Background and objectives: Brachial plexus block is one of the most effective anesthesia and analgesia methods for upper extremity surgeries across different age groups. However, the number of studies on this block in children is insufficient. The aim of this study was to retrospectively analyze and discuss the efficacy and safety of ultrasound (US)- and Ultrasound with nerve stimulator (US + NS)-guided infraclavicular brachial plexus block (ICB) in pediatric patients. Materials and Method: In this study, we retrospectively analyzed the data of 240 pediatric patients admitted to our clinic between October 2020 and April 2023, 120 of whom underwent US-guided ICB and 120 who underwent US + NS-guided ICB. Results: Demographic data of both groups who underwent US and US + NS-guided ICB were similar. The mean procedure time was 6.1 ± 0.8 min for the US group and 8.31 ± 0.82 min for the US + NS group (p < 0.001). The mean operative time was 62.4 ± 11.3 min in the US group and 62.4 ± 9.5 min in the US + NS group (p = 0.73). Intraoperative and postoperative opioid and additional analgesia use and pain scores at 1, 3, 6, 9, 12, 15, and 24 h were recorded in both groups. The mean duration of the motor block (MBD) was 6.20 ± 0.95 h in the US group and 6.29 ± 0.88 h in the US + NS group (p = 0.46). The mean duration of sensory block (SBD) was 9.38 ± 2.13 h in the US group and 9.53 ± 2.05 h in the US + NS group (p = 0.38). Conclusions: In pediatric patients, US and US + NS-guided ICB applications are effective and safe in ease of application, prolonged analgesia, and low complication rates. In skilled hands, US-guided ICB can be as effective as US + NS-guided ICB. Further prospective studies with more significant patient populations are needed to validate these findings.

Background/Objectives: Ultrasound-guided brachial plexus blocks are widely used in upper extremity surgery. The costoclavicular block (CCB) has been defined in recent years as an alternative to the infraclavicular block (ICB) and attracts attention due to its anatomical advantages. However, studies comparing these two techniques using objective physiological parameters are limited. This study aimed to compare the effectiveness of CCB and ICB techniques by measuring tissue oxygenation with near-infrared spectroscopy (NIRS) and evaluating the role of NIRS in demonstrating block success. Methods: Eighty patients undergoing upper extremity surgery were included in this prospective, randomized, comparative study, and the patients were randomly divided into two groups: CCB (n = 40) and ICB (n = 40). Block success was evaluated using tissue oxygen saturation (StO₂) and its change (ΔStO₂) measured by NIRS in addition to sensory and motor assessments. In addition, hemodynamic parameters were recorded. Results: A statistically significant increase in StO₂ and ΔStO₂ values was observed after block application in both groups. In the costoclavicular block group, the median StO₂ increased from 78.5 [8.5] at baseline to 86.5 [9.75] at 20 min (p < 0.001), while in the infraclavicular block group, it increased from 75.0 [12.0] to 85.0 [9.0] (p < 0.001). Similarly, the ΔStO₂ values increased from 0.0 [0.0] to 9.5 [8.25] in the costoclavicular group and from 0.0 [0.0] to 11.0 [9.0] in the infraclavicular group (both p < 0.001). This increase began in the early period and paralleled sensory-motor block findings, indicating that NIRS measurements objectively reflect block success. An isolated intergroup difference in StO₂ was observed at t10 (83.92 ± 6.17 vs. 80.33 ± 7.31, p = 0.023), but no consistent intergroup superiority was demonstrated across the follow-up period. No statistically significant intergroup differences were found for ΔStO₂ at any time point (p > 0.05). The block success rates were similar between groups. The hemodynamic parameters remained stable in both groups, and no clinically significant adverse events were observed. Conclusions: CCB and ICB techniques have similar efficacy and safety profiles in upper extremity surgery. NIRS-derived StO₂ and ΔStO₂ changes appear to be promising complementary physiological markers associated with block onset. However, the present study was not designed to establish diagnostic cut-off values or predictive accuracy; therefore, NIRS should be interpreted as an adjunct to, rather than a replacement for, conventional sensory and motor block assessment.

Background and Objectives: Sepsis is a life-threating organ dysfunction condition caused by the body’s uncontrolled response to an infection. Many traditional and novel inflammatory markers have been used to determine poor prognosis in patients’ sepsis. The inflammatory prognostic index (IPI) is also a novel marker of inflammation. As there are no studies examining the association of the IPI with in-hospital mortality in patients with sepsis nor its performance compared with other inflammatory markers, we aimed to investigate the clinical importance of the IPI for predicting in-hospital mortality in sepsis patients. Materials and Methods: A total of 157 consecutive patients diagnosed with sepsis were retrospectively included in this study. The systemic immune-inflammation index (SII; platelet × neutrophil/lymphocyte), the systemic inflammatory response index (SIRI; neutrophil × monocyte/lymphocyte), the aggregate index of systemic inflammation (AISI; neutrophil × platelet × monocyte/lymphocyte) and the IPI (C-reactive protein × neutrophil-to-lymphocyte ratio [NLR]/albumin) were calculated for all patients. Patients were divided into two groups: survivors (n = 81) and non-survivors (n = 76). Results: Non-survivor patients had significantly higher SII (p = 0.002), SIRI (p < 0.001), AISI (p = 0.002) and IPI (p < 0.001) than survivors. The AUC of the IPI was significantly higher than those of the SII (0.751 vs. 0.645; p = 0.010) and the AISI (0.751 vs. 0.648; p = 0.021) and tended to be higher than that of the SIRI (0.751 vs. 0.687; p = 0.091). Based on logistic regression analysis, the IPI was found to be an independent predictor of mortality (OR: 1.007, 95%CI: 1.002–1.012, p = 0.006). Conclusions: The IPI is a novel combined inflammatory marker that can be easily obtained from laboratory parameters. We determined that the IPI had moderately higher discriminatory ability than the SII and the AISI in patients with sepsis, which indicates that it may be used for risk stratification in this population.

Background/Objectives: To compare ultrasound-guided erector spinae plane block (ESPB) with an intramuscular nonsteroidal anti-inflammatory drug (IM NSAID) for analgesia during extracorporeal shock wave lithotripsy (ESWL). Methods: In this prospective, randomized, open-label trial, 90 patients scheduled for ESWL were allocated into three equal groups: ultrasound-guided ESPB at the T7 level; 75 mg of IM diclofenac sodium 30–45 min before the procedure; or no analgesic premedication (control). Pain was rated on the Visual Analog Scale (VAS) during the procedure, and hemodynamic variables, postprocedural analgesic requirement, and patient satisfaction were also recorded. Results: Mean intraoperative VAS scores differed among the groups (ESPB 2.96 ± 2.76, NSAID 4.47 ± 2.41, control 5.30 ± 2.15; p = 0.002, η² = 0.14). At the first shock wave and at the 25th minute, VAS scores were lower in the ESPB group than in both other groups; at all remaining time points they were lower than in the control group. Early postprocedural analgesic requirement was highest in the control group (33.3% vs. 6.7% and 10.0%; p = 0.016), as it was at the 8th hour (p = 0.007). Satisfaction was lower in the control group than in the ESPB group (p = 0.018), with no significant difference between the control and NSAID groups after adjustment for multiple comparisons. Hemodynamic variables did not differ among the groups, and no complications were observed. Conclusions: ESPB gave better pain control during ESWL than no analgesia, and outperformed the IM NSAID regimen at the first shock wave and at the 25th minute. It also lowered the early analgesic requirement and improved satisfaction, which makes it a practical analgesic option for ESWL.

Background and Objectives: Spinal anesthesia is increasingly preferred in pediatric surgeries due to its rapid onset, high success rate, and low risk of systemic complications. However, the influence of age and body mass index (BMI) on block characteristics in adolescents remains insufficiently studied. Materials and Methods: This retrospective study evaluated 190 pediatric patients (aged 9–18 years; 154 male, 36 female) undergoing elective surgery with spinal anesthesia. Patients were stratified by age (Group 1: 9–14 years; Group 2: 15–18 years) and BMI (Group A: 16.00–19.65 kg/m²; Group B: 19.66–23.31 kg/m²). The primary outcome was sensory block duration. Secondary outcomes included sedation requirements, complications, analgesic requirement times, and Visual Analog Scale (VAS) scores. Results: Group 2 had significantly longer sensory block duration and lower postoperative VAS scores at 3 and 12 h compared to Group 1 (p < 0.001). Lower BMI was associated with greater sedation requirements (p < 0.001) and a higher incidence of intraoperative nausea and vomiting (p = 0.013). Complications were infrequent (hypotension 6.3%, bradycardia 2.1%, PONV 7.1%, postoperative headache 3.1%) and managed conservatively. Conclusions: Age and BMI meaningfully influence spinal anesthesia characteristics in pediatric patients. Older adolescents achieved longer sensory block durations and better postoperative analgesia, whereas younger and lower-BMI patients required more sedation and had higher nausea rates. Individualized spinal anesthesia planning, considering age, BMI, and developmental stage, may optimize clinical outcomes. Prospective studies are warranted to validate these findings.