Abstract Study objective Patients undergoing open nephrectomy surgery experience severe perioperative pain, which is primarily due to incision of several muscles. Abdominal wall blocks are known to reduce pain without causing epidural-associated hypotension. We conducted this study to compare unilateral ultrasound-guided transmuscular quadratus lumborum block and posterior transversus abdominis block in combination with general anesthesia alone in terms of intraoperative and postoperative analgesics and hemodynamics and postoperative complications. Methods This was a randomized, double-blinded, controlled trial conducted in the operating room. This study included 48 patients aged 20-60 years, with ASA I and II, and a body mass index ≤ 30 kg.m-2 who were scheduled for open nephrectomy procedure.The 48 patients scheduled for nephrectomy were randomly allocated into one of the following three groups after induction of general anesthesia: Group A (n = 16) received USG transmuscular QLB; Group B (n = 16) received unilateral USG posterior transversus abdominis plane (TAP) block; and Group C (n = 16; control group) did not receive any blocks. Introperative fentanyl consumption, and hemodynamics (heart rate and mean arterial pressure (MAP)) were recorded after anesthesia induction, at surgical incision, and every 15 min till the end of surgery. Visual Analogue Scale (VAS) was evaluated immediately at 30 min and 1,2,4,6, and 12 hours postoperatively. The time of first analgesic request was also recorded. Results Intraoperative fentanyl consumption (µg) was significantly lower in Groups A and B (164.69 ± 27.35 and 190.31 ± 44.48, respectively) than in Group C (347.50 ± 63.64) (p < 0.001). Postoperatively, total pethidine consumption was significantly lower in Groups A and B than in Group C (85.31 ± 6.68, 84.06 ± 4.17 mg, and 152.19 ± 43.43 mg, respectively) (p < 0.001. Time to rescue analgesia was longer in Groups A and B than in Group C (138.75 ± 52.39 min, 202.50 ± 72.25 min, and 37.50 ± 13.42 min, respectively) (p < 0.001). VAS score was significantly lower in Groups A and B than in Group C at 30 min and 1, 2, 4, and 6 hours postoperatively. Conclusion Transmuscular quadratus lumborum block and posterior transversus abdominis blocks were effective in providing perioperative analgesia in patients undergoing open nephrectomy. However, quadratus lumborum block provided superior analgesia.

Resumo Objetivo: Avaliar a aplicabilidade da proteína C reativa salivar, do volume médio de plaquetas, a proporção de neutrófilos-linfócitos e a proporção de plaquetas/linfócitos no diagnóstico de sepse neonatal. Métodos: Estudo caso-controle prospectivo de 70 neonatos a termo, 35 com sepse (20 com sepse comprovada e 15 com sepse clínica) e 35 controles saudáveis. As concentrações de PCR no soro e salivar foram medidas por ensaio imunossorvente ligado a enzima (Elisa), ao passo que o VMP, PNL e PPL foram medidos por contador de células sanguíneas automatizado. Resultados: Este estudo mostrou uma diferença estatisticamente significativa da média de PCR salivar entre os neonatos com sepse e os controles (12,0 ± 4,6 ng/L em comparação com 2,8 ± 1,2 ng/L), respectivamente. Um ponto de corte 3,48 ng/L na PCR salivar mostrou sensibilidade de 94,3% e especificidade de 80%. A PCR salivar mostrou, ainda, boa precisão preditiva para prever altos valores de PCR no soro em neonatos com sepse. O VMP e a PNL mostraram diferença significativa entre os neonatos com sepse e os controles (10,2 ± 1,2 fL em comparação com 8,0 ± 0,5 fL), (2,9 ± 1,7 em comparação com 1,6 ± 0,4), respectivamente. O VMP no ponto de corte 10,2 fL apresentou 80% de sensibilidade e especificidade. A PNL no ponto de corte 2,7 fL apresentou 80% de sensibilidade e 57,1% de especificidade. Conclusão: Este estudo fornece uma base para outros estudos na utilidade da PCR salivar, VMP e PNL como marcadores de diagnóstico de sepse neonatal.

Abstract Objective: To assess the applicability of salivary C-reactive protein, mean platelet volume, neutrophil-lymphocyte ratio, and platelet lymphocyte ratio in the diagnosis of neonatal sepsis. Methods: Prospective case-control study of 70 full-term neonates, 35 with sepsis (20 with proven sepsis and 15 with clinical sepsis) and 35 healthy controls. Serum and salivary C-reactive protein concentrations were measured by enzyme-linked immunosorbent assay while mean platelet volume, neutrophil-lymphocyte ratio, and platelet lymphocyte ratio were measured by automated blood cell counter. Results: This study showed statistically significant difference of mean salivary C-reactive protein between septic neonates and controls (12.0 ± 4.6 ng/L vs. 2.8 ± 1.2 ng/L) respectively. At a cut-off point of 3.48 ng/L, salivary C-reactive protein showed 94.3% sensitivity and 80% specificity. Salivary C-reactive protein also showed good predictive accuracy for predicting elevated serum C-reactive protein values in septic neonates. Mean platelet volume and neutrophil-lymphocyte ratio showed significant difference between septic neonates and controls (10.2 ± 1.2 fL vs.8.0 ± 0.5 fL; 2.9 ± 1.7 vs. 1.6 ± 0.4, respectively). At a cut-off point of 10.2 fL, mean platelet volume presented 80% sensitivity and specificity. At a cut-off point of 2.7, neutrophil-lymphocyte ratio presented 80% sensitivity and 57.1% specificity. Conclusion: This study provides support for further studies on the usefulness of salivary C-reactive protein, mean platelet volume, and neutrophil-lymphocyte ratio as diagnostic markers for neonatal sepsis.