Challenge Journal of Perioperative Medicine
type: channel
description: cjpm.challengejournal.com Challenge Journal of Perioperative Medicine is an international, triannually published and open access scholarly journal that publishes that publishes original research articles as well as short communications, review articles, case reports, discussions, book reviews, images and letters to editor related to all aspects of perioperative medicine, including educational materials. Content of CJPM aims to develop a point of view for researchers and healthcare professionals regarding regional techniques for pain medicine, surgical anesthesia, and postoperative analgesia. A double blind peer-review policy is followed in order to increase the scientific quality of the published papers.
publisher: Tulpar Academic Publishing
language: en-US
publication name: Challenge Journal of Perioperative Medicine
issn: 2980-292X
items: Cover & Contents Vol.4 No.1
items: Walking the tightrope: Anaesthesia for fragile hearts and overactive glands in elderly hip surgery
items: Failed labour epidural analgesia: mechanisms, risk factors and stepwise management: Guideline-based review
items: The predictive impact of perioperative hypofibrinogenemia on re-exploration in cardiac surgery: Insights from a single-center analysis
items: Perioperative factors associated with severe early postoperative pain after single-level lumbar discectomy: A retrospective cohort study
items: The effects of intravenous esmolol on hemodynamic response to endotracheal intubation and rocuronium onset time: A retrospective analysis
items: Prediction of postoperative acute kidney injury after cardiopulmonary bypass cardiac surgery: The role of preoperative inflammatory indices and intraoperative perfusion stress
items: Cover & Contents Vol.3 No.3
items: Erratum to: The impact of vagal nerve stimulation from the lateral neck region on venous cannulation pain: A randomized controlled trial
items: Evaluation of the content quality of regional anesthesia and postoperative analgesia approaches generated by ChatGPT-4.0 according to surgical incision sites
items: Deep serratus anterior plane block vs. rhomboid intercostal plane block for analgesia after breast cancer surgery: A prospective, double-blind randomized study
items: Evaluation of quality of life and psychosocial factors in hemodialysis patients: A medical student-led observational survey study from a Turkish university hospital
items: Retrospective comparison of anesthetic effects of bupivacaine and bupivacaine + dexmedetomidine in infraclavicular brachial plexus block in upper limb surgery
items: Cost-effectiveness of fascial plane blocks in laparoscopic cholecystectomy: A retrospective study
items: Levobupivacaine versus bupivacaine for spinal anesthesia in jackknife position: A randomized trial in pilonidal sinus surgery
items: Cover & Contents Vol.3 No.2
items: Motor Block Following Lumbar Erector Spinae Plane Block for Postoperative Analgesia After Lumbar Spinal Surgery: A Case Report
items: Awake laparoscopic cholecystectomy under thoracal segmental spinal anesthesia and intermediate cervical plexus block: A case series
items: Effects on cardiopulmonary bypass duration and optic nerve sheath diameter changes
items: Tonsillectomy in a pediatric patient with propionic acidemia: Anesthesia management and potential perioperative challenges
items: “Keeping it steady”: Anaesthetic challenges in insulinoma surgery
items: Radiological evaluation of central venous catheter tip malposition
items: The effects of lycopene in lung injury associated with cecum ligation and perforation-induced sepsis in rats: An investigative animal experiment study
items: Ultrasound-guided supraclavicular nerve and interscalene block for clavicle surgery in pregnancy: A case report and case-based literature review
items: The impact of vagal nerve stimulation from the lateral neck region on venous cannulation pain: A randomized controlled trial
items: Cover & Contents Vol.3 No.1
items: Neuraxial anesthesia in pregnant patients with neurological disorders ‒ Safety and practice strategies: A review
items: Unexpected venous anomaly around the brachial plexus during supraclavicular block: A case report
items: Triple threat: Anesthetic approach to IVF twin gestation, pre-eclampsia and peripartum cardiomyopathy in caesarean section
items: Left colon volvulus following sigmoidectomy
items: Retrospective evaluation of analgesia approaches in patients undergoing thoracic surgery over the last one year: A single-center study
items: Early detection of acute kidney injury in critically ill burn patients: Evaluating the predictive role of serum and urinary NGAL
items: Cover & Contents Vol.2 No.3
items: https://www.challengejournal.com/index.php/cjpm/article/view/803
items: The effect of modified paramedian and median approaches of spinal anesthesia on postspinal acute low back pain in patients undergoing urological surgery: a prospective cohort study
items: Comparison of the effects of femoral and axillary artery cannulation on ischemic cerebral injury in acute type A aortic dissection surgery: A retrospective study
items: Assessing the efficacy of sugammadex based on ideal body weight for reversal of moderate neuromuscular blockade in obstetric patients across different BMI categories: A prospective study
items: Effectiveness of dry needle therapy in patients with chronic nonspecific low back pain
items: How does intravenous ondansetron affect motor and sensory block in spinal anesthesia administered with intrathecal levobupivacaine? A prospective randomized controlled study
items: Cover & Contents Vol.2 No.2
items: Perioperative ventricular dysrhythmia management in ranula cyst excision surgery
items: Anaphylaxis following unfractionated heparin administration: How safe is this drug in the treatment of thromboembolism?
items: Block combinations: The answer sought or a waste of effort?
items: https://www.challengejournal.com/index.php/cjpm/article/view/805
items: Analyzing the educational quality of YouTube videos on paravertebral block techniques
items: Perioperative complications in patients undergoing urological surgery with spinal anesthesia: A prospective, observational study
items: Cover & Contents Vol.2 No.1
items: A comprehensive retrospective analysis of interfascial plane blocks and peripheral nerve blocks at a tertiary research hospital: Single center experience
items: Evaluation of Analgesic Nociceptive Index in intraoperative and postoperative pain management in general anesthesia applied with two different methods
items: Comparison of the analgesic effects of different bupivacaine concentrations in continuous femoral block after total knee arthroplasty surgery

Cover & Contents Vol.4 No.1
type: item
creator: Journal Management CJPM
rights: Copyright (c) 2026 Tulpar Academic Publishing http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2026-02-28
publication date: 2026-02-28
volume: 4
number: 1

Walking the tightrope: Anaesthesia for fragile hearts and overactive glands in elderly hip surgery
type: item
description: Anesthetic management of elderly patients with ischemic heart disease, dilated cardiomyopathy with severe left ventricular dysfunction, and hyperthyroidism undergoing bipolar hemiarthroplasty presents unique challenges. Hyperthyroidism can exacerbate cardiac conditions, increasing perioperative risks. Preoperative optimization involves achieving euthyroid status using antithyroid medications and beta-blockers to control heart rate. A comprehensive cardiovascular evaluation is essential to manage heart failure and maintain hemodynamic stability. Severe pulmonary arterial hypertension further complicates anesthetic management due to increased perioperative morbidity and mortality. These patients are at higher risk for complications such as myocardial infarction and respiratory failure during anesthesia and surgery. Intraoperatively, regional anesthesia techniques may be preferred to minimize cardiovascular stress. Close monitoring of pulmonary pressures and ventricular function is crucial during the perioperative period. Postoperative care should focus on vigilant monitoring for potential complications, including thyroid storm, cardiac events, and exacerbation of pulmonary arterial hypertension. A multidisciplinary approach involving anesthesiologists, cardiologists, pulmonologists, and surgeons is essential to enhance surgical outcomes in such high-risk patients. In this case report, we present the combination of lumbar and sacral plexus blocks that we applied as the sole anesthesia method in a high-risk patient with multiple comorbidities undergoing bipolar hemiarthroplasty surgery.
creator: Ranganath Laxman Channappagoudar
creator: Shilpa Shivananda
rights: Copyright (c) 2026 by the Authors. This is an open access article distributed under the CC BY licence. http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2026-02-28
publication date: 2026-02-28
volume: 4
number: 1
starting page: 38
ending page: 41
doi: 10.20528/cjpm.2026.01.006

Failed labour epidural analgesia: mechanisms, risk factors and stepwise management: Guideline-based review
type: item
description: Bacgkround: Epidural analgesia is the most widely used neuraxial technique for labour pain management; however, inadequate or failed analgesia remains a frequent and clinically relevant problem. This review aims to summarise the mechanisms and risk factors associated with failed labour epidural analgesia and to present a stepwise management approach aligned with current European Society of Anaesthesiology and Intensive Care (ESAIC) guidance. Methods: A review of clinical guidelines, observational studies and interventional trials addressing labour epidural failure, breakthrough pain and rescue strategies was performed. Results: Failed labour epidural analgesia is a multifactorial condition involving catheter-related issues such as suboptimal insertion depth, migration, unilateral or patchy block and unintended catheter placement, in addition to maternal, obstetric and operator-related factors. Effective management requires structured reassessment of pain characteristics, labour progression, sensory block level, catheter position and infusion parameters. Stepwise rescue strategies, including catheter manipulation, patient repositioning and adjustment of local anaesthetic dosing, may restore analgesic efficacy. Persistent inadequacy necessitates timely senior review and early consideration of catheter re-siting or alternative neuraxial techniques. Conclusions: Early recognition and structured, stepwise management are essential for the effective treatment of failed labour epidural analgesia. Adherence to evidence-based guidelines, optimization of technical practice and appropriate organisational support may reduce failure rates and improve maternal outcomes.
creator: Selvinaz Yüksel Tanrıverdi
creator: İlknur Hatice Akbudak
rights: Copyright (c) 2026 by the Authors. This is an open access article distributed under the CC BY licence. http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2026-02-28
publication date: 2026-02-28
volume: 4
number: 1
starting page: 32
ending page: 37
doi: 10.20528/cjpm.2026.01.005

The predictive impact of perioperative hypofibrinogenemia on re-exploration in cardiac surgery: Insights from a single-center analysis
type: item
description: Background: Postoperative bleeding in cardiac surgery is a serious complication associated with increased morbidity, mortality, and healthcare costs. The objective of this study was to identify independent risk factors for re-exploration due to bleeding in patients undergoing cardiac surgery, with a particular emphasis on the predictive role of perioperative hypofibrinogenemia. Methods: In this single-center retrospective observational cohort study, a total of 593 consecutive adult patients who underwent cardiac surgery between January 1, 2025, and June 30, 2025, were retrospectively reviewed. The primary endpoint was surgical re-exploration for bleeding within 48 hours postoperatively. Demographic characteristics, comorbidities, laboratory parameters, surgical variables, and postoperative complications were recorded. Variables found to be significant in univariate analysis were further analyzed using multivariate logistic regression. The threshold value of postoperative fibrinogen for predicting re-exploration risk was calculated. Results: The overall re-exploration rate was 15.6%. Approximately 10% of cases were urgent surgeries. Independent risk factors identified in multivariate analysis were female sex (OR=2.7; p=0.001), age ≥65 years (OR=2.0; p=0.011), body mass index (BMI) outside the normal range (OR=2.7; p=0.002), preoperative fibrinogen <1.5 g/L (OR=3.7; p=0.007), and postoperative fibrinogen <1.5 g/L (OR=2.7; p=0.012). The ROC analysis for postoperative fibrinogen was statistically significant (AUC=0.691; 95% CI 0.629–0.752; p<0.001). The optimal cut-off was 2.06 g/L (Youden index=0.346), with 79.8% sensitivity and 54.8% specificity. Patients undergoing re-exploration had significantly longer ICU stays (p<0.001) and higher mortality rates (p<0.001). Conclusions: The risk of re-exploration in cardiac surgery is increased in association with female sex, advanced age, abnormal BMI, and particularly perioperative hypofibrinogenemia. A preoperative fibrinogen …
creator: Aslıhan Aykut
creator: Nisan Özsan
creator: Fatıma Beyza Artıran
creator: Zeliha Aslı Demir
rights: Copyright (c) 2026 by the Authors. This is an open access article distributed under the CC BY licence. http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2026-02-28
publication date: 2026-02-28
volume: 4
number: 1
starting page: 1
ending page: 9
doi: 10.20528/cjpm.2026.01.001

Perioperative factors associated with severe early postoperative pain after single-level lumbar discectomy: A retrospective cohort study
type: item
description: Background: Lumbar disc herniation is a frequent cause of radicular low back pain, 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 ou…
creator: Erkan Bayram
creator: Şükrü Çiftçi
rights: Copyright (c) 2026 by the Authors. This is an open access article distributed under the CC BY licence. http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2026-02-28
publication date: 2026-02-28
volume: 4
number: 1
starting page: 15
ending page: 20
doi: 10.20528/cjpm.2026.01.003

The effects of intravenous esmolol on hemodynamic response to endotracheal intubation and rocuronium onset time: A retrospective analysis
type: item
description: Background: Airway instrumentation during induction can elicit acute sympathetic stimulation with transient cardiovascular fluctuations, particularly elevations in arterial blood pressure. Esmolol, an ultra–short-acting β₁-selective antagonist, is often administered peri-induction to blunt these peri-intubation responses. However, its effects on neuromuscular blockade onset in routine clinical practice remain insufficiently explored. This retrospective study evaluated the association between peri-induction intravenous esmolol administration, hemodynamic responses to endotracheal intubation, and the onset time of rocuronium-induced neuromuscular blockade. Methods: We retrospectively reviewed anesthesia charts of adult patients (18–60 years) with ASA physical status I–II who underwent elective surgery. Patients were classified according to peri-induction esmolol use: an esmolol group receiving a single intravenous bolus of 0.5 mg/kg (500 µg/kg) administered over 1 minute, and a control group without beta-blocker administration (30 patients per group). Anesthesia induction was performed with thiopental, fentanyl, and rocuronium (0.6 mg/kg). Neuromuscular blockade onset time was defined as the time from rocuronium administration to Train-of-Four count 1. Hemodynamic parameters were recorded before and after endotracheal intubation, and intubation conditions were assessed using the Cooper scale. Results: Demographic characteristics were comparable between groups. The time to Train-of-Four count 1 was significantly longer in the esmolol group compared with controls (129.9 ± 22.8 s vs. 88.5 ± 12.0 s, p < 0.001). Between-group differences in systolic and diastolic arterial pressure were observed at specific early peri-intubation time points but were not sustained thereafter. Intubation conditions were significantly better in the esmolol group, with a higher proportion of patients achieving excellent Cooper scale scores (p < 0.05). Conclusions: Peri-induction intravenous esm…
creator: Mustafa Simsek
creator: Elif Bombaci
rights: Copyright (c) 2026 by the Authors. This is an open access article distributed under the CC BY licence. http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2026-02-28
publication date: 2026-02-28
volume: 4
number: 1
starting page: 10
ending page: 14
doi: 10.20528/cjpm.2026.01.002

Prediction of postoperative acute kidney injury after cardiopulmonary bypass cardiac surgery: The role of preoperative inflammatory indices and intraoperative perfusion stress
type: item
description: Background: Postoperative acute kidney injury is a frequent complication after cardiac surgery performed with cardiopulmonary bypass and is closely associated with increased mortality. This study aimed to evaluate the predictive value of preoperative renal function, routinely available inflammatory indices, and intraoperative perfusion stress–related parameters for the development of postoperative acute kidney injury in adult cardiac surgery. Methods: This single-center retrospective cohort study included 455 adult patients aged 18 years or older who underwent elective or urgent coronary artery bypass grafting, valve surgery, or combined procedures with cardiopulmonary bypass between January 1, 2025 and January 1, 2026. Postoperative acute kidney injury was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria by comparing the highest serum creatinine value measured within the first 72 postoperative hours with the preoperative creatinine level obtained within 48 hours before surgery. Preoperative inflammatory indices derived from routine blood tests and intraoperative perfusion-related variables were recorded. Independent predictors of acute kidney injury were identified using parsimonious multivariable logistic regression analysis, and discriminative performance was assessed by receiver operating characteristic analysis. Results: Postoperative acute kidney injury occurred in 216 patients (47.5%), and 12.7% developed stage two or higher acute kidney injury. In-hospital mortality was significantly higher in patients with acute kidney injury compared with those without acute kidney injury (25.5% versus 6.7%), increasing progressively with advancing severity. Advanced age, higher preoperative serum creatinine, and longer cardiopulmonary bypass duration were independently associated with postoperative acute kidney injury. For stage two or higher acute kidney injury, age and cardiopulmonary bypass duration remained independent predictors. Alt…
creator: Mehmet Akif Yilmaz
creator: Mehmet Zubeyir Guney
creator: Nuray Uzun
creator: Hasan Emre Kivanc
creator: Ebubekir Sonmez
creator: Muhammed Enes Aydin
rights: Copyright (c) 2026 by the Authors. This is an open access article distributed under the CC BY licence. http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2026-02-28
publication date: 2026-02-28
volume: 4
number: 1
starting page: 21
ending page: 31
doi: 10.20528/cjpm.2026.01.004

Cover & Contents Vol.3 No.3
type: item
creator: Journal Management CJPM
rights: Copyright (c) 2025 Tulpar Academic Publishing http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2025-10-30
publication date: 2025-10-30
volume: 4
number: 1

Erratum to: The impact of vagal nerve stimulation from the lateral neck region on venous cannulation pain: A randomized controlled trial
type: item
description: This article corrects an error in the authorship listing of the original publication: Canikli Adiguzel S. The impact of vagal nerve stimulation from the lateral neck region on venous cannulation pain: A randomized controlled trial. Chall J Perioper Med. 2025; 3(2):48–53. https://doi.org/10.20528/cjpm.2025.02.003 Due to an editorial error, the original article listed only the corresponding author. The correct authorship should be as follows: Senay Canikli Adiguzel, Emre Can Soydan, Ebru Kayikci, Mustafa Suren, Ismail Okan The Editorial Office of Challenge Journal of Perioperative Medicine apologizes for this error. The scientific content of the article remains unchanged.
creator: Senay Canikli Adiguzel
creator: Emre Can Soydan
creator: Ebru Kayikci
creator: Mustafa Suren
creator: Ismail Okan
rights: Copyright (c) 2025 Tulpar Academic Publishing http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2025-10-30
publication date: 2025-10-30
volume: 4
number: 1
starting page: 111
ending page: 111
doi: 10.20528/cjpm.2025.03.007

Evaluation of the content quality of regional anesthesia and postoperative analgesia approaches generated by ChatGPT-4.0 according to surgical incision sites
type: item
description: Background: Large language models (LLMs) are increasingly consulted for perioperative decision support, yet their ability to give professional-grade guidance for regional anesthesia and analgesia remains uncertain. Materials and Methods: In a prospective observational study, we presented eight incision-based figures (Items 2–9) representing common abdominal incisions to ChatGPT-4.0 and requested a regional anesthesia technique and postoperative analgesia plan for each. Five independent anesthesiologists rated each response on Accuracy, Comprehensiveness, and Safety using a 5-point Likert scale. Inter-rater reliability was summarized with Fleiss’ κ. One non-incision item (Item 10) was analyzed descriptively and excluded from pooled statistics. Single-shot prompts were used. Results: Mean ratings were high: Accuracy 4.28, Comprehensiveness 4.30, Safety 4.00 (1–5 scale). Inter-rater agreement was substantial for Safety (κ=0.76) and lower for Accuracy (κ=0.33) and Comprehensiveness (κ=0.31). Two consistent low points emerged: right-lower-quadrant (McBurney/Lanz) incision‒Safety mean 3.0 and suprapubic (Pfannenstiel) incision‒Accuracy 3.0; Comprehensiveness 3.4; Safety 3.4. When explicitly asked for postoperative plans, the model rarely proposed neuraxial techniques (e.g., epidural), favoring fascial-plane/peripheral strategies. Conclusions: An LLM produced clinically usable suggestions for common abdominal incisions with strong safety agreement, but performance was not uniform, and neuraxial options were under-recommended. These tools may serve as a helpful adjunct for education and option-generation, yet they should be used with expert oversight and local protocols. Future work should test repeated sampling, prompt standardization, model/tier comparisons, and link recommendations to patient outcomes.
creator: Müzeyyen Beldağlı
rights: Copyright (c) 2025 by the Author. This is an open access article distributed under the CC BY licence. http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2025-10-30
publication date: 2025-10-30
volume: 4
number: 1
starting page: 100
ending page: 105
doi: 10.20528/cjpm.2025.03.005

Deep serratus anterior plane block vs. rhomboid intercostal plane block for analgesia after breast cancer surgery: A prospective, double-blind randomized study
type: item
description: Background: Ultrasound-guided interfascial plane blocks are widely used in breast cancer surgery, but direct comparisons of deep serratus anterior plane block (SAPB) and rhomboid intercostal plane block (RIPB) are limited. Materials and Methods: Single-center, prospective, randomized, double-blind trial of 40 women (ASA I–III) undergoing oncologic breast surgery. Participants were allocated to SAPB or RIPB, both as single-shot, ultrasound-guided adjuncts to standardized multimodal analgesia. The primary outcome was 24-hour morphine consumption; secondary outcomes were pain scores (NRS at rest and with 90° arm abduction at prespecified times), time to first analgesic request, and adverse events. Results: All randomized patients completed follow-up. Baseline features were comparable except for higher body weight in the SAPB group. The primary outcome did not differ between groups; pain scores were low throughout and showed no between-group differences. Time to first analgesic was similar (log-rank p=0.439). No block-related serious adverse events occurred. Conclusions: Within a standardized multimodal pathway, SAPB and RIPB provided similar early analgesia with low opioid use and a reassuring safety profile. Although the study was not designed for non-inferiority, the findings support RIPB as a practical alternative to SAPB in routine breast cancer surgery. Larger, procedure-stratified studies‒including quality-of-recovery and longer-term outcomes‒are warranted.
creator: Doğukan Kilit
creator: Zeliha Özer
rights: Copyright (c) 2025 by the Authors. This is an open access article distributed under the CC BY licence. http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2025-10-30
publication date: 2025-10-30
volume: 4
number: 1
starting page: 106
ending page: 110
doi: 10.20528/cjpm.2025.03.006

Evaluation of quality of life and psychosocial factors in hemodialysis patients: A medical student-led observational survey study from a Turkish university hospital
type: item
description: Background: Other than kidney-related problems, haemodialysis patients often face reduced mobility and the burden of chronic illness, along with other factors that negatively affect their health-related quality of life (HRQoL). Depression, fatigue, and pain are common, yet these issues are often overlooked during routine clinical follow-up. We aimed to assess fatigue, depressive mood, and functional limitations in patients with chronic kidney disease (CKD) undergoing haemodialysis and to examine their associations with demographic, clinical, and psychosocial factors. Materials and Methods: This cross-sectional, observational survey was conducted at a university haemodialysis unit in Türkiye. Sixty-four adult patients completed a modified questionnaire based on the SF-36 Health Survey, incorporating dialysis-specific domains. Data were collected through face-to-face interviews administered by trained medical students. Descriptive statistics and chi-square tests were used to examine associations between symptom domains and patient characteristics. Results: Of the 64 patients included (60.9% male, median age 61–70 years), 75.0% received dialysis three times weekly. Post-dialysis fatigue was reported as moderate (35.9%), severe (29.7%), or mild (25.0%). Clinically relevant depressive symptoms were reported by 18.8% of patients, while 43.8% described at least moderate pain. A strong association was found between pain severity and daily activity limitation (χ² = 58.3, df = 9, p < 0.001). Depression was not significantly associated with age, sex, or dialysis frequency. Conclusions: In this cohort, fatigue, pain, and depressive mood were prominent among haemodialysis patients and more closely related to symptom burden than to demographic or dialysis treatment parameters. Routine patient-reported outcome screening and targeted psychosocial interventions may improve quality of life and daily functioning in this population.
creator: Emrah Ereren
creator: Ilker Hasan Karal
creator: Askin Kilic
creator: Ilayda Danismaz
rights: Copyright (c) 2025 by the Authors. This is an open access article distributed under the CC BY licence. http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2025-10-30
publication date: 2025-10-30
volume: 4
number: 1
starting page: 76
ending page: 80
doi: 10.20528/cjpm.2025.03.001

Retrospective comparison of anesthetic effects of bupivacaine and bupivacaine + dexmedetomidine in infraclavicular brachial plexus block in upper limb surgery
type: item
description: Background: The objective of this study was to evaluate the anesthetic efficacy of dexmedetomidine as an adjuvant to bupivacaine in infraclavicular brachial plexus blocks administered for surgical procedures involving the hand and forearm. Materials and Methods: 84 patients, aged between 18-70 years, who underwent elective hand and forearm surgery in between January 2021 and July 2021, had American Society of Anesthesiologists (ASA) classification I-II, and were anesthetized with ultrasound-guided infraclavicular brachial plexus block were included in the study. Group B (n=42): 20 ml bupivacaine 0.5%+20 ml SF, Group B+D (n=42): 20ml bupivacaine 0.5% + 1 mcg/kg dexmedetomidine diluted to a volume of 20 mL was selected from the patients who underwent block. Demographic information of the patients were taken from the preoperative anesthesia evaluation form and recorded. From the information recorded in the patient follow-up form, peak heart rate, mean arterial pressure, oxygen saturation percentage, Visual Analogue Scale (VAS) scores, pinprick test score and Bromage score were recorded as study data. Results: Compared to group B, the onset time of sensory and motor blockade was statistically significantly earlier and the duration of sensory block, motor block and analgesia was statistically significantly longer in group B+D (p<0.05). In Group B+D, VAS score was statistically significantly lower at 10th, 20th, 8th and 12th hours (p<0.05). Conclusions: The addition of 1 mcg/kg dexmedetomidine to 20 ml of 0.5% bupivacaine in infraclavicular brachial plexus block was found to significantly accelerate the onset of sensory and motor block, and to extend the duration of motor block, sensory block, and postoperative analgesia.
creator: Şahan Şahinkaya
creator: Elif Başağan Moğol
creator: Leman Gökçenur Aydın
creator: Selcan Akesen
rights: Copyright (c) 2025 by the Authors. This is an open access article distributed under the CC BY licence. http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2025-10-30
publication date: 2025-10-30
volume: 4
number: 1
starting page: 88
ending page: 94
doi: 10.20528/cjpm.2025.03.003

Cost-effectiveness of fascial plane blocks in laparoscopic cholecystectomy: A retrospective study
type: item
description: Background: Fascial plane blocks have increasingly been used in recent years as a component of multimodal analgesia. The aim of this study was to evaluate the impact of fascial plane blocks, applied for postoperative analgesia, on hospital costs in laparoscopic cholecystectomy (LC) procedures. Materials and Methods: This retrospective, single-center study included 1414 patients who underwent elective LC under general anesthesia between 2020 and 2025. Patients were divided into two groups: those who received fascial plane blocks (Group M, n=346) and those who received the standard analgesia protocol (Group S, n=1068). Total hospital invoice costs at discharge, length of hospital stay, demographic characteristics, ASA scores, and comorbidities were compared between the groups. Results: No significant differences were observed between the groups regarding age, sex, or comorbidity rates. Hospital length of stay was similar. In the overall analysis covering 2020–2025, hospital costs were significantly lower in the fascial plane block group (p<0.001). Subgroup analyses by year revealed a significant cost difference in favor of the fascial plane block group only in 2024. Conclusions: In addition to providing effective analgesia, fascial plane blocks reduced hospital costs in LC procedures, contributing as a cost-effective component of multimodal analgesia.
creator: Serpil Sehirlioglu
rights: Copyright (c) 2025 by the Author. This is an open access article distributed under the CC BY licence. http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2025-10-30
publication date: 2025-10-30
volume: 4
number: 1
starting page: 81
ending page: 87
doi: 10.20528/cjpm.2025.03.002

Levobupivacaine versus bupivacaine for spinal anesthesia in jackknife position: A randomized trial in pilonidal sinus surgery
type: item
description: Background: This study aimed to compare the efficacy and clinical characteristics of levobupivacaine and bupivacaine for spinal anesthesia in the jackknife position during pilonidal sinus surgery. Materials and Methods: The onset and maximum level of sensory block were similar between groups. Regression to S2 occurred significantly earlier in the levobupivacaine group (139.7 ± 7.3 min) compared with the bupivacaine group (165.2 ± 8.0 min, p=0.001). The duration of motor block was also shorter in the levobupivacaine group (125.8 ± 6.5 vs. 148.5 ± 7.2 min, p=0.001). Hemodynamic stability and side-effect profiles were comparable between groups. Results: The onset and maximum level of sensory block were similar between groups. Regression to S2 occurred significantly earlier in the levobupivacaine group (139.7 ± 7.3 min) compared with the bupivacaine group (165.2 ± 8.0 min, p=0.001). The duration of motor block was also shorter in the levobupivacaine group (125.8 ± 6.5 vs. 148.5 ± 7.2 min, p=0.001). Hemodynamic stability and side-effect profiles were comparable between groups. Conclusions: Levobupivacaine provides shorter motor block duration and faster recovery compared with bupivacaine, making it particularly suitable for short procedures performed in the jackknife position. Larger multicenter trials are warranted to validate these findings.
creator: Hamiyet Senol Cakmak
creator: Onur Ozlu
rights: Copyright (c) 2025 by the Authors. This is an open access article distributed under the CC BY licence. http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2025-10-30
publication date: 2025-10-30
volume: 4
number: 1
starting page: 95
ending page: 99
doi: 10.20528/cjpm.2025.03.004

Cover & Contents Vol.3 No.2
type: item
creator: Journal Management CJPM
rights: Copyright (c) 2025 Tulpar Academic Publishing http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2025-06-30
publication date: 2025-06-30
volume: 4
number: 1

Motor Block Following Lumbar Erector Spinae Plane Block for Postoperative Analgesia After Lumbar Spinal Surgery: A Case Report
type: item
description: —
creator: Hande Gungor
creator: Ahmet Cetinkal
rights: Copyright (c) 2025 by the Authors. This is an open access article distributed under the CC BY licence. http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2025-06-30
publication date: 2025-06-30
volume: 4
number: 1
starting page: 74
ending page: 75
doi: 10.20528/cjpm.2025.02.009

Awake laparoscopic cholecystectomy under thoracal segmental spinal anesthesia and intermediate cervical plexus block: A case series
type: item
description: Laparoscopic cholecystectomy (LC) is the preferred approach for treating gallstone disease because of its minimally invasive characteristics. However, factors such as increased intra-abdominal pressure, pneumoperitoneum, and positional changes present significant challenges in anesthetic management. While LC is typically performed under general anesthesia, thoracic segmental spinal anesthesia and cervical plexus block have emerged as effective alternatives in patients for whom general anesthesia poses a high risk. This study reports the use of thoracic spinal anesthesia combined with cervical plexus block in patients where general anesthesia is considered risky. After obtaining informed consent for awake laparoscopic surgery, anesthesia was managed under appropriate monitoring. The combination of spinal anesthesia and cervical plexus block allowed for the successful completion of the procedure, with minimal complications observed in the early postoperative period. In conclusion, thoracic segmental spinal anesthesia and intermediate cervical plexus block offer a safe and effective alternative for patients at high risk for general anesthesia.
creator: Nezir Yilmaz
creator: Yunus Bozok
rights: Copyright (c) 2025 by the Authors. This is an open access article distributed under the CC BY licence. http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2025-06-30
publication date: 2025-06-30
volume: 4
number: 1
starting page: 58
ending page: 61
doi: 10.20528/cjpm.2025.02.005

Effects on cardiopulmonary bypass duration and optic nerve sheath diameter changes
type: item
description: Background: Cardiopulmonary bypass (CPB) causes disruption of the blood-brain barrier and cerebral autoregulation for many reasons. The resulting cerebral edema causes an increase in intracranial pressure. Ultrasonographic optic nevre sheath diameter (ONSD) measurement is one of the non-invasive methods that provides information about intracranial pressure. Numerous studies have demonstrated a correlation between ONSD and intracranial pressure (ICP). We aimed to investigate ONSD changes during CPB and the relationship between these changes and CPB duration. Methods: Twenty six patients aged between 18-75 years, with an ASA score of II or III, which underwent cardiac surgery with CPB are included to the study. ONSD measurements were made throughout surgery and data were recorded. Results: ONSD values increased significantly at 45 and 90 min of CPB and end of the surgery compared to pre-CPB values for both eyes. There was no significant difference between 45 and 90 min. during CPB. A critical ONSD value was detected in 12 patients during CPB. No patient developed neurologic adverse events in the postoperative period. Conclusion: ONSD increased during CPB regardless of duration. With the data obtained from our study, we cannot say that the increase in ONSD will be a predictor of postoperative neurological complications.
creator: Tulay Cardakozu
creator: Nur Nazire Yucal
creator: Ali Ahmet Arikan
creator: Sevim Cesur Okan
creator: Oguz Omay
rights: Copyright (c) 2025 by the Authors. This is an open access article distributed under the CC BY licence. http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2025-06-30
publication date: 2025-06-30
volume: 4
number: 1
starting page: 40
ending page: 47
doi: 10.20528/cjpm.2025.02.002

Tonsillectomy in a pediatric patient with propionic acidemia: Anesthesia management and potential perioperative challenges
type: item
description: Propionic acidemia (PA) is a rare metabolic disorder caused by a deficiency in the propionyl-CoA carboxylase enzyme, leading to the accumulation of toxic metabolites. Surgical procedures pose a risk of metabolic decompensation in patients with PA, requiring careful anesthesia management. A four-year-old male patient with propionic acidemia was scheduled for tonsillectomy due to recurrent upper respiratory tract infections. Midazolam was administered for premedication, and anesthesia induction was achieved with thiopental and rocuronium. Anesthesia maintenance was provided with sevoflurane, and fentanyl was used for analgesia. Postoperative pain management included paracetamol. The procedure was completed without complications, and the patient was transferred to the ward in stable condition. Anesthesia management in PA patients should focus on maintaining metabolic stability. This case demonstrates that with proper preoperative preparation, careful anesthesia management, and close perioperative monitoring, surgical interventions can be safely performed in pediatric patients with PA.
creator: Mehmet Akif Yilmaz
creator: Gokhan Tekin
creator: Berivan Bozan
creator: Mirac Selcen Özkal Yalin
creator: Nuray Uzun
creator: Muhammed Enes Aydin
rights: Copyright (c) 2025 by the Authors. This is an open access article distributed under the CC BY licence. http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2025-06-30
publication date: 2025-06-30
volume: 4
number: 1
starting page: 62
ending page: 64
doi: 10.20528/cjpm.2025.02.006

“Keeping it steady”: Anaesthetic challenges in insulinoma surgery
type: item
description: Insulinoma is a tumor of the pancreas that secretes excessive insulin, causing recurrent hypoglycemia. The median presentation age of 47 years and a mild female preponderance. Most cases are benign, with only 10% showing malignant potential. A typical presentation involves Whipple's triad, which includes symptomatic hypoglycemia, fasting blood glucose below 50 mg/dL, and immediate relief of symptoms after glucose administration. This case report discusses the perioperative anaesthetic management of a 54-year-old patient with insulinoma who underwent laparoscopic enucleation. A comprehensive approach involving preoperative blood glucose optimization through medications and dietary adjustments, vigilant intraoperative monitoring with timely dextrose infusion during tumor manipulation, and careful postoperative control of rebound hyperglycemia using insulin infusion is essential for improved outcomes in these patients. The primary treatment is surgical enucleation, but managing perioperative glycemic fluctuations presents significant challenges for anesthesiologists.
creator: Prakash Muralidhar Padamukhe
creator: Swetha R. Gowda
creator: Siri Chandana Kanamarlapudi
creator: Pragna Hospet
rights: Copyright (c) 2025 by the Authors. This is an open access article distributed under the CC BY licence. http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2025-06-30
publication date: 2025-06-30
volume: 4
number: 1
starting page: 70
ending page: 73
doi: 10.20528/cjpm.2025.02.008

Radiological evaluation of central venous catheter tip malposition
type: item
description: Background: Malposition of central venous catheters is a potentially severe but often preventable complication. This study aimed to assess the radiological distribution of central venous catheter tip positions and to discuss malposition mechanisms based on anatomical and radiographic literature. Methods: A retrospective analysis of 374 patients who underwent intraoperative central venous catheter insertion between January 2022 and December 2023 was conducted. Radiographs were evaluated using a carina-based classification system: Zones A–C (normal) and Zone D (malposition). Data were analyzed retrospectively. Results: The right internal jugular vein was the most commonly preferred access site, used in 80.0% of cases. Zone A: 52.3%, Zone B: 18.5%, Zone C: 17.8%, Zone D (malposition): 11.4%. There was no statistically significant association between catheter size and malposition (p>0.05). Conclusion: Utilizing the carina as a reference point during post-procedural imaging is essential for accurate catheter tip localization. Adjunctive modalities—including intracavitary ECG, ultrasound, and radiography—contribute to complication reduction and procedural safety.
creator: Meltem Ceylan Delice
creator: Nilgun Kavrut Ozturk
rights: Copyright (c) 2025 by the Authors. This is an open access article distributed under the CC BY licence. http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2025-06-30
publication date: 2025-06-30
volume: 4
number: 1
starting page: 54
ending page: 57
doi: 10.20528/cjpm.2025.02.004

The effects of lycopene in lung injury associated with cecum ligation and perforation-induced sepsis in rats: An investigative animal experiment study
type: item
description: Background: The primary aim of this study is to evaluate the effect of lycopene on serum interleukin-1ß (IL-1ß) and interleukin-6 (IL-6) levels in rats subjected to sepsis induced by the cecal ligation and perforation (CLP) method, as well as to assess the impact of lycopene on inflammation in the lungs, which is the first organ affected by sepsis. Methods: Twenty-four male rats were divided into four groups - control (healthy group), sepsis (CLP group), sepsis + lycopene 100 mg/kg (L100 group), and sepsis + lycopene 200 mg/kg (L200 group). Lycopene was administered by gastric lavage at doses of 100 mg/kg to the L100 group and 200 mg/kg to the L200 group. Intracardiac blood samples were collected 18 h after CLP for serum IL-1β and IL-6 level analysis. Lung tissue specimens were also collected for histopathological examination. Results: IL-1β levels decreased significantly in the L100 and L200 groups compared to the CLP group (p<0.001). Both doses of lycopene statistically significantly reduced serum IL-6 levels in the L100 and L200 groups compared to the CLP group. Serum IL-6 levels also decreased significantly in the L200 group compared to the L100 group (p<0.001).The degree of inflammation, vascular congestion and edema decreased significantly in the L200 group compared to the CLP group (p<0.001). Conclusion: Use of lycopene in rats with CLP-induced sepsis reduced serum IL-1β and IL-6 levels and inflammation in lung tissue at histopathological examination. Lycopene can be more effective at a dosage of 200 mg/kg.
creator: Sumeyra Zeren
creator: Ozgur Ozmen
creator: Zekai Halici
creator: Sare Sipal
creator: Betul Gundogdu
creator: Kamber Kasali
creator: Nazim Dogan
creator: Husnu Kursad
rights: Copyright (c) 2025 by the Authors. This is an open access article distributed under the CC BY licence. http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2025-06-30
publication date: 2025-06-30
volume: 4
number: 1
starting page: 32
ending page: 39
doi: 10.20528/cjpm.2025.02.001

Ultrasound-guided supraclavicular nerve and interscalene block for clavicle surgery in pregnancy: A case report and case-based literature review
type: item
description: A 34-year-old woman at 32 weeks of gestation sustained a displaced clavicle fracture following a motor vehicle accident. To avoid the risks of general anesthesia during late pregnancy, ultrasound-guided interscalene and selective supraclavicular nerve blocks were performed with a single skin entry point. Surgery was completed uneventfully, and there was no need for additional analgesics. No maternal or fetal complications observed. This case illustrates the safety and efficacy of regional anesthesia in pregnant trauma patients and highlights the potential of targeted peripheral nerve blocks as a viable alternative to general anesthesia for upper extremity surgeries during pregnancy.
creator: Oguzhan Okumus
creator: Ahmet Ridvan Dogan
creator: Burcu Can
rights: Copyright (c) 2025 by the Authors. This is an open access article distributed under the CC BY licence. http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2025-06-30
publication date: 2025-06-30
volume: 4
number: 1
starting page: 65
ending page: 69
doi: 10.20528/cjpm.2025.02.007

The impact of vagal nerve stimulation from the lateral neck region on venous cannulation pain: A randomized controlled trial
type: item
description: Background: As the cranial nerve with the longest and widest distribution area of the body, the vagus nerve (N.Vagus) has both antinociceptive and neuromodulatory effects and plays a role in the regulation of the heart rate. The objective of this study is to investigate the impact of cold stimulation on vascular access discomfort and heart rate variability, specifically by separately stimulating the N. Vagus nerve on both the right and left sides of the neck thereby assessing any lateralization effect. Methods: 140 patients, ranging in age from 18 to 75, were randomly assigned to one of two groups: Group Left (Group L) or Group Right (Group R). Following cold application to the left lateral neck region of Group L and the right lateral neck region of Group R, venous cannulation was performed. Prior to, following, and subsequent to vascular access, the heart rate, noninvasive blood pressure, oxygen saturation, and numeric pain scale (NRS) values for venous cannulation pain of the patients were documented. Results: Average heart rates and average heart rates after cannulation were considerably lower in both groups after vagal stimulation (p<0.05). No significant difference was observed when comparing the average heart rate values for each time period in Group L and Group R, including the mean heart rate values before vagal stimulation, after vagal stimulation, and after vascular access (p>0.05). The mean heart rate change percentages before and after vagal stimulation were 7±5.8% and 7.1±7.0% in group L and group R respectively, suggesting that heart rate variability was greater in Group R, although this difference was not statistically significant (p>0.05). NRS values were found to be 2.64±1.28 in Group L and 2.85±1.62 in Group R, with no significant difference (p>0.05). Conclusion: While heart rate variability exhibited more prominence on the right side, the difference was not statistically significant. Analyzing the analgesic impact revealed no discernible differenc…
creator: Senay Canikli Adiguzel
rights: Copyright (c) 2025 by the Author. This is an open access article distributed under the CC BY licence. http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2025-06-30
publication date: 2025-06-30
volume: 4
number: 1
starting page: 48
ending page: 53
doi: 10.20528/cjpm.2025.02.003

Cover & Contents Vol.3 No.1
type: item
creator: Journal Management CJPM
rights: Copyright (c) 2025 Tulpar Academic Publishing http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2025-02-28
publication date: 2025-02-28
volume: 4
number: 1

Neuraxial anesthesia in pregnant patients with neurological disorders ‒ Safety and practice strategies: A review
type: item
description: Pregnant patients with neurological disorders face multifaceted challenges arising from both the physiological changes of pregnancy and the underlying neurological conditions. In this unique patient population, anesthesia management requires meticulous planning to ensure maternal and fetal safety while minimizing the risk of neurological complications. Neuraxial anesthesia emerges as a safe and effective option when implemented with appropriate patient selection, a multidisciplinary approach, and individualized anesthesia protocols. This review comprehensively evaluates the clinical benefits of neuraxial anesthesia in pregnant patients with neurological disorders, highlighting critical considerations in its application and potential risks. Drawing upon the existing body of evidence, it aims to promote the safe use of neuraxial techniques and enhance awareness of the challenges inherent in managing this patient group. Additionally, the review underscores the importance of anesthesiologists adopting individualized strategies that address the specific risks associated with neurological pathologies, optimizing the advantages of neuraxial anesthesia in obstetric care.
creator: Mehmet Akif Yilmaz
creator: Nuray Uzun
rights: Copyright (c) 2025 by the Authors. This is an open access article distributed under the CC BY licence. http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2025-02-28
publication date: 2025-02-28
volume: 4
number: 1
starting page: 14
ending page: 20
doi: 10.20528/cjpm.2025.01.003

Unexpected venous anomaly around the brachial plexus during supraclavicular block: A case report
type: item
description: Anatomical variations in the supraclavicular region can greatly affect the success and safety of regional anesthesia techniques, particularly supraclavicular brachial plexus blocks. Identifying these variations is essential to minimize risks. This case involves a 32-year-old male patient with a distal humeral fracture, where an ultrasound-guided supraclavicular block revealed an unusual venous structure encircling the brachial plexus. This atypical vein could pose significant risks, including vascular injury, local anesthetic toxicity, and even cardiac arrest, depending on the anesthetic uBased on its anatomical location and Doppler features, the vein was hypothesized to originate from the subclavian or external jugular vein. This finding underscores the critical importance of thorough ultrasound evaluation and real-time guidance during the procedure to avoid complications. Recognizing such anatomical anomalies is vital to ensuring patient safety, and the integration of ultrasound into routine regional anesthesia practice enhances both precision and effectiveness.
creator: Kübra Yazici
rights: Copyright (c) 2025 by the Author. This is an open access article distributed under the CC BY licence. http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2025-02-28
publication date: 2025-02-28
volume: 4
number: 1
starting page: 26
ending page: 29
doi: 10.20528/cjpm.2025.01.005

Triple threat: Anesthetic approach to IVF twin gestation, pre-eclampsia and peripartum cardiomyopathy in caesarean section
type: item
description: Peripartum cardiomyopathy (PPCM) is a rare idiopathic condition frequently presenting with heart failure secondary to left ventricular systolic dysfunction towards the end of pregnancy or in the months following delivery. Can present as acute life-threatening pulmonary oedema in late pregnancy or early puerperium, its diagnosis is mainly by exclusion of other causes of cardiac dysfunction. Anaesthetic management of such cases poses a challenge; due to the increased risk of various perioperative complications. Morbidity is high due to the reduced physiological reserve in pregnancy. PPCM and severe pre-eclampsia can co-exist and their clinical presentation may overlap, making the diagnosis more difficult and often delayed, with potentially devastating consequences. We report the successful anaesthetic management of lower segment caesarean section in a patient with PPCM with preeclampsia of IVF twin gestation.
creator: Ranganath Laxman Channappagoudar
creator: Chaitra Venkatesh Konappanavar
creator: T. K. Darshini
creator: Akanksha Priya
rights: Copyright (c) 2025 by the Authors. This is an open access article distributed under the CC BY licence. http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2025-02-28
publication date: 2025-02-28
volume: 4
number: 1
starting page: 21
ending page: 25
doi: 10.20528/cjpm.2025.01.004

Left colon volvulus following sigmoidectomy
type: item
description: —
creator: Sabri Selcuk Atamanalp
rights: Copyright (c) 2025 by the Author. This is an open access article distributed under the CC BY licence. http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2025-02-28
publication date: 2025-02-28
volume: 4
number: 1
starting page: 30
ending page: 31
doi: 10.20528/cjpm.2025.01.006

Retrospective evaluation of analgesia approaches in patients undergoing thoracic surgery over the last one year: A single-center study
type: item
description: Objective: Providing adequate analgesia after thoracic surgery plays an important role in preventing pulmonary complications while accelerating postoperative recovery. This study aimed to retrospectively evaluate the effectiveness of analgesia approaches applied to patients who underwent thoracic surgery at Atatürk University Research Hospital in the last year. This study aimed to retrospectively evaluate the effectiveness of analgesia approaches applied to patients who underwent thoracic surgery at Atatürk University Research Hospital in the last year by comparing different analgesia methods in terms of rescue analgesia requirements. Method: This retrospective study was conducted by examining the archive files of patients who underwent thoracic surgery between 2024-2025. Patients were classified according to the analgesia methods applied. The analgesic method used was compared according to the type of surgery applied and the need for rescue analgesia. Results: Intravenous opioid was determined as the most frequently used analgesia method in the analyzed patient group. Rescue analgesia requirement was observed to be the lowest in patients who underwent epidural analgesia. In patients who underwent paravertebral block, it was observed that effective analgesia was provided and the need for rescue analgesia decreased. Conclusion: Epidural analgesia and paravertebral block stand out as effective methods in analgesia management after thoracic surgery. However, the specific advantages and complication risks of each method should be considered. Secondary objectives of this study include analyzing the relationship between analgesia selection and surgical type (VATS and thoracotomy) and determining the choice of analgesia method and its rationale. It is thought that the findings of this study will contribute to the determination of optimal analgesia strategies after thoracic surgery.
creator: Mehmet Akif Yilmaz
creator: Nuray Uzun
creator: Elif Oral Ahiskalioglu
creator: Ali Bilal Ulas
rights: Copyright (c) 2025 by the Authors. This is an open access article distributed under the CC BY licence. http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2025-02-28
publication date: 2025-02-28
volume: 4
number: 1
starting page: 1
ending page: 7
doi: 10.20528/cjpm.2025.01.001

Early detection of acute kidney injury in critically ill burn patients: Evaluating the predictive role of serum and urinary NGAL
type: item
description: Background: Early detection of acute kidney injury (AKI) in critically ill burn patients is crucial for improving outcomes. Neutrophil gelatinase-associated lipocalin (NGAL) has emerged as a promising biomarker for early AKI detection. This study aimed to evaluate the efficacy of serum and urinary NGAL levels in predicting AKI in burn patients admitted to the intensive care unit (ICU). Methods: A prospective observational study was conducted on 31 burn patients admitted to the burn ICU. Serum and urinary NGAL levels were measured at admission (0 hours) and at 12, 24, 36, 48, and 72 hours post-admission. AKI was defined using the RIFLE and AKIN criteria. Renal replacement therapy (RRT) requirements, mortality, and other clinical parameters were recorded. Statistical analyses were performed to assess the correlation between NGAL levels and AKI development. Results: Of the 31 patients, 48.4% required RRT, and 45.2% died. Serum NGAL levels at 0 and 12 hours were significantly higher in patients who developed AKI (p<0.05). A serum NGAL cutoff of 251 ng/ml was identified as a significant predictor of AKI (p<0.05). Urinary NGAL levels did not show significant predictive value for AKI. Mortality was significantly associated with higher burn surface area, increased fluid requirements, and higher SOFA and APACHE II scores (p<0.01). Conclusion: Serum NGAL levels are elevated early in burn patients who develop AKI, suggesting its potential as a predictive biomarker. Urinary NGAL did not show significant predictive value. Further studies with larger cohorts are needed to validate these findings and explore the role of NGAL in guiding early interventions in burn patients.
creator: Izzet Alatli
creator: Buket Kocaman Akbay
rights: Copyright (c) 2025 by the Authors. This is an open access article distributed under the CC BY licence. http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2025-02-28
publication date: 2025-02-28
volume: 4
number: 1
starting page: 8
ending page: 13
doi: 10.20528/cjpm.2025.01.002

Cover & Contents Vol.2 No.3
type: item
creator: Journal Management CJPM
rights: Copyright (c) 2024 Tulpar Academic Publishing http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2024-10-30
publication date: 2024-10-30
volume: 4
number: 1

https://www.challengejournal.com/index.php/cjpm/article/view/803
type: item
title: Comparison of ultrasound-guided fascia iliaca compartment block versus the combined obturator nerve and adductor canal block application in postoperative analgesia for patients undergoing arthroscopic knee surgery
description: Background: Arthroscopic knee surgery is a surgical intervention that is frequently performed by orthopedic clinics and new studies are constantly carried out by anesthetists to ensure effective pain control. This study aimed to compare the efficacy of ultrasound-guided suprainguinal fascia iliaca compartment block (FICB) versus the combined adductor canal and obturator nerve block application in terms of postoperative analgesia in patients undergoing arthroscopic knee surgery under spinal anesthesia. Materials and Method: Sixty patients, who underwent arthroscopic knee surgery under elective conditions were included in the study. They were randomly divided into two groups, Group 1 (n=30) and Group 2 (n=30), using a lottery method. Patients operated under spinal anesthesia received ultrasound-guided suprainguinal fascia iliaca compartment block (FICB) for Group 1. The combined adductor canal and obturator nerve block for Group 2 at the end of the surgery. Intravenous patient-controlled analgesia (PCA) device containing tramadol was connected to all patients in both groups, and they were evaluated for Visual Analog Scale (VAS) scores at 0, 2, 4, 12, and 24 hours of ward follow-up. The amount of PCA used at 24 hours, additional analgesic use, development of side effects, mobilization capabilities, and satisfaction levels were assessed at the end of 24 hours. Results: There were no significant differences between the groups in terms of demographic characteristics and the type of surgery performed (p>0.05). In Group 1, where fascia iliaca block was applied the block administration time was observed to be significantly shorter compared to Group 2 (p<0.05). No significant differences were observed between the two groups in terms of postoperative VAS scores, PCA usage amounts, incidence of side effects, postoperative mobilization abilities, and satisfaction measures (p>0.05). Conclusions: Ultrasound-guided fascia iliaca compartment block alone can be effectively applied fo…
creator: Betül Sevgi Sarıkaya
creator: Bora Bilal
creator: Feyza Çalışır
creator: Cengizhan Yavuz
creator: Gözen Öksüz
creator: Ziya Kursun
creator: Hafize Öksüz
rights: Copyright (c) 2024 by the Authors. This is an open access article distributed under the CC BY licence. http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2024-10-30
publication date: 2024-10-30
volume: 4
number: 1
starting page: 65
ending page: 69
doi: 10.20528/cjpm.2024.03.001

The effect of modified paramedian and median approaches of spinal anesthesia on postspinal acute low back pain in patients undergoing urological surgery: a prospective cohort study
type: item
description: Background: Low back pain after spinal anesthesia may be a complicated issue for many patients. We aimed to evaluate the incidence of postspinal low back pain in the modified paramedian approach of spinal anesthesia compared to the classical median approach. Materials and Method: The study is a prospective non-randomized observational trial. We included 297 patients aged 20 to 80 years who underwent urological surgery under spinal anesthesia. Patients were allocated into two groups: In Group P, patients underwent spinal anesthesia by using a modified paramedian approach and in Group M, the classical median approach was used. Primary outcome was the incidence of postoperative low back pain. Secondary outcomes were number of needle insertion attempts, needle bone contacts and patient satisfaction. Results: The incidence of low back pain in Group M was 70.3% on the first day, 39.5% on the 7th day and 5.9% at the end of one month after surgery. In Group P, the incidence of low back pain was 30.7% on the first day, 12.4% on the 7th day and 0.7% at the end of one month after surgery. The low back pain scores were significantly lower in group P at all-time points. Patient satisfaction was significantly higher in group P (p=0.038). The number of needle interventions (p=0.001) and bone contact (p=0.000) were significantly lower in group P. Conclusions: Low back pain was less common with the modified paramedian approach compared to the classical median spinal approach. We found lower number of needle insertion attempts and bone contacts in the modified paramedian technique. Patient satisfaction was also higher in the paramedian technique.
creator: Büşra Eren Okumuş
creator: Onur Balaban
creator: Bedirhan Günel
creator: Ali Fuat Erdem
rights: Copyright (c) 2024 by the Authors. This is an open access article distributed under the CC BY licence. http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2024-10-30
publication date: 2024-10-30
volume: 4
number: 1
starting page: 77
ending page: 82
doi: 10.20528/cjpm.2024.03.003

Comparison of the effects of femoral and axillary artery cannulation on ischemic cerebral injury in acute type A aortic dissection surgery: A retrospective study
type: item
description: Background: Acute Type A Aortic Dissection (ATAAD) is a life-threatening condition requiring emergency surgical intervention. This retrospective study evaluates the impact of femoral and axillary arterial cannulation techniques on ischemic neurological damage and mortality. Materials and Method: A total of 60 patients who underwent emergency surgery for ATAAD between 2016 and 2021 were analyzed. Patients were divided into two groups based on the arterial cannulation technique: Group A (axillary cannulation) and Group F (femoral cannulation). Preoperative, intraoperative, and postoperative variables were compared between the groups. The primary outcome was incidence of ischemic cerebral injury and secondary outcomes included 30-day all-cause mortality, intensive care unit and hospital length of stay and postoperative complications. Results: There were no statistically significant differences between the two groups in terms of ischemic cerebral injury (p=0.13). There was no significant difference in 30-day mortality between the groups (p= 0.27). Logistic regression analysis revealed that the cannulation type was a risk factor for ischemic cerebral injury development (OR [95% CI]; 119.034 [1.612–8791.314], p=0.029). Conclusions: Our findings indicate that the type of cannulation may be a risk factor for the development of ischemic cerebral injury. Further studies are needed to determine the optimal arterial cannulation technique for improving outcomes in ATAAD surgery.
creator: Semih Murat Yücel
creator: Burhan Dost
creator: Ozgur Komurcu
creator: Emine Özdemir
creator: Caner Genç
creator: Mustafa Kemal Demirag
creator: Deniz Karakaya
rights: Copyright (c) 2024 by the Authors. This is an open access article distributed under the CC BY licence. http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2024-10-30
publication date: 2024-10-30
volume: 4
number: 1
starting page: 94
ending page: 100
doi: 10.20528/cjpm.2024.03.006

Assessing the efficacy of sugammadex based on ideal body weight for reversal of moderate neuromuscular blockade in obstetric patients across different BMI categories: A prospective study
type: item
description: Background: This investigation aimed to evaluate the effectiveness of administering 2 mg/kg intravenous (IV) sugammadex, dosed according to the ideal body weight (IBW) of obstetric patients across three different BMI groups, for the reversal of neuromuscular blockade caused by rocuronium. Materials and Method: A total of ninety female patients, who were categorized as American Society of Anesthesiologists (ASA) II and were 18 years or older, participated in this study. These patients were all scheduled to undergo elective cesarean sections under general anesthesia, providing a well-defined cohort for our investigation. Participants were separated into three groups according to their BMI: Group 1 (n=30) consisted of patients with a BMI less than 30 kg/m², Group 2 (n=30) included those with a BMI ranging from 30 to 39.9 kg/m², and Group 3 (n=30) comprised patients with a BMI over 40 kg/m². At the end of the surgery, each patient received intravenous sugammadex at 2 mg/kg based on ideal body weight, with additional doses as needed, while recording the total amount administered and the times for extubation, motor responses, and first breastfeeding. Results: The total sugammadex dose was found to be notably higher in Group 3 (p=0.002). The time required to reach a Train of Four (TOF) ratio greater than 90% was similar across the groups (p=0.120). However, the recorded durations between sugammadex administration and extubation, accurate motor response, and the time to first breastfeeding significantly differed between the groups. Conclusions: We found that IV sugammadex 2 mg/kg, administered according to the IBW of patients, was effective for reversing moderate neuromuscular blockade in patients of weight categories. However, administering a sugammadex dose of IBW+25% appears to be safer for class III obese patients.
creator: Metin Ozcan
creator: Basak Altiparmak
creator: Semra Gümüş Demirbilek
rights: Copyright (c) 2024 by the Authors. This is an open access article distributed under the CC BY licence. http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2024-10-30
publication date: 2024-10-30
volume: 4
number: 1
starting page: 83
ending page: 88
doi: 10.20528/cjpm.2024.03.004

Effectiveness of dry needle therapy in patients with chronic nonspecific low back pain
type: item
description: Background: Low back pain is a prevalent symptom worldwide, with various underlying causes, making differential diagnosis essential. This study aims to investigate the efficacy of dry needling treatment added to exercise in patients with chronic Nonspecific Low Back Pain (NLBP). The McKenzie exercise program was applied to all participants. Materials and Method: The study comprised sixty participants, randomly allocated into two groups: the dry needling (DNG) and the exercise group (EG). The participants in DNG received a total of six sessions of dry needling treatment, two days a week, to the gluteus medius and quadratus lumborum and multifidus muscles. All participants were given a McKenzie exercise program two sets per day for three weeks. Results: A significant difference was noted in the VAS-night values of the patients within the DNG before treatment (p: 0.004), and the EG also exhibited a significant difference in the VAS-activity (p: 0.017) and VAS-resting (p: 0.024) values following the treatment. A statistically significant decrease was observed in favor of DNG in VAS-rest, VAS-night, VAS-activity values (p>0.001) in the comparions of the groups. Conclusions: Dry needling treatment added to exercise therapy in chronic NLBP patients is effective on activity and rest pain severity in the shortterm results. However, no additive efficacy of dry needling treatment was found on the number of trigger points, disability, and depression.
creator: Elif Özyiğit
creator: Fatih Bağcıer
rights: Copyright (c) 2024 by the Authors. This is an open access article distributed under the CC BY licence. http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2024-10-30
publication date: 2024-10-30
volume: 4
number: 1
starting page: 70
ending page: 76
doi: 10.20528/cjpm.2024.03.002

How does intravenous ondansetron affect motor and sensory block in spinal anesthesia administered with intrathecal levobupivacaine? A prospective randomized controlled study
type: item
description: Background: Spinal anesthesia is commonly performed in surgical procedures, and ondansetron, frequently used as an antiemetic, is often administered to manage postoperative nausea and vomiting. Given their frequent co-administration, we sought to investigate the potential effects of intravenous ondansetron on the block characteristics of spinal anesthesia performed with levobupivacaine. Materials and Method: In this prospective, randomized controlled study, forty patients were divided into two groups: Group L (spinal anesthesia with levobupivacaine) and Group OL (spinal anesthesia with levobupivacaine plus intravenous ondansetron). Results: Our findings showed that while motor block duration was similar between the groups (p>0.05), sensory block duration was significantly shorter in the ondansetron group (p<0.05). There were no significant differences in patient demographics or hemodynamic parameters between the groups (p>0.05). Conclusions: The shortened sensory block with ondansetron administration may be clinically undesirable as it could limit the intended duration of anesthesia. We recommend administering ondansetron at the end of surgery to avoid this effect. Further studies are required to confirm these findings and clarify the mechanisms involved.
creator: Mustafa Felat Ataman
creator: Husnu Suslu
creator: Leyla Saidoglu
rights: Copyright (c) 2024 by the Authors. This is an open access article distributed under the CC BY licence. http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2024-10-30
publication date: 2024-10-30
volume: 4
number: 1
starting page: 89
ending page: 93
doi: 10.20528/cjpm.2024.03.005

Cover & Contents Vol.2 No.2
type: item
creator: Journal Management CJPM
rights: Copyright (c) 2024 Tulpar Academic Publishing http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2024-06-30
publication date: 2024-06-30
volume: 4
number: 1

Perioperative ventricular dysrhythmia management in ranula cyst excision surgery
type: item
description: Ranula cyst is one of the most common pathologies of the sublingual salivary gland. It is formed as a result of damage to the gland ducts and is a retention cyst filled with mucus. Methods such as drainage, excision or cryosurgery are used in the treatment. During surgical treatment, it may cause various dysrhythmias due to its anatomical relationship with the vagus nerve. In this study, we aimed to present our response to arrhythmias seen during ranula cyst excision and resistant to IV administration with local lidocaine administration.
creator: Merve Yaman
creator: Tayfun Aydın
creator: Osman Pala
rights: Copyright (c) 2024 by the Authors. This is an open access article distributed under the CC BY licence. http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2024-06-30
publication date: 2024-06-30
volume: 4
number: 1
starting page: 59
ending page: 61
doi: 10.20528/cjpm.2024.02.005

Anaphylaxis following unfractionated heparin administration: How safe is this drug in the treatment of thromboembolism?
type: item
description: Heparin, a naturally occurring polysaccharide belonging to the glycosaminoglycans (GAG) family, is ubiquitously found in mast cells. Unfractionated heparin is the least processed form of natural GAG, purified from animal tissue. In a 67-year-old female patient diagnosed with hypertension and asthma, who suffered a femoral fracture due to a fall, intravenous heparin sodium was administered for thromboembolic treatment in the postoperative period following closed reduction. Subsequently, respiratory distress, loss of consciousness, and cardiac arrest occured following profound hypotension. The patient, whose clinical findings were evaluated as anaphylaxis, was successfully resuscitated with prompt intervention. Despite immune-mediated reactions and Heparin-Induced Thrombocytopenia (HIT) being commonly encountered side effects in clinical practice, it is crucial for all healthcare professionals to recognize that widely used anticoagulant agents such as heparin sodium can lead to fatal complications.
creator: Kıvanç Öncü
creator: Yasir İlyas
rights: Copyright (c) 2024 by the Authors. This is an open access article distributed under the CC BY licence. http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2024-06-30
publication date: 2024-06-30
volume: 4
number: 1
starting page: 55
ending page: 58
doi: 10.20528/cjpm.2024.02.004

Block combinations: The answer sought or a waste of effort?
type: item
description: —
creator: Basak Altiparmak
creator: Ali İhsan Uysal
rights: Copyright (c) 2024 by the Authors. This is an open access article distributed under the CC BY licence. http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2024-06-30
publication date: 2024-06-30
volume: 4
number: 1
starting page: 62
ending page: 63
doi: 10.20528/cjpm.2024.02.006

https://www.challengejournal.com/index.php/cjpm/article/view/805
type: item
title: Comparison of dexmedetomidine dosing strategies based on Bispectral Index (BIS) and Ramsay Sedation Scale (RSS) in patients undergoing infraumbilical surgeries under spinal anesthesia: A prospective comparative study
description: Objectives and Aim: This study aimed to evaluate the impact of dexmedetomidine infusion dosage adjustment strategies guided by BIS and RSS on total consumption in patients undergoing infraumbilical surgeries under spinal anesthesia. Materials and Method: Eighty patients aged between 18-70 years, classified as American Society of Anesthesiologists (ASA) I and II, who underwent orthopaedic, urological, and plastic surgery under spinal anesthesia were included. Patients received spinal anesthesia in the lateral position through the L3-4 interval using a median approach. Following the observation of free flow of cerebrospinal fluid, spinal anesthesia was induced with 10 mg (2 ml of 5% hyperbaric bupivacaine) bupivacaine and 25 µg of intrathecal fentanyl. When the sensory block reached the T10 level, all patients were administered a dexmedetomidine loading dose of 1 µg/kg IV over 10 min for sedation, and the maintenance drug infusion dose was titrated to maintain BIS values between 60-80 in the first group and RSS at 3-4 in the second group. Throughout the surgery, hemodynamic variables (heart rate and blood pressure), respiratory parameters (respiratory rate), SpO2, sedation scores (BIS and RSS), and drug infusion doses and perioperative complications were recorded. Drug infusion was stopped 5 min before the end of surgery, and the duration of surgery, anesthesia, and total drug consumption were recorded. Statistical analyses were performed, and a p-value of less than 0.05 was considered statistically significant. Results: Desired sedation was achieved by dexmedetomidine administration. A decrease in BIS values and an increase in RSS were observed with the loading dose. In both groups, the heart rate and systolic and diastolic blood pressures were significantly lower at all measurement times than the control values. There was no significant difference in the mean blood pressure between groups B and R (p>0.05). The average blood pressure for B group was 92 ± 14.12 mmHg, …
creator: Suna Kara Gormus
creator: Tulay Cardakoz
creator: Kamil Toker
rights: Copyright (c) 2024 by the Authors. This is an open access article distributed under the CC BY licence. http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2024-06-30
publication date: 2024-06-30
volume: 4
number: 1
starting page: 36
ending page: 42
doi: 10.20528/cjpm.2024.02.002

Analyzing the educational quality of YouTube videos on paravertebral block techniques
type: item
description: Aim: People can learn new skills, explore content related to their interests, and get to know different cultures through YouTube videos. It is important to be conscious when using platforms such as YouTube and to take care to obtain information from verified and reliable sources. Students especially watch medical videos on YouTube, which can improve their medical knowledge. Our aim in this study is to evaluate the educational content and quality of paravertebral block videos on YouTube. Materials and Method: Videos were recorded by typing the term 'paravertebral block ultrasound' into the YouTube search engine. In filtering, sorting was done according to the number of views. 100 videos on the first 5 pages were watched and evaluated. To evaluate the videos on YouTube, we used two different surveys, evaluating the educational content of the videos (Survey 1) and evaluating the quality of the videos (Survey 2). Results: Our study revealed that only a third of paravertebral block education videos met relevant criteria, with just (33) 18.2% demonstrating both good educational quality and preparation. There was a positive correlation between the video educational quality score and all parameters, with significant differences found for “video duration” and “video preparation quality score” (r=0.506, p=0.003, and r=0.84, p<0.001, respectively). Similarly, the video preparation quality score showed a positive correlation with all parameters, with significant differences found for “number of video likes” and “video duration” (r=0.373, p=0.033, and r=0.413, p=0.017, respectively). Conclusions: Paravertebral block videos on YouTube are inadequate in terms of educational and preparation quality. According to our analysis, we do not recommend using YouTube videos for educational purposes.
creator: Muhammed Halit Satıcı
creator: Mahmut Sami Tutar
rights: Copyright (c) 2024 by the Authors. This is an open access article distributed under the CC BY licence. http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2024-06-30
publication date: 2024-06-30
volume: 4
number: 1
starting page: 43
ending page: 54
doi: 10.20528/cjpm.2024.02.003

Perioperative complications in patients undergoing urological surgery with spinal anesthesia: A prospective, observational study
type: item
description: Background: Spinal anesthesia is widely used as the primary anesthesia method in urological surgeries, and this prospective observational study aimed to evaluate the associated complications. Materials and Method: Demographic data, procedures, and spinal anesthesia-related complications (e.g., hypotension, bradycardia, and headache) of patients who underwent urological surgery with spinal anesthesia were recorded perioperatively. Patients were questioned about complications on the 5th and 14th postoperative days. Results: Mean arterial pressure decreases in those administered intraoperative hyperbaric bupivacaine were higher at the 5th (p=0.010), 10th (p=0.003), and 15th minute (p=0.001) than in those administered levobupivacaine and lidocaine. In patients administered crystalloid and colloid solutions, an increase in hypotension was observed at the intraoperative 10th minute (systolic arterial pressure (SAP): p=0.008, diastolic arterial pressure (DAP): p=0.011) and 15th minute (SAP: p=0.017). Post-dural puncture headache (PDPH) occurred on days 1 and 2 in 7 patients and resolved within 3 days. Two patients reported leg pain and one patient reported gluteal numbness with bupivacaine. A majority of the patients (83%) stated that they would prefer spinal anesthesia if they were to have surgery again. Conclusions: Identifying perioperative complications in urological surgeries performed under spinal anesthesia helps in effective management and has implications for clinical practice.
creator: Dilan Akyurt
creator: Hija Yazıcıoğlu
creator: Candan Haytural
creator: Berna Demir
creator: Ayşegül Özgök
rights: Copyright (c) 2024 by the Authors. This is an open access article distributed under the CC BY licence. http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2024-06-30
publication date: 2024-06-30
volume: 4
number: 1
starting page: 30
ending page: 35
doi: 10.20528/cjpm.2024.02.001

Cover & Contents Vol.2 No.1
type: item
creator: Journal Management CJPM
rights: Copyright (c) 2024 Tulpar Academic Publishing http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2024-02-28
publication date: 2024-02-28
volume: 4
number: 1

A comprehensive retrospective analysis of interfascial plane blocks and peripheral nerve blocks at a tertiary research hospital: Single center experience
type: item
description: Aim: This study aimed to analyze regional anesthesia practices at a tertiary research hospital as a single center during a one-year period (January 2022 to January 2023). Materials: Data on over 2,000 nerve blocks were retrospectively reviewed, including: type of nerve block performed (peripheral nerve vs. fascial plane, location of block (upper vs. lower extremity), purpose of block (anesthesia or analgesia) and outcomes. Method: Data was analyzed to assess trends in block utilization, identify preferred block types and locations, and compare the use of peripheral nerve blocks versus fascial plane blocks for anesthesia and analgesia. Additionally, the potential opioid-sparing benefits of fascial plane blocks were evaluated. Results: The analysis revealed a notable shift towards fascial plane blocks (61%) compared to peripheral nerve blocks (39%). Lower extremity blocks were more common (56%), with sciatic, saphenous, and femoral nerve blocks being the most frequently used. In the upper extremity (44%), infraclavicular and interscalene brachial plexus blocks dominated. Interestingly, fascial plane blocks were primarily employed for analgesia, while peripheral nerve blocks served both anesthetic and analgesic purposes. The study identified opioid-sparing advantages associated with fascial plane blocks, highlighting their potential role in multimodal pain management strategies. Conclusions: Based on these findings, areas for improvement in regional anesthesia practices were identified. Educational programs will be adjusted accordingly. Future research will delve deeper into patient characteristics, block selection rationale, and incorporate patient-reported outcomes alongside opioid consumption and pain scores. This study serves as a foundation for future enhancements in regional anesthesia practices, aiming to optimize patient care and outcomes.
creator: Yunus Emre Karapinar
creator: Ela Nur Medetoglu Koksal
creator: Veysel Koksal
creator: Ahmet Murat Yayik
creator: Erkan Cem Celik
creator: Muhammed Enes Aydin
creator: Elif Oral Ahiskalioglu
creator: Ali Ahiskalioglu
rights: Copyright (c) 2024 by the Authors. This is an open access article distributed under the CC BY licence. http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2024-02-28
publication date: 2024-02-28
volume: 4
number: 1
starting page: 16
ending page: 21
doi: 10.20528/cjpm.2024.01.004

Evaluation of Analgesic Nociceptive Index in intraoperative and postoperative pain management in general anesthesia applied with two different methods
type: item
description: Aim: Effectiveness of analgesic nociceptive index (ANI) monitoring in predicting both intraoperative and postoperative early pain in neurosurgery patients undergoing lumbar spinal surgery. The patients were administered general anesthesia using different anesthesia management techniques. Method: The study included a total of 60 patients with American Society of Anesthesiologist (ASA) I-III. The patients were randomly divided into two groups of 30 each using the closed envelope method. Group T received total intravenous anesthesia (TIVA) with remifentanil-propofol, while Group D with desflurane-remifentanil. Non-invasive ANI monitoring was applied to patients undergoing lumbar spinal surgery, and ANI, heart rate, systolic/diastolic arterial pressure values were recorded before and after induction, skin incision, major muscle incision, laminectomy, right-left fasciectomy, screw fixation, after extubation and during the postoperative period. Post-operative heart rate, ANI value, mean arterial pressure values, and visual analog scale (VAS) values were measured. Results: No statistically significant difference was found in terms of the demographic data of the patients. According to the groups, no statistically significant difference was found between the ANI and VAS measurements of the cases at the postoperative 5th minute (P=0.261), postop 10th minute (P=0.379), postop 15th minute (P=0.673), postop 30th minute (P=0.784) and postop 60 minute (p =0.750). Conclusions: In our study on lumbar spine surgery, we could not detect any significant relationship between ANI monitoring and VAS values in the early postoperative period. There was no difference in ANI and VAS with either anaesthetic technique. In light of the results of our study, we believe that more studies are needed on the use of ANI monitoring in the early postoperative period.
creator: Mahmut Alp Karahan
creator: Kadri Burak Ethemoğlu
creator: Evren Büyükfırat
creator: Ahmet Atlas
creator: Veysi Yazar
creator: Mehmet Baki Bilsel
rights: Copyright (c) 2024 by the Authors. This is an open access article distributed under the CC BY licence. http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2024-02-28
publication date: 2024-02-28
volume: 4
number: 1
starting page: 3
ending page: 9
doi: 10.20528/cjpm.2024.01.002

Comparison of the analgesic effects of different bupivacaine concentrations in continuous femoral block after total knee arthroplasty surgery
type: item
description: Aim: In regional anesthesia practice, anesthesists’ goal must be to use the lowest effective concentration of local anesthetics to provide sufficient pain relief while minimizing side effects and complications. This study was designed to compare the analgesic efficacy of two different concentrations of bupivacaine (0.125% and 0.1%) in continuous femoral block for postoperative analgesia. Method: In this study, fifty patients were enrolled, all of whom underwent femoral nerve block catheterization. The block procedure involved the administration of 30ml of bupivacaine solution at a concentration of 0.25%. Following a thirty-minute interval post-block application, patients underwent knee surgery under general anesthesia. During the closure of subcutaneous tissues, an additional 10ml of bupivacaine solution was injected through the catheter. Two groups were formed based on the concentration of the solution administered: Group(0.125%) received bupivacaine at a concentration of 0.125%, while Group(0.1%) received it at a concentration of 0.1%. Subsequently, upon arrival at the postoperative care unit, infusion through the catheter commenced at a rate of 10ml/h-1, maintaining the same concentrations for both groups. In addition to the nerve block, all patients were provided with intravenous Patient Controlled Analgesia (PCA) devices containing morphine for pain management. Throughout the postoperative period, sensory and motor block levels, Numerical Rating Scale (NRS) values for static and dynamic pain assessment, total morphine consumption, morphine demand, as well as any observed side effects and complications, were meticulously recorded for analysis. Results: Postoperatively the NRSstatic values at 24th and 48th hours and NRSdynamic values at the 24th hour were higher in Group(0.1%) and it was statistically significant(p<0,007). And at 48th hour, morphine consumption was significantly higher in Group(0.1%) (p<0,05). Conclusions: In our study, all patients across both e…
creator: Murat Ünal
creator: Serpil Şavlı Mete
creator: Menşure Kaya
creator: Abdurrahman Dünmez
creator: Gülçin Özalp Şenel
creator: Nihal Kadıoğulları
rights: Copyright (c) 2024 by the Authors. This is an open access article distributed under the CC BY licence. http://creativecommons.org/licenses/by/4.0
license: http://creativecommons.org/licenses/by/4.0
date: 2024-02-28
publication date: 2024-02-28
volume: 4
number: 1
starting page: 10
ending page: 15
doi: 10.20528/cjpm.2024.01.003