Anesthetic approach to trauma patients in the city hospital after the 2023 Maras earthquake.

BACKGROUND: The February 6, 2023, Kahramanmaras earthquake caused significant destruction across our country. More than 50,000 people lost their lives, thousands were injured, and health facilities were damaged. Victims were transferred to hospitals in other provinces for treatment. This study evaluates the anesthesia approach applied to the injured who were transferred to our tertiary hospital. METHODS: We retrospectively reviewed the data of patients who underwent surgery between February 6 and February 20, 2023. The study included earthquake victims who underwent emergency trauma surgery, aged 10 years and above. We recorded the date of admission to the hospital, demographic information, type of surgery, surgical site, anesthesia technique, preference for peripheral block, laboratory values, dialysis and intensive care needs, and survival rates. Data analysis was performed using the IBM® Statistical Package for the Social Sciences (SPSS®) Version 26.0. RESULTS: A total of 375 cases were included in the study. Of these, 323 patients underwent surgery for extremity injuries, and 35 for vertebral injuries. Among the extremity injuries, 61.6% were to the lower extremities, and 17.1% to the upper extremities. Debridement was performed on 147 patients, fasciotomy on 49 patients, and amputation on 33 patients. General anesthesia was applied to 352 patients, spinal anesthesia to 19 patients, and sedoanalgesia to four patients. Peripheral nerve block was performed on 33 patients. Dialysis treatment was administered to 105 patients. Twenty-six patients were lost during the treatment process. There were no intraoperative patient deaths. CONCLUSION: The predominance of extremity injuries among earthquake victims increases the inclination towards regional anesthesia. Incorporating Plan A blocks into basic anesthesia skills could enhance the preference for regional anesthesia in disaster situations. Furthermore, transferring the injured to advanced centers may reduce morbidity.

Preoperative ankle block for postoperative analgesia in foot surgery.

BACKGROUND: The use of a tourniquet and patients' preference for general anesthesia (GA) limit performing ankle blocks (AB) as a sole anesthetic technique for orthopedic foot surgery. The aim of this prospective and randomized study was to test the hypothesis that administration of an AB before GA could be effective for postoperative pain relief in patients undergoing outpatient hallux valgus surgery. Primary outcome measure was mean pain score and secondary outcome measures were time to mobilization of patients, time to hospital discharge, and complications. METHODS: A total of 110 adult patients were randomly assigned into two groups: group GA (n = 55) and group GA + AB (n = 55). Group GA + AB received an AB using 100 mg lidocaine 2% and 75 mg bupivacaine 0.5% before the induction of GA. Pain intensity was evaluated using a visual analogue scale (VAS). RESULTS: Mean VAS scores were higher and times to first rescue analgesic were shorter in group GA compared to group GA + AB (p = 0.001). More patients required rescue analgesic in group GA and pethidine consumption was higher (p = 0.001). Time to mobilization was shorter in GA + AB group (p = 0.001) but hospital discharge time was similar between groups (p = 0.269). The incidence of nausea and vomiting was higher in group GA (p = 0.002). CONCLUSION: Ankle block is an effective and simple technique for reducing postoperative pain and opioid consumption. It reduced the time to mobilization without a delay in hospital discharge. It is concluded that the routine administration of AB before GA may be an effective and simple method for pain relief after foot surgery.