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ABSTRACT BACKGROUND AND OBJECTIVES: The aim of this study was to compare the effects of two different doses of intrathecal morphine on postoperative analgesia, postoperative first mobilization and urination times and the severity of side effects. METHODS: After Institutional Ethical Committee approval, 48 ASA I-II patients were enrolled in this randomized double-blinded study. Spinal anesthesia was performed with 0.1 mg (Group I, n = 22) or 0.4 mg (Group II, n = 26) ITM in addition to 7.5 mg heavy bupivacaine. The first analgesic requirement, first mobilization and voiding times, and postoperative side effects were recorded. Statistical analyses were performed using SPSS 15.0 and p < 0.05 was considered as statistically significant. The numeric data were analyzed by thet-test and presented as mean ± SD. Categorical data were analyzed with the chi-square test and expressed as number of patients and percentage. RESULTS: Demographic data were similar among groups. There were no differences related to postoperative pain, first analgesic requirements, and first mobilization and first voiding times. The only difference between two groups was the vomiting incidence. In Group II 23% (n = 6) of the patients had vomiting during the first postoperative 24 h compared to 0% in Group I (p = 0.025). CONCLUSION: For inguinal hernia repairs, the dose of 0.1 mg of ITM provides comparable postoperative analgesia with a dose of 0.4 mg, with significantly lower vomiting incidence when combined with low dose heavy bupivacaine.

Background: Local anesthesia (LA) is often preferred for stabilization of vital signs, depth of anesthesia and pain control in dental restorations but the efficacy of LA administration during deep sedation is controversial.Aim: To retrospectively investigate the effects of LA on heart rate, blood pressure, oxygen saturation, depth of anesthesia and total dose of anesthetic drugs given in pediatric patients sedated for dental procedures.Materials & Methods: Records of 50 healthy children were divided into two groups: Patients who received infiltration LA at the beginning of sedation (Early LA) or who received LA at the end of sedation after completion of restorations (Late LA). Demographic data, hemodynamic data, Bispectral Index (BIS) scores, Ramsey Sedation Scale scores, total propofol dose administered were compared. Since the difference between two quantitative dependent variables did not meet the assumptions of normal distribution, Wilcoxon Signed Rank test was used. Generalized Estimation Models were used to look at the effect of quantitative variables with repeated measures (BIS and Ramsey) on groups.Results: There was no statistically significant difference between the groups in terms vital signs, depth of anesthesia (BIS (p=0.190) and Ramsey score (p=0.887)), and total propofol dose adjusted for BMI (p=0.59). Conclusion: The presence of LA during deep dental sedation has no significant impact on vital signs, depth of anesthesia and total amount of propofol used compared to the absence of LA. LA does not contribute to stabilization of dental sedation, but close monitoring of deep sedation prevents drug overdose.

Background: We aimed to determine the minimum effective volume (MEV) of 0.5% bupivacaine for infraclavicular brachial plexus block. Methods: We assigned patients to volume groups consisting of five consecutive patients. Local anesthetic was sequentially reduced from a starting dose of 30 mL by 2 mL to form the volume groups. Five patients were included in each volume group, and at least 3 of 5 injections had to be successful to consider the volume of the anesthetic as sufficient. The study ended when the anesthetic volume of a group was determined to be unsuccessful (two or fewer successful blocks). Block was successful if the patient reported a sensorial block score of 7 or more on an 8-point scale and sensorial and motor block's total score of 14 on a 16-point scale. Results: The MEV of 0.5% bupivacaine for infraclavicular brachial plexus block was 14 mL. A successful block was achieved in all patients (n = 45) in 9 volume groups, which received 30 mL down to 14 mL. Three blocks were unsuccessful in the 12-mL group. Time to onset of block and time to first postoperative anesthetic administration was 15 (10–15) min and more than 24 h in the 30-mL bupivacaine group, but 40 (30–45) min and 14 (10–24) h were determined for the 14-mL group, respectively. Conclusions: The MEV of 0.5% bupivacaine for ultrasound-guided infraclavicular brachial plexus block was 14 mL. However, this low-dose block has a long onset time of 40 (30–45) min on average.