Challenge Journal of Perioperative Medicine
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.
Copyright (c) 2026 Tulpar Academic Publishing http://creativecommons.org/licenses/by/4.0
Treatment of postpartum posterior reversible encephalopathy syndrome (PRES) with peripheral block
Posterior reversible encephalopathy syndrome (PRES) is associated with high blood pressure and various neurological symptoms. The most common neurological symptom is headache. It is usually diffuse and progressive at onset. If left untreated, symptoms progressively worsen over days to weeks. The excruciating headache associated with this syndrome may also trigger or worsen hypertension, thereby placing patients into a vicious cycle that complicates management. Preeclampsia is one of the reported causes of PRES. In developed countries, 16% of maternal deaths are attributed to hypertensive disorders. There is no specific, established antihypertensive regimen for the treatment of acute hypertension in patients with PRES. The use of intravenous antihypertensives may necessitate admission to the intensive care unit until a stable blood pressure target is achieved. Early recognition and treatment of PRES can help reduce the frequency of complications and improve patient outcomes.
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
The effect of regional anesthesia practices on intensive care unit admission rates in shoulder surgery: A single-center, 7-year retrospective analysis
Background: Shoulder surgeries are performed on a heterogeneous patient population ranging from young to elderly individuals. Across this diverse spectrum, general anesthesia (GA) can increase the risk of perioperative systemic complications and intensive care unit (ICU) admission, whereas regional anesthesia (RA) techniques are known to mitigate these risks and reduce ICU requirements. The aim of the study is to evaluate the effect of transitioning from general anesthesia (GA) to a primary regional anesthesia (RA) model in clinical anesthesia practice on postoperative intensive care unit (ICU) admission rates in patients undergoing shoulder surgery. Materials and Methods: In this single-center, retrospective study, electronic records of patients who underwent shoulder surgery (arthroscopic or open) at Samsun University Samsun Training and Research Hospital between May 2019 and May 2026 were retrospectively reviewed. Patients were divided into two main groups based on the clinical transition to regional anesthesia: before 2022 (GA Period) and after 2022 (RA Period). Postoperative ICU admission rates of the groups were compared as percentages. Results: A total of 947 patients were included in the study. In the post-2022 period, when regional techniques were used as the primary method in routine anesthesia practice, postoperative ICU admission rates were found to be statistically significantly lower compared to the GA period (Group RA: 6.41% and Group GA: 15.24%, p < 0.05). Conclusion: This study demonstrates a significant association between the primary regional anesthesia period and lower postoperative ICU admission rates in shoulder surgery. While this correlation points to a potential benefit for hospital resource optimization, further prospective multi-center studies are required to evaluate these retrospective data.
Copyright (c) 2026 by the Author. This is an open access article distributed under the CC BY licence. http://creativecommons.org/licenses/by/4.0
The effect of hemovac drain use on postoperative pain and patient satisfaction in primary aesthetic breast augmentation: A retrospective comparative study
Background: This study aimed to evaluate the effect of hemovac drain use on postoperative pain and patient satisfaction in patients undergoing primary aesthetic breast augmentation. Materials and Methods: This retrospective single-centre study included 53 patients who underwent bilateral primary aesthetic breast augmentation between January 2024 and May 2026. Patients were divided into non-drain (n=41) and hemovac drain (n=12) groups. Postoperative pain was assessed using the Numeric Rating Scale (NRS). Long-term outcomes were analysed using the Utrecht Questionnaire (UQ), adapted for breast augmentation patients, and overall satisfaction scores. Results: The groups were comparable in terms of age, implant volume, body weight, and body mass index (all p>0.05). On postoperative day 1, right- and left-sided NRS scores were significantly higher in the hemovac drain group [right: 8.5 (8–9) vs 5 (4.5–7); left: 8 (8–9) vs 5 (5–7); both p<0.001]. However, no significant differences were observed between the groups regarding postoperative week 1 and month 1 NRS scores. UQ scores were similar between the groups at postoperative months 1 and 6 (p=0.225 and p=0.909, respectively). Although the overall satisfaction score was numerically higher in the non-drain group, the difference did not reach statistical significance [8 (7–9) vs 7 (7–8); p=0.087]. Conclusion: Patients with hemovac drains demonstrated higher early postoperative pain scores; however, this difference did not persist during subsequent follow-up evaluations. No significant differences were observed between the groups regarding long-term pain outcomes, UQ scores, or overall patient satisfaction. These findings support a selective rather than routine use of drains in primary aesthetic breast augmentation.
Ultrasound-guided bilateral superficial cervical plexus block after neck-lift and temporal-lift surgery: Retrospective observational pilot study
Background: Postoperative analgesia after aesthetic neck surgery is poorly characterised, with limited published data on regional analgesic techniques. We report our initial experience with ultrasound-guided bilateral superficial cervical plexus block (SCPB) for neck-lift and temporal-lift procedures. Methods: In this single-centre retrospective observational case-controlled series, six consecutive patients receiving bilateral SCPB (20 mL of 0.25% bupivacaine at the end of surgery) were compared with 21 contemporaneous controls receiving standard analgesia. All received IV paracetamol and tenoxicam, with on-demand tramadol as rescue. Pain was assessed using the Numeric Rating Scale (NRS, 0–10) at 0, 1, 6, 12, and 24 h, with total analgesic use during hospital stay and satisfaction (1–5 Likert scale) as secondary outcomes. Data are median (IQR); Mann–Whitney U and Fisher exact tests were used. Results: Groups were balanced for age, sex, BMI, ASA status, and operative duration. NRS scores were lower with SCPB at every time point: 0 vs 3 in PACU and at 1 h (P = 0.0002), 0 vs 2 at 6 h (P = 0.0003), 0 vs 2 at 12 h (P = 0.005), and 0 vs 1 at 24 h (P = 0.016). SCPB patients required fewer total paracetamol vials during their hospital stay (median 2.5 vs 7.0; P = 0.0003) and fewer tenoxicam ampoules (2.0 vs 6.0; P = 0.003). Satisfaction was higher with SCPB (median 5 vs 3; P = 0.0005). No block-related complication occurred. Conclusion: US-guided bilateral SCPB was associated with lower pain scores, reduced supplemental analgesic use, and higher satisfaction after aesthetic neck surgery. These hypothesis-generating findings should be confirmed in an adequately powered randomised trial.
Association between admission diagnoses and intensive care unit mortality: A retrospective cohort study
Background: Mortality in the intensive care unit (ICU) is primarily driven by the severity of acute organ dysfunction; however, the prognostic contribution of admission clinical diagnoses beyond severity scores remains incompletely defined. This study aimed to evaluate the association between admission diagnoses and ICU mortality after adjustment for organ dysfunction severity. Methods: This retrospective cohort study included adult patients admitted to a tertiary ICU between January 2024 and December 2025. Patients with missing baseline data or ICU length of stay <24 hours were excluded. Demographic characteristics, comorbidities, admission diagnoses, and disease severity scores were recorded. ICU mortality was the primary outcome. Multivariable logistic regression analysis was performed using the Sequential Organ Failure Assessment (SOFA) score as the primary severity adjustment variable. Results: A total of 1,248 patients were included; 763 (61.1%) died during the ICU stay. In the SOFA-adjusted multivariable model, age (adjusted odds ratio [aOR] 1.02; 95% CI 1.02–1.03), SOFA score (aOR 1.33 per point; 95% CI 1.25–1.41), post–cardiac arrest status (aOR 6.21; 95% CI 4.17–9.23), sepsis (aOR 1.73; 95% CI 1.15–2.59), and active malignancy (aOR 1.69; 95% CI 1.17–2.44) were independently associated with ICU mortality. Neuromuscular disease showed a trend toward increased mortality but did not reach statistical significance. Conclusion: Beyond organ dysfunction severity, selected admission diagnoses—particularly post–cardiac arrest status, sepsis, and active malignancy—provide independent prognostic information for ICU mortality. Incorporating diagnosis-based risk stratification alongside severity scores may improve early prognostic assessment in critically ill patients. Trial Registration: The study was registered at ClinicalTrials.gov (ID: NCT07369206).
Refractory intraoperative hypotension: A case report to keep in mind
Refractory intraoperative hypotension can be triggered by a complex interplay of perioperative factors, including anesthetic-induced vasodilation, patient positioning, surgical blood loss, autonomic dysfunction, and the prolonged effects of the patient's daily medications (such as long-acting irbesartan, amlodipine, and concomitant beta-blocker therapy). While the optimal approach to perioperative renin–angiotensin system inhibitor use remains uncertain, these combined agents can severely impair cardiovascular compensatory mechanisms and blunt vasopressor responsiveness under general anesthesia. A 66-year-old male with hypertension and diabetes underwent posterior spinal instrumentation under general anesthesia. Following induction and prone positioning, severe refractory hypotension developed despite aggressive fluid resuscitation guided by Pleth Variability Index, vasopressors, and inotropic support. Progressive lactic acidosis led to surgical termination at the 150th minute. Postoperative cardiac evaluations were normal. Further history revealed the patient had taken a long-acting triple combined antihypertensive regimen (irbesartan/amlodipine/hydrochlorothiazide) the night before surgery. Norepinephrine support was required for 36 hours postoperatively, followed by a full recovery. While diabetic cardiac autonomic neuropathy and prone positioning create a vulnerable baseline for hemodynamic instability, long-acting triple combination antihypertensive therapy acts as the definitive driver for severe, refractory vasoplegic shock. Concomitant use of renin-angiotensin system inhibitors, calcium channel blockers, and thiazide diuretics can severely impair compensatory vasoconstriction and blunt vasopressor responsiveness under general anesthesia. Perioperative antihypertensive management must be strictly individualized according to drug half-life, combination characteristics, and patient comorbidities.
Walking the tightrope: Anaesthesia for fragile hearts and overactive glands in elderly hip surgery
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.
Failed labour epidural analgesia: mechanisms, risk factors and stepwise management: Guideline-based review
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.
The predictive impact of perioperative hypofibrinogenemia on re-exploration in cardiac surgery: Insights from a single-center analysis
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 level <1.5 g/L emerged as the strongest predictor. These findings suggest that close monitoring of fibrinogen and early replacement strategies may play a critical role in reducing re-exploration rates.
Perioperative factors associated with severe early postoperative pain after single-level lumbar discectomy: A retrospective cohort study
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 outcomes.
The effects of intravenous esmolol on hemodynamic response to endotracheal intubation and rocuronium onset time: A retrospective analysis
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 esmolol was associated with modulation of early hemodynamic responses to endotracheal intubation and a delayed onset of rocuronium-induced neuromuscular blockade. These findings suggest that esmolol may influence both cardiovascular responses and neuromuscular block onset during anesthesia induction. Future prospective investigations are needed to better delineate the clinical significance and mechanistic basis of this observed association.
Prediction of postoperative acute kidney injury after cardiopulmonary bypass cardiac surgery: The role of preoperative inflammatory indices and intraoperative perfusion stress
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. Although inflammatory indices were associated with acute kidney injury, they did not retain independent predictive value in adjusted models. Cardiopulmonary bypass duration demonstrated the strongest discriminative performance for KDIGO stage ≥2 acute kidney injury. Conclusions: Postoperative acute kidney injury is common after cardiac surgery with cardiopulmonary bypass and is strongly associated with increased in-hospital mortality. Age, baseline renal function, and cardiopulmonary bypass duration are key determinants of postoperative acute kidney injury, highlighting intraoperative perfusion stress as a clinically relevant and potentially modifiable risk factor. Trial Registration: The study was registered at ClinicalTrials.gov (ID: NCT05405049).
Copyright (c) 2025 Tulpar Academic Publishing http://creativecommons.org/licenses/by/4.0
Erratum to: The impact of vagal nerve stimulation from the lateral neck region on venous cannulation pain: A randomized controlled trial
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.
Evaluation of the content quality of regional anesthesia and postoperative analgesia approaches generated by ChatGPT-4.0 according to surgical incision sites
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.
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
Evaluation of quality of life and psychosocial factors in hemodialysis patients: A medical student-led observational survey study from a Turkish university hospital
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.
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
Retrospective comparison of anesthetic effects of bupivacaine and bupivacaine + dexmedetomidine in infraclavicular brachial plexus block in upper limb surgery
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.
Cost-effectiveness of fascial plane blocks in laparoscopic cholecystectomy: A retrospective study
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.
Levobupivacaine versus bupivacaine for spinal anesthesia in jackknife position: A randomized trial in pilonidal sinus surgery
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.
Deep serratus anterior plane block vs. rhomboid intercostal plane block for analgesia after breast cancer surgery: A prospective, double-blind randomized study
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.
Motor Block Following Lumbar Erector Spinae Plane Block for Postoperative Analgesia After Lumbar Spinal Surgery: A Case Report
Awake laparoscopic cholecystectomy under thoracal segmental spinal anesthesia and intermediate cervical plexus block: A case series
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.
Effects on cardiopulmonary bypass duration and optic nerve sheath diameter changes
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.
Tonsillectomy in a pediatric patient with propionic acidemia: Anesthesia management and potential perioperative challenges
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.
“Keeping it steady”: Anaesthetic challenges in insulinoma surgery
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.
Radiological evaluation of central venous catheter tip malposition
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.
The effects of lycopene in lung injury associated with cecum ligation and perforation-induced sepsis in rats: An investigative animal experiment study
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.
Ultrasound-guided supraclavicular nerve and interscalene block for clavicle surgery in pregnancy: A case report and case-based literature review
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.
The impact of vagal nerve stimulation from the lateral neck region on venous cannulation pain: A randomized controlled trial
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 difference between the analgesic effects of stimulation from the right and left sides. ------------------------------------------------------ This article has an Erratum. Please see: https://doi.org/10.20528/cjpm.2025.03.007
Neuraxial anesthesia in pregnant patients with neurological disorders ‒ Safety and practice strategies: A review
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.
Unexpected venous anomaly around the brachial plexus during supraclavicular block: A case report
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.
Triple threat: Anesthetic approach to IVF twin gestation, pre-eclampsia and peripartum cardiomyopathy in caesarean section
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.
Left colon volvulus following sigmoidectomy
Retrospective evaluation of analgesia approaches in patients undergoing thoracic surgery over the last one year: A single-center study
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.
Early detection of acute kidney injury in critically ill burn patients: Evaluating the predictive role of serum and urinary NGAL
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.
Copyright (c) 2024 Tulpar Academic Publishing http://creativecommons.org/licenses/by/4.0
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
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 for postoperative analgesia in patients undergoing arthroscopic knee surgery, instead of combined adductor canal and obturator nerve block.
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
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
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.
Comparison of the effects of femoral and axillary artery cannulation on ischemic cerebral injury in acute type A aortic dissection surgery: A retrospective study
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.
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
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.
Effectiveness of dry needle therapy in patients with chronic nonspecific low back pain
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.
How does intravenous ondansetron affect motor and sensory block in spinal anesthesia administered with intrathecal levobupivacaine? A prospective randomized controlled study
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.
Perioperative ventricular dysrhythmia management in ranula cyst excision surgery
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.
Anaphylaxis following unfractionated heparin administration: How safe is this drug in the treatment of thromboembolism?
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.
Block combinations: The answer sought or a waste of effort?