Purpose: Spinal surgery is associated with severe diffuse pain in the postoperative period. Effective pain management plays an essential role in reducing morbidity and mortality. This study is designed to compare the ultrasound-guided erector spinae plane (ESP) block and surgical infiltrative ESP block for postoperative analgesia management after lumbar spinal fusion surgery. Methods: The patients who underwent two or three levels of posterior lumbar spinal fusion surgery were randomly allocated into one of three groups with 30 patients each (Group SE = Surgical ESP block; Group UE = ultrasound-guided ESP block; Group C = Controls). The primary aim was to compare postoperative opioid consumption, and the secondary aim was to evaluate postoperative dynamic and static pain scores and the incidence of opioid-related adverse effects. Results: There was a significant difference in terms of opioid consumption, rescue analgesia on demand, and both static and dynamic pain scores between groups at all time periods (p < 0.05). Group SE and Group UE had lower pain scores and consumed fewer opioids than the controls (p < 0.05). However, the Group UE had lower pain scores and opioid consumption than the Group SE. The sedation level of patients was significantly higher in the control group than in the other two groups. Also, nausea was more common in controls than in the other groups. Conclusion: While both surgical and ultrasound-guided ESP blocks reduced opioid consumption compared to the controls, the patients who received ultrasound-guided ESP blocks experienced better postsurgical pain relief than those in the other groups (surgical ESP and controls).

Fascial plane blocks have become increasingly popular for postoperative analgesia. Recently, Ekinci et al. have defined the peritibial fascial infiltration block (PFIB) for ankle fractures. This report discusses two cases where PFIB was utilized as part of a multimodal analgesic strategy. The first case involved a 13-year-old male with a lateral malleolus fracture following a bicycle accident. The second case concerned a 27-year-old male with bilateral malleolus fractures sustained in a motorcycle accident. In both cases, PFIB was administered preoperatively, and neither patient required supplemental analgesics postoperatively. The PFIB appears to be a promising adjunct in multimodal analgesia for ankle fractures. Further research is warranted to validate its efficacy and broader applications.

Osteogenesis imperfecka, which is a rare autosomal dominant collagen tissue disease that primarily involves the bone, is a condition that requires careful attention in the preoperative period and in terms of anesthesia management. In this case report, we aimed to present our experience with supraclavicular block in a patient with osteogenesis imperfecta who is operated due to intervention for a left humeral fracture, as it is an easy and safe method to use.

Objective: To retrospectively compare the clinical and functional outcomes of wedge plate and dynamic hip screw (DHS) fixation in adult patients with trochanteric femoral fractures.Methods: This retrospective comparative analysis included 64 hips in 63 patients aged 18-60 years who underwent primary fixation of a trochanteric femoral fracture with either a wedge plate (n=38) or a dynamic hip screw (DHS; n=26) between 2005 and 2010. Eligible hips had clinical and radiographic records sufficient for final functional assessment at least 6 months after surgery. Of 149 potentially eligible patients, 66 could not be contacted. Patients who died before final assessment, hips converted to partial arthroplasty after fixation failure, and hips treated with fixation devices other than a wedge plate or DHS were excluded from this comparison. One DHS-treated hip that was converted to partial arthroplasty after implant failure and loss of reduction was excluded during cohort construction. Demographic characteristics, fracture patterns, perioperative findings, postoperative complications, and Harris Hip Score (HHS) outcomes were compared.Results: The mean patient age was 47.89±14.66 years, and 92.2% of the patients were male. Unstable fractures accounted for 73.4% of all fractures and were more frequent in the wedge plate group than in the DHS group (84.2% vs 57.7%; P=.018). The overall mean HHS was 89.85±12.47, with excellent or good functional outcomes in 86.0% of hips. No statistically significant between-group differences were detected in HHS, the overall distribution of functional outcome categories, or the individual recorded postoperative complication categories. Within the retained comparison cohort, revision surgery was required in five wedge plate cases because of mechanical failure involving plate bending and/or breakage and in none of the 26 DHS cases (Fisher exact P=.074).Conclusion: In this selected, retrospective, and relatively small cohort, no statistically significant difference in HHS-based functional outcomes was detected between wedge plate and DHS fixation. The significant imbalance in fracture stability, the five mechanical failures in the wedge plate group, and exclusion of a DHS-treated hip converted to arthroplasty limit comparative inference. These findings should not be interpreted as evidence of equivalence.

Aim Post-dural puncture headache (PDPH) remains an important complication after spinal anesthesia for cesarean delivery. Although cerebrospinal fluid leakage is central to its pathophysiology, systemic hemodynamic changes may also contribute. This prospective observational cohort study evaluated the association between early post-spinal hypotension and PDPH. Methods Pregnant women undergoing elective or semi-elective cesarean delivery under spinal anesthesia were prospectively followed. Systolic blood pressure (SBP), mean arterial pressure, heart rate, ephedrine requirement, and perioperative variables were recorded. The primary exposure was the percentage decrease in SBP at 5 minutes after intrathecal injection. PDPH was assessed during the first 5 postoperative days according to International Classification of Headache Disorders-3 criteria. Logistic regression and receiver operating characteristic (ROC) analyses were performed. Results A total of 353 patients were included, and PDPH occurred in 10 patients (2.83%). Baseline hemodynamic variables were similar between patients with and without PDPH. Patients who developed PDPH had lower 5-minute SBP and a greater percentage decrease in SBP from baseline. Severe hypotension (SBP decrease ≥20%) was associated with higher odds of PDPH (Firth OR 7.62, 95% CI 2.21–32.01; P = .002). The percentage decrease in SBP showed good discrimination for PDPH (AUC 0.880, 95% CI 0.807–0.937); an exploratory Youden-derived threshold of an 18.85% decrease was identified but requires external validation. In Firth penalized multivariable logistic regression, percentage SBP decrease remained independently associated with PDPH. Conclusion In parturients undergoing cesarean delivery under spinal anesthesia, greater early post-spinal systolic hypotension was independently associated with subsequent PDPH. These findings support further investigation of hemodynamic stability as a potentially relevant factor in PDPH prevention.