Comparison of the Analgesic Effect of Pericapsular Nerve Group Block and Lumbar Erector Spinae Plane Block in Elective Hip Surgery.

Background and Objectives: The aim of this study was to compare the effectiveness of pericapsular nerve group (PENG) and lumbar erector spinae plane (L-ESP) blocks, both administered with a high volume (40 mL) of local anesthetic (LA), for multimodal postoperative analgesia in patients undergoing hip surgery. Materials and Methods: This was a prospective, double-blind, randomized study that included 75 adult patients who were divided into three equal groups: control, PENG, and L-ESP. The study compared pain intensity, morphine consumption, time to first morphine request, and postoperative satisfaction between the control group, which received standard multimodal analgesia, and the block groups, which received PENG or L-ESP block in addition to multimodal analgesia. The numerical rating scale (NRS) was used to measure pain intensity. Results: The results showed that the block groups had lower pain intensity scores and morphine consumption, a longer time to the first morphine request, and higher postoperative satisfaction compared to the control group. The median maximum NRS score during the first 12 h was four in the control group, two in the PENG group, and three in the L-ESP group. The control group (21.52 ± 9.63 mg) consumed more morphine than the two block groups (PENG, 11.20 ± 7.55 mg; L-ESP, 12.88 ± 8.87 mg) and requested morphine 6.8 h earlier and 5 h earlier than the PENG and L-ESP groups, respectively. The control group (median 3) had the lowest Likert satisfaction scores, while the PENG group (median 4) had the lowest NRS scores (L-ESP, median 4). Conclusions: The application of PENG or L-ESP blocks with high-volume LA in patients undergoing hip surgery reduces the need for postoperative analgesia and improves the quality of multimodal analgesia.

Comparison of the clinical efficacy of ultrasound-guided GON blockade using low and high concentrations of bupivacaine in chronic migraine.

Background/aim: In this study, it was aimed to retrospectively compare the effect of greater occipital nerve (GON) block performed with ultrasonography using low (0.3%) and high (0.5%) concentrations of bupivacaine on pain scores and patient satisfaction in chronic migraine (CM). Materials and methods: The mean number of days with pain, the mean duration of pain in the attacks, and the highest numerical rating scale (NRS) scores recorded in the 1 month preblock and 1 and 3 months postblock of 80 patients (40 for Group 1, 0.3% bupivacaine; 40 for Group 2, 0.5% bupivacaine) who underwent ultrasonography-guided GON block were recorded from the patient file data. According to the protocol applied by our clinic, GON block was applied to each patient 6 times with the same procedures, in total. Results: While there was a statistically significant difference between the groups in terms of the number of days with pain and the maximum NRS score in the 1-month preblock evaluation (p = 0.01, p < 0.001), at 3 months postblock, no statistical difference was observed in terms of the number of days with pain, duration of pain, or NRS score (p = 0.961, p = 0.108, and p = 0.567). In the intragroup evaluations, at 3 months postblock, the number of days with pain decreased from 17.5 days to 7 days in Group 1 and from 24.0 days to 8.0 days in Group 2. The duration of pain and maximum NRS values were statistically significantly decreased in the intragroup evaluation in both groups pre and postblock. Conclusion: Complications arising from the procedure and the local anesthetic used are essential points to consider in applying GON block. In CM treatment using GON block application, a similar effect to the standard local anesthetic application (0.5%) can be achieved by administering local anesthetic at a lower dose (0.3%).

The Effect of Preprocedural Low-Dose Ketamine for Pain and Anxiety in Patients during Thoracic Epidural Catheterization.

Background and Objectives: Thoracic epidural catheterization (TEC) can be both uncomfortable and fearful for patients when performed awake with the thought that the procedure may be painful. The aim of this study was to assess the effect of low-dose intravenous ketamine administration on pain and anxiety during the TEC procedure. Materials and Methods: Sixty patients were randomly divided into two groups to receive intravenous (IV) placebo (Group P) and IV low-dose (0.15 mg/kg) ketamine (LDK) (Group K) 3 min before the procedure in a double-blind manner. A visual analog scale (VAS) was used to measure anxiety (VAS-A) and pain (VAS-P) scores. Vital parameters were monitored before premedication (T1), 20 min after premedication (T2), during skin anesthesia (T3), during TEC (T4), and 5 min after TEC (T5). VAS-A values were recorded at T1, T3, T4, and T5 periods, and VAS-P levels were noted at T3, T4, and T5 periods. Results: During TEC (T4), both VAS-P and VAS-A were significantly lower in Group K (p < 0.001). The mean VAS-A value was 10.6 mm lower, and the mean VAS-P value was 9 mm lower in Group K than in Group P at the T4 time point. Additionally, the mean VAS-P value was 7.7 mm lower in Group K compared to Group P at the T3 time point (p < 0.001). Both groups showed a statistically significant difference in VAS-A measurements when compared at their respective time points (p < 0.001). However, only Group P demonstrated a statistically significant difference in VAS-P measurements (p < 0.001). VAS-P values remained stable in Group K. The number of patients who did not recall the procedure was significantly higher in Group K (p < 0.001). Furthermore, the number of patients who would consent to the same procedure in the future was significantly higher in Group K (p = 0.007). Conclusions: A preprocedural LDK (0.15 mg/kg) can effectively prevent anxiety and pain experienced by patients during the TEC procedure. Administration of LDK may provide a more comfortable procedure process without causing ketamine-induced side effects (hemodynamic, respiratory, and psychological).

Factors Influencing Morbidity and Mortality Rates in Tertiary Intensive Care Units in Turkey: A Retrospective Cross-Sectional Study.

BACKGROUND AND OBJECTIVES: The objective of this study was to determine the correlation between the prognosis of patients admitted to a tertiary intensive care unit (ICU) and the admitted patient population, intensive care conditions, and the workload of intensive care staff. MATERIALS AND METHODS: This was a retrospective cross-sectional study that analyzed data from all tertiary ICUs (a minimum of 40 and a maximum of 59 units per month) of eight training and research hospitals between January 2022 and May 2023. We compared monthly data across hospitals and analyzed factors associated with patient prognosis, including mortality and pressure injuries (PIs). RESULTS: This study analyzed data from 54,312 patients, of whom 51% were male and 58.8% were aged 65 or older. The median age was 69 years. The average number of tertiary ICU beds per unit was 15 ± 6 beds, and the average occupancy rate was 83.57 ± 19.28%. On average, 7 ± 9 pressure injuries (PI) and 10 ± 7 patient deaths per unit per month were reported. The mortality rate (18.66%) determined per unit was similar to the expected rate (15-25%) according to the Acute Physiology and Chronic Health Evaluation (APACHE) II score. There was a statistically significant difference among hospitals on a monthly basis across various aspects, including bed occupancy rate, length of stay (LOS), number of patients per ICU bed, number of patients per nurse in a shift, rate of patients developing PI, hospitalization rate from the emergency department, hospitalization rate from wards, hospitalization rate from the external center, referral rate, and mortality rate (p < 0.05). CONCLUSIONS: Although generally reliable in predicting prognosis in tertiary ICUs, the APACHE II scoring system may have limitations when analyzed on a unit-specific basis. ICU-related conditions have an impact on patient prognosis. ICU occupancy rate, work intensity, patient population, and number of working nurses are important factors associated with ICU mortality. In particular, data on the patient population admitted to the unit (emergency patients and patients with a history of malignancy) were most strongly associated with unit mortality.

Can chin-nape circumference and the ratio of neck circumference to chin-nape circumference predict difficult mask ventilation or difficult intubation in obese patients?

We aimed to evaluate the success of the ratio of chin-nape circumference (CNC) and neck circumference (NC) to CNC in predicting difficult mask ventilation (DMV) or difficult intubation (DI). Eighty-seven obese patients (body mass index ≥ 30) were evaluated between September 15, 2019 and September 15, 2020. Mallampati score, mouth opening, upper lip bite test, distance between incisors, thyromental distance (TMD), sternomental distance (SMD), and thyromental height were recorded. NC and CNC were measured in a neutral position. The ratio of NC to TMD and the ratio of NC to CNC were calculated. Mask ventilation was graded according to the method described by Han et al (Grade 3 or 4 equals DMV). DI assessment was performed using the intubation difficulty scale (IDS, IDS < 5 equals easy intubation, IDS ≥ 5 equals DI). Logistic regression analysis was performed to identify the variables thought to be effective in DMV and DI. Receiver operating characteristic curves were generated for each parameter considered effective. DMV was found in 17.2% (n = 15) of the patients included in the study, and DI was found in 16.1% (n = 14). The relationship between DMV and age, male gender, obstructive sleep apnea syndrome, NC, ratio of NC to TMD, ratio of NC to SMD, ratio of NC to CNC, and CNC was significant. Male gender and NC >45.5 cm were independent risk factors for DMV. The relationship between DI and distance between incisors, NC, ratio of NC to TMD, ratio of NC to SMD, and CNC was significant. A distance between the incisors < 4.85 cm and a NC > 41.5 cm were found to be independent risk factors for DI. CNC may predict DMV and DI in obese patients. The ratio of NC to CNC may predict DMV in obese patients.

How large is the organ donor potential in Germany? Results of an analysis of data collected on deceased with primary and secondary brain damage in intensive care unit from 2002 to 2005.

The number of potential organ donors depends on various factors, among which the number of deceased with primary or secondary brain damage is the most decisive. In the north-east donor region of Germany with 7.69 million inhabitants, 2019 cases of deceased with primary or secondary brain damage were reported by 136 intensive care units during 2002-2005. In a study, 64% of these deceased were identified as potential donors. This represents 40.7 potential donors per million inhabitants. It can be concluded that in the other donor regions of Germany a comparable number of potential donors exists, yet not all possible donors are being detected and referred. The conversion rate (percentage of potential donors who become effective donors) in the years 2002-2005 was 47%. The main reason for the conversion rate being so low was the large number of relatives who declined an organ donation (73%). More than 90% of the relatives in the north-east region did not know the deceased's will in the acute situation. From our point of view the high refusal rate can be decreased mainly by two measures: improvement of the family approach and integrating the topic of organ donation into schools' curricula.