Postoperative pain can lead to serious complications in the short and medium term. It may also increase the risk of converting acute pain into chronic pain, leading to the development of postthoracotomy pain syndrome (PTPS). The aim of this study was to demonstrate the effectiveness of erector spinae plane block (ESPB) and paravertebral block (PVB) in managing acute postoperative pain and preventing the development of PTPS in patients undergoing thoracotomy and lobectomy. This prospective, randomized study included American Society of Anesthesiologists (ASA) class II-III patients aged 18–70 years who underwent elective unilateral lobectomy via a thoracotomy. The study was conducted at Başakşehir Çam and Sakura City Hospital, following approval from the hospital’s ethics committee on May 20, 2022 (protocol number: KAEK.2022.05.155). Patients were randomly assigned into ESPB (n = 30) and PVB (n = 30) groups using a computer-generated randomization sequence prior to surgery. Intravenous patient-controlled analgesia (PCA) was provided for 24 h postoperatively. Resting numerical rating scala (NRS) and Prince Henry Hospital Pain Scale (PHHPS) scores were evaluated at 0, 2, 6, 12, and 24 h after surgery. Pain levels were further assessed via telephone interviews using the NRS at 2 weeks and 2 months postoperatively. The baseline NRS score was significantly lower in the PVB group (3.97 ± 0.61) compared to the ESPB group (4.37 ± 0.85) (p = 0.044). The mean number of PCA requests, mean opioid consumption and number of patients receiving rescue analgesics were significantly lower in the PVB group than in the ESPB group (p < 0.05). No significant differences were observed between the groups in hemodynamic parameters (p > 0.05). PTPS developed in 3 patients (1 in PVB, 2 in ESPB), with no significant intergroup difference (p = 0.561). PVB and ESPB provided effective acute pain control after thoracotomy, with PVB showing superior outcomes in analgesic use and pain scores. Early management of postoperative pain may improve short-term recovery and potentially reduce PTPS incidence, which was 5% in our study—lower than reported in the literature. ClinicalTrials.gov (ID NCT06964698). The clinical trial was retrospectively registered on April 02, 2025.

Suprainguinal Fascia Iliaca Compartment Block (SFICB) is a widely utilized technique for managing postoperative pain in hip surgery. The timing of its administration, either preoperative or postoperative, plays a crucial role in influencing patient outcomes. This study aims to compare the effects of preoperative versus postoperative SFICB on postoperative recovery in patients undergoing hip hemiarthroplasty (HHA). In this prospective randomized trial, 60 patients scheduled for HHA were randomly assigned to two groups: Group PreS (preoperative SFICB) and Group PostS (postoperative SFICB). SFICB was performed under ultrasound guidance using 0.20% bupivacaine. The primary outcome was assessed using the Quality of Recovery-15 (QoR-15) score at 24 h postoperatively. Secondary outcomes included the Nursing Delirium Screening Scale (N-DSS), postoperative nausea/vomiting (PONV), and opioid consumption. Demographic variables were comparable between groups (p > 0.05). Spinal anesthesia duration was shorter in Group PreS (p = 0.005), while surgery and total procedure times were similar (p > 0.05). QoR-15 scores improved in both groups, with significant increases in moderate (p = 0.004, p = 0.047) and severe pain (p < 0.001, p = 0.028). At T1, total QoR-15 (p = 0.034) and severe pain score (p < 0.001) were significantly better in Group PreS. Preoperative fentanyl need was lower in Group PreS (p < 0.001). Although first rescue analgesia time was longer in Group PostS (p = 0.026) morphine equivalent consumption (p = 0.564) was similar. N-DSS, delirium incidence, and PONV showed no differences (p > 0.05). No complications were observed. Preoperative SFICB improved postoperative QoR-15 scores compared to postoperative SFICB in elderly HHA patients, but optimal timing and perioperative settings require further research. ClinicalTrials.gov (ID NCT05965544). The clinical trial was prospectively registered on July 20, 2023.

Background/Objectives: After the earthquakes in Turkey, many citizens were injured, and a long ongoing process requiring physiological and psychological treatments began. The aim of this study was to observe the pain and psychological changes in earthquake victims in light of the QoR-15 score. Methods: After approval by the local ethics committee (Decision No. 2023-194), earthquake victims with catheters in trauma and reconstructive surgery were retrospectively evaluated. Demographic and catheterization data were collected. Baseline, 24 h, 72 h QoR-15 (Quality of Recovery-15), and VAS (Visual Analog Scala) scores were compared for changes over time. Results: A total of 40 catheters were placed in 29 patients (after the exclusion of children, 36 catheters were evaluated in 26 (15 w/11 m) patients). The mean age of the patients was 35.57 ± 13.69 years, and the duration of catheterization was 8 (4.25–12.75) days. An infusion of 0.1% bupivacaine 0.5–1 mg/kg/24 h was started routinely. The QoR-15 scores of the patients at baseline, 24 h, and 72 h were 80.45 ± 17.76, 95.27 ± 15.16, and 101.06 ± 15.52, respectively (p < 0.001). The VAS scores of the patients at baseline, 24 h, and 72 h were 4.61 ± 1.41, 1.79 ± 1.36, and 0.76 ± 0.86, respectively (p < 0.001). Conclusions: In this study, a significant improvement in QoR-15 and VAS scores was achieved as a result of catheter insertion in earthquake victims. Considering that post-traumatic injuries require repeated surgeries and that pain aggravates the existing psychological state, it can be said that catheterization is beneficial.

Objectives: The correct determination of the vertebral level is important in anesthesia management and the prevention of possible risks. It has been shown that estimation of L4/5 intervertebral lumbar level based on Tuffier’s line determined by palpation (palpated L4/5) is often inaccurate. In this study, it was aimed to investigate how Tuffier’s line changes in the lateral decubitus position due to pregnancy. Material and Methods: The patients were divided into two groups in this prospective cohort study. The pregnant patients were assigned to Group P (n = 75) while the non-pregnant patients were assigned to Group NP (n = 60). Lumbar ultrasound was conducted in both groups in the left lateral decubitus position to verify the vertebral level determined by Tuffier’s line that was detected by palpation. Demographic data, determination time of Tuffier’s line, ultrasound, and the detected vertebral levels were recorded in both groups. Results and Discussion: Vertebral levels detected by both techniques were compatible with 35 (46.6%) patients in Group P and 36 (60%) patients in Group NP (p = 0.165). The vertebral levels in Group P detected via ultrasound were determined at L2 in three (4%) patients, at L2/3 in three (4%) patients, at L3 intervals in three (4%) patients, and at the L3/4 interval in 31 (41.3%) patients. The vertebral levels of the patients in Group NP detected via ultrasound was at L2/3 in 2 (3.3%) patients, and at the L3/4 interval in 22 (36.7%) patients. For the risk of insertion from a risky injection site, the OR = 3.96–95 and GA = 0.82–19.05 in Group P were higher compared to Group NP (approximately 4 times higher). While Group P was significantly limited in the risk analysis, according to L3 (p = 0.087), the risk under this level was similar (p = 0.124). In this study, the verification of Tuffier’s line determined through palpation did not show the correct vertebral level in almost half of the patients in the lateral decubitus position, regardless of pregnancy and demographic data. Conclusion: We believe a possible spinal cord injury can be prevented by determining the needle insertion site via lumbar ultrasound in the pregnant patients. Bangladesh Journal of Medical Science Vol. 22 No. 03 July’23 Page : 529-535

Aims: Effective postoperative analgesia is essential in thoracic surgery to preserve respiratory function, facilitate early mobilization, and reduce pulmonary complications. Thoracic epidural analgesia (TEA) has traditionally been regarded as the gold standard for pain control. However, the increasing use of minimally invasive approaches such as video-assisted thoracoscopic surgery (VATS) has prompted the adoption of ultrasound-guided peripheral regional anesthesia techniques, including the paravertebral block (PVB), erector spinae plane block (ESPB), and serratus anterior plane block (SAPB). This study aimed to compare TEA and peripheral regional blocks in terms of postoperative pain scores, opioid consumption, and recovery parameters in patients undergoing VATS procedures. Methods: This retrospective study included patients who underwent elective VATS between January 2023 and January 2025. Based on the analgesic technique received, patients were divided into two groups: TEA (n=82) and peripheral block group (PER, n=65). Pain was assessed using the Visual Analog Scale (VAS) at the post-anesthesia care unit (PACU) and at 24, 48, and 72 hours postoperatively. Opioid doses were standardized to morphine milligram equivalents (MME). Additional outcomes included intraoperative opioid use, postoperative rescue analgesia, length of hospital stay (LOS), complication rates, and 90-day mortality. Results: Patients in the TEA group had significantly lower VAS scores at all time points compared to the PER group (p