Quadratus lumborum block (QLB) and modified thoracoabdominal nerves block through perichondrial approach (m-TAPA) can be used for postoperative analgesia in laparoscopic cholecystectomies (LC). The aim of this study is to evaluate the analgesic efficacy of anterior QLB and m-TAPA during the first 24 hours postoperatively. This study was designed as a randomized, prospective, single-blinded trial. Preoperatively, patients were divided into two groups: Group QLB (n=55) and Group m-TAPA (n=53). The anterior QLB was applied to Group QLB, while the m-TAPA was applied to the other group. After the blocks were administered, the dermatome areas covered at the 20th and 30th minutes were evaluated using a cold test. Intraoperative remifentanil consumption was recorded, while Numerical Rating Scale scores at rest (rNRS) and during movement (dNRS), opioid consumption, time to first rescue analgesic use, and complications were evaluated during the first 24 postoperative hours. There was no statistically significant difference between the groups in terms of total analgesic consumption during the first 24 hours, rNRS and dNRS values at hours 1, 4, 8, 12, and 24, time to first rescue analgesic use, intraoperative remifentanil consumption and complications. When comparing dermatome involvement between the groups, it was observed that dermatome coverage in the m-TAPA group was mostly distributed in the T7-T10 dermatomes, while in the QLB group, it was mostly distributed in the T10-L1 dermatomes. We believe that both anterior QLB and m-TAPA can be used as part of opioid-free multimodal analgesia for postoperative analgesia during the first 24 hours in LC.

Erector Spinae Plane Block (ESPB) is employed as a component of multimodal analgesia in laparoscopic cholecystectomy (LC) procedures. The objective of this study is to assess the impact of ESPB performed at different levels during LC operations on postoperative pain scores and opioid consumption. A total of 103 patients undergoing LC were divided into three groups: Group Th7 (ESPB administered at the 7th thoracic vertebra level), Group Th9 (ESPB administered at the 9th thoracic vertebra level), and the control group. Patients were evaluated at 30 min, 1, 4, 8, 12, and 24 h postoperatively. Morphine consumption within the first 24 h postoperatively, resting and dynamic Numeric Rating Scale (NRS) scores, and complication rates were assessed. When comparing morphine consumption among the groups, it was observed that patients who received ESP blocks had significantly lower morphine consumption at 1, 4, 8, 12, and 24 h compared to the control group. However, no significant difference was found between Group Th7 and Group Th9. In Group Th7 and Group Th9, the resting NRS scores at 30 min, 1, 4, and 24 h, as well as all dynamic NRS scores except at the 8th hour, were significantly lower compared to the control group. However, there was no significant difference between Group Th7 and Group Th9. In LC surgeries, ESPB administered at the Th7 and Th9 levels exhibited similar analgesic efficacy. ESPB applied at the Th7 and Th9 levels can be utilized as part of multimodal analgesia.

Article: Analgesic efficacy of a quadratus lumborum block and ilioinguinal-iliohypogastric block in cesarean deliveries: a randomized study - Minerva Anestesiologica 2025 Apr 23 - Minerva Medica - Journals

Objective: In recent years, the pericapsular nerve group (PENG) block and anterior quadratus lumborum block (aQLB) have emerged as regional anesthesia techniques commonly used for pain control after hip surgery. This study compared their analgesic efficacy during the first 48 hours following surgery under spinal anesthesia. Methods: In this prospective, randomized, single-blinded study, patients were assigned to either the PENG ( n = 43) or the aQLB group ( n = 30). The primary outcome of the study was the total tramadol consumption within the first 48 hours postoperatively. Secondary outcomes included time to first rescue analgesia, resting and dynamic NRS pain scores at 2, 12, 24, and 48 hours postoperatively, and the incidence of complications. Results: In this study, postoperative tramadol consumption within the first 48 hours was significantly lower in the PENG (96.74 ± 77.36 mg) compared to the aQLB group (196.33 ± 157.43 mg) ( p = 0.004). Additionally, the time to first rescue analgesia was significantly longer in the PENG (9.03 ± 7.67 hours) than in the aQLB group (6.81 ± 6.70 hours) ( p = 0.048). NRS scores were similar between the groups at all time points. Quadriceps weakness was not observed in any patient. Conclusion: The PENG block provides effective postoperative analgesia without causing motor blockade, making it advantageous for early mobilization in patients undergoing hip surgery. It can be used as a part of multimodal analgesia.

In this retrospective research, it was aimed to evaluate predictive values of lactate-related ratios on mortality in intensive care units (ICUs) at multivariable level. A total of 4985 patients who were hospitalized in the Anesthesia Intensive Care Unit of Istanbul Gaziosmanpaşa SUAM between January 2015 and January 2025 were included in the study. Patients’ age, gender, body mass index, hospitalization diagnoses and chronic diseases, lactate, albumin, hemoglobin, potential of hydrogen (pH), HCO₃⁻, base excess, platelets, APACHE II score, and 28-day mortality values were obtained. Lactate albumin ratio (LAR), lactate hemoglobin ratio, lactate pH ratio, and lactate bicarbonate ratio of the patients were analyzed. Age, pH, and LAR parameter means were significantly higher in the non-survival group, whereas blood extracellular fluid mean was significantly higher in the survival group ( P < .05). Acute renal failure and ketoacidosis were more common in the non-survival group ( P < .05). Twenty-eight-day mortality was significantly correlated with age ( R = 0.077; P < .01), acute renal failure ( R = 0.030; P < .05), ketoacidosis ( R = 0.028; P < .05), albumin ( r = −0.117; P < .01), base excess in the extracellular fluid ( R = 0.032; P < .05), pH ( R = 0.036; P < .05), LAR (0.057; P < .01), and hospitalization duration ( R = 0.044; P < .01). Effects of age ( B = 0.020; P < .01), acute renal failure ( B = −0.648; P < .05), base excess in the extracellular fluid ( B = 0.024; P < .05), pH ( B = 1.753; P < .05), and LAR ( B = 4.893; P < .01) were statistically significant. Although the LAR parameter has a predictive value on 28-day mortality in ICU patients, this is not the case in acute renal failure patients. The LAR variable in acute renal failure patients may have different mechanism than in other ICU patients, and this mechanism may be misleading for LAR. Therefore, further predictive parameters are needed for ICU 28-day mortality in acute renal failure patients.