Omur Ercelen - Academia.edu (original) (raw)

Papers by Omur Ercelen

Turkiye Klinikleri Neurosurgery - Special Topics, 2019

European Journal of Anaesthesiology, Mar 1, 1996

Background and aims Erector spinae plane (ESP) block is a novel technique in which local anesthet... more Background and aims Erector spinae plane (ESP) block is a novel technique in which local anesthetic (LA) is injected between the erector spinae muscle and transverse process under ultrasound guidance. It has been used as a postoperative analgesia method in many surgical procedures. The mechanism of action is not clear. There are well-described anatomical gaps in the intertransverse connective tissue that might explain how LA can pass from the ESP into the para-vertebral space. Although it is efficient, in real life there is block failure/lack of efficiency that tells us there might be things to consider about the block. We would like to present our modified technique (ESP-3), which aims to be a more reliable block. Methods We performed ESP-3 for 6 patients (1-breast surgery with fleb, 4-thoracoscopic pleurodesis and 1-lobectomy). Blocks were performed at sitting position. A linear-ultrasound probe was placed longitudinal parasagittal orientation. After transverse process (TP) was identified, an 22G-echogenic needle (Braun-StimuplexUltra360) was inserted in-plane caudal-to-cranial approach. The needle tip made contact with TP and 10 ml of LA (Bupivacaine) was given to the fascial plane. Then the needle moves from the most proximal part of the TP, past intertransverse ligament and 15 ml of LA is injected just above the superior costotransverse ligament. Results Before the end of the surgeries, non-steroid anti-inflammatory drug and paracetamol were given. Opioids were not needed. None of the patients complained about the pain. No complication was recorded. Conclusions Facial plane blocks are promising. They can be as effective as epidurals. With our modified ESP technique, we hypothesized a more consistent and reliable block can be achieved.

Research Square (Research Square), Mar 11, 2022

Background: Pain after cardiac surgery is both multifocal and multifactorial. Sternotomy, sternal... more Background: Pain after cardiac surgery is both multifocal and multifactorial. Sternotomy, sternal retraction, internal mammary dissection, posterior rib dislocation or fracture, possible brachial plexus injury, and mediastinal and pleural drains contribute to pain experienced in the immediate postoperative period. Ineffective pain management can cause systemic and pulmonary complications and signi cant cardiac consequences Methods: This study was conducted to compare the effectiveness of regional anesthesia techniques for perioperative pain management in cardiac surgery patients at our clinic. The effects of analgesic methods, in terms of contributing to recovery, have been examined. Results: Records of 229 patients who underwent coronary artery bypass surgery between January 2015 and March 2020 were reviewed. It was also observed that none of the patients received balloon pump support, but 20 were transferred to the Cardiovascular intensive care unit while intubated. The anesthesia methods of patients transferred to intubation intensive care were examined, as regional anesthesia was used in 2 patients, while no regional anesthesia was used in 18 patients. Notably, the consumption of opioids in cases where regional anesthesia was used was statistically low. Conclusion: Regional anesthesia techniques severely limit opioid consumption during cardiac surgery. Its importance will gradually increase in terms of rapid recovery criteria. According to our study results in cardiac surgery, double injection of the erector spinae plane block seems to be the most effective. Thus, we supported the facial plane blocks during cardiac surgery. Trial Number: The study is registered with clinicaltrials. The study has an ethics committee registration and approval with the number 2021.464.IRB1.131.

Background and aims Anesthesia management of oesophageal-atresia with tracheo-oesophageal fistula... more Background and aims Anesthesia management of oesophageal-atresia with tracheo-oesophageal fistula (TOF) repair is a challenge. We report a 48-hour-old neonate, 3050 g (>75 percentile) scheduled for TOF repair. Methods Patient was born at 37 weeks gestation. There were no other coexisting anomalies found. There was a Type-C TOF. Anesthetic plan is combined anesthesia with a thoracic epidural catheter. After routine monitoring general anesthesia induced with sevoflurane%3. While maintaining spontaneous ventilation surgeon perform a rigid-bronchoscopy determined that the fistula is at most distal part of carina. Endotracheal tube is placed and try to preserve spontaneous ventilation so not to inflate the stomach. Within right lateral position ultrasonographic examination done, anatomic structures and epidural depth is defined. Epidural space is determined at 1,3 cm depth with loss of air method through 20G toughy needle. Epidural catheter was placed at 4th thoracic level.%0,1 bupivacaine 1 ml is given for epidural anesthesia. Sevoflurane is reduced to%1,5 during surgery. During right thoracotomy surgeon requested muscle-relaxation. Surgery took 180 minutes. Because it was a complex TOF-repair patient transferred remained intubated to the neonatal intensive-care unit. Results During postoperative period%0,1 bupivacaine 1,5 ml.h-1 infusion started. Minimal sedation needed. Two attempts of extubation failed because of stridor and forced ventilation. Patient extubated at 5th postoperative day and continued with nasal CPAP. Epidural catheter taken out at 5th postoperative day. Conclusions Regional anesthesia reduces stress response and sedation requirements in neonates. Ultrasonography is a valuable tool for neuroaxial techniques especially for neonates. With the aid of ultrasonography, failure rates and complications are also reduced.

Yeni üroloji dergisi, Oct 27, 2022

Robot yardımlı cerrahi, daha küçük kesiler, daha az postoperatif ağrı ve daha az intraoperatif ka... more Robot yardımlı cerrahi, daha küçük kesiler, daha az postoperatif ağrı ve daha az intraoperatif kan kaybı ile günlük aktivitelere daha hızlı dönüş gibi avantajlar sunmaktadır. Torasik epidural analjezi, abdominal cerrahide mükemmel analjezi sağlar. Ancak özellikle torasik epidural analjezinin hipotansif etkisi minimal invaziv cerrahilerin hızlı iyileşmeye olan katkısını gölgede bırakmaktadır. Fasiyal plan blokları bu açıdan daha avantajlı olabilir. Bu çalışmada robotik prostatektomi, nefrektomi ve sistektomi operasyonlarında bölgesel analjezi tekniklerinin etkileri değerlendirildi. Gereç ve Yöntemler: Etik Kurul onayı (2021.467.IRB1.134) alındıktan sonra Ocak 2018 ile Ocak 2022 yılları arasında robotik prostatektomi, nefrektomi ve sistektomi ameliyatı geçiren hastaların kayıtları retrospektif olarak incelendi. Bulgular: Tam dokümantasyona sahip yüz kırk hasta bu çalışmaya dahil edildi. Kullanılan bölgesel analjezi yöntemleri kayıt altına alındı. Epidural analjeziye ek olarak fasyal plan bloklarının kullanıldığı görüldü. Robotik prostat ameliyatlarında transversus abdominis plan ve rektus kılıf blokları, robotik nefrektomi ameliyatlarında ise transversus abdominis plan bloklarının etkili analjezik özellik gösterdiği görülmüştür. Sonuç: Özellikle robotik prostatektomi operasyonlarında transversus abdominis plan bloğu ve rektus kılıf bloğu kombinasyonu etkili postoperatif analjezi sunmaktadır.

Anestezi dergisi, Apr 28, 2022

media (excessive absorption of liquid or gas), thermal and/or mechanical injuries, or a combinati... more media (excessive absorption of liquid or gas), thermal and/or mechanical injuries, or a combination of all of them. During hysteroscopic surgery, there is a potential risk for air or gas to entery the circulation through exposed uterine veins. Large open venous sinuses allow entry of air or gas into the right side of the heart and pulmonary system, especially when there is a favorable pressure gradient created by the Trendelenburg position of the patient and/or the intrauterine distension due to the fluid. Therefore, pulmonary gas embolism is a known complication during operative hysteroscopy that may have significant consequences (3,4). The gas entering This work is licensed by "Creative Commons Attribution-NonCommercial-4.0 International (CC)".

Journal of Cardiothoracic Surgery, Jul 6, 2022

Background: Pain after cardiac surgery is both multifocal and multifactorial. Sternotomy, sternal... more Background: Pain after cardiac surgery is both multifocal and multifactorial. Sternotomy, sternal retraction, internal mammary dissection, posterior rib dislocation or fracture, potential brachial plexus injury, and mediastinal and pleural drains all contribute to pain experienced in the immediate postoperative period. Ineffective pain management can result in systemic and pulmonary complications and significant cardiac consequences. Methods: This study compared the effectiveness of regional anesthesia techniques for perioperative pain management in cardiac surgery patients at our clinic. The effects of different analgesic methods, in terms of contributing to recovery, were examined. Results: The records of 221 patients who had undergone coronary bypass surgery were evaluated retrospectively. The extubation rate in the operating room was 91%. No patient received balloon pump support, and 20 patients were transferred to the cardiovascular intensive care unit while intubated. Regional anesthesia was performed on two of these 20 patients, but not on the remaining 18. Examination of intraoperative and postoperative opioid consumption revealed significantly lower levels among patients receiving regional anesthesia. The most effective results among the regional anesthesia techniques applied were achieved with double injection erector spinae plane block. Conclusion: Regional anesthesia techniques severely limit opioid consumption during cardiac surgery. Their importance will gradually increase in terms of rapid recovery criteria. Based on our study results, double injection of the erector spinae plane block seems to be the most effective technique in cardiac surgery. We therefore favor the use of fascial plane blocks during such procedures. Trial Numbers The study is registered with ClinicalTrials (NCT05282303). Ethics committee registration and approval were Granted under Number 2021.464.IRB1.131.

Anestezi dergisi, Oct 24, 2022

Objective: Appropriate pain treatment before, during, and after surgery positively affects the im... more Objective: Appropriate pain treatment before, during, and after surgery positively affects the immune system and prevents chronic pain. Postoperative thoracotomy pain is both severe and difficult to manage. In addition to systemic opioid and non-opioid analgesics, neuraxial analgesic techniques such as thoracic epidural analgesia or thoracic paravertebral block are widely applied for pain control. Various fascial plane blocks are also used in thoracic surgery. The purpose of this study was to investigate the analgesic effectiveness of regional analgesia techniques used in thoracic surgeries in our clinic. Methods: Following receipt of approval from the Koç University Clinical Research Ethics Committee, the records of 372 patients who underwent video-assisted thoracoscopic surgeries at the VKV American Hospital, Turkey, between January 2019 and December 2021 were reviewed retrospectively. Results: Patients who received epidural analgesia exhibited statistically significantly lower pain scores and postoperative additional analgesic needs (p<0.001). Rhomboid intercostal subserratus block as the most effective option for postoperative analgesia among alternative regional analgesia methods according to postoperative pain scores and postoperative opioid consumption. Conclusion: We still recommend thoracic epidural as the first choice for patient comfort, especially in clinics where thoracic anesthesia experience is high. Moreover, with the increasing prevalence of fascial plane blocks, we think that rhomboid intercostal blocks may be an important alternative in thoracic surgery.

Medicine, Sep 9, 2022

Introduction: Abdominal wall blocks are frequently used due to the use of effective blocks, such ... more Introduction: Abdominal wall blocks are frequently used due to the use of effective blocks, such as the transversus abdominis plane (TAP) block and the widespread use of ultrasound (US) imaging. A good knowledge of abdominal innervation is required for the use of abdominal wall blocks. We describe the extraordinary performance of external oblique intercostal (EOI) blocks in 3 different surgeries. Patient concerns, diagnosis and interventions: Case 1: A man aged 30 to 35 was taken to the operating room for open liver surgery. After surgery, unilateral EOI block and bilateral TAP block were performed with the patient in the supine position, and a catheter was placed under the external oblique muscle. Postoperative analgesia was followed by patient-controlled analgesia (PCA) through the catheter. Case 2: A male patient aged 35 to 40 was taken to the operating room for laparoscopic liver surgery. After surgery, unilateral (EOI) block and bilateral TAP block were performed with the patient in the supine position. The patient received iv tramadol PCA (bolus dose 10 mg only, lockout 20 minutes). Case 3: A man aged 25 to 30 was taken to the operating room for laparoscopic bariatric surgery. After the surgery, bilateral EOI and bilateral rectal sheath blocks were performed with the patient in the supine position. The patient received iv tramadol PCA (bolus dose 10 mg only, lockout 20 minutes). Outcomes: All patients had low NRS scores in the recovery unit and very low opioid consumption in the first 72 hours postoperatively. All were satisfied with the quality of analgesia. Conclusion: We think that EOI block will come to occupy a significant place in upper abdominal analgesia, especially in obese patients, due to its wide innervation area and ease of application.

Background and aims Video-assisted thoracoscopic surgeries contribute positively to postoperative... more Background and aims Video-assisted thoracoscopic surgeries contribute positively to postoperative complications, length of hospital stay and management of pain. We aimed to present our experience in awake thoracoscopic surgeries with high thoracic epidural to the patients with limited functional lung capacity. Methods 8 patients underwent uniportal thoracoscopy and thoracoscopic surgery. Epidural catheter was inserted at the T3-4 level in the operation room. 2 mg of morphine and 25 mg of Bupivacaine were administered from the epidural catheter. T2-L1 sensory block formation was observed in patients. Results Pleurectomy-pleurodesis was performed in 7 and wedge resection in 1 of 8 patients. The mean operation time was 25.4 min, and in 2 patients, operation was 45 min. Two patients had coughing during the operation, stellate ganglion block was performed, and the surgery proceeded. None of the patients developed intraoperative complications. No hemodynamic changes were observed. Conclusions We believe that thoracic epidural, and awake surgery are safe and usable in patients with poor general condition and comorbidities. Two important conditions that can be seen in awake thoracic surgery are coughing during the operation and postoperative period of open pneumothorax. The complaint of cough that may occur is disturbing both the patient‘s comfort and the surgical team, and the stellate ganglion block is highly beneficial in our case. Awake thoracoscopy also begins to take place in Enhanced Recovery After Surgery protocols (ERAS) which are attempting to be devised in thoracic surgery anesthesia. We believe awake thoracoscopic surgery can safely performed in selected patients.

Journal of Clinical Anesthesia, Mar 1, 2020

Regional Anesthesia and Pain Medicine, Oct 30, 2019

Regional Anesthesia and Pain Medicine, Dec 18, 2019

Cureus

The interscalene brachial plexus block (ISBB) constitutes the gold standard for analgesia after s... more The interscalene brachial plexus block (ISBB) constitutes the gold standard for analgesia after shoulder procedures. Ipsilateral phrenic nerve block remains the most common adverse effect after ISBB. Alternative nerve blocks are performed in shoulder surgery in order to prevent hemi-diaphragmatic paralysis (HDP). The purpose of the present study was to investigate the minimum effective local anesthetic volume of 0.5% bupivacaine for postoperative analgesia with an anterior suprascapular nerve block (ASSB). The secondary aim was to investigate diaphragm functions with the local anesthetic doses used while conducting effective volume research. Method This prospective observational study was conducted at the American Hospital of Istanbul, Turkey, from March to July 2022. The initial injected volume of 0.5% bupivacaine was 10 ml. Our clinical experience indicates that this yields a complete sensory block of the anterior suprascapular nerve. In accordance with the up-and-down method, the volume of 0.5% bupivacaine used for a particular patient was determined by the outcome of the preceding block, which represented block success. In case of effective ASSB being achieved, the volume of 0.5% bupivacaine to be administered to the next patient was lowered by 1 ml. In case of block failure, however, the volume of 0.5% bupivacaine to be applied in the subsequent case was increased by 1 ml. Ipsilateral hemi-diaphragmatic movement measurements were taken before (baseline) and 30 minutes after the block. General anesthesia was induced 60 minutes after the completion of the block performance by means of a standardized protocol. Results Sixty-seven patients were included in the study. The ED50 and ED95 calculated for anterior suprascapular nerve block using probit transformation and logistic regression analysis were 2.646 (95% CI, 0.877-2.890) and 3.043 ml (95% CI, 2.771-4.065), respectively. When complete paralysis was defined as 75% or above, partial paralysis as 25-50%, and no paralysis as 25% or less, volumes of 6 ml or lower appeared to cause no paralysis for the anterior suprascapular nerve block. Conclusion We, therefore, recommend using a volume of 6 ml or less in order to achieve diaphragm-sparing features for anterior suprascapular nerve blocks.

Journal of Clinical Anesthesia, 2021

Bilateral rhomboid block may provide complete pain relief following bilateral breast surgery Prop... more Bilateral rhomboid block may provide complete pain relief following bilateral breast surgery Prophylactic bilateral mastectomy combined with breast reconstruction with implants are performed for breast cancer treatment and prophylaxis [1]. Without regional anesthetic techniques surgery may lead to severe postoperative pain. Elsharkawy et al. [2] recently introduced "rhomboid block" providing analgesia for a variety of thoracic surgeries. Altıparmak et al. [3] has shown that rhomboid block reduces opioid requirement following breast surgery. Effective analgesia following surgery has benefits beyond analgesia including enhanced recovery quality and reduced incidence of postmastectomy pain syndrome. It is important to provide effective analgesia using regional techniques with reduced opioid requirement and related side effects [4]. We would like to share our experience on use of bilateral rhomboid block for postoperative analgesia in two female patients who underwent bilateral mastectomy surgery as cancer treatment with concomitant breast reconstruction with implants. Written informed consent to publish the case was obtained from both patients. Following premedication with midazolam 3 mg iv preoperatively, patients were taken to the operating room. Rhomboid block was performed as described by Elsharkawy et al. before general anesthesia induction in prone position. Blocks were done under ultrasound guidance (GE, LOGIQ P9 R3, Seongnam-si, Republic of Korea) with large bandwidth, multifrequency linear probe (4-12 MHz) and a 22G, 50 mm, insulated facet type needle (Braun Sonoplex, Melsungen, Germany). For each side 20 ml of 0,25% bupivacaine was injected be

Cureus, 2021

Introduction Arthroscopic shoulder surgeries are usually performed in a sitting position. The sit... more Introduction Arthroscopic shoulder surgeries are usually performed in a sitting position. The sitting position is known to cause physiological changes related to cardiovascular adaptation. Interscalene nerve blocks (ISB) are the most commonly used techniques and are considered gold standard regional anesthesia methods for shoulder surgeries. Cerebral vessels located around sympathetic ganglia provide sympathetic system integrity. This local anesthetic spreading during ISB could be a side effect or provide a protective effect on cerebral ischemia. Our study aimed to investigate the cerebral protective effect of the ISB in arthroscopic shoulder surgeries in a sitting position. Material and methods After the approval of Koç University Clinical Research Ethics Committee (2020.020.IRB1.011), records of patients between January and December 2019 with shoulder arthroscopy at the Vehbi Koç Foundation (VKV) American hospital were retrospectively reviewed. Records of the hemodynamic response, INVOS TM (Medtronic, Minneapolis, USA) (rSO2) parameters, pain scores, and additional analgesic needs of all cases were examined in the intraoperative and postoperative period. Results Data of 40 patients who met the criteria to be included in the study was analyzed. Our study showed that the sitting position leading to hypotension coincided with a decrease in INVOS values. Nevertheless, we did not record any significant hypotension after ISB, and this may be due to the use of a minimal dose of local anesthetic. There was a certain increase in near-infrared spectroscopy (NIRS) values after ISB. We saw that the value of regional oxygen saturation (rSO2) increased on both the ISB side and the non-ISB side. This shows that the ISB can have a global impact on the brain. Specificially, the increase in rSO2 values in the ISB side compared to the other side suggests that ISB has possible positive effects on cerebral blood flow. Conclusion Our study has shown that ISB may transiently increase the rSO2 levels in the sitting position during shoulder surgery.

Turkiye Klinikleri Neurosurgery - Special Topics, 2019

European Journal of Anaesthesiology, Mar 1, 1996

Background and aims Erector spinae plane (ESP) block is a novel technique in which local anesthet... more Background and aims Erector spinae plane (ESP) block is a novel technique in which local anesthetic (LA) is injected between the erector spinae muscle and transverse process under ultrasound guidance. It has been used as a postoperative analgesia method in many surgical procedures. The mechanism of action is not clear. There are well-described anatomical gaps in the intertransverse connective tissue that might explain how LA can pass from the ESP into the para-vertebral space. Although it is efficient, in real life there is block failure/lack of efficiency that tells us there might be things to consider about the block. We would like to present our modified technique (ESP-3), which aims to be a more reliable block. Methods We performed ESP-3 for 6 patients (1-breast surgery with fleb, 4-thoracoscopic pleurodesis and 1-lobectomy). Blocks were performed at sitting position. A linear-ultrasound probe was placed longitudinal parasagittal orientation. After transverse process (TP) was identified, an 22G-echogenic needle (Braun-StimuplexUltra360) was inserted in-plane caudal-to-cranial approach. The needle tip made contact with TP and 10 ml of LA (Bupivacaine) was given to the fascial plane. Then the needle moves from the most proximal part of the TP, past intertransverse ligament and 15 ml of LA is injected just above the superior costotransverse ligament. Results Before the end of the surgeries, non-steroid anti-inflammatory drug and paracetamol were given. Opioids were not needed. None of the patients complained about the pain. No complication was recorded. Conclusions Facial plane blocks are promising. They can be as effective as epidurals. With our modified ESP technique, we hypothesized a more consistent and reliable block can be achieved.

Research Square (Research Square), Mar 11, 2022

Background: Pain after cardiac surgery is both multifocal and multifactorial. Sternotomy, sternal... more Background: Pain after cardiac surgery is both multifocal and multifactorial. Sternotomy, sternal retraction, internal mammary dissection, posterior rib dislocation or fracture, possible brachial plexus injury, and mediastinal and pleural drains contribute to pain experienced in the immediate postoperative period. Ineffective pain management can cause systemic and pulmonary complications and signi cant cardiac consequences Methods: This study was conducted to compare the effectiveness of regional anesthesia techniques for perioperative pain management in cardiac surgery patients at our clinic. The effects of analgesic methods, in terms of contributing to recovery, have been examined. Results: Records of 229 patients who underwent coronary artery bypass surgery between January 2015 and March 2020 were reviewed. It was also observed that none of the patients received balloon pump support, but 20 were transferred to the Cardiovascular intensive care unit while intubated. The anesthesia methods of patients transferred to intubation intensive care were examined, as regional anesthesia was used in 2 patients, while no regional anesthesia was used in 18 patients. Notably, the consumption of opioids in cases where regional anesthesia was used was statistically low. Conclusion: Regional anesthesia techniques severely limit opioid consumption during cardiac surgery. Its importance will gradually increase in terms of rapid recovery criteria. According to our study results in cardiac surgery, double injection of the erector spinae plane block seems to be the most effective. Thus, we supported the facial plane blocks during cardiac surgery. Trial Number: The study is registered with clinicaltrials. The study has an ethics committee registration and approval with the number 2021.464.IRB1.131.

Background and aims Anesthesia management of oesophageal-atresia with tracheo-oesophageal fistula... more Background and aims Anesthesia management of oesophageal-atresia with tracheo-oesophageal fistula (TOF) repair is a challenge. We report a 48-hour-old neonate, 3050 g (>75 percentile) scheduled for TOF repair. Methods Patient was born at 37 weeks gestation. There were no other coexisting anomalies found. There was a Type-C TOF. Anesthetic plan is combined anesthesia with a thoracic epidural catheter. After routine monitoring general anesthesia induced with sevoflurane%3. While maintaining spontaneous ventilation surgeon perform a rigid-bronchoscopy determined that the fistula is at most distal part of carina. Endotracheal tube is placed and try to preserve spontaneous ventilation so not to inflate the stomach. Within right lateral position ultrasonographic examination done, anatomic structures and epidural depth is defined. Epidural space is determined at 1,3 cm depth with loss of air method through 20G toughy needle. Epidural catheter was placed at 4th thoracic level.%0,1 bupivacaine 1 ml is given for epidural anesthesia. Sevoflurane is reduced to%1,5 during surgery. During right thoracotomy surgeon requested muscle-relaxation. Surgery took 180 minutes. Because it was a complex TOF-repair patient transferred remained intubated to the neonatal intensive-care unit. Results During postoperative period%0,1 bupivacaine 1,5 ml.h-1 infusion started. Minimal sedation needed. Two attempts of extubation failed because of stridor and forced ventilation. Patient extubated at 5th postoperative day and continued with nasal CPAP. Epidural catheter taken out at 5th postoperative day. Conclusions Regional anesthesia reduces stress response and sedation requirements in neonates. Ultrasonography is a valuable tool for neuroaxial techniques especially for neonates. With the aid of ultrasonography, failure rates and complications are also reduced.

Yeni üroloji dergisi, Oct 27, 2022

Robot yardımlı cerrahi, daha küçük kesiler, daha az postoperatif ağrı ve daha az intraoperatif ka... more Robot yardımlı cerrahi, daha küçük kesiler, daha az postoperatif ağrı ve daha az intraoperatif kan kaybı ile günlük aktivitelere daha hızlı dönüş gibi avantajlar sunmaktadır. Torasik epidural analjezi, abdominal cerrahide mükemmel analjezi sağlar. Ancak özellikle torasik epidural analjezinin hipotansif etkisi minimal invaziv cerrahilerin hızlı iyileşmeye olan katkısını gölgede bırakmaktadır. Fasiyal plan blokları bu açıdan daha avantajlı olabilir. Bu çalışmada robotik prostatektomi, nefrektomi ve sistektomi operasyonlarında bölgesel analjezi tekniklerinin etkileri değerlendirildi. Gereç ve Yöntemler: Etik Kurul onayı (2021.467.IRB1.134) alındıktan sonra Ocak 2018 ile Ocak 2022 yılları arasında robotik prostatektomi, nefrektomi ve sistektomi ameliyatı geçiren hastaların kayıtları retrospektif olarak incelendi. Bulgular: Tam dokümantasyona sahip yüz kırk hasta bu çalışmaya dahil edildi. Kullanılan bölgesel analjezi yöntemleri kayıt altına alındı. Epidural analjeziye ek olarak fasyal plan bloklarının kullanıldığı görüldü. Robotik prostat ameliyatlarında transversus abdominis plan ve rektus kılıf blokları, robotik nefrektomi ameliyatlarında ise transversus abdominis plan bloklarının etkili analjezik özellik gösterdiği görülmüştür. Sonuç: Özellikle robotik prostatektomi operasyonlarında transversus abdominis plan bloğu ve rektus kılıf bloğu kombinasyonu etkili postoperatif analjezi sunmaktadır.

Anestezi dergisi, Apr 28, 2022

media (excessive absorption of liquid or gas), thermal and/or mechanical injuries, or a combinati... more media (excessive absorption of liquid or gas), thermal and/or mechanical injuries, or a combination of all of them. During hysteroscopic surgery, there is a potential risk for air or gas to entery the circulation through exposed uterine veins. Large open venous sinuses allow entry of air or gas into the right side of the heart and pulmonary system, especially when there is a favorable pressure gradient created by the Trendelenburg position of the patient and/or the intrauterine distension due to the fluid. Therefore, pulmonary gas embolism is a known complication during operative hysteroscopy that may have significant consequences (3,4). The gas entering This work is licensed by "Creative Commons Attribution-NonCommercial-4.0 International (CC)".

Journal of Cardiothoracic Surgery, Jul 6, 2022

Background: Pain after cardiac surgery is both multifocal and multifactorial. Sternotomy, sternal... more Background: Pain after cardiac surgery is both multifocal and multifactorial. Sternotomy, sternal retraction, internal mammary dissection, posterior rib dislocation or fracture, potential brachial plexus injury, and mediastinal and pleural drains all contribute to pain experienced in the immediate postoperative period. Ineffective pain management can result in systemic and pulmonary complications and significant cardiac consequences. Methods: This study compared the effectiveness of regional anesthesia techniques for perioperative pain management in cardiac surgery patients at our clinic. The effects of different analgesic methods, in terms of contributing to recovery, were examined. Results: The records of 221 patients who had undergone coronary bypass surgery were evaluated retrospectively. The extubation rate in the operating room was 91%. No patient received balloon pump support, and 20 patients were transferred to the cardiovascular intensive care unit while intubated. Regional anesthesia was performed on two of these 20 patients, but not on the remaining 18. Examination of intraoperative and postoperative opioid consumption revealed significantly lower levels among patients receiving regional anesthesia. The most effective results among the regional anesthesia techniques applied were achieved with double injection erector spinae plane block. Conclusion: Regional anesthesia techniques severely limit opioid consumption during cardiac surgery. Their importance will gradually increase in terms of rapid recovery criteria. Based on our study results, double injection of the erector spinae plane block seems to be the most effective technique in cardiac surgery. We therefore favor the use of fascial plane blocks during such procedures. Trial Numbers The study is registered with ClinicalTrials (NCT05282303). Ethics committee registration and approval were Granted under Number 2021.464.IRB1.131.

Anestezi dergisi, Oct 24, 2022

Objective: Appropriate pain treatment before, during, and after surgery positively affects the im... more Objective: Appropriate pain treatment before, during, and after surgery positively affects the immune system and prevents chronic pain. Postoperative thoracotomy pain is both severe and difficult to manage. In addition to systemic opioid and non-opioid analgesics, neuraxial analgesic techniques such as thoracic epidural analgesia or thoracic paravertebral block are widely applied for pain control. Various fascial plane blocks are also used in thoracic surgery. The purpose of this study was to investigate the analgesic effectiveness of regional analgesia techniques used in thoracic surgeries in our clinic. Methods: Following receipt of approval from the Koç University Clinical Research Ethics Committee, the records of 372 patients who underwent video-assisted thoracoscopic surgeries at the VKV American Hospital, Turkey, between January 2019 and December 2021 were reviewed retrospectively. Results: Patients who received epidural analgesia exhibited statistically significantly lower pain scores and postoperative additional analgesic needs (p<0.001). Rhomboid intercostal subserratus block as the most effective option for postoperative analgesia among alternative regional analgesia methods according to postoperative pain scores and postoperative opioid consumption. Conclusion: We still recommend thoracic epidural as the first choice for patient comfort, especially in clinics where thoracic anesthesia experience is high. Moreover, with the increasing prevalence of fascial plane blocks, we think that rhomboid intercostal blocks may be an important alternative in thoracic surgery.

Medicine, Sep 9, 2022

Introduction: Abdominal wall blocks are frequently used due to the use of effective blocks, such ... more Introduction: Abdominal wall blocks are frequently used due to the use of effective blocks, such as the transversus abdominis plane (TAP) block and the widespread use of ultrasound (US) imaging. A good knowledge of abdominal innervation is required for the use of abdominal wall blocks. We describe the extraordinary performance of external oblique intercostal (EOI) blocks in 3 different surgeries. Patient concerns, diagnosis and interventions: Case 1: A man aged 30 to 35 was taken to the operating room for open liver surgery. After surgery, unilateral EOI block and bilateral TAP block were performed with the patient in the supine position, and a catheter was placed under the external oblique muscle. Postoperative analgesia was followed by patient-controlled analgesia (PCA) through the catheter. Case 2: A male patient aged 35 to 40 was taken to the operating room for laparoscopic liver surgery. After surgery, unilateral (EOI) block and bilateral TAP block were performed with the patient in the supine position. The patient received iv tramadol PCA (bolus dose 10 mg only, lockout 20 minutes). Case 3: A man aged 25 to 30 was taken to the operating room for laparoscopic bariatric surgery. After the surgery, bilateral EOI and bilateral rectal sheath blocks were performed with the patient in the supine position. The patient received iv tramadol PCA (bolus dose 10 mg only, lockout 20 minutes). Outcomes: All patients had low NRS scores in the recovery unit and very low opioid consumption in the first 72 hours postoperatively. All were satisfied with the quality of analgesia. Conclusion: We think that EOI block will come to occupy a significant place in upper abdominal analgesia, especially in obese patients, due to its wide innervation area and ease of application.

Background and aims Video-assisted thoracoscopic surgeries contribute positively to postoperative... more Background and aims Video-assisted thoracoscopic surgeries contribute positively to postoperative complications, length of hospital stay and management of pain. We aimed to present our experience in awake thoracoscopic surgeries with high thoracic epidural to the patients with limited functional lung capacity. Methods 8 patients underwent uniportal thoracoscopy and thoracoscopic surgery. Epidural catheter was inserted at the T3-4 level in the operation room. 2 mg of morphine and 25 mg of Bupivacaine were administered from the epidural catheter. T2-L1 sensory block formation was observed in patients. Results Pleurectomy-pleurodesis was performed in 7 and wedge resection in 1 of 8 patients. The mean operation time was 25.4 min, and in 2 patients, operation was 45 min. Two patients had coughing during the operation, stellate ganglion block was performed, and the surgery proceeded. None of the patients developed intraoperative complications. No hemodynamic changes were observed. Conclusions We believe that thoracic epidural, and awake surgery are safe and usable in patients with poor general condition and comorbidities. Two important conditions that can be seen in awake thoracic surgery are coughing during the operation and postoperative period of open pneumothorax. The complaint of cough that may occur is disturbing both the patient‘s comfort and the surgical team, and the stellate ganglion block is highly beneficial in our case. Awake thoracoscopy also begins to take place in Enhanced Recovery After Surgery protocols (ERAS) which are attempting to be devised in thoracic surgery anesthesia. We believe awake thoracoscopic surgery can safely performed in selected patients.

Journal of Clinical Anesthesia, Mar 1, 2020

Regional Anesthesia and Pain Medicine, Oct 30, 2019

Regional Anesthesia and Pain Medicine, Dec 18, 2019

Cureus

The interscalene brachial plexus block (ISBB) constitutes the gold standard for analgesia after s... more The interscalene brachial plexus block (ISBB) constitutes the gold standard for analgesia after shoulder procedures. Ipsilateral phrenic nerve block remains the most common adverse effect after ISBB. Alternative nerve blocks are performed in shoulder surgery in order to prevent hemi-diaphragmatic paralysis (HDP). The purpose of the present study was to investigate the minimum effective local anesthetic volume of 0.5% bupivacaine for postoperative analgesia with an anterior suprascapular nerve block (ASSB). The secondary aim was to investigate diaphragm functions with the local anesthetic doses used while conducting effective volume research. Method This prospective observational study was conducted at the American Hospital of Istanbul, Turkey, from March to July 2022. The initial injected volume of 0.5% bupivacaine was 10 ml. Our clinical experience indicates that this yields a complete sensory block of the anterior suprascapular nerve. In accordance with the up-and-down method, the volume of 0.5% bupivacaine used for a particular patient was determined by the outcome of the preceding block, which represented block success. In case of effective ASSB being achieved, the volume of 0.5% bupivacaine to be administered to the next patient was lowered by 1 ml. In case of block failure, however, the volume of 0.5% bupivacaine to be applied in the subsequent case was increased by 1 ml. Ipsilateral hemi-diaphragmatic movement measurements were taken before (baseline) and 30 minutes after the block. General anesthesia was induced 60 minutes after the completion of the block performance by means of a standardized protocol. Results Sixty-seven patients were included in the study. The ED50 and ED95 calculated for anterior suprascapular nerve block using probit transformation and logistic regression analysis were 2.646 (95% CI, 0.877-2.890) and 3.043 ml (95% CI, 2.771-4.065), respectively. When complete paralysis was defined as 75% or above, partial paralysis as 25-50%, and no paralysis as 25% or less, volumes of 6 ml or lower appeared to cause no paralysis for the anterior suprascapular nerve block. Conclusion We, therefore, recommend using a volume of 6 ml or less in order to achieve diaphragm-sparing features for anterior suprascapular nerve blocks.

Journal of Clinical Anesthesia, 2021

Bilateral rhomboid block may provide complete pain relief following bilateral breast surgery Prop... more Bilateral rhomboid block may provide complete pain relief following bilateral breast surgery Prophylactic bilateral mastectomy combined with breast reconstruction with implants are performed for breast cancer treatment and prophylaxis [1]. Without regional anesthetic techniques surgery may lead to severe postoperative pain. Elsharkawy et al. [2] recently introduced "rhomboid block" providing analgesia for a variety of thoracic surgeries. Altıparmak et al. [3] has shown that rhomboid block reduces opioid requirement following breast surgery. Effective analgesia following surgery has benefits beyond analgesia including enhanced recovery quality and reduced incidence of postmastectomy pain syndrome. It is important to provide effective analgesia using regional techniques with reduced opioid requirement and related side effects [4]. We would like to share our experience on use of bilateral rhomboid block for postoperative analgesia in two female patients who underwent bilateral mastectomy surgery as cancer treatment with concomitant breast reconstruction with implants. Written informed consent to publish the case was obtained from both patients. Following premedication with midazolam 3 mg iv preoperatively, patients were taken to the operating room. Rhomboid block was performed as described by Elsharkawy et al. before general anesthesia induction in prone position. Blocks were done under ultrasound guidance (GE, LOGIQ P9 R3, Seongnam-si, Republic of Korea) with large bandwidth, multifrequency linear probe (4-12 MHz) and a 22G, 50 mm, insulated facet type needle (Braun Sonoplex, Melsungen, Germany). For each side 20 ml of 0,25% bupivacaine was injected be

Cureus, 2021

Introduction Arthroscopic shoulder surgeries are usually performed in a sitting position. The sit... more Introduction Arthroscopic shoulder surgeries are usually performed in a sitting position. The sitting position is known to cause physiological changes related to cardiovascular adaptation. Interscalene nerve blocks (ISB) are the most commonly used techniques and are considered gold standard regional anesthesia methods for shoulder surgeries. Cerebral vessels located around sympathetic ganglia provide sympathetic system integrity. This local anesthetic spreading during ISB could be a side effect or provide a protective effect on cerebral ischemia. Our study aimed to investigate the cerebral protective effect of the ISB in arthroscopic shoulder surgeries in a sitting position. Material and methods After the approval of Koç University Clinical Research Ethics Committee (2020.020.IRB1.011), records of patients between January and December 2019 with shoulder arthroscopy at the Vehbi Koç Foundation (VKV) American hospital were retrospectively reviewed. Records of the hemodynamic response, INVOS TM (Medtronic, Minneapolis, USA) (rSO2) parameters, pain scores, and additional analgesic needs of all cases were examined in the intraoperative and postoperative period. Results Data of 40 patients who met the criteria to be included in the study was analyzed. Our study showed that the sitting position leading to hypotension coincided with a decrease in INVOS values. Nevertheless, we did not record any significant hypotension after ISB, and this may be due to the use of a minimal dose of local anesthetic. There was a certain increase in near-infrared spectroscopy (NIRS) values after ISB. We saw that the value of regional oxygen saturation (rSO2) increased on both the ISB side and the non-ISB side. This shows that the ISB can have a global impact on the brain. Specificially, the increase in rSO2 values in the ISB side compared to the other side suggests that ISB has possible positive effects on cerebral blood flow. Conclusion Our study has shown that ISB may transiently increase the rSO2 levels in the sitting position during shoulder surgery.