Çağdaş Baytar

Lumbar disc herniation surgery is associated with considerable postoperative pain despite its minimally invasive nature. Regional fascial plane blocks may reduce opioid consumption and improve recovery as part of multimodal analgesia. This study compared the analgesic efficacy of ultrasound-guided intertransverse process (ITP) and modified thoracolumbar interfascial plane (mTLIP) blocks with conventional analgesia in patients undergoing lumbar disc herniation surgery. In this prospective randomized controlled trial, 84 patients undergoing elective lumbar disc herniation surgery under general anesthesia were allocated to a Control group, an mTLIP group, or an ITP group (n = 28 each). The primary outcome was cumulative morphine consumption during the first 24 postoperative hours. Secondary outcomes included postoperative pain scores, Quality of Recovery-15 (QoR-15) scores, intraoperative remifentanil consumption, and adverse events. Twenty-four-hour morphine consumption was significantly higher in the Control group than in the mTLIP and ITP groups (28.79 ± 10.11 mg vs. 16.93 ± 10.11 mg and 12.86 ± 6.14 mg, respectively; both p < 0.001), with no difference between the block groups. Intraoperative remifentanil consumption was significantly lower in the ITP and mTLIP groups than in the Control group (p < 0.001 and p = 0.001, respectively). Resting pain scores were significantly lower in the ITP group than in the Control group throughout the postoperative period, while dynamic pain scores were lower at the PACU time point and at 6, 12, and 24 h. No significant differences in pain scores were observed between the mTLIP and Control groups or between the two block groups. QoR-15 scores at 24 h were significantly higher in the ITP group than in the Control group (137 [102-150] vs. 130 [60-147]; p = 0.010). No significant differences in postoperative nausea and vomiting were observed, and no block-related complications occurred. Both ITP and mTLIP blocks reduced perioperative opioid requirements after lumbar disc herniation surgery, with no significant difference between the two blocks. Compared with conventional analgesia, the ITP block was additionally associated with lower postoperative pain scores and improved recovery quality. Both techniques appear to be safe, comparably effective, opioid-sparing components of multimodal analgesia. ClinicalTrials.gov NCT06391541. Prospectively registered on April 26, 2024.

When Distance Matters: The Quadro-iliac Plane Block in Complex Multilevel Posterior Spinal Fusion Surgery - Turkish Journal of Anaesthesiology and Reanimation

Peripheral intravenous catheter (PIVC) fracture is a rare but potentially serious iatrogenic complication associated with intravascular fragment retention and embolic risk. We report a 67-year-old man undergoing modified radical neck dissection in whom the abrupt cessation of infusion revealed a fracture of an 18-gauge PIVC placed on the dorsum of the hand. Ultrasonography confirmed retained intravascular fragments. Surgical exploration under ongoing general anesthesia identified and successfully retrieved three fractured catheter segments within 10 minutes. The patient recovered uneventfully. This case emphasizes the importance of careful intraoperative catheter monitoring, awareness of mechanical compression risk -- including avoidance of placing a non-invasive blood pressure cuff on the same limb as the operative catheter -- and prompt imaging-guided management of suspected catheter fracture.

Background: We aimed to investigate the effects of the external oblique intercostal plane block (EOIPB) and subcostal transversus abdominis plane (TAP) block on postoperative pulmonary function in patients undergoing laparoscopic cholecystectomy. The primary outcome was spirometric pulmonary function test (PFT) results. Secondary outcomes included postoperative pain scores, opioid consumption, and postoperative recovery assessed using the Quality of Recovery (QoR)-15 questionnaire. Methods: A total of 102 patients aged 18– 65 years with ASA physical status I–III who underwent elective laparoscopic cholecystectomy were included in this prospective observational study. According to the perioperative analgesia technique applied, patients were evaluated in three groups: Group Subcostal (n=34), Group EOIPB (n=34), and Group Control (n=34). After losses to follow-up, 90 patients were included in the final analysis. Preoperative and postoperative spirometric PFTs, postoperative pain scores, opioid consumption, and QoR-15 scores were recorded and compared among groups. Results: Postoperative reductions in FVC, FEV₁, predicted FEV₁, and PEF values were observed in all groups but were significantly more pronounced in the Control group. At postoperative hour 1, pulmonary function parameters were significantly lower in the Control group compared with both block groups (p < 0.05). Predicted FEV₁ at postoperative hour 1 was significantly higher in the EOIPB group than in Subcostal group (p = 0.003). Postoperative pain scores and opioid consumption were significantly lower in both block groups compared with the Control group (p < 0.05), whereas QoR-15 scores were significantly higher (p < 0.05). No significant differences were observed between the two block groups for most postoperative outcomes. Conclusion: Both EOIPB and subcostal TAP block were associated with attenuated decline in postoperative pulmonary function, reduced opioid consumption, and improved early postoperative recovery after laparoscopic cholecystectomy.

The aim of this study was to compare the analgesic efficacy and recovery outcomes of the serratus posterior superior intercostal plane block (SPSIPB) and the serratus anterior plane block (SAPB) with conventional analgesia in patients undergoing oncoplastic breast surgery. One hundred and five patients aged 18–65 years with an ASA physical status of I–III were included in this prospective, randomized controlled study. Patients were randomly assigned in a 1:1:1 ratio to three groups: the Control Group, the SPSIPB Group, and the SAPB Group. Outcome assessors were blinded to group allocation. The primary outcome was cumulative tramadol consumption during the first 24 h postoperative. Secondary outcomes included Numeric Rating Scale (NRS) scores at rest and during activity, Quality of Recovery-15 (QoR-15) scores, and the incidence of postoperative nausea and vomiting (PONV). Cumulative tramadol consumption during the first 24 h was significantly lower in the SPSIPB and SAPB groups compared with the Control Group (p < 0.001), with no significant difference between the two block groups. Although NRS pain scores were comparable among groups at all time points, QoR-15 scores were significantly higher and antiemetic requirements were lower in both block groups compared with the Control Group. The SPSIPB and SAPB reduced opioid consumption and improved quality of recovery compared with conventional management, despite similar pain scores, with no significant difference between the two techniques.

Insufficient lung expansion due to inadequate pain management and opioid consumption is one of the most important factor for perioperative atelectasis and and the use of ultrasound in the diagnosis of atelectasis has been quite common in recent years. The effectiveness of posterior quadratus lumborum block (QLB) in postoperative analgesia after open surgery is well established. The present study aimed to investigate the effects of posterior QLB on perioperative atelectasis in pediatric surgeries. Sixty patients who underwent elective inguinal hernia repair and orchipexy surgery under general anesthesia were included in the study. The patients were divided into 2 groups: Control (n = 30) and QLB, (n = 30). Posterior quadratus lumborum block was administered to the QLB group. Incidence of atelectasis and modified lung ultrasound (LUS) scores were recorded before induction (T1), at the end of surgery (T2), and before leaving the recovery unit (1 h after extubation) (T3). Pain was evaluated with Face, Legs, Activity, Cry, Consolability (FLACC) scores in the postoperative period. The analgesics administered in the recovery unit and ward were recorded. A significant difference was observed in the incidence of atelectasis and total LUS scores between groups at T2 and T3. Both outcomes were higher in the control group. A significant difference was observed between the groups in terms of FLACC scores at 0, 2, and 6 h postoperatively. In all three time periods, the scores in the QLB group were lower. A significant difference was observed between the groups in terms of rescue analgesic usage in the recover room and during ward follow-up. Analgesia requirement was higher in the Control group. Ultrasound-guided posterior QLB in pediatric patients undergoing inguinal hernia repair and orchiopexy surgery decreases the incidence of atelectasis and total LUS scores by reducing pain scores and the amount of opioids required. Trial registration: NCT04830280 registered 2021/03–11.

Tourniquet deflation during lower extremity surgery is associated with abrupt physiological changes that may influence intracranial pressure (ICP) and cerebral oxygenation. This prospective observational study aimed to evaluate changes in ICP following tourniquet deflation using ultrasonographic optic nerve sheath diameter (ONSD) measurements and to investigate their association with cerebral oxygenation parameters. This prospective observational study included 43 adult patients undergoing lower extremity surgery with tourniquet application under standardized general anesthesia. In addition to routine hemodynamic monitoring, bilateral cerebral oxygen saturation (rSO ₂ ) was continuously monitored using near-infrared spectroscopy, and ONSD measurements were performed at predefined time points. End-tidal carbon dioxide (EtCO ₂ ) levels and tourniquet duration were recorded. Patients were stratified into 2 groups according to ONSD values (≥5 mm and 2 , EtCO ₂ , and tourniquet times were compared between groups. Correlation analyses were conducted to assess the relationships among these variables. ONSD and EtCO ₂ values measured at 5 and 15 minutes after tourniquet deflation were significantly higher than pre-deflation values. Bilateral rSO ₂ values following tourniquet deflation were significantly higher compared with measurements obtained before anesthesia induction, tourniquet inflation, and immediately prior to deflation. At 5 minutes after tourniquet deflation, EtCO ₂ levels and tourniquet duration were significantly higher in patients with ONSD ≥5 mm compared with those with ONSD 2 and ONSD, EtCO ₂ and bilateral rSO ₂ , and between ONSD and tourniquet duration at this time point. Tourniquet deflation during lower extremity surgery is associated with transient increases in EtCO ₂ , ONSD, and cerebral oxygenation parameters. These findings suggest significant physiological associations between tourniquet duration, carbon dioxide levels, and surrogate markers of ICP and cerebral oxygenation; however, further studies incorporating direct ICP measurements and clinical neurological outcomes are required to determine their clinical significance.