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.

Amaç: Ciddi aort stenozu olan hastalarda, cerrahiye alternatif olarak son yıllarda Transkateter aort kapak implantasyonu (TAVİ) uygulaması ortaya çıkmış ve daha popüler hale gelmiştir. TAVİ işlemi için kullanılacak anestezi tekniği (genel anestezi veya sedasyon) konusunda fikir birliği mevcut değildir ve tartışmalar devam etmektedir.Bu çalışmada Hastanemizde TAVİ uygulanan hastalardaki perioperatif anestezi deneyimimizi değerlendirmeyi amaçladık. Materyal ve metod: Çalışmaya 2020-2023 yılları arasında hastanemizde TAVI işlemi uygulanan 36 hastaların anestezi yönetim verilerinin retrospektif olarak incelendi.Hastaların demografik verileri, yandaş hastalıkları gibi özellikleri ile ekokardiyografik parametreler, anestezi yöntemi, kullanılan anestezik ilaçlar, ameliyat süresi, kalp yoğun bakım ünitesinde (YBÜ) yatış süresi, toplam yatış süresi, perioperatif komplikasyonlar ve mortalite gibi veriler tüm hastalar için kaydedildi. Hastalar her işlem sırasında verilen anestezi türüne göre GA ve sedasyon olarak ayrıldı. Bulgular: Çalışmaya 6'sı Genel anestezi ( % 16,64 ) ve 30'u ( % 83,3 ) sedasyon uygulanan 36 hasta çalışmaya dahil edildi. İşlem süresi açısından karşılaştırdığımız zaman ise sedasyon yapılan hastalarda (59.12±15.33 dk ) Genel Anestzi yapılan hastalara (79.56±21.58 dk ) göre daha kısaydı (p=0,001). Anestezi süresi de işlem süresine paralellik göstermiştir. Diğer parametreler her iki gruptada anlamlı bir fark göstermemiştir. Sonuç: Uygulanacak anestezi yönetimi hastanın mevcut ek hastalıkları, ekibin deneyimine göre karar verilmeli Her iki yöntem için de yakın hemodinami takibi, ekipman hazırlığı yapılmalı, intraoperatif dönemde gelişebilecek komplikasyonları tanımalı ve buna hazırlıklı olmalıyız. TAVI'yi bilinçli sedasyon veya genel anestezi altında gerçekleştirme kararı, uygulamayı bilgilendirecek iyi kalitede randomize veriler mevcut oluncaya kadar, sonuçta Kalp Ekibinin deneyimi ve yerel hastane politikası tarafından belirlenebilir. Sedasyon uygulamasının TAVİ işlemi sırasında sırasında güvenle uygulanabildiği kanaatineyiz.

Aim: Effectiveness of analgesic nociceptive index (ANI) monitoring in predicting both intraoperative and postoperative early pain in neurosurgery patients undergoing lumbar spinal surgery. The patients were administered general anesthesia using different anesthesia management techniques.Method: The study included a total of 60 patients with American Society of Anesthesiologist (ASA) I-III. The patients were randomly divided into two groups of 30 each using the closed envelope method. Group T received total intravenous anesthesia (TIVA) with remifentanil-propofol, while Group D with desflurane-remifentanil. Non-invasive ANI monitoring was applied to patients undergoing lumbar spinal surgery, and ANI, heart rate, systolic/diastolic arterial pressure values were recorded before and after induction, skin incision, major muscle incision, laminectomy, right-left fasciectomy, screw fixation, after extubation and during the postoperative period. Post-operative heart rate, ANI value, mean arterial pressure values, and visual analog scale (VAS) values were measured.Results: No statistically significant difference was found in terms of the demographic data of the patients. According to the groups, no statistically significant difference was found between the ANI and VAS measurements of the cases at the postoperative 5th minute (P=0.261), postop 10th minute (P=0.379), postop 15th minute (P=0.673), postop 30th minute (P=0.784) and postop 60 minute (p =0.750).Conclusions: In our study on lumbar spine surgery, we could not detect any significant relationship between ANI monitoring and VAS values in the early postoperative period. There was no difference in ANI and VAS with either anaesthetic technique. In light of the results of our study, we believe that more studies are needed on the use of ANI monitoring in the early postoperative period.