Ramazan Aslanparcasi

Background/Objectives: To compare ultrasound-guided erector spinae plane block (ESPB) with an intramuscular nonsteroidal anti-inflammatory drug (IM NSAID) for analgesia during extracorporeal shock wave lithotripsy (ESWL). Methods: In this prospective, randomized, open-label trial, 90 patients scheduled for ESWL were allocated into three equal groups: ultrasound-guided ESPB at the T7 level; 75 mg of IM diclofenac sodium 30–45 min before the procedure; or no analgesic premedication (control). Pain was rated on the Visual Analog Scale (VAS) during the procedure, and hemodynamic variables, postprocedural analgesic requirement, and patient satisfaction were also recorded. Results: Mean intraoperative VAS scores differed among the groups (ESPB 2.96 ± 2.76, NSAID 4.47 ± 2.41, control 5.30 ± 2.15; p = 0.002, η² = 0.14). At the first shock wave and at the 25th minute, VAS scores were lower in the ESPB group than in both other groups; at all remaining time points they were lower than in the control group. Early postprocedural analgesic requirement was highest in the control group (33.3% vs. 6.7% and 10.0%; p = 0.016), as it was at the 8th hour (p = 0.007). Satisfaction was lower in the control group than in the ESPB group (p = 0.018), with no significant difference between the control and NSAID groups after adjustment for multiple comparisons. Hemodynamic variables did not differ among the groups, and no complications were observed. Conclusions: ESPB gave better pain control during ESWL than no analgesia, and outperformed the IM NSAID regimen at the first shock wave and at the 25th minute. It also lowered the early analgesic requirement and improved satisfaction, which makes it a practical analgesic option for ESWL.

Background/Objectives: Ultrasound-guided brachial plexus blocks are widely used in upper extremity surgery. The costoclavicular block (CCB) has been defined in recent years as an alternative to the infraclavicular block (ICB) and attracts attention due to its anatomical advantages. However, studies comparing these two techniques using objective physiological parameters are limited. This study aimed to compare the effectiveness of CCB and ICB techniques by measuring tissue oxygenation with near-infrared spectroscopy (NIRS) and evaluating the role of NIRS in demonstrating block success. Methods: Eighty patients undergoing upper extremity surgery were included in this prospective, randomized, comparative study, and the patients were randomly divided into two groups: CCB (n = 40) and ICB (n = 40). Block success was evaluated using tissue oxygen saturation (StO₂) and its change (ΔStO₂) measured by NIRS in addition to sensory and motor assessments. In addition, hemodynamic parameters were recorded. Results: A statistically significant increase in StO₂ and ΔStO₂ values was observed after block application in both groups. In the costoclavicular block group, the median StO₂ increased from 78.5 [8.5] at baseline to 86.5 [9.75] at 20 min (p < 0.001), while in the infraclavicular block group, it increased from 75.0 [12.0] to 85.0 [9.0] (p < 0.001). Similarly, the ΔStO₂ values increased from 0.0 [0.0] to 9.5 [8.25] in the costoclavicular group and from 0.0 [0.0] to 11.0 [9.0] in the infraclavicular group (both p < 0.001). This increase began in the early period and paralleled sensory-motor block findings, indicating that NIRS measurements objectively reflect block success. An isolated intergroup difference in StO₂ was observed at t10 (83.92 ± 6.17 vs. 80.33 ± 7.31, p = 0.023), but no consistent intergroup superiority was demonstrated across the follow-up period. No statistically significant intergroup differences were found for ΔStO₂ at any time point (p > 0.05). The block success rates were similar between groups. The hemodynamic parameters remained stable in both groups, and no clinically significant adverse events were observed. Conclusions: CCB and ICB techniques have similar efficacy and safety profiles in upper extremity surgery. NIRS-derived StO₂ and ΔStO₂ changes appear to be promising complementary physiological markers associated with block onset. However, the present study was not designed to establish diagnostic cut-off values or predictive accuracy; therefore, NIRS should be interpreted as an adjunct to, rather than a replacement for, conventional sensory and motor block assessment.

Background and Objectives: Sepsis is a life-threating organ dysfunction condition caused by the body’s uncontrolled response to an infection. Many traditional and novel inflammatory markers have been used to determine poor prognosis in patients’ sepsis. The inflammatory prognostic index (IPI) is also a novel marker of inflammation. As there are no studies examining the association of the IPI with in-hospital mortality in patients with sepsis nor its performance compared with other inflammatory markers, we aimed to investigate the clinical importance of the IPI for predicting in-hospital mortality in sepsis patients. Materials and Methods: A total of 157 consecutive patients diagnosed with sepsis were retrospectively included in this study. The systemic immune-inflammation index (SII; platelet × neutrophil/lymphocyte), the systemic inflammatory response index (SIRI; neutrophil × monocyte/lymphocyte), the aggregate index of systemic inflammation (AISI; neutrophil × platelet × monocyte/lymphocyte) and the IPI (C-reactive protein × neutrophil-to-lymphocyte ratio [NLR]/albumin) were calculated for all patients. Patients were divided into two groups: survivors (n = 81) and non-survivors (n = 76). Results: Non-survivor patients had significantly higher SII (p = 0.002), SIRI (p < 0.001), AISI (p = 0.002) and IPI (p < 0.001) than survivors. The AUC of the IPI was significantly higher than those of the SII (0.751 vs. 0.645; p = 0.010) and the AISI (0.751 vs. 0.648; p = 0.021) and tended to be higher than that of the SIRI (0.751 vs. 0.687; p = 0.091). Based on logistic regression analysis, the IPI was found to be an independent predictor of mortality (OR: 1.007, 95%CI: 1.002–1.012, p = 0.006). Conclusions: The IPI is a novel combined inflammatory marker that can be easily obtained from laboratory parameters. We determined that the IPI had moderately higher discriminatory ability than the SII and the AISI in patients with sepsis, which indicates that it may be used for risk stratification in this population.