Sezgin Bilgin

Background Postoperative pain after laparoscopic colorectal surgery (LCS) is complex, involving both somatic and visceral components. Anterior subcostal quadratus lumborum block (QLB) is a novel regional technique that may provide dual analgesic coverage. Objective To evaluate the analgesic efficacy of ultrasound-guided anterior subcostal QLB in patients undergoing LCS. Design This prospective, randomized, observer-blinded trial included 60 adults scheduled for elective LCS at a university hospital between October 2024 and May 2025. Patients were randomly allocated to receive either bilateral anterior subcostal QLB or no regional anesthesia or local anesthetic infiltration (control). Main outcome measures The primary outcome was cumulative intravenous morphine milligram equivalent consumption at 24 hours postoperatively. Secondary outcomes included 12 hours intravenous morphine milligram equivalent consumption, pain scores (at rest and activity), time to first demand for patient-controlled analgesia (PCA), rescue analgesic/antiemetic use, block-related complications and recovery parameters. Results Data from 55 patients were analyzed (QLB (n=27); control (n=28)). The median 24-hour intravenous morphine milligram equivalent consumption was significantly lower in the QLB group than that in the control group (15 mg (Q1–Q3, 6.5–22 mg) vs 24.3 mg (Q1–Q3, 20.3–30.3 mg); p=0.006). Pain scores at all time points were significantly lower in the QLB group (pConclusions The anterior subcostal QLB was associated with reduced postoperative opioid use, lower pain scores and a lower incidence of postoperative nausea–vomiting after LCS, suggesting a potential role in enhancing recovery. Trial registration number NCT06653439; registration date: 20 October 2024.

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 The effects of the erector spinae plane (ESP) block on chronic postsurgical pain (CPSP) after cardiac surgery remain unclear. This study evaluated the efficacy of bilateral ESP block in reducing the incidence and severity of CPSP after cardiac surgery. Methods This prospective, randomized, controlled, single-blind trial included 63 patients aged 18–80 years with American Society of Anesthesiologists physical status II–III, scheduled for elective cardiac surgery via median sternotomy. Participants received a bilateral ultrasound-guided ESP block or standard care without regional anesthesia. The primary outcome was the Brief Pain Inventory (BPI) score at 3 months postoperatively. Secondary outcomes included morphine consumption in the first 24 hours; Numerical Rating Scale (NRS) scores during rest/activity at 0, 3, 6, 12, and 24 hours; BPI scores at 6 months postoperatively; and Douleur Neuropathique 4 (DN4) and Hospital Anxiety and Depression Scale (HADS) scores at 3 and 6 months postoperatively. Results The BPI scores of the two groups did not differ significantly at 3 months postoperatively (median (IQR): 0(26) vs 12 (31), p=0.166). However, 24 hours postoperative morphine consumption (8 mg vs 10.5 mg, pConclusions The ESP block effectively reduced acute pain and opioid consumption; however, it had no significant effect on the incidence or severity of CPSP at 3 and 6 months.

Amaç: Bu çalışmanın amacı, bidirectional endoskopi işlemlerinde (özofagogastroduodenoskopi [ÖGD] ve kolonoskopi) anestezistlerin prosedür sırası tercihlerini ve bu tercihlere etki eden faktörleri değerlendirmektir. Gereç ve Yöntemler: Tanımlayıcı ve kesitsel tasarımda yürütülen bu anket çalışması, Kasım-Aralık 2024 tarihleri arasında Türkiye genelinde ameliyathane dışı anestezi uygulamalarında deneyimli anestezistlere çevrim içi platformlar aracılığıyla uygulanmıştır. Çalışmaya, endoskopi ünitelerinde aktif görev alan ve bidirectional endoskopi konusunda deneyimli 204 anestezist katılmıştır. Anket formu, katılımcıların demografik bilgileri, klinik pratikleri, prosedür sırası tercihleri ve tercih nedenlerini sorgulayan sorulardan oluşmuştur. Verilerin istatistiksel analizi SPSS 22.0 programı kullanılarak gerçekleştirilmiş, kategorik değişkenler Pearson Ki-Kare testi ile değerlendirilmiş ve p0,05). Sonuç: Anestezistlerin bidirectional endoskopide işlem sırası tercihleri çeşitli hasta ve çevresel faktörlerden etkilenmektedir. Çoğu anestezist, hasta güvenliği ve ekip dinamiklerini göz önünde bulundurarak işlem sırası olarak ÖGD ile başlamayı tercih etmektedir. Elde edilen bulgular, multidisipliner ekip çalışmasının ve hasta özelliklerinin dikkate alınmasının, hasta güvenliği ve prosedürel başarı açısından önemini vurgulamaktadır.

Inability to remain motionless owing to pain during magnetic resonance imaging (MRI) may increase the need for sedation and analgesia. Here, we present a case where ultrasound-guided sacral erector spinae plane block (ESPB) was used successfully for pain management during an MRI in a patient suffering from severe sacral pain. Sacral ESPB was performed with a total of 30 mL of 0.25% bupivacaine at the level of the intermediate sacral crest. The patient achieved sensory block in the L5–S4 dermatomes without motor block, resulting in complete pain relief. This case report highlights the feasibility of ultrasound-guided sacral ESPB as a potential pain management technique.

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.

Nowadays, 10% povidone-iodine is a topical antiseptic solution that is commonly used in surgical areas’ sterilization, wound cleaning and daily wound dressing. Severe complications may arise from povidone-iodine when it is not used carefully and in adequate proportion. Povidone-iodine-induced chemical skin reactions is one of the severe complications. Given the widespread use of povidone-iodine, clinicians need to be aware of this possible adverse drug reaction and of preventive cautions. This report presents two cases about povidone-iodine related skin reaction (these reactions are also called as chemical burns or chemical skin reactions) which are encountered in our hospital (Ondokuz Mayıs University, Samsun, Turkey) to point this important issue.