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    Comparison of bilateral pectoral nerve block 2 and local anesthetic infiltration for pain control in cardiac surgery
    (2022) Bicak, Mustafa; Salik, Fikret
    Aim: We aimed to compare the effect on postoperative pain of pre-emptive bilateral Pectoral Nerve Block 2 by ultrasound with local anesthetic infiltration on the sternotomy line and drain insertion points in cardiac surgery. Materials and Methods: The study included 40 patients with open heart surgery under general anesthesia aged over 18 years. Patients were randomly divided into 2 groups. Group 1(bilateral Pectoral Nerve Block 2 (PECS 2) performed with ultrasound) and Group 2 (local anesthesia infiltration). Patients had intraoperative and postoperative opioid consumption amounts, duration on ventilator, visual analog scale (VAS) scores when moving (cough) and at rest, inspiratory flow rates and hospitalization duration recorded. Results: Group 1 was identified to have lower intraoperative and postoperative opioid consumption amounts (p<0.001). The rescue opioid requirements in the postoperative period were lower in Group 1 (p=0.002). The postoperative analgesia duration was longer in Group 1 (p=0.000). The duration on ventilator in the postoperative period was shorter for those with PECS 2 administration (p=0.010). The VAS score at rest was lower in Group 1 in the 48th hour (p=0.033). VAS score when moving was lower in Group 1 in the 24th and 48th hours (p=0.015, 0.001, respectively) After extubation, peak inspiratory flow rates were found to be statistically significantly higher in Group 1 in the 12th, 16th, 24th, 48th and 72nd hours. Conclusion: PECS 2 may be a part of Enhanced recovery after surgery protocols in cardiovascular surgery because of its contribution to lower VAS scores, less opioid consumption, and less pulmonary complications during the perioperative period.
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    Evaluation of the relationship of Delta-CO2 with IVC-CI, IJV-CI, and CVP values in intubated critically ill patients with spontaneous breathing, and who were applied invasive mechanical ventilation in CPAP mode
    (2020) Kacar, Cem Kivilcim; Uzundere, Osman; Bicak, Mustafa; Kandemir, Deniz; Kaya, Sedat; Yektas, Abdulkadir
    Aim: Our aim in this study is to understand whether there is a correlation between IVC-CI, IJV-CI, CVP, and Delta-CO2 values in critical patients in the ICU and whether these values can be used interchangeably in monitoring intravascular fluid status.. Materials and Methods: Patients included in this study were selected from critical ICU patients between 18-90 years old with an unknown hypovolemic status that had spontaneous breathing and underwent invasive mechanical ventilation in CPAP mode. Patients’ parameters were consecutively measured by USG with the inferior vena cava collapsibility index (IVC-CI), internal jugular vein collapsibility index (IJV-CI), CVP, and Delta-CO2. The results were recorded, and any correlations were checked.Results: There was a statistically significant and moderately negative correlation (r = -0.428, p 0.001) between CVP and IVC-CI, and a statistically significant and weakly negative correlation between CVP and IJV-CI (r = -0.374, p = 0.001). There was a statistically significant and weakly positive correlation (r = 0.369, p = 0.001) between IVC-CI and IJV-CI. There was no statistically significant correlation between Delta-CO2 and IVC-CI, IJV-CI, and CVP.Conclusion: We think that CVP, IVC-CI and IJV-CI can be used interchangeably in the assessment of the intravascular volume status of critical patients, but Delta-CO2 cannot be used to assess intravascular volume status instead of these parameters.