Efficacy of Serratus Posterior Superior Intercostal Plane Block on Postoperative Pain and Total Analgesic Consumption in Patients Undergoing Reduction Mammoplasty Surgery: An Evidence Based Report.

Serratus posterior superior intercostal plane block (SPSIPB) is a novel technique that provides analgesia in shoulder, hemithorax and in the back of the neck. In this study, the efficacy of this block on postoperative pain and quality of recovery is reported in ten consecutive patients who had undergone reduction mammoplasty. Blocks were performed bilaterally with 30 ml 0.25 % bupivacaine for each side, at the end of surgery. Cumulative tramadol consumption and numerical rating scale (NRS) scores during rest (static) and coughing (dynamic) were assessed within the first postoperative 24 hours. Mean total tramadol consumption was 39 ±9.94 mg. NRS scores above 4 were observed in 5 patients in the dynamic NRS assessment at the postoperative 1st hour, while static and dynamic NRS scores were ≤4 at other durations. SPSIPB may play a part in postoperative multimodal analgesia following mammoplasty in the future and may reduce total analgesic consumption. Key Words: Serratus posterior superior intercostal plane block, Reduction mammoplasty, Breast surgery, Postoperative analgesia.

Effects of Modified Thoracoabdominal Nerve Block Through Perichondrial Approach on Postoperative Pain and Analgaesic Consumption in Patients Undergoing Laparoscopic Cholecystectomy.

OBJECTIVE: To investigate postoperative analgaesic efficacy of modified thoracoabdominal nerve block through perichondrial approach (M-TAPA) and its effect on opioid consumption in patients undergoing laparoscopic cholecystectomy (LC) surgery. STUDY DESIGN: Randomised, controlled trial. Place and Duration of the Study: Department of Anaesthesiology and Reanimation, Sivas Cumhuriyet University, Sivas, Turkiye, from April to May 2023. METHODOLOGY: The study was conducted in two randomised groups: M-TAPA (n = 21) and control group (CG) (no block) (n = 21). All patients had standard general anaesthesia. M-TAPA patients had bilateral M-TAPA block with 0.25% bupivacaine (total volume, 40 ml) at the end of the surgery. In contrast, CG patients had only tramadol for postoperative pain. A numerical rating scale (NRS) and visual analogue scale (VAS) were used for postoperative pain assessment. Total tramadol consumption was calculated. RESULTS: M-TAPA's NRS and VAS scores were lower in postoperative 24 hours (p<0.05). Total tramadol consumption was 116.67 ± 32.91 mg in CG and 35.71 ± 39.19 mg in M-TAPA (p<0.001). CONCLUSION: Bilateral M-TAPA block for postoperative pain control after LC surgery provided effective analgaesia for up to 24 hours and reduced total opioid consumption. Although the M-TAPA block is a novel approach, it will be a part of multimodal analgaesia for routine postoperative pain management in abdominal surgeries. However, more studies with higher numbers of patients will be needed. KEY WORDS: Analgaesia, Bupivacaine, Laparoscopic cholecystectomy, Nerve block, Pain management.

The investigation of host genetic variants of toll-like receptor 7 and 8 in COVID-19.

Toll-like receptors (TLRs) recognize infectious agents and play an important role in the innate immune system. Studies have suggested that TLR single nucleotide polymorphisms (SNPs) are associated with poor antiviral responses against SARS-CoV-2. Therefore, we aimed to investigate the relationship of TLR7 and TLR8 (SNPs) with COVID-19 disease prognosis. A total of 120 COVID-19 patients, 40 outpatients, 40 clinical ward patients and 40 intensive care unit (ICU) patients were included in the study. TLR7 (rs179009), TLR8-129 C/G (rs3764879) and TLR8 Met1Val (rs3764880) SNPs were genotyped using the PCR-RFLP method. In female patients, individuals carrying AG genotype and G allele for TLR8 Met1Val SNP were found at a higher frequency in patients hospitalized in the ICU than in patients followed in the clinical ward (p < 0.05). In terms of the other two SNPs, no significant difference was found between the groups in females. Furthermore, in male patients, A allele of TLR7 rs179009 SNP was at a higher frequency in patients who have at least one comorbidity than in patients who have no comorbidity (p < 0.05). Our results suggest that TLR8 Met1Val SNP is important in the COVID-19 disease severity in females. Furthermore, TLR7 rs179009 SNP is important in male patients in the presence of comorbid diseases.

Efficacy of serratus posterior superior intercostal plane block (SPSIPB) on post-operative pain and total analgesic consumption in patients undergoing video-assisted thoracoscopic surgery (VATS): A double-blinded randomised controlled trial.

Background and Aims: Serratus posterior superior intercostal plane block (SPSIPB) is a novel technique that can provide analgesia in the hemithorax, shoulder, and back of the neck. This study aimed to evaluate the post-operative analgesic effect of SPSIPB in patients undergoing video-assisted thoracoscopic surgery (VATS). Methods: It is a double-blind, randomised controlled trial. Twenty-four adult patients who underwent VATS via the uniportal technique were randomised into two groups: the SPSIPB group (n = 12) received SPSIPB along with intravenous patient-controlled analgesia (PCA) with tramadol, whereas the control group (n = 12) received only PCA with tramadol. At the end of the surgery, patients in the SPSIPB group received a unilateral SPSIPB under ultrasound guidance with the use of 30-mL bupivacaine 0.25%. The primary outcome was the numerical rating scale (NRS) scores of the patients. Secondary outcomes included the amount of tramadol and rescue analgesic (paracetamol) consumed by the patients, followed up for post-operative 24 hours. Categorical variables were compared using the Chi-Square Test. Mann-Whitney U Test was used to compare groups of variables that were not normally distributed. Results: The SPSIPB group had lower NRS values during post-operative 24 hours (P < 0.001). Mean (standard deviation) total tramadol consumption was 58.33 (26.23) mg in the SPSIPB group and 144.17 (13.11) mg in the control group (P < 0.001). Rescue analgesic need was lower in the SPSIP group in the first 18 post-operative hours (P < 0.05). Conclusion: Serratus posterior superior intercostal plane block provides good analgesia in the thoracic region after video-assisted thoracoscopic surgery.

Relationship between Systemic Immune-inflammation Index and Mortality in Intensive Care Patients Diagnosed with Crimean-Congo Hemorrhagic Fever.

OBJECTIVE: To evaluate the power of the systemic immune-inflammation index in the prediction of mortality in severe Crimean-Congo hemorrhagic fever patients. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Department of Anaesthesiology and Reanimation, Sivas Cumhuriyet University, Sivas, Turkey, from January to June 2022. METHODOLOGY: Intensive care patients diagnosed with Crimean-Congo hemorrhagic fever, between January 2012 and January 2022, were included. Demographic data, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and systemic immune-inflammation index were recorded. Receiver operating characteristic analysis, Cox regression analysis and Kaplan-Meier mortality analyses were done. RESULTS: A cut-off value <1.85 for neutrophil to lymphocyte ratio showed 41.67% sensitivity and 97.06% specificity. A cut-off value <80.75 for the systemic immune-inflammation index showed 84.72% sensitivity and 76.47% specificity. A cut-off value <37.86 for platelet-to- lymphocyte ratio showed 84.72% sensitivity and 73.53% specificity. In patients with systemic immune-inflammation index value <80.75, the mortality rate increased 2.549 times and 3.732 times in patients with a platelet-to-lymphocyte ratio value <37.86. CONCLUSION: Similar sensitivity and specificity levels were found for systemic immune-inflammation index and platel-to-lymphocyte ratio regarding the mortality prediction power and impact on mortality. Both tests can be used for the prediction of mortality during the hemorrhagic period in patients with severe Crimean-Congo Hemorrhagic Fever. KEY WORDS: Crimean-congo hemorrhagic fever, Systemic immune inflammation index, Mortality, Platelet-to-lymphocyte ratio.

Evaluation of the Effect of Interscalene Brachial Plexus Block on Intracranial Pressure Using Optic Nerve Sheath Diameter and Internal Jugular vein Collapsibility Index.

OBJECTIVE: To determine the effect of single-shot interscalene brachial plexus (ISBP) block on intracranial pressure (ICP) by evaluating the extravascular volume effect of the medicine on the internal jugular vein (IJV). STUDY DESIGN: Interventional study. PLACE AND DURATION OF STUDY: Department of Anaesthesiology and Reanimation, Sivas Cumhuriyet University, Sivas, Turkey, from January to June 2022. METHODOLOGY: Thirty-four patients were included in this prospective clinical study. All patients had single-shot ISBP block with 25 ml of local anaesthetic. Optic nerve sheath diameter (ONSD), maximum (Dmax) and minimum (Dmin) diameters of IJV and IJV collapsibility index (IJV-CI) were recorded before the block (basal), 20 minutes, and 60 minutes after the block. RESULTS: Twenty-nine patients had higher ONSD values at 60th minute compared to their basal values. There were negative correlations between the changes of ONSD and IJVCI (r=0.616, p<0.001) and ONSD and Dmax (r=0.581, p<0.001) in time period between basal and 20th minute. There were negative correlations between the changes of ONSD and IJVCI (r=0.518, p=0.002), ONSD and Dmax (r=0.664, p<0.001) in time period between basal and 60th minute. CONCLUSION: Single-shot ISBP block with 25 ml of local anaesthetic may be a factor that increases ICP. Repeated intraoperative ONSD measurements are recommended in patients operated with ISBP block. KEY WORDS: Interscalene Brachial Plexus Block, Intracranial pressure, Optic nerve sheath diameter, Internal jugular vein collapsibility index.

Effect of adding dexmedetomidine to intra-articular levobupivacaine on postoperative pain following arthroscopic meniscus surgery: A prospective, double-blind, randomized, placebo- controlled, clinical trial.

OBJECTIVE: The aim of this study was to determine the effect of adding dexmedetomidine to intra-articular levobupivacaine on postoperative pain levels and analgesic requirements following arthroscopic meniscectomy. METHODS: A total of 60 American Society of Anesthesiologist physical status I-II patients, aged 20 to 62 years, and scheduled for arthroscopic partial meniscectomy under general anesthesia were included in this study. All the patients were randomly assigned to one of four groups (15 patients in each group): Group 1 (8 male, 7 female; mean age = 46.70 ± 13.13 years; 0.9% isotonic 20 ml), group 2 (7 male, 8 female; mean age = 42.60 ± 12.18 years; levobupivacaine 0.5 mg/kg plus 0.9% isotonic), group 3 (8 male, 7 female; mean age = 43.80 ± 12.63 years; 1µg/kg dexmedetomidine plus 0.9% isotonic), and group 4 (7 female, 8 male; mean age = 40.40 ± 11.79 years; levobupivacaine 0.5 mg/kg plus 1µg/kg dexmedetomidine and 0.9% isotonic). All medications were administered at the end of arthroscopic surgery. Pain levels were measured using a Visual Analogous Scale (VAS) and Verbal Rating Scale (VRS) at postoperative 1, 2, 4, 6, 12, and 24 hours. RESULTS: VAS scores at rest were significantly lower in Group 4 at postoperative 1th, 2nd, 4th, 6th,12th, and 24th hours than in other groups. The time to take the first analgesic was significantly higher in Group4 (964 ± 288 min), and total analgesic consumption was significantly lower in Group 4 compared to those of other groups. CONCLUSION: Although administration of intra-articular dexmedetomidine alone may have a weaker effect than intra-articular levobupivacaine on postoperative pain relief after arthroscopic partial meniscectomy, adding dexmedetomidine to intra-articular levobupivacaine may increase the durationand quality of postoperative analgesia without any side effect. LEVEL OF EVIDENCE: Level I, Therapeutic Study.

The effects of hyperventilation on seizure length and cerebral oxygenation during electroconvulsive therapy.

OBJECTIVE: Previous studies have reported that hyperventilation prolongs seizure length. However, there is no clear consensus in clinical guidelines on how to perform hyperventilation during Electroconvulsive Therapy (ECT). The present study aims to investigate the effects of hyperventilation on seizure length and cerebral oxygenation. METHODS: Forty patients aged 18-65 and classified as ASA I-II, who would have their first ECT course were included in the study. Ethics committee approval was obtained and all patients' consent was taken. The consecutive patients were randomized into two groups as follows: group H (20 patients; target etCO2: 25-30 mmHg) and group N (20 patients; target etCO2 35-40 mmHg). All patients were ventilated with a facial mask for two minutes and later were ventilated by a laryngeal mask (LMA) for one minute. Vital signs, peripheric oxygen saturation (SpO2), and regional oxygen saturation (rSO2) were measured before general anesthesia induction, on the 3rd minute of ventilation with an LMA (LMA3), on the 1st minute postictal (PI1), on the 5th (PI5), and 10th (PI10) minutes. The motor seizure duration, Richmond sedation-agitation scale, and the time needed to reach Aldrete Score 9 were also recorded. RESULTS: There was a significant difference between the groups when they were compared concerning seizure length and recovery time. However, when we compared the rSO2 values that were measured at different times in group H, the difference between the measurements was statistically significant. When rSO2 values in group H were compared in doubles, there were significant differences between measurements between the basal and LMA3, basal and PI1, and the basal and PI5. When Richmond agitation scores in both groups are compared, there were no significant differences between the groups. CONCLUSION: This study found that seizure length was longer, and the recovery time was shorter in group H. There was a contribution of hyperventilation on cerebral oxygenation that was measured on the same person at different times, but cerebral oxygenation was not statistically different from patients that were normoventilated. More studies are required to form a consensus regarding how hyperventilation applies to ECT.

The effect of postoperative serratus anterior plane block on postoperative analgesia in patients undergoing breast surgery.

OBJECTIVES: This study aimed to evaluate the effect of serratus anterior plane block (SAP) on postoperative morphine consumption. We aimed to determine the differences between both similar blocks and evaluate the effect of the methods of application of this block on patients' postoperative pain scores and morphine consumption. MATERIAL AND METHODS: This study is a single-center, prospective and observational study performed with 40 volunteer patients with American Society of Anesthesiologists (ASA) I-III, who were 18-70 years of age, scheduled for breast surgery. A total of 40 patients who underwent general anesthesia were divided into two groups each with 20 patients. While SAP block was applied to the study group, no block was applied to the control group. SAP block was made by injecting a total of 40 ml of 0.25% bupivacaine between 2 muscles after the test dose was injected with saline. All patients were followed up for 12 hours postoperatively with patient-controlled analgesia (PCA) pump. Morphine consumption, visual analogue score (VAS) values and side effects were recorded at the postoperative 1st, 6th and 12th hours. RESULTS: There was no significant difference between the two groups in terms of hemodynamic parameters and demographic data. Postoperative morphine consumption and postoperative analgesic requirement were significantly lower in the SAP block group (p <0.001). Postoperative VAS values were significantly lower in the SAP block group (p <0.001). No complication was observed related to the block. CONCLUSION: It was found that the SAP block reduced morphine consumption, significantly decreased VAS values, and reduced side effects due to opioids postoperatively.

Are women in Turkey both risks and resources in disaster management?

From a global perspective, the universality of gender-related societal issues is particularly significant. Although gender inequality is considered a sociological problem, the large number of female victims in disasters warrants an assessment of disaster management sciences. In this article, related concepts are discussed based on their relevance sociologically and in disaster management to develop a common terminology and examine this complex topic, which is rooted in different social profiles and anthropological heterogeneity throughout the world. A brief history is discussed, and significant examples are provided from different disasters in Turkey to illustrate why a woman-oriented approach should be adopted when evaluating concepts of gender inequality. Observations of disasters have shown that it is important to apply international standards (humanitarian charter and minimum disaster response standards), especially during periods of response and rehabilitation. Relevant factors related to gender should be included in these standards, such as women's health and hygiene, which will be discussed in more detail. A woman-based approach is designed in relation to two aspects: risks and resources. Thus, gender-sensitive methods of mitigating and preventing disasters are provided. The main purpose of the article is to contribute to the development of a universal culture that prioritizes gender in disaster management.