Erkan Bayram

Postoperative pain control is important in patients with obesity undergoing laparoscopic bariatric surgery, as inadequate analgesia may increase opioid consumption and delay recovery. Ultrasound-guided fascial plane blocks are increasingly used as part of multimodal analgesia. The recto-intercostal plane block (RIPB) is a recently described technique that may provide effective upper abdominal wall analgesia when applied bilaterally with a high-volume approach. However, evidence regarding its efficacy in bariatric surgery is limited. This study aimed to evaluate whether bilateral ultrasound-guided RIPB reduces postoperative opioid consumption and improves recovery after laparoscopic sleeve gastrectomy. This prospective, randomized, assessor-blinded controlled trial included 56 patients with obesity undergoing elective laparoscopic sleeve gastrectomy under general anesthesia. Patients were allocated to receive either bilateral ultrasound-guided RIPB at the end of surgery (RIPB group, n = 28) or standard analgesic management without regional block (Control group, n = 28). The RIPB was performed using bupivacaine diluted to a final concentration of 0.25% and a total volume of 60 mL, with 30 mL administered per side. All patients received standardized multimodal analgesia and intravenous patient-controlled analgesia with morphine. The primary outcome was cumulative intravenous morphine consumption within the first 24 postoperative hours. Secondary outcomes included pain scores, rescue opioid use, postoperative nausea and vomiting, and quality of recovery assessed using the Quality of Recovery-15 questionnaire. Twenty-four-hour cumulative morphine consumption was significantly lower in the RIPB group than in the Control group (median [IQR]: 5 [4-10.25] mg vs. 24.5 [21.75-30] mg; p < 0.001). Static and dynamic NRS scores were significantly lower in the RIPB group at the 1st postoperative hour, with no significant differences at later time points after correction for multiple comparisons. Quality of recovery at 24 h was significantly better in patients receiving RIPB (median [IQR]: 131.5 [123-137.25] vs. 113.0 [109-119]; p < 0.001). Rescue opioid use and postoperative nausea and vomiting rates were similar between groups. No block-related complications were observed. Bilateral ultrasound-guided high-volume recto-intercostal plane block significantly reduced postoperative opioid consumption and improved early recovery in patients with obesity undergoing laparoscopic sleeve gastrectomy. ClinicalTrials.gov identifier: NCT07253610 .registered on 19 November 2025; Retrospectively Registered.

And lumbar discectomy remains one of the most commonly performed spinal procedures when conservative treatment fails. Despite advances in surgical technique and perioperative management, postoperative pain—particularly during the early postoperative period—remains clinically relevant. Severe pain within the first 24 hours after surgery may delay mobilization, increase opioid requirements, and complicate recovery. However, perioperative factors associated with severe early postoperative pain following elective single-level lumbar discectomy remain incompletely understood.Methods: This retrospective cohort study included adult patients undergoing elective single-level lumbar discectomy under general anesthesia. Postoperative pain intensity was assessed using the maximum numeric rating scale score recorded within the first 24 hours. Severe pain was defined as a score ≥7. Demographic, operative, and analgesic variables, including operative duration, intraoperative opioid exposure (fentanyl equivalents), multimodal analgesia, and rescue opioid use, were analyzed. Univariable and multivariable logistic regression analyses identified factors independently associated with severe early postoperative pain.Results: Among 322 patients, 78 (24.2%) experienced severe early postoperative pain. Longer operative duration (adjusted odds ratio 1.38 per 10-minute increase), higher intraoperative opioid exposure (adjusted odds ratio 1.29 per 50 microgram increase), absence of multimodal analgesia (adjusted odds ratio 0.46), and post-anesthesia care unit rescue opioid administration (adjusted odds ratio 3.12) were independently associated with severe pain within the first 24 hours.Conclusions: Severe early postoperative pain after single-level lumbar discectomy is common and is influenced by perioperative factors. Optimizing multimodal analgesia and limiting intraoperative opioid exposure may improve outcomes.

Association of Preoperative Neutrophil-to-Lymphocyte Ratio With Post-Dural Puncture Headache After Cesarean Delivery - Article abstract #952396

Background Preoperative anxiety adversely affects anesthetic management, hemodynamic stability, and recovery. Among modifiable perioperative variables, the impact of preoperative waiting time on anxiety and postoperative outcomes has been insufficiently explored. Aim To assess the relationship between waiting time and perioperative anxiety, hemodynamic responses, intraoperative opioid use, and postoperative analgesic requirements in adults undergoing elective surgery under general anesthesia. Methods In this prospective observational study, 130 ASA I–II adults were evaluated in the preoperative waiting area. The Amsterdam Preoperative Anxiety and Information Scale (APAIS), systolic blood pressure, and heart rate were measured on arrival and immediately pre-induction. Waiting time was the interval between these assessments. Intraoperative fentanyl/remifentanil doses and postoperative tramadol consumption were recorded. Pearson correlation and linear regression were used (p < 0.05). Results Longer waiting times were associated with higher pre-induction APAIS scores (r = 0.339, p < 0.001) and greater postoperative tramadol use (r = 0.333, p < 0.001). Waiting time inversely correlated with preoperative systolic blood pressure (r = − 0.253, p = 0.004). Associations with intraoperative opioid doses were not significant. Female sex, lower education, prior surgery, and negative surgical experiences were associated with higher anxiety. Midazolam premedication did not prevent anxiety escalation in patients with extended waiting times. Conclusion Preoperative waiting time is a modifiable, hospital-based factor that meaningfully influences perioperative anxiety and postoperative analgesic demand. Reducing unnecessary delays through individualized perioperative planning may enhance patient comfort, support hemodynamic stability, and reduce postoperative analgesic requirements.

BACKGROUND Background: Hemogram-derived indices, including the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), are widely used for diagnostic and prognostic purposes in critically ill patients. However, these indices may be influenced not only by disease processes but also by therapeutic interventions such as cytokine-filtered continuous renal replacement therapy (CRRT). This study aimed to evaluate temporal changes in NLR and PLR in patients with sepsis undergoing cytokine-filtered CRRT. MATERIAL AND METHODS Material and Methods: Data from 93 intensive care unit patients who received cytokine-filtered CRRT between January 2020 and December 2022 at a single tertiary care center were retrospectively reviewed. Hemogram values were recorded at baseline (Day 0) and on Days 1, 2, and 3. The primary outcome was the change in PLR; secondary outcomes included changes in NLR and other hematologic parameters. Statistical analyses were performed using repeated measures analysis of variance and regression modeling. RESULTS Results: PLR significantly decreased from Day 0 to Days 2 and 3 (P CONCLUSIONS Conclusions: NLR and PLR are sensitive to cytokine-filtered CRRT and may reflect treatment-related effects, rather than disease progression. Careful consideration of the timing and clinical context of laboratory sampling is essential when interpreting these indices in intensive care unit settings.

Background: The aim of our study is to compare the effect of the 30° reverse Trendelenburg position combined with the beach chair position on respiratory parameters in laparoscopic sleeve gastrectomy (LSG) with the 30° reverse Trendelenburg position alone. Material and method: Fifty patients with body mass index > 30 were included in the study. The patients were divided into two groups; in the control group, the standard 30° reverse Trendelenburg. In the beach chair group, the feet were positioned at 30° flexion from the hips after a 30° RTP. For both positions, blood pressures, pulses, saturations, EtCO2, respiratory rate, inspiratory pressure (Pins), positive end-expiratory pressure (PEEP), minute volume, tidal volume, peak airway pressure (Ppeak), and dynamic compliance were recorded. In addition, the general surgeon was asked about his satisfaction with the intra-abdominal operation site view and whether he was uncomfortable with the position. Results: Regardless of the group, the average age of the cases was 36.7 ± 12.1 years. There was no difference between the groups in terms of age, gender, BMI, operation time, blood pressures, heart rates, EtCO2, respiratory rate, PEEP, minute volume, tidal volume, and postoperative oxygen saturation (p > 0.05). Inspiratory and peak pressure were lower and dynamic compliance was higher in the beach chair position (p < 0.05). It was observed that the beach chair position decreased inspiratory and peak pressures and increased dynamic compliances in patients with a BMI between 35.1 and 40 (p < 0.05). Surgical satisfaction was high for both positions and there was no discomfort with the position. Conclusion: It was determined that the beach chair position in LSGs reduced inspiratory and peak pressures and increased dynamic compliance. These parameters were related to BMI, and the beach chair position was more positive in terms of intraoperative lung pressures and dynamic compliance, especially in patients with a BMI between 35.1 and 40. ClinicalTrials.gov ID: NCT06402474.

Objective: Cardiopulmonary arrest is considered to be an unpredicted event leading to sudden death. The primary purpose of the study is to investigate the effects of antiarrhythmic drugs during defibrillation within cardiopulmonary resuscitation (d-CPR) on survival outcomes. Materials and Methods: The antiarrhythmic drug treatment during d-CPR management in our hospital from 2015 to 2022 were evaluated retrospectively. Demographic information, and details related to resuscitation were obtained from the “Cardiopulmonary Resuscitation and Code Blue Forms”. According to inclusion criteria, from 898 patient data 135 were included. The treatment of anti-arrhythmic drugs administered during d-CPR management were lidocaine, amiodarone, or amiodarone&lidocaine together. Data recorded related to the present study were evaluated primarily according to the return of spontaneous circulation (ROSC) and survival outcomes. Results: The mean cardiopulmonary resuscitation duration was 31.82±22.37 minutes in patients with ROSC and 42.40±9.28 minutes in non-ROSC, p<0.01. Amiodarone administration during d-CPR was the highest preffered treatment from 2015 to 2022, when compared with the usage of amiodarone&lidocaine together (14.1%), p<0.01. However the administration of lidocaine during d-CPR (39.3% of all) appered to be performed before 2020 in our hospital. Additionally amiodarone revealed a positive effect on systolic blood pressure and mean arterial pressure in ROSC patients (p=0.02, p=0.04 respectively), while the choice of antiarrhythmic drug treatment during d-CPR management showed no significant difference on survival status. Conclusion: The observed ROSC was 42.2%. The choice of antiarrhythmic drug treatment during d-CPR management showed no significant difference on survival status, although amiodarone revealed a positive effect on systolic blood pressure and mean arterial pressure in the patients with ROSC.