Objective: Nowadays, the painless childbirth preference of expectant mothers is gradually increasing. The most important and first objective in labor analgesia should be the safety of mother and baby. Our objective in this study is to compare the effects of combined spinal-epidural analgesia (CSE) and epidural analgesia on analgesia quality and labor in labour analgesia. Methods: Our study was performed prospectively on 40 primigravid pregnant women who requested painless childbirth and were included in the ASAI-II group, between September 1, 2018, and November 30, 2018. Pregnant women who had single fetus at 36-42 weeks, have vertex presentation, no contraindications for regional analgesia, have active contractions and with 3-4 cm cervical opening were randomly divided into two groups in the study. Combined Spino Epidural group (= Group CSE, n = 20), Epidural analgesia group (= Group EPI, n = 20) was determined as the groups. To the pregnant women in the Group CSE, Intrathecal dose in a manner that 2.5 mg hyperbaric bupivacaine + 12.5 µg fentanyl total volume of 1 ml was injected. To the pregnant women in the Group EPI, 20 G epidural catheter was placed with the method used in the first group and fixed to the skin. Epidural analgesia solutions (20 mg bupivacaine + 50 µg fentanyl +15 cc saline) were prepared in 20 cc injectors containing 0.1% bupivacaine + 2.5 µg/ml fentanyl for use in both groups. When the VAS values became 4, these prepared solutions were planned to be given as 10 ml intermittent bolus from these epidural catheters. Results: The mean values of maternal age, weight, and height, and infant height have not shown any difference according to the groups (p> 0.05). The first VAS median value was obtained as 5 in both groups. However, the VAS values were accumulated in the higher values in the combined spinal-epidural group (p = 0.031). Although the second VRS and VAS median values were lower in the pure epidural, the outlet VRS and VAS values have been obtained lower in the combined spinal-epidural group. Conclusion: For normal spontaneous vaginal delivery, every mother should be offered labour analgesia options such as CSE analgesia and epidural analgesia. CSE analgesia may be a good alternative to epidural analgesia because of its advantages such as the onset of fast analgesia, shortening the first stage of labour and increasing the comfort of the mother in the outlet.

Objective: To research the short-term effects on neonates of different anesthesia methods administered for elective cesareans.Methods: Data obtained from files and electronic medical records of 157 singleton cesarean cases and neonates from January 2018 to December 2019 were retrospectively analyzed and 6 cases were excluded from the study. A total of 151 cases were divided into general anesthesia-propofol (n=30), spinal (n=100) and general anesthesia-pentothal (n=21) groups.Results: A total of 151 cesarean cases that meet the inclusion criteria in the date interval of the study were assessed. Of cases, 100 (66%) were in the spinal anesthesia group, 30 (20%) were in the general anesthesia-propofol group and 21 (14%) were in the general anesthesia-pentothal group. There was no significant difference between the study groups in terms of demographic data. The umbilical cord pCO2 value was significantly low in the spinal anesthesia group (43.60±5.52) compared to the general-pentothal group (47.38±5.71). The umbilical cord HCO3 value was lower in the spinal anesthesia group (22.69±1.62) compared to the general-pentothal (23.48±1.53) and general-propofol groups (23.49±1.83). There was a significant variation in postnatal treatment types according to anesthesia method (p=0.012). The rate not requiring treatment was lowest in the general-propofol group (46.7%), while the rate of balloon-valve mask use (46.7%) was highest compared to the other groups. In terms of 5th minute Apgar scores, there was a significant difference between the groups (p=0.024). Patients in the general-propofol group had significantly lower 5th minute Apgar scores compared to patients in the spinal group.Conclusion: The balloon-valve mask rate was highest for those with propofol general anesthesia. Additionally, it was identified that neonates in both general anesthesia groups had higher neonatal intensive care unit requirements compared to the spinal anesthesia group.

Objectives: We aimed to compare the total amount of inhalation anesthesia consumed and the amount of fentanyl used as an additional dose in cases where transversus abdominis plane and rectus sheath blocks were applied for postoperative analgesia. Methods: Eighty patients aged 18-75 years, classified as ASA I-II, who were scheduled for laparoscopic cholecystectomy, were included. The patients were divided into two groups: those who received a combination of transversus abdominis and rectus sheath blocks under general anesthesia (Group B, n=40), and those who received analgesia with tramadol under general anesthesia (Group C, n=40). Throughout the procedure, both groups were monitored to maintain the entropy target value between 40-60 with a maximum MAC value of 1.3. At the end of the procedure, the total amount of inhalation agent consumed, and the additional need for superficial anesthesia/analgesia, as well as the total amount of fentanyl added as an extra dose, were recorded. Results: Comparing the total amount of inhalation agent consumed throughout the case, it was found to be 27.05±7.43 mL in Group C (Control group) and 12.25±4.34 mL in Group B (Block group), with a statistically significant difference between the groups. There was a significant difference in the need for additional intraoperative and the total amount of fentanyl consumed between the groups (P<0.05). Conclusions: In laparoscopic cholecystectomy cases, we observed that the use of transversus abdominis plane block and rectus sheath block combined with standardized general anesthesia monitored by entropy reduced the amount of inhalation agent consumed, as well as the need for additional intraoperative and total opioid consumption.

Background and Objectives: Epidural analgesia after total knee arthroplasty (TKA) is effective, but its side effects are largely dose-dependent. This study evaluated whether adding intraoperative periarticular multimodal infiltration to epidural patient-controlled analgesia (PCA) reduces epidural drug consumption and side effects. Materials and Methods: In this prospective, single-centre randomised controlled trial (ClinicalTrials.gov NCT06872528, registered 24 February 2025), 72 patients undergoing unilateral TKA under combined spinal–epidural anaesthesia were randomised to epidural PCA plus periarticular infiltration with a modified Ranawat solution (Group EP) or epidural PCA alone (Group E). Eleven patients were withdrawn because of catheter dislodgement, and 61 were analysed (Group EP, n = 31; Group E, n = 30). The primary outcomes were epidural local anaesthetic consumption and the incidence of complications and rescue analgesia. Pain (visual analogue scale, VAS), PCA bolus number, haemodynamics and time to first voiding were also recorded for 48 h. Results: VAS scores did not differ between groups at any time point. Cumulative epidural volume was lower in Group EP at 24 h (188.4 ± 43.4 vs. 213.2 ± 44.5 mL; p = 0.032) but not at 48 h (344.0 ± 52.5 vs. 361.8 ± 57.8 mL; p = 0.213). Epidural volume and bolus number were lower in Group EP during the 2–6 h and 12–24 h intervals. Vomiting was less frequent in Group EP (9.7% vs. 40.0%; p = 0.006). Rescue analgesia, nausea, pruritus, urinary retention, haemodynamics and time to first voiding were similar. Conclusions: Adding periarticular infiltration to epidural PCA did not further reduce pain scores, but it reduced epidural consumption during the first postoperative day and the incidence of vomiting; the difference in epidural consumption was modest and should be confirmed in larger trials.

Amaç: Yeni koronavirüs SARS-CoV-2 (COVID-19) sağlık çalışanlarını enfekte edebilir. COVID-19 salgını sırasında ameliyathane ekip üyelerini korumak ve rasyonel olarak kişisel koruyucu ekipman (KKD) korumak için kurumsal bir algoritma geliştirdik. Acil cerrahi ve ameliyathanede COVID-19 salgını ile ilgili en güncel bilgileri gözden geçirmeyi amaçladık. Metot: Farklı branşlardan oluşan doktorlarımızla oluşturduğumuz komitemiz ile girişimsel bir platform (ameliyathane, girişimsel ve endoskopi), potansiyel yayılma örüntüleri, maruz kalma riski ve KKD'nin korunmasına dayanan kılavuzlarımızı geliştirdik. Deneyimlerimizi 2 aylık bir sürede ameliyat edilen 128 hasta ile paylaşmayı amaçladık. Girişimler: 2019-nCoV şüphesi olan hastalar için acil durum prosedürleri için anestezi yönetimi ve enfeksiyon kontrol kılavuzları Namık Kemal Üniversitesi Tıp Fakültesi'nde hazırlanmış ve uygulanmıştır. Bulgular: Ameliyathane ekibi üyelerine yönelik önlemler için kurumsal yönergelerimizi açıklayan bir karar algoritması oluşturuldu. Bu algoritma ameliyatın aciliyetine, cerrahi bölgede beklenen viral yüke, virüsü aerosol haline getirme prosedürü fırsatına ve hastanın semptomlara ve testlere dayanarak enfekte olma olasılığına dayanır. Sonuçlar: COVID-19'un yeni bir tehdit olmasına rağmen, girişimsel platform ekipleri için izlemesi kolay bir karar algoritması geliştirerek, optimum sağlık çalışanı güvenliğini sağlayabildiğimizi gösterdik.