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.

Determinations of medical futility in the intensive care unit (ICU) are high-stakes, ethically charged, and clinically variable. Contemporary literature increasingly frames such situations as potentially inappropriate treatment (PIT), particularly when physiologically feasible interventions are judged unlikely to provide meaningful benefit. This study aimed to construct a transparent decision-analytical framework for identifying the clinical factors ICU physicians prioritise when assessing futility and PIT, using a hybrid multi-criteria decision-making (MCDM) approach. A decision-analytical modelling study was conducted in Türkiye with a national expert panel of 20 ICU physicians with 1–18 years of post-speciality experience. A two-round Delphi pre-process with five intensivists, using an a priori 80% consensus threshold, identified 15 clinical factors and 8 evaluation criteria. Criterion weights were derived using Shannon Entropy, and six MCDM techniques were applied in parallel. Bootstrap resampling, ±20% sensitivity analysis, and Spearman rank correlation were used to assess stability and agreement. Terminal malignancy (F4) and irreversible neurological injury (F5) ranked first and second across all six methods (mean ranks 1.000 and 2.000, σ = 0.00, 100% bootstrap stability). Inter-method agreement was very strong (Spearman ρ = 0.964–1.000, p < 0.001), while inter-group agreement across experience strata was moderate to strong ( ρ = 0.643–0.807, p < 0.01). Documented treatment limitation preference (F15) ranked last across every method and experience group. Early-career clinicians ranked clinical frailty (F2) first, whereas advanced clinicians elevated refractory shock (F6) to fourth. Advanced age (F1) showed the widest experience-related variation, ranking 5th, 14th, and 11th across early-career, mid-career, and advanced groups, respectively. The Top-5 factors remained stable under ± 20% weight perturbation. In this expert-panel MCDM framework, ICU physicians appeared to prioritise biological non-recoverability when assessing futility and PIT, while treating treatment limitation preference as a separate ethical domain. The framework captures clinicians’ cognitive prioritisation rather than outcome-validated prognostic accuracy and should be read as a decision-support scaffold, not a bedside prediction tool. Prospective outcome validation and recalibration across different legal and cultural settings are required before clinical implementation.

Dear EditorAcetamiprid, a neonicotinoid insecticide widely used in agricultural practice, has occasionally been reported to cause severe neurological and cardiovascular effects following acute expo...

Quetiapine is one of the atypical antipsychotic drugs that is widely used especially in psychiatric practice. There are case reports of quetiapine overdose in the literature. In this article, we present the case of intensive care management of an adult male patient after high dose quetiapine intake with the help of the current literature. A systematic literature review was conducted along with the case report. PubMed, Web of Science and Scopus databases were searched for "quetiapine intoxication" and 25 articles were found. Of the twenty-one quetiapine overdose articles, 1963 cases were identified. The mean age of the cases was 34.5 years and the intoxication was predominantly female. The patients were more likely to have a diagnosis of depression. The mean dose was determined as 9.6 g. The most common neurological findings were coma and accompanying seizures. Cardiovascular (CVS) findings included tachycardia, hypotension and QTc prolongation. Since quetiapine does not have an active antidote, activated charcoal and gastric lavage were usually applied after the patients applied to the emergency department. Intubation was required in severe cases. Mortality was 31 in 1693 cases (1%). 3 patients used alcohol together with quetiapine. Rhabdomyolysis developed in 14 patients. Neuroleptic malignant syndrome (NMS) developed in 2 patients and acute respiratory distress syndrome (ARDS) due to quetiapine use in 1 patient. In a case report, carboxyhemoglobin (COHb) elevation was detected as a result of the use of quetiapine together with zolpidem. Conclusion: In cases of quetiapine intoxication, patients should be monitored in the ICU due to the development of life-threatening conditions due to the neurological, cardiovascular and renal system effects of the drug. There is no specific antidote. Therefore, patients may need supportive treatments. This study was associated with significant toxicity and dangerous complications in quetiapine overdose. In more severe overdose cases, careful and often prolonged clinical observation is required.