Serratus posterior superior intercostal plane block for breast surgery: A report of three cases, novel block and new indication

Breast surgery is a common surgical procedure in the world. Since it affects the postoperative recovery and mobilization, pain after breast surgery is an important issue.1 Several regional techniques such as interpectoral/ pectoserratus blocks (PECS I/II), erector spinae plane block (ESPB), and rhomboid intercostal plane block (RIB) are used for pain relief after breast surgery. PECS I-II blocks most commonly used techniques for breast analgesia.2 However, they are closed to the surgical area, and the local anesthetic distribution may be affected by the surgical incision of the pectoral muscles. ESPB may be performed from the cervical to the sacral vertebrae. The clinical, cadaveric, and radiological results of ESPB are inconsistent.3 RIB provides focused hemithoracic analgesia; however, RIB fails to cover the cranial aspect of the T2 dermatome.

The efficacy of ultrasound-guided anterior quadratus lumborum block for pain management following lumbar spinal surgery: A randomized controlled trial

Background: Quadratus lumborum block (QLB) is a fascial plane block. There is no randomized study on the efficacy of QLB for lumbar surgery. We evaluated the efficacy of QLB for postoperative pain management and patient satisfaction after lumbar disc herniation surgery (LDHS). Methods: Sixty patients with ASA score I-II planned for LDHS under general anesthesia were included. We allocated the patients into two groups: the QLB group (n = 30) or the control group (n = 30). QLB was performed with 30 ml 0.25% bupivacaine in the QLB group. Paracetamol 1 g IV 3 × 1 was ordered to the patients at the postoperative period. If the NRS score was ≥ 4, 1 mg/ kg tramadol IV was administered as rescue analgesia. Results: There was a reduction in the median static NRS at 0 h and 2 h with QLB compared to the control group (p < 0.05). There was no difference in the resting NRS at any other time point up to 24 h. The median dynamic NRS was significantly lower at 0, 2, 4, 8, and 16 h in the QLB group (p < 0.05). The need for rescue analgesia was significantly lower in the QLB group. The incidence of nausea was significantly higher in the control group. The postoperative patient satisfaction was significantly higher in the QLB group (p < 0.05). Conclusion: We found that the QLB is effective for pain control following LDHS

Clinical Experience for Modified Thoracoabdominal Nerve Block Through Perichondrial Approach (M-TAPA) in Five Patients. Dermatomal Evaluation and Application of Different Volumes: A Case Series and Review of Literature

Thoracoabdominal nerves block through perichondrial approach (TAPA) is a novel block and provides abdominal analgesia. TAPA block targets the both anterior and the lateral branches of the thoracoabdominal nerves. Modified-TAPA (M-TAPA) was defined due to the need for blocking certain dermatomes depending on the surgical incision sites. In the literature, the knowledge about the efficiency and dermatomal coverage of M-TAPA is limited. In this case series, we want to report our experiences with this issue

Sequential Application of Oxygen Therapy via High-flow Nasal Cannula and Non-invasive Ventilation in COVID-19 Patients with Acute Respiratory Failure in the Intensive Care Unit: A Prospective, Observational Study

Objective:Non-invasive mechanical ventilation (NIV) and high-flow nasal oxygen therapy (HFNO) are the most frequently used methods for treating hypoxemia in those diagnosed with coronavirus disease-2019 (COVID-19) in the intensive care unit (ICU). In this prospective study, we compared the effects of these two treatment modalities applied alternately in the same patient.Materials and Methods:Standard oxygen therapy (SOT) was administered for 1 hour to patients hospitalized in the ICU with a diagnosis of acute hypoxemic respiratory failure (AHRF) and acute respiratory distress syndrome (ARDS) due to COVID-19. HFNO and NIV were applied alternately to patients who met the inclusion criteria, and we evaluated the effects of HFNO and NIV applied to the same patient.Results:Thirty of forty-five patients admitted to the ICU for COVID-19 ARDS met the inclusion criteria for the study. According to the first and second arterial blood gas (ABG) values, the PaO2/FiO2 (P/F) ratio was significantly higher during NIV compared to both baseline and HFNO. In addition, the ROX index was significantly higher during NIV than HFNO, and SpO2 in NIV increased significantly compared with the baseline value. In both methods, patient satisfaction according to the visual analog scale was better than that of SOT. Eighty percent (24/30) of the patients were orotracheally intubated; 13 patients were transferred to the ward (43.3%), 2 patients were discharged home (6.7%), and 15 patients died (50%).Conclusion:Starting respiratory support with HFNO and/or NIV rather than SOT is more effective in improving oxygenation in patients with AHRF and ARDS due to COVID-19 and other causes. NIV is more effective than HFNO in increasing the SpO2 and P/F ratio

Çelik fiber ilaveli etriyesiz betonarme kirişlerin eğilme etkisi altındaki davranışlarının doğrusal olayan sonlu elemanlar analizi ile belirlenmesi

Çelik fiber katkılı betonarme elemanların kullanımı son yıllarda artmakla birlikte bu elemanların yapısal davranışlarının modellenmesinde mevcut analitik yöntemler yetersiz kalmakta ve doğrusal olmayan sonlu elemanlar yöntemi gibi sayısal yöntemlere ihtiyaç duyulmaktadır. Bu çalışmada üç noktalı statik yükleme altında davranışı deneysel olarak belirlenmiş çelik fiber katkılı iki kiriş ile çelik fiber katkısı olmayan bir kiriş Değiştirilmiş Basınç Alanı Teorisi'ne dayanan bir doğrusal olmayan sonlu elemanlar yöntemi ile analiz edilmiş ve sonuçlar irdelenmiştir Kullanılan yöntemde çatlamış betonda çatlak yüzeyleri arasında çelik fiberlerin ilettiği çekme gerilmelerinin modellenmesinde Basitleştirilmiş Kapsamlı Gömülme Modeli seçilmiştir. Analiz sonuçları deney sonuçlarıyla karşılaştırıldığında kullanılan sonlu elemanlar yönteminin kirişlerin eğilme kapasitelerini ve oluşan ana çatlakları yüksek hassasiyetle belirlediği, ancak kirişlerin deplasman kapasitelerini olduğundan çok daha düşük bulduğu görülmüştür. Modelin ana çatlakları doğru tespit etmekle birlikte oluşan çok sayıda küçük çatlakları doğru tespit edememesi ve bunun sonucu olarak ana çatlaklarda donatı kopmasının olduğundan erken gerçekleşmesi sonucu kirişin düşük deplasmanlarda göçtüğü değerlendirilmiştir. Daha hassas çözümler için çelik fiber katkısının modellenmesinde daha gelişmiş modellere ihtiyaç olduğu görülmüştür

A case report of a pericapsular nerve group block for transcatheter aortic valve implantation

A pericapsular nerve group (PENG) block is an interfascial plane block that targets the articular branches of the femoral and obturator nerves. PENG blocks may be used for hip, vein, and groin surgeries. Transcatheter aortic valve implantation (TAVI) is a common treatment for aortic valve stenosis (AVS). Patients who undergo TAVI tend to be at high risk due to their older age and comorbidities. A PENG block using a high volume of local anesthetics may be as effective as a lumbar plexus block. In this case report, we describe successful anesthesia management using PENG blocks in 2 patients who underwent TAVI

A Rare Case of Septic Shock in an Adolescent: Rectal Perforation Resulting from a Fall from a Hammock

Anorectal injuries are rarely seen in children. These injuries may sometimes lead to peritoneal contamination and result in severe clinical manifestations. Herein, we present a 14-year-old male patient who presented with symptoms of septic shock and was diagnosed with rectal perforation occurring after a fall from a hammock. The patient underwent sigmoid colostomy. In order to decrease the morbidity and mortality from anorectal traumas, an early and accurate diagnosis as well as detection and treatment of additional organ injuries are required. Therefore, atypical presentations should be born in mind. (The Me­di­cal Bul­le­tin of Ha­se­ki 2014; 52: 133-6

Modified thoracoabdominal nerve block through perichondrial approach (M-TAPA) vs local infiltration for pain management after laparoscopic cholecystectomy surgery: a randomized study

Purpose: Modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) targets thoracoabdominal nerves. Our primary aim was to compare M-TAPA vs local infiltration on pain management in patients underwent laparoscopic cholecystectomy (LC) surgery. Methods: Patients with ASA class I-II patients aged between 18 and 65 years scheduled for elective LC under general anesthesia were enrolled in the study. There were two randomized groups: Group M: M-TAPA group (n = 30) and the local infiltration (LI) group (n = 30). M-TAPA was performed with totally 40 ml 0.25% bupivacaine in the M group. LI was performed in infiltration group. The primary outcome of the study was pain score in the PACU, the secondary outcomes were the patient satisfaction scores, rescue analgesic need, and adverse effects during the 24-h postoperative period. Results: The static NRS scores were significantly lower in Group M at the postoperative first 4 h (p = 0.001). There was a significant decrease in the dynamic NRS scores in Group M at the postoperative first 16 h (p = 0.001). The incidence of nausea was significantly higher in the LI group (12 vs. 5 patients, p = 0.047). The need for rescue analgesia was significantly lower in Group M (p = 0.009). The patient satisfaction scores were significantly higher in Group M (p = 0.001). Conclusion: M-TAPA provides superior analgesia compared to LI in patients undergoing LC