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.

Introduction: We aimed to define the characteristics of patients hospitalised in a palliative care unit and evaluate the role of palliative care services in the geriatric age group. The priorities and treatment approaches needed according to age groups were also evaluated. Materials and Methods: The records of patients aged 18 years and older who followed up with palliative care between 01/2020-12/2021 were reviewed retrospectively. Patients aged 18-64 were defined as “group-1”, patients aged 65-75 as “group-2”, patients aged 76-90 as “group-3”, and patients aged 91 and over as “group-4”. The patient’s age, sex, diagnosis, comorbidities, length of stay in the clinic, prognosis, pressure ulcers and immobilisation status were recorded and compared according to age groups. Results: A total of 560 patients were included. The mean age was 73.14±14.22 years, and 53.2% were women. 48.2% of patients were transferred to the palliative care unit from the intensive care unit. Groups-1, 2, 3, and 4 consisted of 139 (24.8%), 129 (23%), 254 (45.4%), and 38 (6.8%) patients, respectively. When patients were examined according to age group, there was a statistically significant difference between the groups in terms of sex, pressure ulcers, immobilisation, mean hospital stay in the palliative care, and prognosis (p=0.026, p≤.001, p=0.006, p≤.001, p≤.001). While 72% of patients were discharged from the palliative care unit, 28% died during admission. The prognosis was better in group-1 compared to other groups. Conclusion: Geriatric age and presence of chronic disease were the primary groups receiving palliative care. Access and integration of these patients to palliative care must be expanded. Keywords: Palliative Care; Geriatrics; Critical Care; Chronic Diseases; Health Services Accessibility.

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 si anesthetic application (0.5%) can be achievedby administering local anesthetic at a lower dose (0.3%).

Although hepatoblastoma is rare, it is the most malignant tumour of childhood. Treatment is usually done by surgical resection and chemotherapy. The mortality and morbidity have decreased due to improvements in the treatments. In this process, hepatic resection has a risk of pulmonary embolism, and this condition could be fatal. In this case, a 9-month-old patient who was treated with chemotherapy and then underwent hepatectomy was presented. We used non-invasive methods such as the perfusion index (PI), the plethysmographic variability index (PVI) (Massimo Radical 7) and non-invasive total haemoglobin measurement (SpHb) rather than invasive measurements. During closure of the surgical skin incision, the end-tidal CO2 (ETCO2) value dropped, after which arrhythmia and bradycardia resulted in cardiac arrest. Cardiopulmonary resuscitation (CPR) was initiated. However, the patient did not respond to CPR. We concluded that heparin may be administered to reduce the risk of thrombosis in patients undergoing liver surgery.