Background Postoperative nausea and vomiting (PONV) is the most frequent surgical complication after pain. We assessed the effect of the erector spinae plane (ESP) block on PONV incidence, nausea severity, pain levels, rescue antiemetic and analgesic requirements, intraoperative remifentanil use, and the correlation between pain and nausea severity in patients undergoing elective single-level lumbar disc herniation (LDH) surgery. Methods A prospective, randomized, double-blind study included 92 patients with American Society of Anesthesiologists I–II status who were scheduled for lumbar disc herniation surgery under general anesthesia. Patients were randomized into two groups: the ESP group (Group E) and the control group (Group C). The ESP group received bilateral ESP block with 20 mL of 0.25% bupivacaine per side (total 40 mL) alongside standard intraoperative analgesia, while the control group received a sham block. All patients received intravenous ondansetron for PONV prophylaxis. Postoperatively, standard analgesia was provided; patients with a Numerical Rating Scale (NRS) score ≥4 received intravenous dexketoprofen. We defined PONV as significant nausea (NRS≥4), vomiting, or the need for rescue medication. Patients with persistent nausea (>20 min), no improvement in nausea score, or multiple vomiting episodes received 4 mg intravenous ondansetron. Results A total of 81 patients (Group E: 40, Group C: 41) were included in the final analysis. The overall PONV incidence at 0–24 hours was 10% in the ESP group and 34.1% in the control group (p<0.05). The ESP group exhibited a significantly lower incidence of nausea at 0–2, 2–4, and 4–12 hours postoperatively (p<0.05). Rescue antiemetic use was also lower in the ESP group (p<0.05). Intraoperative remifentanil requirements decreased in the ESP group (p<0.05). Pain intensity was significantly lower in the ESP group at 0–2, 2–4, and 4–12 hours (p<0.05), with reduced rescue analgesic use at 0–24 hours (p<0.05). Postoperative pain and nausea intensity showed a strong positive correlation at 0–2 hours (p<0.001), with moderate correlations at 2–4, 4–12 (p<0.001), and 12–24 hours (p=0.003). Conclusion ESP block reduced PONV incidence and severity while providing effective analgesia in LDH surgery. This technique may contribute to multimodal analgesia and PONV prophylaxis. Trial registration number NCT06710457/https://www.clinicaltrials.gov/ (November/26/2024).

Preoperative anxiety and pain can adversely affect recovery and satisfaction. Music is a safe, low-cost, non-pharmacological intervention that may enhance perioperative outcomes. This study evaluated the effects of patient-preferred music on anxiety, recovery, pain, satisfaction, and hemodynamics during unilateral knee arthroplasty under spinal anesthesia. In this prospective, randomized, controlled, single-blind trial, 80 patients were assigned to either a music group (Group M) or a control group (Group C). Group M listened to preferred music via headphones before and during surgery, while Group C received standard care. Anxiety (State-Trait Anxiety Inventory; state: STAI-S, trait: STAI-T), recovery (Quality of Recovery-15 [QoR-15]), pain (Numeric Rating Scale [NRS]), satisfaction, and hemodynamic parameters were measured. Minimal clinically important difference (MCID) analyses were used to assess clinical significance. Sixty-five patients (Group M: 32; Group C: 33) were analyzed. Postoperative STAI-S scores were significantly lower in Group M ( p = .001), with a 6.18-point difference exceeding the MCID by 283%. QoR-15 scores were higher in Group M ( p = .007), surpassing the MCID by 123%. Group M also showed lower systolic blood pressure at several perioperative points ( p < .05), lower NRS pain scores at the 12th postoperative hour ( p = .001), and reduced need for rescue analgesia ( p = .035). Satisfaction was significantly greater in Group M ( p = .001). No significant differences were found in heart rate ( p > .05). Patient-preferred music significantly improved anxiety, pain, recovery quality, hemodynamic stability, and satisfaction. MCID analysis confirmed clinical relevance. Music may serve as an effective and feasible adjunct in perioperative care.

Impact of Ultrasonography-Guided Transversus Abdominis Plane Block and Local Anesthetic Infiltration in the Surgical Field on Postoperative Analgesic Requirements for Laparoscopic Cholecystectomy Procedures - Istanbul Medical Journal

Background/Objective: Patients who have undergone Billroth II gastrectomy may develop gastroparesis, hypomotility, and reflux esophagitis. These patients are at risk of aspiration of gastric contents into the lungs when subsequently sedated for Endoscopic Retrograde Cholangiopancreatography (ERCP) procedures. The aim of this study was to compare conscious sedation and deep sedation in terms of pulmonary complications in this selected cohort. Methods: Patients who had previously undergone Billroth II surgery and underwent ERCP procedure with sedation for gallstones or biliary tract strictures in a tertiary hospital between January 2020 and September 2023 were studied. Patient records were retrospectively obtained from the hospital information system. All the patients were divided into two groups as conscious sedation (Group CS) and deep sedation (Group DS). The groups were compared statistically in terms of pulmonary complications. Results: A total of 63 ERCP procedures were performed on 28 patients who had undergone Billroth II gastrectomy. There were 37 procedures involving conscious sedation (Group CS) and 26 involving deep sedation (Group DS). No statistically significant difference was found regarding pulmonary aspiration (p = 0.297) and other respiratory complications such as laryngospasm or desaturation between the two groups. In Group DS, it was observed that vomiting incidence was higher (p = 0.012), and airway maneuver requirements were increased (p = 0.007). Conclusions: In patients who have undergone Billroth II gastrectomy, both conscious sedation and deep sedation techniques can be used effectively during ERCP procedures. The complication rates and patient outcomes of the two techniques are comparable. The occurrence of respiratory complications leading to adverse post-procedural outcomes requires careful monitoring and meticulous follow-up for these patients.