patients, 27 males and 22 females, were included in the study. The mean age was 55.6 +/- 14.6 years. The most common comorbidities were hypertension (n=27), diabetes (n=15). Patients in the HFO group were hospitalized for 16.6 +/- 9.4 days, HFO was applied for 6 +/- 4.6 days. Patients in the NIV group were hospitalized for 9.4 +/- 6.4 days, NIV was applied for 5.8 +/- 4.2 days. The saturation of the patients who were administered HFO (84.1 +/- 4.6) were found to be lower than those who received NIV (88.7 +/- 2). It was determined that 18.37% of 49 patients e.g. 5 of whom were treated with HFO and 4 of them were those who received NIV treatment. The ROX index was found to be significantly lower in the death group (n=9) compared to the survivors (n=40). In radiological imaging, there was no significant difference in the severity of pneumonia in patients treated with HFO and NIV. Lactate dehydrogenase and C-reactive protein from acute phase reactants at the time of hospitalization were significantly higher in the group who ex. Conclusion: It was determined that HFO or NIV was not different in terms of mortality in thr non-intensive care COVID service.Öğe Comparative results after transabdominal Duhamel and Boley procedures in Hirschsprung disease(Logos Medical Publishing, 2019) Çelikkaya, Mehmet Emin; Atici, Ahmet; El, Çi?dem; Urfali, Senem; Akçora, BülentObjective: Hirschsprung Disease (HD) is a neurocristopathy resulting from the migration failure of neural crest cells during intestinal development. It results in aganglionic colon and causes a functional constipation in children. We aimed to compare functional outcomes such as voluntary bowel movements, encopresis and constipation in patients with HD following Boley and Duhamel procedures. Method: Patients who underwent pull through procedures using Boley or Duhamel methods were included in the study. All patients underwent a three-stage operation (opening of the ostomy, definitive operation and closure of the ostomy). Krickenbeck criteria were used to evaluate postoperative functional outcomes including voluntary bowel movements, soiling and constipation. Results: Twenty-seven patients were male and 12 were female. 12 patients underwent Boley and 27 patients Duhamel procedure. In the majority of patients, the pathology was in the rectosigmoid region (n:28, 71.79%). The rates of voluntary bowel movement were 83.33% in the Boley and 85.18% in the Duhamel group. There was no statistically significant difference between the two groups (p<0.05). No significant difference was found between the two groups in terms of the frequency and degree of soiling (Duhamel 22.21%, and Boley 16.66%, p>0.05). In the Duhamel group, constipation was more frequent than Boley group (p<0.05). Conclusion: Each technique has advantages and disadvantages compared to each other. In the majority of cases no serious complication is encountered, regardless of which technique is chosen for definitive surgery. It is recommended that the surgeon should continue to use the technique it is accustomed to and does well. © 2019 Turkey Association of Pediatric Surgery.Öğe Comparison of epidural anesthesia with the combination adductor canal and ipack block in knee arthroplasty patients(Anestezi Dergisi, 2024) Celik, Mehmet Murat; Fakioglu, Onur; Urfali, Senem; Celik, Omer FarukObjective: Motor function-preserving peripheral nerve blocks have begun to play an important role in multimodal analgesic approaches of the patients with total knee arthroplasty (TKA). The aim of this study is to compare the effects of anesthesia methods on postoperative analgesia and early rehabilitation of patients after total knee arthroplasty. Methods: In this retrospective study, in which patients with unilateral TKA were screened, two groups were formed from selected patients. Group EA was administered 0.03 mg kg-1 of morphine with 10 cc saline through the epidural catheter in the postoperative period. In Group Adductor Canal Block (ACB)+ infiltration of local anesthetic between the popliteal artery and capsule of the knee block (IPACK), 10 mL 0.5% bupivacaine, 10 mL 2% lidocaine and 20 mL local anesthetic mixtures were made separately for ACB and IPACK blocks at one time. Primary postoperative outcome was Visual Analogue Scale (VAS), secondary outcomes were physical therapy ambulation test results. Results: In this study, postoperative pain score rates as the primary outcome were measured as follows: VAS8: 5 / 4 (p=0.041); VAS12: 5 / 4 (p=0.004) and VAS24: 4 / 3 (p=0.001) and lower pain scores were obtained in the ACB + IPACK group. In timed up to go (TUG) tests, TUG24 was 36/34 (p=0.001), TUG48 32.5/30 (p=0.012) and TUG72 20/12. Better ROM measurements were recorded in group ACB+IPACK at both 24 and 48 hours. Conclusion: In the ACB + IPACK group, better pain scores, more significant ambulation values, and less side-effect profile were obtained. © 2024 Anestezi Dergisi. All rights reserved.Öğe Comparison of the effects of general and regional anesthesia on Apgar scores in patients undergoing cesarean section: Retrospective evaluation of 196 cases(2008) Inano?lu, Kerem; Özbakiş Akkurt, Ça?la; Asfuro?lu, Zeynel; Urfali, Senem; Turhano?lu, SelimObjective: This study was designed to investigate the effects of anesthesia methods performed in patients undergoing cesarean section in Mustafa Kemal University, Tayfur Ata Sökmen Faculty of Medicine between 2004 and 2007, on Apgar scores. Method: Apgar scores of patients who received general or regional anesthesia in cesarean sections performed in Mustafa Kemal University, Tayfur Ata Sökmen Faculty of Medicine between 2004 and 2007 were retrospectively investigated and compared. Results: No difference was found regarding maternal age, gestation week, and weight of patients who received general or regional anesthesia (p > 0.05). Apgar scores recorded at 1st and 5th min were also similar between the groups (p > 0.05). Conclusion: We observed that general and regional anesthetic methods performed in patients undergoing cesarean section in our hospital through 2004-2007 years had no significant effect on Apgar scores.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 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 EFFICIENCY OF PROPOFOL CO-ADMINISTERED WITH REMIFENTANIL AND FENTANYL OVER LARYNGEAL MASK AIRWAY INSERTION(Soc Stinte Farmaceutice Romania, 2017) Urfali, Senem; Aykut, Buket Cagla OzbakisIn this study we assessed and compared the conditions during insertion of the Laryngeal Mask Airway (LMA) to patients undergoing minor surgery, who received either remifentanil, fentanyl, or normal saline co-administered with propofol. Ninety patients with American Society of Anesthesiology (ASA) class-I/II aged from 18 to 60 years undergoing minor surgery were included in this prospective study. Patients were randomly allocated to receive either normal saline (Group I), fentanyl 1 mu g/kg (Group II), or remifentanil 1 mu g/kg (Group III) over 30 s following induction of anaesthesia with propofol 2.5 mu g/kg + lidocaine 1 mu g/kg. LMA insertion conditions including mouth opening, ease of placement, coughing, swallowing, laryngospasm, airway obstruction and patients' movement were assessed. Time to eyelash reflex loss, time to successfully place LMA, number of attempts and haemodynamic variables were also recorded. Demographic data were all similar between the groups. Heart rate and blood pressure values were lower in remifentanil and fentanyl groups in comparison with the saline group. Induction rates were found to be the highest in the remifentanil group, followed by fentanyl and saline groups. Both remifentanil and fentanyl increased the LMA insertion tolerance when co-administered with propofol, with remifentanil producing slightly better conditions.Öğe Efficiency of propofol co-administered with remifentanil and fentanyl over laryngeal mask airway insertion(Romanian Society for Pharmaceutical Sciences, 2017) Urfali, Senem; Aykut, Buket Cagla OzbakisIn this study we assessed and compared the conditions during insertion of the Laryngeal Mask Airway (LMA) to patients undergoing minor surgery, who received either remifentanil, fentanyl, or normal saline co-administered with propofol. Ninety patients with American Society of Anesthesiology (ASA) class-I/II aged from 18 to 60 years undergoing minor surgery were included in this prospective study. Patients were randomly allocated to receive either normal saline (Group I), fentanyl 1?g/kg (Group II), or remifentanil 1 ?g/kg (Group III) over 30 s following induction of anaesthesia with propofol 2.5 ?g/kg + lidocaine 1 ?g/kg. LMA insertion conditions including mouth opening, ease of placement, coughing, swallowing, laryngospasm, airway obstruction and patients’ movement were assessed. Time to eyelash reflex loss, time to successfully place LMA, number of attempts and haemodynamic variables were also recorded. Demographic data were all similar between the groups. Heart rate and blood pressure values were lower in remifentanil and fentanyl groups in comparison with the saline group. Induction rates were found to be the highest in the remifentanil group, followed by fentanyl and saline groups. Both remifentanil and fentanyl increased the LMA insertion tolerance when co-administered with propofol, with remifentanil producing slightly better conditions. © 2017, Romanian Society for Pharmaceutical Sciences. All Rights reserved.Öğe Is Surgery the Only Fate of the Patient with Leriche Syndrome ? Our Endovascular Therapy Results Early Follow-Up Outcomes(Forum Multimedia Publishing, Llc, 2022) Beyaz, Metin Onur; Urfali, Senem; Kaya, Sefer; Oruc, Dilan; Fansa, IyadAim: In this research, we aimed to present early follow-up results of the endovascular treatment in patients with Leriche syndrome at our single center.Methods and materials: Between October 2020 and January 2022, 14 patients with Leriche syndrome (12 men, two women) who underwent endovascular treatment at our center retrospectively were evaluated. Before the treatment, the ankle-brachial index (ABI) was found 0.50 +/- 0.11 on the right leg and 0.45 +/- 0.09 on the left leg.Results: All of the patients with Leriche syndrome applied to our clinic for the first time. In five patients, the fully occluded lesion length was over 3 cm (ranging between 3.5-7.2 cm), hence they were treated with aortic and bilat-eral iliac bare metallic stents. Although in one patient, the aortic occluding lesion was below 3 cm; it was treated with a bare aortic and bilateral bare iliac stent application because the lesion in the aorta was too calcific. In eight patients, the lesion length was less than 3 cm, bilateral iliac metal bare stents were applied in a kissing stent way.Conclusion: Endovascular therapy for chronic aorto-iliac occlusive disease has an early high technical success with pri-mary and secondary patency rates. Especially in patients with high risk factors, it may be considered as a good alternative to conventional surgery.Öğe The Matrix Metalloproteinase Inhibitor Batimastat Reduces Epidural Fibrosis After Laminectomy in Rats(Turkish Neurosurgical Soc, 2023) Yurtal, Ziya; Ozkan, Huseyin; Kutlu, Tuncer; Deveci, Mehmet Zeki Yilmaz; Urfali, Boran; Urfali, SenemAIM: To investigate the efficacy of locally applied batimastat after laminectomy in preventing postoperative epidural fibrosis. MATERIAL and METHODS: Thirty-two Wistar albino male rats weighing 200-250 g were used. The rats were assigned to four different groups (I-Control group, II-sham group, III-Laminectomy+Batimastat group, and IV-Laminectomy+Spongostan (TM) group). The rats were euthanized 28 days after surgery before TNF-alpha, IL6, IL-1 beta, IL10, TGF-beta 1, and MMP9 gene expression levels of tissue in the surgical area were determined with qPCR. TNF-alpha, IL6, and IL10 protein levels were also measured in both tissue and plasma. In addition, the surgical area was evaluated by histopathological and immunohistochemical methods. RESULTS: TNF-alpha, IL6, and IL-1 beta gene expression levels were higher in the batimastat group than in the control group. Whereas IL10 gene expression levels increased about two-fold in the sham and Spongostan (TM) groups, in the batimastat group, it was similar to that in the control group. TGF-beta 1 gene expression was three-fold higher in the sham group but was similar to that in the control group in both batimastat and Spongostan (TM) groups. MMP9 gene expression levels significantly decreased only in the batimastat group. In addition, fibrosis score, fibroblast cell count, inflammatory cell count, and CD105 expression decreased in the batimastat group relative to the control. CONCLUSION: Molecular and pathological examination results suggested that batimastat is an effective agent in reducing the occurrence of epidural fibrosis after laminectomy.Öğe Neuropathic Pain and Sleep Quality(Academic Press Ltd-Elsevier Science Ltd, 2020) Huzmeli, Esra Dogru; Urfali, Senem; Gokcek, Ozden[Abstract Not Available]Öğe Protective Effects of Minocycline against Short-Term Ischemia-Reperfusion Injury in Rat Brain(Karger, 2013) Aras, Mustafa; Urfali, Boran; Serarslan, Yurdal; Ozgur, Tumay; Ulutas, Kemal Turker; Urfali, Senem; Altas, MuratThe aim of this study was to assess the effects of minocycline on cerebral ischemia-reperfusion (I/R) injury in rats. The study was carried out on 24 male Wistar albino rats, weighing 200-250 g, which were divided into three groups: (i) control (n = 8), (ii) I/R (n = 8) and (iii) I/R + minocycline (n = 8). Minocycline was administrated at a dose of 90 mg/kg p.o. to the I/R group 48, 24 and 1 h before ischemia. Following bilateral exposure of the common carotid arteries by anterior cervical dissection and separation of the vagus nerve, I/R injury was performed by occlusion. Following reperfusion, malondialdehyde (MDA), superoxide dismutase, glutathione peroxidase and catalase levels in the blood and brain tissue, and creatine kinase (CK), CK-BB, lactate dehydrogenase (LDH), neuron-specific enolase (NSE) and protein S100 beta levels in the blood were measured and the histopathological changes were monitored. Regarding histopathological evaluation, symptoms of degeneration were significantly improved in the I/R + minocycline group compared to the I/R-only group. Statistical analysis of the biochemical parameters revealed significant differences in MDA (p < 0.001), nitric oxide (p < 0.05), CK (p < 0.05) and CK-MB (p < 0.05) levels between the I/R + minocycline group and the I/R group. According to the literature, the effect of minocycline is firstly assessed by LDH, CK-MB, NSE and S-100 beta analysis in addition to antioxidant status and histopathological analysis. (C) 2014 S. Karger AG, BaselÖğe Safety and Complications of Sedation Anesthesia during Pediatric Auditory Brainstem Response Testing(Karger, 2022) Urfali, Senem; Urfali, Boran; Sarac, Elif Tugba; Koyuncu, OnurObjective: The auditory brainstem response (ABR) test has been widely used in childhood. Although it is a painless procedure, sedation can be needed in pediatric patients. Thus, this study aimed to evaluate safety and complications of sedation anesthesia applied in pediatric patients during ABR testing. Methods: Medical records of 75 children who underwent ABR testing between 2018 and 2020 were evaluated retrospectively in terms of applicability, safety, and complications of sedation anesthesia. Results: The ages ranged from 3 to 9 (mean 6.2) years. Comorbidity was detected in 20% (n = 15); 3 had multiple comorbidities, and the most common comorbidity was Down syndrome (4%). The drugs used in sedation anesthesia were midazolam in 81.3% (n = 61), a combination of propofol and ketamine in 14.7% (n = 11), and only propofol in 4% (n = 3) of the patients. An additional drug use was needed in 44% (n = 33). The mean procedure time was 40 (range 30-55) min. The mean anesthesia duration was 45 (range 35-60) min. The mean recovery time was 10 (range 5-15) min. Complications related to anesthesia developed in 4 (5.33%) of the patients; respiratory distress, agitation, cough, and nausea-vomiting were seen in one of the patients, respectively. Complications like bradycardia and respiratory or cardiac arrest were not seen at all. Conclusions: The complication rate of sedation anesthesia performed during ABR testing of pediatric patients is quite low. It may be more beneficial to use combinations of sedation drugs instead of using a single sedation drug. Although sedation anesthesia appears to be safe in general, the potentially life-threatening complications of sedative agents should be remembered, especially in children who have comorbidities.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 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.
