OBJECTIVES:This study aimed to compare the analgesic efficacy of a combined deep and superficial serratus anterior plane block (SAPB) with deep SAPB alone in patients undergoing video-assisted thoracoscopic surgery (VATS). DESIGN:A prospective, randomized clinical trial. SETTING:Single-center, academic hospital. PARTICIPANTS:Sixty patients undergoing elective VATS. INTERVENTIONS:One group received a combined deep and superficial SAPB (each 15 mL of 0.375% bupivacaine with epinephrine 5 µg/mL injected both deep to and above the serratus anterior muscle) (group DS), while the other group received 30 mL of the same solution deep into the serratus anterior muscle only (group D). Additionally, 5 mL of 0.25% bupivacaine was infiltrated at the chest tube insertion site in all patients. Standardized multimodal analgesia included intravenous morphine (0.1 mg/kg), paracetamol (1,000 mg), and ibuprofen (800 mg), administered 30 minutes before the end of surgery. Postoperative analgesia was maintained with intravenous patient-controlled fentanyl. MEASUREMENTS AND MAIN RESULTS:Demographic and operative characteristics were comparable between the groups. Total postoperative opioid consumption within 24 hours, expressed in morphine milligram equivalents, was 27.12 ± 16.67 mg in group D and 32.84 ± 19.86 mg in group DS, with no significant difference between groups (p = 0.137). The total amount of rescue analgesia was 11.67 ± 11.47 mg in group D and 16.33 ± 12.45 mg in group DS, with no statistically significant difference between the groups (p = 0.141). Postoperative pain scores and the incidence of opioid-related adverse effects were similar between groups (p > 0.05 for all). CONCLUSIONS:This study demonstrates that a single deep SAPB provides equivalent postoperative analgesia to combined single and deep SAPB. Both techniques offered comparable postoperative analgesia and safety profiles.

Background/Objectives: Shoulder arthroscopies are commonly conducted in orthopedic practice. The interscalene brachial plexus block (ISB) is regarded as the “gold standard” for postoperative analgesia in shoulder surgeries. The serratus posterior superior intercostal plane block (SPSIPB) was introduced as an innovative treatment for addressing thoracic and shoulder discomfort. This study aims to examine the effects of SPSIPB and ISB techniques on postoperative pain levels, opioid intake, and respiratory function measures in patients having shoulder arthroscopy. Methods: Patients were divided into two groups. In the ISB group, 15 mL of fluid containing 0.25% bupivacaine was applied between interscalene muscles, while in the SPSIPB group, 30 mL of 0.25% bupivacaine was applied in the fascial plane between the serratus posterior superior muscle and the intercostal muscles. Results: There were no statistically significant differences in demographic characteristics (p > 0.05). VAS scores were statistically lower in the ISB group compared to the SPSIPB group at rest at 1, 2, 4, 8, 12, and 24 h postoperatively in the PACU (p < 0.05). VAS scores were also lower in the ISB group compared to the SPSIPB group during active movement at 1, 2, 4, 8, and 12 h postoperatively in the PACU (p < 0.05). Twenty-four-hour fentanyl consumption was lower in the ISB group compared to the SPSIPB group (407.50 ± 169.32 μg and 767.50 ± 178.00 μg, respectively, p < 0.001). The decrease in FEV1 and FVC was higher in the ISB group compared to the SPSIPB group (p < 0.001). Conclusions: ISB effectively relieves pain during shoulder arthroscopic procedures; however, while SPSIPB is considered a more advantageous option in terms of respiratory safety, it may not provide adequate analgesia on its own.

Introduction The optimal techniques of a parasternal intercostal plane (PIP) block to cover the T2–T6 intercostal nerves have not been elucidated. This pilot cadaveric study aims to determine the optimal injection techniques that achieve a consistent dye spread over the second to sixth intercostal spaces after both ultrasound-guided superficial and deep PIP blocks. We also investigated the presence of the transversus thoracis muscle at the first to sixth intercostal spaces and its sonographic identification agreement, as well as the location of the internal thoracic artery in relation to the lateral border of the sternum. Methods Ultrasound-guided superficial or deep PIP blocks with single, double, or triple injections were applied in 24 hemithoraces (three hemithoraces per technique). A total volume of dye for all techniques was 20 mL. On dissection, dye distribution over the first to sixth intercostal spaces, the presence of the transversus thoracis muscle at each intercostal space and the distance of the internal thoracic artery from the lateral sternal border were recorded. Results The transversus thoracis muscles were consistently found at the second to sixth intercostal spaces, and the agreement between sonographic identification and the presence of the transversus thoracis muscles was >80% at the second to fifth intercostal spaces. The internal thoracic artery is located medial to the halfway between the sternal border and costochondral junction along the second to sixth intercostal spaces. Dye spread following the superficial PIP block was more localized than the deep PIP block. For both approaches, the more numbers of injections rendered a wider dye distribution. The numbers of stained intercostal spaces after superficial block at the second, fourth, and fifth intercostal spaces, and deep block at the third and fifth intercostal spaces were 5.3±1.2 and 5.7±0.6 levels, respectively. Conclusion Triple injections at the second, fourth, and fifth intercostal spaces for the superficial approach and double injections at the third and fifth intercostal spaces for the deep approach were optimal techniques of the PIP blocks.

Large language models (LLMs) are used in all areas of life and have become one of the information sources for those seeking healthcare. Although ChatGPT is the most well-known, Claude, CoPilot, and GEMINI are also among the other LLMs. Some of these models have been studied in terms of their response quality metrics to frequently asked questions (FAQs) about broad content areas like anesthesia and to specific FAQs related to obstetric analgesia. However, no studies have yet been conducted on questions related to nerve blocks. In this study, we evaluated the quality of the answers given by the four LLMs to frequently asked questions related to ‘nerve block’. Prospective, Delphi study, Survey. Ten FAQs were identified and presented to four LLMs. A Delphi study was conducted to develop an assessment tool. A survey study was then conducted using the developed tool, in which the evaluators, selected through a thorough process, evaluated the LLM responses. The quality of LLM responses was assessed by raters using the ARQuAT (Assessing Response Quality in AI Texts) tool, determined through Delphi rounds. Evaluation criteria included content criteria such as accuracy, comprehensiveness, security, timeliness, and relevance, as well as communication criteria such as understandability, empathy, ethical considerations, readability, and neutrality. ChatGPT and Claude demonstrated superior performance in ARQuAT-Overall scores compared to GEMINI and CoPilot (p < 0.001). ChatGPT and Claude achieved satisfaction rates above 80

Breast cancer surgery is frequently associated with moderate to severe postoperative pain. While the serratus anterior plane block (SAPB) provides effective anterolateral chest wall analgesia, it may inadequately cover the anterior intercostal nerve branches. This study aimed to determine whether adding a superficial parasternal intercostal plane block to SAPB improves postoperative opioid consumption, pain scores, and dermatomal sensory coverage. In this prospective, randomized, double-blind trial, 64 patients aged 18–65 years undergoing elective breast surgery were randomly allocated into two groups. Group S (n = 32) received a preoperative SAPB with 30 mL of 0·25

Effective postoperative analgesia after lumbar transpedicular fixation (TPF) surgery remains challenging because of extensive tissue trauma and high nociceptive burden. Ultrasound-guided fascial plane blocks have emerged as important components of multimodal analgesia in spinal surgery. This study aimed to compare the analgesic efficacy, opioid consumption, technical performance, and quality of recovery associated with the modified thoracolumbar interfascial plane (mTLIP) block versus the anterior quadratus lumborum block (QLB) in patients undergoing two- or three-level lumbar TPF surgery. In this prospective, randomized, single-center trial, 100 patients (ASA I–II) scheduled for two- or three-level lumbar TPF surgery were randomly assigned to receive bilateral ultrasound-guided mTLIP (n = 50) or anterior QLB (n = 50) in addition to standardized general anesthesia and multimodal postoperative analgesia. The primary outcome was cumulative fentanyl consumption during the first 24 postoperative hours. Secondary outcomes included interval opioid consumption, postoperative pain scores, time to first analgesic request, block performance characteristics, opioid-related adverse effects, and quality of recovery assessed using the QoR-15 questionnaire. Baseline demographic and surgical characteristics were comparable between groups. Fentanyl consumption during the first 4 postoperative hours was significantly lower in the mTLIP group compared with the QLB group (75 [50–125] µg vs. 125 [75–175] µg; p = 0.017). Opioid consumption during the 4–8 h and 8–24 h intervals, as well as total 24-hour fentanyl consumption, did not differ significantly between groups. Postoperative pain scores at rest and during movement, time to first analgesic request, additional analgesic requirements, QoR-15 scores, and opioid-related adverse effects were similar. The mTLIP block demonstrated significantly shorter performance time and superior needle visualization compared with QLB (p < 0.001). In patients undergoing multi-level lumbar TPF surgery, the mTLIP block provided superior opioid-sparing analgesia in the early postoperative period compared with anterior QLB, while overall analgesic efficacy and quality of recovery were comparable thereafter. Improved technical performance and procedural efficiency may favor mTLIP as a practical regional analgesia option in extensive lumbar spinal surgery.

Objective:Regional anaesthesia for hip surgery aims to cover both articular and cutaneous nerves. Current techniques often miss components or require multiple injections. We hypothesized that the deep iliacus plane block (DIPB)-which involves injection deep to the iliacus muscle at the anterior inferior iliac spine-could simultaneously target both lumbar plexus branches and articular nerves. Methods:We conducted a cadaveric investigation and a retrospective clinical pilot. Bilateral DIPB was performed on a fresh cadaver (50 mL dye) using 50 mL of dye to assess dye spread. Clinically, 20 hip fracture patients received a single-injection DIPB (30-40 mL of 0.25% bupivacaine). Blocks were performed postoperatively (n = 13) or preoperatively for positioning (n = 7). Primary outcomes included dye spread and opioid consumption. Pain scores were evaluated before and after the block in the positioning subset. Results:Cadaveric dye stained the lateral femoral cutaneous nerve (LFCN), the femoral nerve (FN), and the pericapsular branches. In the clinical cohort (n = 20), the median postoperative numeric rating scale (NRS) score was 1; only one patient required rescue analgesia within 24 hours. In the positioning subset (n = 7), median NRS dropped from 9.0 (7-10) to 1.0 (0-2) 30 minutes post-block (P < 0.001). Conclusion:Preliminary findings suggest that DIPB may provide simultaneous coverage of the LFCN, FN, and pericapsular branches with a single injection. Further prospective studies are required to confirm the safety and efficacy.

Background and Objectives: Accurately diagnosing acute appendicitis (AA) in children remains clinically challenging due to overlapping symptoms with other pediatric conditions and limitations in conventional diagnostic tools. The systemic immune-inflammation index (SII) has emerged as a promising biomarker in adult populations; however, its utility in pediatrics is still unclear. This study aimed to evaluate the diagnostic accuracy of SII in distinguishing pediatric acute appendicitis from elective non-inflammatory surgical procedures and to assess its predictive value in identifying complicated cases. Materials and Methods: This retrospective, single-center study included 397 pediatric patients (5–15 years), comprising 297 histopathologically confirmed appendicitis cases and 100 controls. Demographic and laboratory data were recorded at admission. Inflammatory indices including SII, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) were calculated. ROC curve analysis was performed to evaluate diagnostic performance. Results: SII values were significantly higher in the appendicitis group (median: 2218.4 vs. 356.3; p < 0.001). SII demonstrated excellent diagnostic accuracy for AA (AUROC = 0.95, 95% CI: 0.92–0.97), with 91% sensitivity and 88% specificity at a cut-off > 624. In predicting complicated appendicitis, SII showed moderate discriminative ability (AUROC = 0.66, 95% CI: 0.60–0.73), with 83% sensitivity but limited specificity (43%). Conclusions: SII is a reliable and easily obtainable biomarker for diagnosing pediatric acute appendicitis and may aid in early detection of complicated cases. Its integration into clinical workflows may enhance diagnostic precision, particularly in resource-limited settings. Age-specific validation studies are warranted to confirm its broader applicability.

OBJECTIVE:This study was designed to compare the hemodynamic effects of acute normovolemic hemodilution (ANH) and norepinephrine infusion during autologous blood donation, with a particular focus on cardiac cycle efficiency (CCE), an energy-based parameter of cardiovascular performance. DESIGN:A prospective, randomized clinical trial. SETTINGS:Single-center, academic hospital. PARTICIPANTS:Forty patients undergoing coronary artery bypass graft surgery. INTERVENTIONS:In the ANH group, a crystalloid solution was administered simultaneously to the contralateral upper extremity. The volume of replacement fluid was calculated at a 3:1 ratio relative to the volume of blood withdrawn. In the norepinephrine infusion (NA) group, no fluid was administered during the donation process. Instead, norepinephrine infusion was administered at a rate of 0.05 µg/kg/min. MEASUREMENTS AND MAIN RESULTS:Hemodynamic parameters were monitored at three time points during the blood donation process. The primary outcome was the comparison of CCE changes between groups. Secondary outcomes included other advanced hemodynamic variables, metabolic indicators, and short-term postoperative clinical results. Changes in CCE during autologous blood donation were comparable between groups (ANH: 0.20 ± 0.51, NA: 0.5 ± 0.57, p = 0.373). Hemodynamic stability was achieved in both groups, with no relevant differences in cardiac index, stroke volume index, or metabolic markers (p > 0.05). Dynamic preload parameters showed expected physiological patterns in the norepinephrine group, consistent with volume-sparing circulatory support. None of the patients experienced acute kidney injury. There was no difference between the groups in terms of intensive care unit or hospital length of stay. CONCLUSIONS:Norepinephrine infusion demonstrated hemodynamic equivalence to ANH in the setting of autologous blood donation during coronary artery bypass graft surgery. Its ability to preserve circulatory function without fluid administration suggests it may serve as a viable alternative to ANH, particularly in patients requiring careful volume management.

OBJECTIVE:To evaluate the analgesic efficacy of bilateral erector spinae plane block (ESPB) versus the combination of deep parasternal intercostal plane block (DPIPB) and serratus anterior plane block (SAPB) for managing acute pain after cardiac surgery. DESIGN:Prospective, randomized, assessor-blinded controlled trial SETTING: A single institution, an academic university hospital PARTICIPANTS: Sixty patients scheduled for elective on-pump cardiac surgery through median sternotomy INTERVENTIONS: Patients were allocated at random into 2 groups: bilateral ESPB (n = 30) and combined DPIPB and SAPB (n = 30). MEASUREMENTS AND MAIN RESULTS:The primary outcome was postoperative opioid consumption over the first 24 hours. Secondary outcomes included pain scores at rest and during coughing, rescue analgesia requirements, and opioid-related adverse effects. Cumulative opioid consumption was significantly lower in the ESPB group compared to the DPIPB+SAPB group (mean, 330.00 ± 206.82 µg v 464.17 ± 232.74 µg; p = 0.022). No significant differences were observed in pain scores at the sternotomy or drain sites at rest or during coughing at any time point (p > 0.05). Additionally, there were no significant differences in rescue analgesic requirements or opioid-related side effects between the 2 groups (p > 0.05). CONCLUSIONS:In patients undergoing open-heart surgery through median sternotomy, bilateral ESPB provided more effective opioid-sparing analgesia compared to the combined DPIPB+SAPB technique, despite similar subjective pain scores and side effect profiles. These findings support the broader dermatomal spread and prolonged efficacy of ESPB, although both techniques appear to be clinically effective as components of multimodal analgesia strategies.

JOURNAL/mgres/04.03/01612956-202606000-00005/figure1/v/2025-08-18T154854Z/r/image-tiff Low-flow anesthesia aims to minimize anesthetic gas consumption while maintaining adequate anesthesia. To examine the effects of minimal-flow anesthesia on perioperative lung dynamics and postoperative pulmonary function tests, a prospective, randomized controlled study was conducted between October 2023 and March 2024 at Atatürk University. A total of 66 patients (15 males, 45 females) with confirmed American Society of Anesthesiologists (ASA) grade I-II, aged 18-65 years, and scheduled for elective laparoscopic cholecystectomy were included in the study. Patients were randomized into two groups: MeFA (medium flow anesthesia, 2 L/min fresh gas flow) and MiFA (minimal flow anesthesia, 0.5 L/min fresh gas flow). In both groups, dynamic compliance values, peak inspiratory pressure (PIP) values, total inhalation anesthetic drug consumption, total remifentanil drug consumption, duration of anesthesia, duration of surgery, and spirometry test results were recorded. Respiratory measurements were recorded at the 5th minute after intubation (T1), 5th (T2), 10th (T3), 30th (T4), and 60th (T5) minutes after surgical incision and immediately after the surgical suturing (T6) pulse. There was no significant difference in compliance or PIP values between the groups from T1 to T5 (P > 0.05). However, at T6, the MeFA group exhibited a significant decrease in compliance and an increase in PIP compared with the MiFA group (P < 0.05). Additionally, significant differences in compliance and PIP values were found across all time intervals compared with those at T1, except for the T5-6 compliance values in the MiFA group (P < 0.001). No significant difference in respiratory function test values was noted between the groups (P > 0.05). The MiFA group exhibited a relatively milder reduction in compliance values and a lesser elevation in PIP values. Compared with medium-flow anesthesia, minimal-flow anesthesia may help mitigate perioperative lung function deterioration. These findings suggest potential benefits in preserving lung mechanics, warranting further research. This trial was registered at clinicaltrials.gov (identifier No. NCT06055335, registered March 25, 2023).

Caudal epidural block is a widely performed procedure for postoperative pain control of pediatric patients. As the local anesthetic acts by spreading cranially after caudal block, it may lead to several effects on the cerebrospinal fluid and intracranial region. Children aged 1–7, ASA I-II were included in this study. The patient population was assigned into two groups as the Caudal Block Group (Group CB) and the Control Group (Group C) Caudal block with 0.25

INTRODUCTION:The modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) has been proposed as an effective regional anesthesia technique for reducing postoperative opioid consumption in patients undergoing laparoscopic cholecystectomy (LC). We conducted this systematic review and meta-analysis with trial sequential analysis to assess the analgesic efficacy of M-TAPA block in LC. EVIDENCE ACQUISITION:We searched Pubmed Central, Scopus and Cochrane Central Register of Controlled Trials (from inception to until 1 July 2024). The effects of the M-TAPA were compared with those of sham block, placebo and no intervention. Randomized controlled trials, observational and retrospective studies were included. The primary outcome was postoperative opioid consumption at 24 hours, while secondary outcomes included pain scores at 12 and 24 hours, postoperative nausea and vomiting (PONV), and rescue analgesic requirements. EVIDENCE SYNTHESIS:This meta-analysis included six studies encompassing four randomized controlled trials, one retrospective study, and one prospective observational study, with a total of 350 patients. The analysis demonstrated a significant reduction in postoperative opioid consumption (MD -9.06; 95% CI -11.6 to -6.48, P=0.001) in the M-TAPA group. Additionally, patients receiving M-TAPA reported lower pain scores at 12 and 24 hours postoperatively. The risk of PONV was significantly reduced (OR 0.19; 95% CI 0.10 to 0.39, P=0.001), and fewer patients required rescue analgesics (OR 0.24; 95% CI 0.09 to 0.65, P=0.05). CONCLUSIONS:M-TAPA block provides superior analgesia when compared with control group in LC.

INTRODUCTION:The transversalis fascia plane block (TFPB) has been utilized for pain relief following cesarean delivery (CD) but its analgesic efficacy remains controversial. This systematic review and meta-analysis with trial sequential analysis, aimed to evaluate the effectiveness of TFPB in providing postoperative analgesia for patients undergoing CD. EVIDENCE ACQUISITION:A comprehensive literature search was conducted to identify trials comparing TFPB with a control group in CD patients. The primary outcome was opioid consumption within the first 24 hours postoperatively. Secondary outcomes included pain scores at rest and during movement at 12 and 24 hours, incidence of postoperative nausea and vomiting (PONV), and the need for rescue analgesia. EVIDENCE SYNTHESIS:Seven studies involving a total of 478 patients (240 in the TFPB group and 238 in the control group) met the inclusion criteria. Patients in the TFPB group demonstrated significantly lower opioid consumption within the first 24 hours postoperatively, with a mean difference (MD) of -5.80 mg of morphine equivalents (95% CI -9.13 to -2.47; P<0.001). Additionally, the likelihood of requiring rescue analgesia was significantly reduced in the TFPB group, with an odds ratio (OR) of 0.28 (95% CI 0.14 to 0.55; P<0.001). However, there were no statistically significant differences in pain scores at rest or during movement at 12 and 24 hours postoperatively. CONCLUSIONS:This systematic review and meta-analysis suggests that TFPB may reduce opioid consumption and the need for rescue analgesics in patients undergoing CD. However, its effect on postoperative pain scores remains inconclusive, highlighting the need for further research to better understand its clinical benefits.