Background: Rhomboid intercostal plane block (RIB) has been described in the last decade. In this study, we aimed to evaluate the outcomes of RIB in terms of perioperative analgesia and patient and physician satisfaction in patients undergoing CIED. Methods: The randomized controlled trial was structured into two arms, each comprising 25 patients and allocation was performed using a sealed-envelope randomization technique. Local anaesthesia group-LAG received only local anaesthesia (LA) (prilocaine 2%) as the standard procedure. RIB group-RIBG received RIB in addition to the standard procedure. Demographic and clinical data about the patients and the procedures performed were recorded. The first and second rescue treatments in cases of pain during the procedure and the first and second rescue treatments during the postoperative follow-up were also recorded. Pain levels during the procedure, at the end of the procedure and 3, 6, 12, and 24 h after the procedure were determined according to the NRS-11(Numeric Rating Scale-11). Patient and physician satisfaction were recorded on a five-point Likert scale. The primary outcome of the study was the efficacy of RIB in patients undergoing CIED implantation, assessed by NRS-11 pain scores during the procedure and in the postoperative period. As secondary outcome, patient and physician satisfaction levels were evaluated during the procedure. Results: There was less need for additional local anaesthetic in the RIBG than in the LAG ( p < 0.001). NRS-11 scores during implantation, at the end of the implantation procedure, and at the 3-, 6-, 12-, and 24-hour follow-ups were greater in the LAG ( p < 0.001). The satisfaction levels of both doctors and patients were higher in the RIBG ( p < 0.001). Conclusions: RIB application in CIED implantations showed adequate analgesic efficacy in patients during the perioperative period and up to 24 h postoperatively. At the same time, it provided high procedural satisfaction for patients and physicians. RIB should be considered in the multimodal analgesia approach in the perioperative analgesia of this patient group. There is a need for collaboration between anaesthesiologists and cardiologists to establish protocols, including RIB, for perioperative pain management in patients who undergo CIED implantation. Trial registration: This study was registered in the Clinical Trials (ID: NCT06449599, 27/05/2024).

Anesthesia and Drug Addicted Patients - Bagcilar Medical Bulletin

Background: Postherpetic neuralgia (PHN) is a neuropathic pain syndrome that can be resistant to traditional therapies and severely impairs quality of life. The serratus posterior superior intercostal plane block (SPSIPB) is a recently described regional anesthesia technique conducted under ultrasound guidance, thought to provide analgesia for thoracic neuropathic pain. This research analyzed the effectiveness and safety of SPSIPB in patients with thoracic PHN. Methods: Thirty-four thoracic PHN patients who underwent SPSIPB between June 2023 and February 2025 were retrospectively evaluated. Pain intensity was evaluated utilizing the Numerical Rating Scale (NRS-11), neuropathic pain symptoms using the Douleur Neuropathique 4 (DN4) questionnaire, and quality of life using the 12-item Short Form Health Survey (SF-12). Measurements were taken before the procedure and at 1 month and 3 months post-procedure. Results: Thirty-four patients were included. Mean patient age was 68.4 ± 7.1. Among all patients, 50% were female. The NRS-11 scores decreased from 7.6 ± 1.1 before the procedure to 2.8 ± 1.3 at 3 months ( p < 0.001). The DN4 scores also decreased from 6.4 ± 1.0 before the procedure to 3.1 ± 1.2 at 3 months after the procedure ( p < 0.001). Significant increases were observed in both the physical and mental component scores of the SF-12 ( p < 0.001). No severe complications were encountered. Conclusion: SPSIPB administered under ultrasound guidance is associated with a reduction in pain intensity and an improvement in quality of life in patients with thoracic postherpetic neuralgia. However, given the study’s retrospective design and the absence of a control group, these outcomes should not be considered indicative of a causal effect; instead, they should be interpreted as hypothesis-generating. Prospective, randomized controlled trials are needed to demonstrate the efficacy of SPSIPB and its comparative benefits relative to other interventions. Trial registration: This retrospective single-center study was conducted in accordance with the Helsinki Declaration. It was registered on clinicaltrials.gov (NCT07067892).

Objective: The role of sedation during cervical interlaminar epidural steroid injections remains controversial in terms of patient comfort and procedural safety. This study aimed to present the early clinical outcomes of cervical interlaminar epidural steroid injections performed under sedation in patients with cervical radiculopathy. Methods: This retrospective observational study included 44 patients who underwent cervical interlaminar epidural steroid injections under sedation. Pain intensity was assessed before the procedure and at 4 hours after the procedure using the NRS-11, and post-procedural patient satisfaction was evaluated using a Likert scale. Cumulative radiation dose, fluoroscopy time, and intra-procedural complications were analyzed. Mild-to-moderate sedation was targeted, and the Modified Observer’s Assessment of Alertness/Sedation Scale (MOAA/S) was used to assess the level of sedation. Results: At 4 hours post-procedure, a significant decrease in NRS-11 scores was observed compared with pre-procedure scores. Most patients reported high post-procedure satisfaction. No major complications were observed during the study period, and the minor side effects were transient. However, due to the retrospective nature of the study and the absence of a comparison group without sedation, the findings cannot be considered to definitively reflect the effect of sedation. Conclusion: Cervical interlaminar epidural steroid injections administered with mild-to-moderate sedation were associated with early pain reduction and high patient satisfaction. However, given the limitations of the present study, these findings should be interpreted with caution, and prospective, controlled studies are required to determine the true contribution of sedation.

Although transvenous cardiac implantable electronic device (CIED) implantation is generally considered a minor procedure, long-lasting pocket-site pain may

Background: This study evaluated the analgesic efficacy of the serratus posterior superior intercostal plane block (SPSIPB) in patients undergoing CIED implantation. Methods: In this study, 60 patients undergoing primary CIED implantation were randomized to receive either ultrasound-guided SPSIPB (n = 30) or a sham-control group procedure (n = 30). The primary outcome was perioperative pain intensity, assessed using the Visual Analog Scale (VAS) intraoperatively and at 3, 6, 12, and 24 h postoperatively. Secondary outcomes included postoperative sleep quality measured by the Sleep Quality Numeric Rating Scale (SQ-NRS), patient and physician satisfaction scores. Results: SPSIPB significantly reduced pain scores at all time points compared with the control group (all p < 0.001). Clinically significant intraoperative pain (VAS ≥ 4) occurred in 83.3% of controls but in none of the SPSIPB patients (p < 0.001). Postoperatively, clinically significant pain dropped from 93.3% in controls to just 3.3% with SPSIPB (p < 0.001), with the block group maintaining significantly lower pain scores at 3, 6, 12, and 24 h (mean reductions vs. control of 4.70, 4.13, 3.97, and 1.90 points, respectively; p < 0.001). SQ-NRS scores were lower in the SPSIPB group than in the control group (median 2 vs. 7, p < 0.001). Poor sleep quality (SQ-NRS ≥ 6) was observed in 80.0% of controls and in none of the SPSIPB patients. Patient and physician satisfaction were significantly higher in the SPSIPB group (median Likert score: 5 vs. 3, p < 0.001). Conclusions: Preoperative SPSIPB was associated with substantially lower perioperative pain scores and reduced rescue analgesic requirements during the first 24 h after CIED implantation. Improvements in postoperative sleep quality and patient–physician satisfaction were also observed; however, these secondary outcomes should be interpreted as exploratory. Larger multicenter trials are warranted to confirm the magnitude and generalizability of these findings.