Ersin Koksal

Background Laparoscopic sleeve gastrectomy (LSG) is associated with significant postoperative pain despite being minimally invasive. External oblique intercostal block (EOIB) has emerged as a novel regional anesthesia technique targeting upper abdominal wall innervation. In this systematic review and meta-analysis with trial sequential analysis (TSA), we aimed to systematically assess the analgesic efficacy of EOIB in patients undergoing LSG, focusing on opioid consumption, pain scores, rescue analgesia use, and recovery outcomes. Methods We systematically searched PubMed, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and Web of Science (from inception to until 22 May 2025). The primary outcome was 24-h opioid consumption. Secondary outcomes included pain scores, postoperative nausea and vomiting (PONV), and rescue analgesic use. Risk of bias was assessed using RoB 2, and the certainty of evidence was evaluated using the GRADE approach. Results Four RCTs (n = 249) were included. EOIB significantly reduced 24-h morphine milligram equivalent (MME) consumption (MD − 12.76 mg; 95% CI − 16.76 to − 8.77; p < 0.001). EOIB also lowered postoperative pain scores and decreased rescue analgesic use (OR 0.20; 95% CI 0.09–0.45). PONV incidence was reduced, but not statistically significant. TSA demonstrated that the current evidence is sufficient to confirm a statistically significant effect, with no further trials required. Conclusions EOIB appears to be a safe and effective component of multimodal analgesia in LSG, with TSA results supporting the robustness of current evidence.

Aim: Awake deep brain stimulation (DBS) surgery requires the patient to remain conscious for optimal electrode placement through intraoperative neurophysiological monitoring. However, hypertension during awake DBS poses significant clinical challenges, potentially compromising surgical accuracy and patient safety. Nicardipine and esmolol are both used for intraoperative blood pressure control, but their comparative efficacy in awake DBS remains unclear. The aim of this study was to compare the effectiveness of nicardipine and esmolol in controlling intraoperative blood pressure during awake DBS surgery under monitored anesthesia care. Material and Methods: This retrospective study evaluated patients who underwent awake DBS surgery under MAC between January 2020 and April 2025. Forty adult patients experiencing intraoperative hypertension (systolic arterial pressure [SAP] ≥150 mmHg) were included and divided into two groups based on the antihypertensive agent administered: nicardipine (n = 20) or esmolol (n = 20). Hemodynamic parameters, antihypertensive requirements, and intraoperative complications were compared between the groups. Results: Mean intraoperative SAP was significantly lower in the nicardipine group compared to the esmolol group (121.9 ± 2.6 mmHg vs. 127.9 ± 3.5 mmHg, p = 0.04). Although the frequency of hypertensive episodes tended to be lower with nicardipine, this did not reach statistical significance (15.9% ± 3.6 vs. 26.1% ± 4.1, p = 0.21). Esmolol resulted in significantly lower heart rates (69.2 ± 2.8 bpm vs. 87.9 ± 2.0 bpm, p = 0.01) but required higher doses of rescue antihypertensives (glyceryl trinitrate: 53.1 ± 5.8 mg vs. 25.8 ± 1.2 mg, p < 0.001). No major intraoperative complications or conversions to general anesthesia occurred in both groups. Conclusions: Nicardipine provided more effective and stable intraoperative blood pressure control than esmolol during awake DBS surgery, reducing the need for additional antihypertensive medications. Both agents were safely administered without compromising patient cooperation or neurophysiological monitoring. Therefore, nicardipine may be preferable due to the less need for rescue antihypertensive treatment.

Background: In recent years, the suprainguinal fascia iliaca compartment block (SFICB) has become more common in clinical practice. This assessor-blinded dose-finding study aimed to determine the minimum effective concentration (MEC90, MEC95) of bupivacaine for a single-injection SFICB in patients undergoing arthroscopic anterior cruciate ligament repair. Methods: This prospective study was conducted at a tertiary hospital (postoperative recovery room and ward). The SFICB was performed as a postsurgical intervention after spinal anesthesia. Seventy patients were allocated using the biased-coin design up-and-down sequential method. The ultrasound-guided SFICB was performed using different bupivacaine concentrations, and standard multimodal analgesia was administered to all patients. Block success was defined as the absence of pain or presence of only tactile sensation during the pinprick test conducted on the anterior and lateral regions of the mid-thigh six hours postoperatively.Results: According to isotonic regression and bootstrap CIs, the MEC90 value of bupivacaine for a successful SFICB was 0.123% (95% CI [0.098, 0.191]) and the MEC95 value was 0.188% (95% CI [0.113, 0.223]).Conclusions: Our study showed that the MEC90 and MEC95 values for bupivacaine administered via an SFICB for analgesia were 0.123% and 0.188%, respectively. One advantage of using lower concentrations of bupivacaine is the associated reduction in quadriceps weakness.

Background and Objectives: Total knee arthroplasty (TKA) is a commonly performed orthopedic procedure, and is often accompanied by significant postoperative pain. The supra-inguinal fascia iliaca block (SIFIB), similar to an anterior lumbar plexus block, is frequently used in hip surgeries. The interspace between the popliteal artery and capsule of the posterior knee (IPACK) block is a regional anesthesia technique that targets the posterior innervation of the knee capsule. This retrospective study aimed to compare the analgesic effects of SIFIB and SIFIB + IPACK on patients undergoing TKA under spinal anesthesia. Materials and Methods: This retrospective study revealed the data collected from a tertiary hospital. Patient data were gathered for individuals who underwent unilateral TKA under spinal anesthesia during the period between 1 January 2023 and 1 September 2023. Inclusion criteria comprised patients falling within ASA class I–III, those following a standardized perioperative analgesia regimen, and individuals receiving opioids via a patient-controlled analgesia device (PCA) as part of their postoperative pain management strategy. Patients were grouped as SIFIB and SIFIB + IPACK according to the performed regional anesthesia technique. Results: In the study, the data of 88 patients in total, 61 in the SIFIB group and 27 in the IPACK group, were analyzed. The 24 h cumulative morphine consumption was similar in the SIFIB and SIFIB + IPACK groups (10.62 ± 6.58 mg vs. 12.55 ± 8.84 mg, respectively; p: 0.258). The NRS scores of the groups were similar in all time frames. Conclusions: Our study reveals that combining IPACK with SIFIB in the multimodal analgesia plan does not provide additional benefits in terms of postoperative opioid consumption and pain scores in patients undergoing unilateral THA under spinal anesthesia.

Aim: To investigate magnetic resonance image quality and the number of motion artifact-related repeated sequences based on anesthesia or sedation management during preoperative MR imaging for DBS surgery. Material and Methods: The medical records of patients who underwent DBS procedures at the hospital of Ondokuz Mayis University, between April 2011 and October 2021 were retrospectively analyzed. Age, gender, and diagnosis information were recorded for each case. Patients were grouped into general anesthesia, sedation, no sedation groups. The evaluation of magnetic resonance images was performed by a specialized in neuroradiology. The radiologist classified the image quality as good, moderate, or poor based on artifacts resulting from unwanted motion. Results: A total of 127 patients, out of 190 patients, were included in the study. There were no significant differences in image quality based on anesthesia/sedation method and airway management (p>0.05). No significant differences were observed in the number of repeated sequences when compared based on anesthesia/sedation method and airway management (p>0.05). Conclusion: General anesthesia, sedation, or no sedation during preoperative magnetic resonance imaging in patients with movement disorders did not result in significant differences in image quality and the number of sequences requiring repetition.

Background Dexmedetomidine is a potent and highly selective alpha-2 adrenoceptor agonist with sympatholytic, sedative, anxiolytic and analgesic properties. The aim of this study is to determine the effect of a dexmedetomidine infusion in liver transplant recipients in the early postoperative period on early and smooth extubation. Methods We performed a retrospective chart review of 21 patients undergoing liver transplantation between December 1, 2018 and February 31, 2020. Patients were divided into the dexmedetomidine and midazolam groups. The primary outcome was the extubation time. Secondary outcomes were mean arterial pressure and heart rate before and after extubation. The collected data included the patients’ age, gender, surgery time, Model for End-stage Liver Disease score, cold ischemia time, blood transfusion amount and extubation visual analogue scale (VAS) scores. Results Extubation time was significantly shorter in the dexmedetomidine group than in the midazolam group (median [minimum-maximum], 4 [0-6], 8 [4-13] hours, respectively, P = .000). Extubation VAS scores were statistically significantly lower in dexmedetomidine group (P = .000). Mean arterial pressure values before and after extubation were significantly higher in patients' midazolam group than the dexmedetomidine group (P = .003, P = .005, respectively). Conclusions Dexmedetomidine infusions provided early and smooth extubation with stable haemodynamics in our patients.

Background Quadratus lumborum blocks (QLBs) are relatively novel regional anaesthesia techniques, and the efficacy of all three types of QLB for postoperative analgesia in caesarean delivery (CD) has been demonstrated in separate studies. The aim of the present study is to compare the analgesic efficacy of the QLB-II and QLB-III blocks performed at the end of surgery in patients undergoing spinal anaesthesia for CD. Methods We conducted a comparative, blinded, prospective, randomised and efficiency study. A total of 80 patients scheduled for elective CD under spinal anaesthesia were randomly allocated to receive either bilateral ultrasound-guided QLB-II or QLB-III block in a 1:1 ratio. The primary outcome was opioid consumption administered by a patient-controlled analgesia in the first 24 hours postoperatively. The secondary outcome of the study was pain intensity. Also, the time of first opioid requirement and the presence of nausea and vomiting were recorded. Results Morphine consumption was statistically significantly lower in the QLB-III group when compared with the QLB-II group at the 3rd, 6th, 12th and 24th hours (P < .001, P < .001, P = .004, and P = .015, respectively). The QLB-III group showed significantly lower pain scores at rest at the 1st, 3rd, 6th, 9th and 24th hours after surgery (P < .001, P < .001, P < .001, P = .007 and P < .001, respectively). The QLB-III group also showed significantly lower pain score on movement at all measurement times (P < .001). Conclusions The analgesic efficacy of QLB-III was superior to QLB-II in patients who had undergone CD under spinal anaesthesia without use of intrathecal opioids and nonsteroidal anti-inflammatory drugs.