BACKGROUND:Hemiplegic shoulder pain (HSP) is a common complication after stroke, significantly impairing rehabilitation. While suprascapular nerve block (SSNB) has shown promise in pain management, its long-term efficacy, especially with repeated applications, remains unclear. OBJECTIVE:This study aimed to evaluate the effectiveness of ultrasound-guided repeated SSNB in reducing pain, improving range of motion (ROM), and enhancing motor function in patients with HSP. METHODS:This double-blind, randomized controlled trial included 42 patients with HSP, allocated to either the SSNB group or the control group in a 1:1 ratio. The SSNB group received ultrasound-guided injections of levobupivacaine and triamcinolone at baseline, 3 weeks, and 6 weeks, while the control group received sham injections. All participants followed a standardized physiotherapy program. Pain was assessed using the visual analog scale, ROM with a goniometer, spasticity with the Ashworth scale, and motor recovery with the Brunnstrom scale. Assessments were conducted at baseline, 1, 4, and 7 weeks. RESULTS:Thirty-nine patients completed the study. The SSNB group showed significant reductions in visual analog scale scores at 1, 4, and 7 weeks compared to the control group (P < .05). ROM for abduction and flexion significantly improved in the SSNB group at 7 weeks (P < .05). However, there were no significant differences between groups in Ashworth or Brunnstrom scores at any time point. CONCLUSION:Repeated SSNB effectively reduces pain and improves ROM in patients with HSP when combined with physiotherapy. However, it does not significantly impact spasticity or motor function. Further research with longer follow-ups and active comparators is needed to determine its long-term benefits.

RATIONALE:Cerebrospinal fluid (CSF) leaks, arising from abnormal openings in the protective layers surrounding the spinal cord and brain, are a significant medical concern. These leaks, triggered by various factors including trauma, medical interventions, or spontaneous rupture, lead to the draining of CSF-an essential fluid safeguarding the nervous system. A classic symptom of CSF leaks is an incapacitating headache exacerbated by sitting or standing but relieved by lying down. Spontaneous intracranial hypotension (SIH) denotes the clinical condition marked by postural headaches due to spontaneous CSF leakage and hypotension, often misdiagnosed or underdiagnosed. While orthostatic headaches are the hallmark, SIH may manifest with an array of symptoms including nausea, tinnitus, hearing loss, visual disturbances, and dizziness. Treatment options encompass conservative measures, epidural blood patches (EBP), and surgery, with EBP being the primary intervention.PATIENT CONCERN:The patient did not express any specific concerns regarding their medical diagnosis. However, they did harbor apprehensions that their condition might necessitate surgical intervention in the future.DIAGNOSIS:The patient had been treated with antibiotics with a pre-diagnosis of sinusitis and was admitted to the neurology department of our hospital when his symptoms failed to improve. Cranial magnetic resonance imaging was interpreted as thickening of the dural surfaces and increased contrast uptake, thought to be due to intracranial hypotension. Cranial MR angiography was normal. Full-spine magnetic resonance imaging revealed a micro-spur at the C2 to 3 level and the T1 to 2 level in the posterior part of the corpus.INTERVENTIONS:The cervical EBP was performed in the prone position under fluoroscopic guidance. There were no complications.OUTCOMES:The patient was invited for follow-up 1 week after the procedure, and control examination was normal.LESSONS:SIH poses a diagnostic challenge due to its diverse clinical presentation and necessitates precise imaging for effective intervention. Cervical EBP emerges as a promising treatment modality, offering relief and improved quality of life for individuals grappling with this condition. However, clinicians must carefully assess patients and discuss potential risks and benefits before opting for cervical blood patches.

Background:Postoperative pain continues to represent an important problem even after minimally invasive robotic-assisted laparoscopic radical prostatectomy, which results in discomfort in the postoperative period and sometimes prolongs hospital stays. Regional anesthesia and analgesia techniques are used in addition to systemic analgesics with the multimodal approach in postoperative pain management. Ultrasound-guided fascial plane blocks are becoming increasingly important, especially in minimally invasive surgeries. Another important cause of discomfort is urinary catheter pain. The present randomized controlled study investigated the effect of rectus sheath block on postoperative pain and catheter-related bladder discomfort in robotic prostatectomy operations.Methods:This randomized controlled trial was conducted from March to August 2022. Written informed consent was obtained from all participants. Approval for the study was granted by the Clinical Research Ethics Committee. All individuals provided written informed consent, and adults with American Society of Anesthesiologists Physical Condition classification I to III planned for robotic prostatectomy operations under general anesthesia were enrolled. Following computer-assisted randomization, patients were divided into 2 groups, and general anesthesia was induced in all cases. Rectus sheath block was performed under general anesthesia and at the end of the surgery. No fascial plane block was applied to the patients in the non-rectus sheath block (RSB) group.Postoperative pain and urinary catheter pain were assessed using a numerical rating scale. Fentanyl was planned as rescue analgesia in the recovery room. In case of numerical rating scale scores of 4 or more, patients were given 50 mu g fentanyl IV, repeated if necessary. The total fentanyl dose administered was recorded in the recovery room. IV morphine patient-controlled analgesia was planned for all patients. All patients' pain (postoperative pain at surgical site and urethral catheter discomfort) scores and total morphine consumption in the recovery unit and during follow-ups on the ward (3, 6, 12, and 24 hours) in the postoperative period were recorded.Methods:This randomized controlled trial was conducted from March to August 2022. Written informed consent was obtained from all participants. Approval for the study was granted by the Clinical Research Ethics Committee. All individuals provided written informed consent, and adults with American Society of Anesthesiologists Physical Condition classification I to III planned for robotic prostatectomy operations under general anesthesia were enrolled. Following computer-assisted randomization, patients were divided into 2 groups, and general anesthesia was induced in all cases. Rectus sheath block was performed under general anesthesia and at the end of the surgery. No fascial plane block was applied to the patients in the non-rectus sheath block (RSB) group.Postoperative pain and urinary catheter pain were assessed using a numerical rating scale. Fentanyl was planned as rescue analgesia in the recovery room. In case of numerical rating scale scores of 4 or more, patients were given 50 mu g fentanyl IV, repeated if necessary. The total fentanyl dose administered was recorded in the recovery room. IV morphine patient-controlled analgesia was planned for all patients. All patients' pain (postoperative pain at surgical site and urethral catheter discomfort) scores and total morphine consumption in the recovery unit and during follow-ups on the ward (3, 6, 12, and 24 hours) in the postoperative period were recorded.Results:Sixty-one patients were evaluated. Total tramadol consumption during follow-up on the ward was significantly higher in the non-RSB group. Fentanyl consumption in the postanesthesia care unit was significantly higher in the non-RSB group. Total morphine consumption was significantly lower in the RSB group at 0 to 12 hours and 12 to 24 hours. Total opioid consumption was 8.81 mg in the RSB group and 19.87 mg in the non-RSB group. A statistically significant decrease in urethral catheter pain was noted in the RSB group at all time points.Conclusion:RSB exhibits effective analgesia by significantly reducing postoperative opioid consumption in robotic prostatectomy operations.

Background and AimsThis retrospective study aims to evaluate the efficacy, safety, and complications associated with two types of interscalene nerve catheters used in shoulder arthroscopy surgeries: the conventional-catheter and the catheter-over-needle.MethodsA comprehensive 7-year retrospective analysis was conducted at a single institution, involving 696 patients who underwent shoulder arthroscopy surgeries after taking an approval from the Local Ethics Committee (2020.023.IRB2.004). Patient characteristics included a mean age of 50.4 years, American Society of Anesthesiologists (ASA) classifications of ASA-1 (53.4%), ASA-2 (33.3%), and ASA-3 (13.2%), and a mean Body Mass Index of 25.34. Various surgery types were included, and the analysis focused on 610 patients with catheters.ResultsDyspnea was observed in 8.6%, while Horner syndrome was present in 13.2% of patients. Early catheter-dislodgement occurred in 5.2% of the conventional-catheter group and 1.9% of the catheter-over-needle group demonstrating a statistically significant difference (p=0.041). Late catheter dislodgement rates were 5.6% in the conventional-catheter group and 2.8% in the catheter-over-needle group, which did not reach statistical significance. Pain scores at 24-hours postoperatively were significantly lower in the catheter-over-needle group (mean NRS-score: 1.98) compared to the conventional-catheter group (mean NRS-score: 2.36).ConclusionsThis retrospective evaluation of interscalene nerve catheter types in shoulder arthroscopy surgeries demonstrates that the catheter-over-needle technique yields a lower incidence of early catheter dislodgement, reduced rates of dyspnea and Horner syndrome, and significantly lower pain scores at 24 hours compared to the conventional catheter technique. The increasing utilization of the catheter-over-needle technique over time may have influenced the results due to the operator’s growing expertise.

Objective: This study aimed to assess the potential of intrathecal administration of lipid emulsions as a targeted therapeutic strategy to mitigate the hemodynamic consequences of high or total spinal anesthesia induced by bupivacaine in a rat model.Materials and Methods: After receiving approval from Koç University's Local Ethics Board of Animal Experiments, 14 adult female Wistar Albino rats were randomized into two groups: Lipid and Saline.After inducing a high spinal block, each group was treated with either intrathecal lipid emulsions or isotonic saline solutions, respectively.Hemodynamic parameters such as systolic, diastolic, and mean arterial blood pressures, as well as heart rate, were continuously monitored.A histological analysis was conducted upon completion of the study. Results:The Lipid group exhibited a significant increase in mean systolic (p=0.002),diastolic (p=0.002), and arterial pressures (p=0.002)compared to the Saline group.The mean pulse rate also differed significantly between the groups (p=0.009).Notably, while all rats in the Saline group succumbed, only two fatalities occurred in the Lipid group, with the other five rats surviving (p=0.021). Conclusion:This study suggests that intrathecal administration of lipid emulsions can serve as a rapid and effective intervention to counteract the hypotension and bradycardia induced by high or total spinal anesthesia with bupivacaine in rats.While these findings are promising, further experimentation and clinical trials are required to confirm this method's potential, focusing on its long-term safety, efficacy, and the establishment of an optimal administration protoco.

OBJECTIVE:This prospective, randomized study aimed to compare anterior suprascapular nerve block versus interscalene block in terms of diaphragm paralysis in arthroscopic shoulder surgery. METHODS:Fifty-two patients undergoing shoulder arthroscopy surgery were prospectively randomly assigned to interscalene block (n=25) or anterior suprascapular nerve block groups (n=27) (each group receiving 5 mL, 0.5% bupivacaine). The ipsilateral diaphrag matic excursion was assessed in all patients using ultrasound imaging before (baseline), 30 minutes, and 24 hours after block completion. Pain scores were recorded 1 hour preoperative, 30-60 minutes in the postoperative recovery unit, and at 6 and 24 hours postoperatively. RESULTS:No complete paralysis was observed in either treatment group. The incidence of a partial decrease in diaphragm movements was significantly lower in the anterior suprascapular nerve block than in the interscalene block group (1 vs. 21 patients) (P < .01). Twenty-six patients in the anterior suprascapular nerve block and 4 in the interscalene block group had less than a 25% decrease in hemidiaphrag matic movements, 30 minutes after the blockade. Pain scores were similar in the 2 groups. However, mean pain scores at 24 hours post operatively were significantly higher in the interscalene block than in the anterior suprascapular nerve block group (P < .05). Time to first pain post-block was significantly longer in the anterior suprascapular nerve block compared to the interscalene block group (677.04 ± 52.17 minutes vs. 479.2 ± 99.74 minutes, P < .05). CONCLUSION:Anterior suprascapular nerve block and interscalene block both appear to be clinically effective in providing postoperative analgesia for patients undergoing arthroscopic shoulder surgery under general anesthesia. However, the time to first pain is significantly longer with anterior suprascapular nerve block. Pain scores at 24 hours postoperatively were significantly lower in the anterior supra scapular nerve block compared to the interscalene block group. Diaphragmatic movements after anterior suprascapular nerve block were also better preserved at both 30 minutes after the block and 24 hours after surgery. LEVEL OF EVIDENCE:Level I, Therapeutic Study.

BACKGROUND:Pain after cardiac surgery is both multifocal and multifactorial. Sternotomy, sternal retraction, internal mammary dissection, posterior rib dislocation or fracture, potential brachial plexus injury, and mediastinal and pleural drains all contribute to pain experienced in the immediate postoperative period. Ineffective pain management can result in systemic and pulmonary complications and significant cardiac consequences.METHODS:This study compared the effectiveness of regional anesthesia techniques for perioperative pain management in cardiac surgery patients at our clinic. The effects of different analgesic methods, in terms of contributing to recovery, were examined.RESULTS:The records of 221 patients who had undergone coronary bypass surgery were evaluated retrospectively. The extubation rate in the operating room was 91%. No patient received balloon pump support, and 20 patients were transferred to the cardiovascular intensive care unit while intubated. Regional anesthesia was performed on two of these 20 patients, but not on the remaining 18. Examination of intraoperative and postoperative opioid consumption revealed significantly lower levels among patients receiving regional anesthesia. The most effective results among the regional anesthesia techniques applied were achieved with double injection erector spinae plane block.CONCLUSION:Regional anesthesia techniques severely limit opioid consumption during cardiac surgery. Their importance will gradually increase in terms of rapid recovery criteria. Based on our study results, double injection of the erector spinae plane block seems to be the most effective technique in cardiac surgery. We therefore favor the use of fascial plane blocks during such procedures. Trial Numbers The study is registered with ClinicalTrials (NCT05282303). Ethics committee registration and approval were Granted under Number 2021.464.IRB1.131.

media (excessive absorption of liquid or gas), thermal and/or mechanical injuries, or a combination of all of them.During hysteroscopic surgery, there is a potential risk for air or gas to entery the circulation through exposed uterine veins.Large open venous sinuses allow entry of air or gas into the right side of the heart and pulmonary system, especially when there is a favorable pressure gradient created by the Trendelenburg position of the patient and/or the intrauterine distension due to the fluid.Therefore, pulmonary gas embolism is a known complication during operative hysteroscopy that may have significant consequences (3,4).The gas entering

Background and AimsAbdominal wall blocks are frequently used due to the use of blocks that are effective, such as the transversus abdominis plane (TAP) block and the widespread use of ultrasound (US) imaging. We want to present the extraordinary performance of external oblique intercostal block in three different surgeries.MethodsA 30 – 35 year-old male patient was taken to the operating room for open liver surgery. After the surgery, unilateral external oblique intercostal block (EOI) and bilateral TAP block were performed in the supine position, and the catheter was placed under the external oblique muscle. Postoperative analgesia is followed by patient-controlled analgesia through the catheter. A 35 – 40 year-old male patient was taken to the operating room for laparoscopic liver surgery. After the surgery, unilateral external oblique intercostal block (EOI) and bilateral TAP block were performed supine. The patient had iv tramadol PCA (only bolus dose 10 mg lockout 20 min). A 25 – 30 year-old male patient was taken to the operating room for laparoscopic bariatric surgery. After the surgery, bilateral external oblique intercostal block (EOI) and bilateral RB were performed supine. The patient had iv tramadol PCA (only bolus dose 10 mg lockout 20 min).ResultsAll patients had low NRS scores in the recovery unit. All patients had very low opioid consumption within 72 hours postoperatively. All the patient was satisfied with the quality of analgesia.ConclusionsWe think that EOI block will have a significant place in abdominal analgesia, especially in obese patients, due to its wide innervation area and easy application.

Objective: The advantages of robot-assisted surgery include shorter incisions, less postoperative pain, perioperative blood loss, and a faster return to daily functions. Thoracic epidural analgesia (TEA) provides highly satisfactory analgesia in abdominal surgery. However, its hypotensive effect, particularly in minimally invasive procedures, exceeds its contribution to rapid recovery. Fascial plane blocks may be more beneficial in that context. This study evaluated the effects of regional analgesia techniques in robotic prostatectomy, nephrectomy, and cystectomy operations. Material and Methods: Following IRB Ethics Committee approval (2021.467.IRB1.134), the records of patients who had undergone robotic prostatectomy, nephrectomy, and cystectomy surgeries were retrospectively reviewed between January 2018 and January 2022. Results: One hundred and forty patients with full documentation were included in this study. Various regional analgesia methods were used. Fascial plane blocks were seen to be used in addition to epidural analgesia. Transversus abdominis plane (TAP) and rectus sheath blocks exhibited satisfactory results in robotic prostate surgeries and TAP blocks in robotic nephrectomy operations. Conclusion: In robotic prostatectomy and nephrectomy operations, we recommend fascial plane blocks as the first-choice method for postoperative analgesia. Keywords: regional anesthesia, robotic surgery, radical prostatectomy, minimally invasive surgery, fascial plane blocks, recovery after surgery

Introduction: Abdominal wall blocks are frequently used due to the use of effective blocks, such as the transversus abdominis plane (TAP) block and the widespread use of ultrasound (US) imaging. A good knowledge of abdominal innervation is required for the use of abdominal wall blocks. We describe the extraordinary performance of external oblique intercostal (EOI) blocks in 3 different surgeries. Patient concerns, diagnosis and interventions: Case 1: A man aged 30 to 35 was taken to the operating room for open liver surgery. After surgery, unilateral EOI block and bilateral TAP block were performed with the patient in the supine position, and a catheter was placed under the external oblique muscle. Postoperative analgesia was followed by patient-controlled analgesia (PCA) through the catheter. Case 2: A male patient aged 35 to 40 was taken to the operating room for laparoscopic liver surgery. After surgery, unilateral (EOI) block and bilateral TAP block were performed with the patient in the supine position. The patient received iv tramadol PCA (bolus dose 10 mg only, lockout 20 minutes). Case 3: A man aged 25 to 30 was taken to the operating room for laparoscopic bariatric surgery. After the surgery, bilateral EOI and bilateral rectal sheath blocks were performed with the patient in the supine position. The patient received iv tramadol PCA (bolus dose 10 mg only, lockout 20 minutes). Outcomes: All patients had low NRS scores in the recovery unit and very low opioid consumption in the first 72 hours postoperatively. All were satisfied with the quality of analgesia. Conclusion: We think that EOI block will come to occupy a significant place in upper abdominal analgesia, especially in obese patients, due to its wide innervation area and ease of application.

Providing analgesia after bariatric surgery might be challenging due to a high prevalence of obstructive sleep apnea syndrome and the increased sensitivity to respiratory depression triggered by opioid overuse after surgery. Various combination methods with paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs), and other pain medications such as ketamine or gabapentin have been suggested for reduction of the opioid usage. Regional anesthetic techniques represent a valuable option as they improve patient comfort while reducing opioid-related side effects. In this study, we have evaluated the adjuvant benefits of these various techniques in reduction of the postoperative pain in bariatric surgery. After the approval of the IRB Ethics Committee, the records of the patients who had laparoscopic bariatric surgery between January 2019 and December 2021 were reviewed retrospectively. Records of 120 patients who underwent laparoscopic bariatric surgery between January 2019 and December 2021 were reviewed. In total, 113 patients with full documentation were included in this study. Among these, 74 patients were administered regional analgesia. The main regional analgesia techniques were transversus abdominis plane and rectus sheath block. The pain scores of those receiving regional analgesia were statistically low. The opioid consumption after transversus abdominis plane and rectus sheath block was significantly lower than that of others. External oblique intercostal block alone provides a postoperative opioid consumption similar to those of transversus abdominis plane and rectus sheath block. The use of fascial plane blocks in bariatric surgery significantly reduces opioid consumption. Transversus abdominis plane and rectus sheath block combination and external oblique intercostal block seem to be the most effective options. NCT05284695.

Objective: Totally implantable venous access ports (TIVAPs) are widely preferred for oncology patients who need chemotherapy. Although peripheral cannula or catheter in a large vein may help chemotherapy treatment; some complications such as vascular irritation, thrombosis may interrupt the treatment. To avoid this interruption, TIVAPs are usually preferred. The aim of the study was to evaluate device related complications and safety with anesthesia team implanted TIVAPs. Methods: This retrospective study was conducted on patients who underwent procedure for implantation of TIVAPs in our hospital between the dates of January 2017 - December 2020. The demographic data, vascular access side, complications seen related to TIVAPs insertion procedure, the number of removed catheters, reasons of removal of catheters were recorded. Results: During this study period 700 TIVAPs procedure have been performed in our clinic. While 646 patients (92.3%) had right sided TIVAPs, 678 patients (96.8%) had TIVAPs inserted to subclavian vein. When the most common cancer seen in this patient group was colorectal cancer, hepatobiliary tract cancer group came second. Total number of removed catheters for some reasons was 107 which is 15.2% of all patients. When the causes for catheter removal were examined, it was discovered that although systemic infection was the most common reason (47 patients, or 6.7%), the number of patients with positive culture from the port was extremely rare (19 patients) (2.71%). Conclusion: We think that when TIVAPs are inserted under ultrasound guidance and fluoroscopy control in the operating room, the incidence of complications will be relatively low. Especially in cancer patients, TIVAPs can be inserted and used safely with high patient comfort. Keywords: Totally implantable venous access port systems, complications, patient safety, port infection

Objective: Appropriate pain treatment before, during, and after surgery positively affects the immune system and prevents chronic pain.Postoperative thoracotomy pain is both severe and difficult to manage.In addition to systemic opioid and non-opioid analgesics, neuraxial analgesic techniques such as thoracic epidural analgesia or thoracic paravertebral block are widely applied for pain control.Various fascial plane blocks are also used in thoracic surgery.The purpose of this study was to investigate the analgesic effectiveness of regional analgesia techniques used in thoracic surgeries in our clinic.Methods: Following receipt of approval from the Koç University Clinical Research Ethics Committee, the records of 372 patients who underwent video-assisted thoracoscopic surgeries at the VKV American Hospital, Turkey, between January 2019 and December 2021 were reviewed retrospectively.Results: Patients who received epidural analgesia exhibited statistically significantly lower pain scores and postoperative additional analgesic needs (p<0.001).Rhomboid intercostal subserratus block as the most effective option for postoperative analgesia among alternative regional analgesia methods according to postoperative pain scores and postoperative opioid consumption. Conclusion:We still recommend thoracic epidural as the first choice for patient comfort, especially in clinics where thoracic anesthesia experience is high.Moreover, with the increasing prevalence of fascial plane blocks, we think that rhomboid intercostal blocks may be an important alternative in thoracic surgery.

Objective The interscalene brachial plexus block (ISBB) constitutes the gold standard for analgesia after shoulder procedures. Ipsilateral phrenic nerve block remains the most common adverse effect after ISBB. Alternative nerve blocks are performed in shoulder surgery in order to prevent hemi-diaphragmatic paralysis (HDP). The purpose of the present study was to investigate the minimum effective local anesthetic volume of 0.5% bupivacaine for postoperative analgesia with an anterior suprascapular nerve block (ASSB). The secondary aim was to investigate diaphragm functions with the local anesthetic doses used while conducting effective volume research. Method This prospective observational study was conducted at the American Hospital of Istanbul, Turkey, from March to July 2022. The initial injected volume of 0.5% bupivacaine was 10 ml. Our clinical experience indicates that this yields a complete sensory block of the anterior suprascapular nerve. In accordance with the up-and-down method, the volume of 0.5% bupivacaine used for a particular patient was determined by the outcome of the preceding block, which represented block success. In case of effective ASSB being achieved, the volume of 0.5% bupivacaine to be administered to the next patient was lowered by 1 ml. In case of block failure, however, the volume of 0.5% bupivacaine to be applied in the subsequent case was increased by 1 ml. Ipsilateral hemi-diaphragmatic movement measurements were taken before (baseline) and 30 minutes after the block. General anesthesia was induced 60 minutes after the completion of the block performance by means of a standardized protocol. Results Sixty-seven patients were included in the study. The ED50 and ED95 calculated for anterior suprascapular nerve block using probit transformation and logistic regression analysis were 2.646 (95% CI, 0.877-2.890) and 3.043 ml (95% CI, 2.771-4.065), respectively. When complete paralysis was defined as 75% or above, partial paralysis as 25-50%, and no paralysis as 25% or less, volumes of 6 ml or lower appeared to cause no paralysis for the anterior suprascapular nerve block. Conclusion We, therefore, recommend using a volume of 6 ml or less in order to achieve diaphragm-sparing features for anterior suprascapular nerve blocks.

Objective: Suprascapular nerve blockade is one of the treatment methods used in various shoulder pains.The aim of this study is to investigate the clinical efficacy of suprascapular nerve block performed using the supraclavicular approach in patients with shoulder pain.Methods: This study involved patients treated for shoulder pain.Forty-patients were randomly divided into two groups, one treated with suprascapular nerve block with the supraclavicular approach, and conventional suprascapular nerve block.Both groups received 5 mL of 0.5% levobupivacaine.The patients' range of motion (ROM) and pain (Verbal Analogue Scale, VAS) were measured before the procedures.Short-form-36 (SF-36), and the Disability of Arm, Shoulder and Hand (DASH) questionnaire were studied.The patients were re-evaluated at the 1 st hour of the procedure and 3 weeks after the procedure.Results: Mean VAS scores at the 3 rd week were significantly lower than at the 1 st hour and before the procedure in both groups (p<0.001).Mean 3 rd week ROM-abduction and ROM-flexion scores were significantly higher than the pre-procedural values (p<0.001).In both treatment groups, the mean DASH value at the 3 rd week was significantly lower (p<0.001),whereas, the mean 3 rd week SF-36 value was significantly higher (p<0.001)than the pre-procedural values.No significant differences were observed between the groups in terms of the mean VAS, ROM, SF-36 or DASH values (p>0.05). Conclusion:In our study, it has been shown that with the supraclavicular approach, the suprascapular nerve can be easily detected and blocked in the neck region under the omohyoid muscle and is clinically as effective as the classical method of suprascapular nerve block in the treatment of shoulder pain.It was found that nerve blocks not only reduced shoulder pain, but also effectively reduced the limitation of movement and improved the quality of life of the patients.

To the Editor Although interscalene brachial plexus block is accepted as a gold standard technique in shoulder surgeries, even at low local anesthetic doses such as 5 mL, phrenic nerve involvement may result in hemidiaphragmatic paralysis (HDP).[1][1] Therefore, search for diaphragm sparing nerve

Introduction Arthroscopic shoulder surgeries are usually performed in a sitting position. The sitting position is known to cause physiological changes related to cardiovascular adaptation. Interscalene nerve blocks (ISB) are the most commonly used techniques and are considered gold standard regional anesthesia methods for shoulder surgeries. Cerebral vessels located around sympathetic ganglia provide sympathetic system integrity. This local anesthetic spreading during ISB could be a side effect or provide a protective effect on cerebral ischemia. Our study aimed to investigate the cerebral protective effect of the ISB in arthroscopic shoulder surgeries in a sitting position. Material and methods After the approval of Koç University Clinical Research Ethics Committee (2020.020.IRB1.011), records of patients between January and December 2019 with shoulder arthroscopy at the Vehbi Koç Foundation (VKV) American hospital were retrospectively reviewed. Records of the hemodynamic response, INVOSTM (Medtronic, Minneapolis, USA) (rSO2) parameters, pain scores, and additional analgesic needs of all cases were examined in the intraoperative and postoperative period. Results Data of 40 patients who met the criteria to be included in the study was analyzed. Our study showed that the sitting position leading to hypotension coincided with a decrease in INVOS values. Nevertheless, we did not record any significant hypotension after ISB, and this may be due to the use of a minimal dose of local anesthetic. There was a certain increase in near-infrared spectroscopy (NIRS) values after ISB. We saw that the value of regional oxygen saturation (rSO2) increased on both the ISB side and the non-ISB side. This shows that the ISB can have a global impact on the brain. Specificially, the increase in rSO2 values in the ISB side compared to the other side suggests that ISB has possible positive effects on cerebral blood flow. Conclusion Our study has shown that ISB may transiently increase the rSO2 levels in the sitting position during shoulder surgery.

Introduction Various regional anesthesia techniques such as thoracic epidural, thoracic paravertebral block, erector spinae plane block (ESPB), parasternal intercostal blocks are used in cardiac surgery for postoperative analgesia. In our study, we investigated the analgesic efficacy of the dual injection technique of ESPB in beating heart coronary bypass surgeries. Methods The records of patients with coronary artery bypass (CABG) surgery in the beating heart at the VKV American Hospital between January and December 2019 were retrospectively analyzed. The data of 30 patients who met the criteria to be included in the study were analyzed. Whether any opioid use is required for maintenance of anesthesia it is recorded. The pain scores of the patients are recorded by the intensive care team and cardiovascular service nurses for the first 48 hours. Results The absence of secondary responses to pain in all surgical periods, including skin incision and sternotomy, and low number of rating scale (NRS) scores in the postoperative 0- to 24-hour period show that the technique we developed can produce effective analgesia. After the 24th postoperative hour, the patients were followed up in the cardiovascular service and there was no opioid use between 24- to 48-hour period. Conclusion Our approach, in which the local anesthetic is applied by approaching the superior costa-transverse ligament (SCTL) in the ESPB, provides an effective analgesia in coronary artery bypass surgeries in the beating heart. The main purpose of our new approach is to increase the amount of local anesthetic in the paravertebral area. We recommend using our modified technique for effective analgesia after CABG surgeries.