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Gamze Ertaş,1 Hamiyet Şenol Çakmak,1 Sevda Akdeniz,1 Alparslan Yurtbay,2 Ebru Polat,2 Yavuz Yigit,3,4 Nezih Sertöz,5 Serkan Tulgar1 1Department of Anesthesiology, Samsun University Faculty of Medicine, Samsun Training and Research Hospital, Samsun, Turkiye; 2Department of Orthopedic Surgery, Samsun University Faculty of Medicine, Samsun Training and Research Hospital, Samsun, Turkiye; 3Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar; 4Blizard Institute, Queen Mary University, London, UK; 5Department of Anesthesiology and Reanimation, Ege University, Faculty of Medicine, İzmir, TurkiyeCorrespondence: Yavuz Yigit, Hamad Medical Corporation,Hamad General Hospital, Department of Emergency Medicine, Hamad General Hospital, Emergency Department, Doha, 3050, Qatar, Tel +97430616054, Email yyigit@hamad.qaIntroduction: Hip fracture surgeries in patients present significant challenges, particularly in managing pain during spinal anesthesia positioning. The Pericapsular Nerve Group Block (PENG) has shown promise in addressing this issue, but the ideal volume of local anesthetic for PENG is still uncertain. In our study, we aimed to analyze the effects of administering PENG block with two different volumes on analgesic quality for patients undergoing hip fracture surgery.Methods: In this prospective, randomized controlled trial, the effects of administering a PENG block with 20 mL versus 30 mL of local anesthetic in patients undergoing hip fracture surgery under spinal anesthesia were compared. The primary outcome was pain during spinal anesthesia positioning, and secondary outcomes included postoperative pain scores and opioid consumption.Results: A total of 60 patients were analyzed, with 30 in each group. Critical parameters such as the time of spinal anesthesia administration and the satisfaction of the anesthesiologist showed no significant differences (p=0.918; p=0.741, respectively). NRS scores recorded before, during, and after the positioning for spinal anesthesia exhibited similar patterns (p=0.290; p=0.247; p=0.288, respectively). The cumulative opioid requirements did not exhibit a statistically significant difference at 24 hours (p = 0.098). Quadriceps weakness was significantly more in the PENG-30 group 6 hours after surgery but had recovered by the 9th hour (p= 0.004).Conclusion: In patients undergoing hip fracture surgery, the effects of applying the PENG block with 20 mL or 30 mL of local anesthetic are comparable in terms of positioning for spinal anesthesia and postoperative analgesic requirements.Keywords: hip fracture surgery, pericapsular nerve group block, PENG, spinal anesthesia positioning, postoperative analgesia, local anesthetic volume

Serkan Tulgar,1 Muhammed Enes Aydin,2,3 Ali Ahiskalioglu,2,3 Alessandro De Cassai,4 Yavuz Gurkan5 1Maltepe University Faculty of Medicine, Department of Anesthesiology and Reanimation, Istanbul, Turkey; 2Ataturk University School of Medicine, Department of Anaesthesiology and Reanimation, Erzurum, Turkey; 3Clinical Research, Development and Design Application and Research Center, Ataturk University School of Medicine, Erzurum, Turkey; 4Anaesthesiology and Intensive Care, University Hospital of Padua, Padua, Italy; 5Koc University, Faculty of Medicine Department of Anesthesiology and Reanimation, Istanbul, TurkeyCorrespondence: Serkan TulgarMaltepe University Hospital, Maltepe, Istanbul, TurkeyTel +905055423985Email serkan.tulgar@maltepe.edu.trAbstract: Defined in the last decade, erector spinae plane block (ESPB) is one of the more frequently used interfacial plans, and it has been the most discussed block among the recently defined techniques. Lumbar ESPB administered at lumbar levels is relatively novel and is a new horizon for regional anesthesia and pain practice. In this article, we aim to explain and introduce different approaches and explain the possible mechanism of action of lumbar ESPB. The objective of this review is to analyze the case reports, clinical and cadaveric studies about lumbar ESPB that have been published to date. We performed a search in “Pubmed” and “Google Scholar” database. After a selection of the relevant studies, 59 articles were found eligible and were included in this review. While we believe that lumbar ESPB is reliable and easy, we suggest that its efficacy and indications should be verified with anatomical and clinical studies, and its safety should be confirmed with pharmacokinetic studies. Moreover, the possibility of complications must be considered.Keywords: lumbar erector spinae block, regional anesthesia, interfascial plane blocks

Serkan Tulgar,1 Ali Ahiskalioglu,2 Alessandro De Cassai,3 Yavuz Gurkan41Department of Anesthesiology and Reanimation, Faculty of Medicine, Maltepe University, Istanbul, Turkey; 2Department of Anaesthesiology and Reanimation, School of Medicine, Ataturk University, Erzurum, Turkey; 3Section of Anaesthesiology and Intensive Care, Department of Medicine (DIMED), University of Padua, Padua, Italy; 4Department of Anesthesiology and Reanimation, Faculty of Medicine, Koç University, Istanbul, TurkeyCorrespondence: Serkan Tulgar Fakültesi Maltepe, Üniversitesi Hastanesi, 39 Feyzullah Caddesi, Maltepe, Istanbul, TurkeyTel +90 505 542 3985Email serkantulgar.md@gmail.comAbstract: Erector spinae plane block (ESPB) is a newly described interfascial plane block, and the number of articles on the bilateral application of ESPB is increasing in the literature. In this paper, in addition to analyzing bilateral ESPB cases and studies published so far, we aimed to review the relevant anatomy, describe the mechanism of spread of the injectant, demonstrate varying approaches to ESPB, and summarize case reports and clinical trials, as well as provide current insight on this emerging and popular block. Randomized controlled studies, comparative studies of ESPB versus other methods, and pharmacokinetic studies of bilateral applications must be the next step in clearly understanding bilateral ESPB.Keywords: bilateral erector spinae block, regional anesthesia, interfascial plane blocks

Background: Effective pain management in pediatric cardiac surgery is essential for optimizing postoperative outcomes and promoting faster recovery. While intravenous analgesia remains a standard approach, regional anesthesia (RA) techniques have gained attention in this population due to their analgesic efficacy, reduced dependence on systemic opioids, and enhanced hemodynamic stability., Main Body: This article provides an overview of current evidence of RA techniques for pediatric cardiac surgery. We discuss the role of RA in pediatric pain management, outlining various techniques, such as epidural, paravertebral block, fascial plane blocks and their specific applications, clinical outcomes, and the challenges posed by pediatric anatomy and pharmacokinetics. Pain assessment in pediatric populations and the complications associated with RA are also explored., Conclusion: Despite the demonstrated efficacy of RA in this patient group, there is a need for large-scale randomized multicenter studies to establish standardized protocols and strengthen the evidence base for its use in pediatric cardiac surgery., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: Burhan Dost is an editorial board member of BMC Anesthesiology. All other authors declare no competing interests., (© 2025. The Author(s).)

Introduction: The modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) has been proposed as an effective regional anesthesia technique for reducing postoperative opioid consumption in patients undergoing laparoscopic cholecystectomy (LC). We conducted this systematic review and meta-analysis with trial sequential analysis to assess the analgesic efficacy of M-TAPA block in LC., Evidence Acquisition: We searched Pubmed Central, Scopus and Cochrane Central Register of Controlled Trials (from inception to until 1 July 2024). The effects of the M-TAPA were compared with those of sham block, placebo and no intervention. Randomized controlled trials, observational and retrospective studies were included. The primary outcome was postoperative opioid consumption at 24 hours, while secondary outcomes included pain scores at 12 and 24 hours, postoperative nausea and vomiting (PONV), and rescue analgesic requirements., Evidence Synthesis: This meta-analysis included six studies encompassing four randomized controlled trials, one retrospective study, and one prospective observational study, with a total of 350 patients. The analysis demonstrated a significant reduction in postoperative opioid consumption (MD -9.06; 95% CI -11.6 to -6.48, P=0.001) in the M-TAPA group. Additionally, patients receiving M-TAPA reported lower pain scores at 12 and 24 hours postoperatively. The risk of PONV was significantly reduced (OR 0.19; 95% CI 0.10 to 0.39, P=0.001), and fewer patients required rescue analgesics (OR 0.24; 95% CI 0.09 to 0.65, P=0.05)., Conclusions: M-TAPA block provides superior analgesia when compared with control group in LC.

Quadro-iliac plane block (QIPB) is a novel regional anesthesia technique that provides analgesia in the abdominal, lumbar, and hip regions. Case reports about the efficacy of this block in the literature are limited. In this report, we would like to share our successful QIPB experience with a patient with chronic myofascial low back pain., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 International Anesthesia Research Society.)

Introduction: Sedation is often required during flexible fiberoptic bronchoscopy (FFB) to ensure patient comfort and the success of the procedure. The choice of sedative agents may differ between anesthesiologists and pulmonologists. This pilot study aimed to investigate the current pre-procedure preparation, monitoring, premedication and sedation practices for FFB in Türkiye, focusing on the preferences and practices of pulmonologists., Materials and Methods: A structured survey consisting of 30 questions was distributed to pulmonologists at various hospitals in Türkiye via Google Forms. A total of 97 responses were received, of which 80 were analyzed. Participants were divided into two groups based on their FFB experience: Group 1 with ≥10 years of experience and Group 2 with <10 years of experience., Result: The majority of pulmonologists ordered complete blood count, biochemistry, and coagulation tests before the procedure. The most preferred oral ingestion duration was 6-8 hours. Additionally, 98% of the physicians reported using at least one agent for premedication purposes. Routine topical local anesthetic use was high in both groups (88.3% and 85%, respectively). In addition, 40% of the physicians stated that they always applied sedation during FOB, and 48% stated that they applied sedation in certain situations, and that patient request was the most effective factor. Without the assistance of an anesthesiologist, pulmonologists preferred mono midazolam or a combination of midazolam and fentanyl for sedation. In Group I, two physicians reported using dexmedetomidine for combination sedation. It was also determined that propofol was not used in cases where an anesthesiologist was not available. Additionally, 47% of the physicians reported that they found current sedation practices completely adequate., Conclusions: Findings highlight the variability in sedation practices for FFB in Türkiye and underscore the need for standardized guidelines to optimize patient care and procedural outcomes. This study can be considered as a fundamental step towards more comprehensive studies by pulmonologists.

Background: The impact of routine preoperative anesthesia evaluations on potential perioperative complications remains unclear. This study aimed to investigate the effect of preoperative evaluation on early perioperative hemodynamic and respiratory complications., Methods: This prospective observational study analyzed data from patients aged 18 to 80 who underwent elective surgery between October 15, 2023, and February 15, 2024. The study evaluated the effect of preoperative anesthesia evaluation on hemodynamic and respiratory complications occurring during surgery and within the first 24 h postoperatively, as well as its impact on the length of hospital stay., Results: The analysis included 1117 patients for whom complete data was available. Hemodynamic and respiratory complications were observed in 545 patients (48.7%), occurring within the first 24 h intraoperatively and postoperatively. Because no additional examinations beyond routine blood tests, radiological imaging, and electrocardiograms were performed in the preoperative period, the impact of these tests on the development of hemodynamic and respiratory complications could not be determined. There was no statistically significant association between the presence or absence of preoperative consultation and the occurrence of early perioperative hemodynamic and respiratory complications [OR (95% CI): 0.879 (0.646-1.195); P = 0.411], nor did it affect the length of hospital stay [median (IQR); 2 (3) vs. 2 (3); P = 0.245]., Conclusion: While the impact of routinely requested laboratory and imaging methods before surgery could not be assessed in this study, consultations that were requested did not affect hemodynamic and respiratory complications in the early perioperative period or on the duration of hospital stay., Trial Registration Number: Samsun University Samsun Training and Research Hospital, following ethics committee approval (Samsun University clinical research ethics committee (KAEK) 2.12.2023) and Clinical Trials (NCT06203171 / 04.18.2024) registration., Competing Interests: Declarations. Human ethics and consent to participate declarations: The study was approved by the Samsun University Samsun Training and Research Hospital Ethics Committee (Samsun University Clinical Research Ethics Committee (KAEK) 02.12.2023). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. Consent to participate: Not applicable., (© 2024. The Author(s).)

Background: Inconsistent nomenclature and anatomical descriptions of regional anesthetic techniques hinder scientific communication and engender confusion; this in turn has implications for research, education and clinical implementation of regional anesthesia. Having produced standardized nomenclature for abdominal wall, paraspinal and chest wall regional anesthetic techniques, we aimed to similarly do so for upper and lower limb peripheral nerve blocks., Methods: We performed a three-round Delphi international consensus study to generate standardized names and anatomical descriptions of upper and lower limb regional anesthetic techniques. A long list of names and anatomical description of blocks of upper and lower extremities was produced by the members of the steering committee. Subsequently, two rounds of anonymized voting and commenting were followed by a third virtual round table to secure consensus for items that remained outstanding after the first and second rounds. As with previous methodology, strong consensus was defined as ≥75% agreement and weak consensus as 50%-74% agreement., Results: A total of 94, 91 and 65 collaborators participated in the first, second and third rounds, respectively. We achieved strong consensus for 38 names and 33 anatomical descriptions, and weak consensus for five anatomical descriptions. We agreed on a template for naming peripheral nerve blocks based on the name of the nerve and the anatomical location of the blockade and identified several areas for future research., Conclusions: We achieved consensus on nomenclature and anatomical descriptions of regional anesthetic techniques for upper and lower limb nerve blocks, and recommend using this framework in clinical and academic practice. This should improve research, teaching and learning of regional anesthesia to eventually improve patient care., Competing Interests: Competing interests: EA: grants from Swiss Academy for Anesthesia Research, Bbraun, Swiss National Science Foundation. Honoraria from Bbraun and Sintetica. JG: consulting fees from Pacira Biosciences and Pajunk Medical. AP: honoraria from FuijiFilm Sonosite. MW: advisory Board for Sintetica, Honoraria from Wisonic and Medovate. SA: Advisory Panel for DATAR innovations. JA: moderator of the Working Group Regional Anaesthesia Switzerland, Honoraria from Medtronic and Sintetica. AMRA: honoraria form AllerganSébastien Bloc—Consulting fees from BBraun—GE Medical Systems—Pajunk—Pfizer SAS. JB: Consulting fees from Intelligent Ultrasound. BC: jonoraria from Bbraun and Rivanna, Consulting from Stryker and Flat Medical, Research funding from Pacira, Share Options from Flat Medical. AC: speaking honoraria from GE Healthcare, royalties from textbook Oxford University Press. SC: consulting fees from MSD, Bbraun Medical, Wisonic, research grants from BARA (Belgian association of Regional anesthesia), ESRA and BeSARP (Belgian anesthesia society) HE-Consulting/Advisory Board Neuronoff, SPR, GateScience, NeuronoffBenjamin Fox—Speaking fees from Medovate and Sintetica. SG: consulting and speaking fees from MSD Switzerland. PH: royalties from Bestek Products. NH: Honoraria from Butterfly Network. RMGH- Honoraria from GE Healthcare. MH: consulting fees from Pacira Biosciences, Honoraria from Parcira Biosciences and Pajunk Medical. BMI: research funding to institution from SPR Therapeutics, Infutronix, Epimed International. AM: Consultant fees from Intelligent Ultrasound. CM: consultant fees from Masimo Corporation. SGM: Owner SGM Consulting, Partner Parvizi Surgical Innovations, Patent for Multicatheter infusion system. AN: Research support from SPR Therapeutics. SLO: Royalties from book Wolters-Kluwer. APawa: Honoraria from GE Healthcare, Consulting fees from Pacira Biosciences. PP: equipment support from Sonosiite Fujifilm Canada. MPS: Medovate speaking but no honoraria paid. SKS- Cofounder of Gate Science (developing a catheter for performing nerve blocks) JS: consulting fees from Sintetica. RT: Consulting fees from Clarius Mobile Health. VU: Associate Editor of the Canadian Journal of Anesthesia and Regional Anesthesia & Pain Medicine journals. TV: honoraria from CSL Behring, Pajunk., (© American Society of Regional Anesthesia & Pain Medicine 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Several studies demonstrate that both external oblique ıntercostal block (EOIB) and modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) contribute to analgesia in the anterior abdomen by targeting the thoracoabdominal nerves through distinct pathways. However, the sensory assessment and dermatomal analysis remain poorly understood., Methods: This prospective observational study aimed to determine the sensory assessment and dermatomal regression rate of EOIB and M-TAPA in patients undergoing laparoscopic cholecystectomy. The study included a total of 24 patients, with 12 patients in each group. Blocks were performed bilaterally, administering 25 mL of bupivacaine 0.25% for each side, resulting in a total volume of 50 mL. The anterior abdominal wall was vertically partitioned into the midabdomen, left-lateral abdomen, and right-lateral abdomen, and horizontally divided into the epigastric, umbilical, and hypogastric regions. Sensory block was assessed at the 45 th minute with cold stimulus and pinprick. Subsequent evaluations were at intervals of 6, 10, 14, 18, 22, and 24 hours., Results: The blocked area percentile with cold sensation in the anterior abdomen was 43.07% (36.67-55.74) with EOIB, 40.49% (34.05-43.67) with M-TAPA (P=0.3219). When the region above the intertubercular plane was examined with cold sensation, EOIB covered 55.92% (46.75-62.07), and M-TAPA covered 49.60% (40.39-54.03) of the epigastric and umbilical areas. Assessment of the midabdominal portion of the anterior abdomen revealed that the blocked area percentile was statistically significantly higher in the M-TAPA group with both cold sensation and pinprick. At 45 minutes, the percentage of blocked dermatomes was 100% between T7-T8 in the EOIB group and between T7-T10 in the M-TAPA group. Both groups exhibited lower success rates in dermatomes T5 and T12, with no sensory block within the L1 dermatome, and cutaneous dermatomal block status either absent or negligible after 24 hours. All trocar entries were located within the cutaneous sensory block for both blocks, except for trocar C, which was located most laterally., Conclusions: Bilateral EOIB and M-TAPA produce a comparable sensory cutaneous block in the anterior abdomen, particularly in the umbilical and epigastric regions. Additionally, the midabdominal cutaneous blocked area was greater in patients undergoing M-TAPA, suggesting a more consistent distribution along the anterior cutaneous branches of the thoracoabdominal nerves.

Ischemic stroke, caused by the interruption of the blood supply to the brain, requires prompt medical intervention to prevent irreversible damage. Anesthetic management is pivotal during surgical treatments like mechanical thrombectomy, where precise strategies ensure patient safety and procedural success. This narrative review highlights key aspects of anesthetic management in ischemic stroke, focusing on preoperative evaluation, anesthetic choices, and intraoperative care. A rapid yet thorough preoperative assessment is crucial, prioritizing essential diagnostic tests and cardiovascular evaluations to determine patient frailty and potential complications. The decision between general anesthesia (GA) and conscious sedation (CS) remains debated, with GA offering better procedural conditions and CS enabling continuous neurological assessment. The selection of anesthetic agents-such as propofol, sevoflurane, midazolam, fentanyl, remifentanil, and dexmedetomidine-depends on local protocols and expertise balancing neuroprotection, hemodynamic stability, and rapid postoperative recovery. Effective blood pressure management, tailored airway strategies, and vigilant postoperative monitoring are essential to optimize outcomes. This review underscores the importance of coordinated care, incorporating multimodal monitoring and maintaining neuroprotection throughout the perioperative period.

Introduction: Breast cancer is the most prevalent cancer among women, often necessitating surgical intervention. While surgeries like lumpectomy can be performed under local anesthesia, more extensive procedures typically require general anesthesia. Awake breast cancer surgery has emerged as an alternative due to risks associated with general anesthesia and patient preference., Methods: This prospective observational study, conducted from July 2022 to July 2023, evaluated the effectiveness of ultrasound-guided fascial plane blocks for awake breast surgery. Patients aged 18-80 years undergoing unilateral breast surgery were included, following ethical committee approval and written informed consent. Exclusion criteria were prior breast surgery, coagulopathies, infections, allergies to local anesthetics, psychiatric disorders, body mass index over 40 kg/m², and chest deformities. The combination of interpectoral, pecto-serratus, and deep serratus plane blocks was used as the primary anesthetic method, with a superficial parasternal block added in cases where complete cutaneous coverage was not achieved., Results: Seventeen patients were enrolled. The primary outcome, sufficient surgical anesthesia without deep sedation, was achieved in 15 patients. The combination of the aforementioned blocks proved effective, with an average surgery duration of 59.66 min, and propofol requirements averaging 1.77 mg/kg/hour. Most patients reported high satisfaction levels, and no early or late block-related complications were observed., Conclusion: The combination of fascial plane blocks is a viable option for awake breast cancer surgery, potentially eliminating the need for more invasive anesthesia techniques. Further studies are necessary to confirm these findings in larger, homogeneous patient groups., (© 2024. The Author(s).)

Background: The Modified Early Obstetric Warning System (MEOWS) is a score-based or color-coded system that detects changes in physiological parameters and enables earlier diagnosis and care of worsening obstetric patients. The aim of this study is to evaluate the tool's performance and contribute to its use in Türkiye by translating MEOWS into Turkish., Methods: This prospective and descriptive study, approved by the local ethics committee, included 350 obstetric in-patients who gave birth at Samsun Training and Research Hospital, Gynecology and Children's Hospital between April and August 2022. The study involved patients with a gestational week greater than 28 weeks and up to six weeks postpartum., Results: The average age of the patients was 28.9±5.9 (18-40) years, with trigger values occurring in 34.6% (n=121) and morbidity occurring in 30.9% (n=108) of the cases. The most common trigger among the individual physiological indicators was high systolic blood pressure (28.3%). When the performance of MEOWS was evaluated, a statistically significant correlation was found between trigger and morbidity (Kappa=0.605; p<0.001). The sensitivity of MEOWS in estimating morbidity was 77.78% (95% confidence interval [CI]: 68.76-85.21%), specificity was 84.71% (95% CI: 79.55-89.00%), Positive Predictive Value (PPV) was 69.42% (95% CI: 62.40-75.64%), Negative Predictive Value (NPV) was 89.52% (95% CI: 85.67-92.43%), and accuracy was 82.57% (95% CI: 78.18-86.40%)., Conclusion: MEOWS was found to be an effective screening tool for predicting morbidity in this study and performs well in Turkish with sufficient sensitivity, specificity, and accuracy. However, the inclusion of long-term results would provide a more comprehensive understanding of the effectiveness of MEOWS.

Background and Objectives : Despite numerous described techniques, laparoscopy has yet to replace open surgery as the gold standard for inguinal hernia (IH) repair in children. This may be due to many variables, including the lack of long-term follow-up and concern for increased recurrence. In this study, we present our long-term follow-up data on children undergoing percutaneous internal ring suturing (PIRS) for IH repair. Materials and Methods : This retrospective cohort study included children who underwent PIRS for IH between May 2013 and May 2021 at three tertiary care institutions, with at least three years of follow-up. Age at surgery, side of IH, presence of contralateral patent processus vaginalis, surgical and anesthesia time, and complications were noted. Parents were contacted to enquire about long-term complications, such as recurrence. Results : Long-term follow-up (average 6.9 ± 2.3 years) was available for 714 patients. For unilateral and bilateral procedures, the average surgical time was 13.6 ± 5.4 and 19.9 ± 3.0, and the average anesthesia time was 27.7 ± 12.9 and 33.9 ± 14.1 min, respectively. Complications were seen in 0.84% of patients and 1.2% of procedures, and recurrence was observed in 0.98% of patients and 0.78% of procedures. Conclusions : Our study, with a nearly 7-year follow-up, provides substantial evidence that PIRS is a safe and effective technique for IH repair in children, with low recurrence and complication rates. Despite the study's retrospective nature and limited sample size, it contributes valuable data supporting the use of PIRS in pediatric IH repair.

Ultrasound (US)-guided cervical selective nerve root block (CSNRB) procedures are increasingly being performed as an alternative to conventional fluoroscopy (FL)-guided epidural injections for the treatment of cervical radicular pain. The aim of this study was to compare the effectiveness of US-guided CSNRB versus FL-guided interlaminar cervical epidural steroid injection (IL-CESI) for cervical radicular pain. A total of 60 patients with cervical radicular pain due to a single-level disc herniation were randomized into either the FL or US group. The numeric rating scale, Short Form-36, and neck disability index were evaluated before treatment at months 1, 3, and 6 after treatment. Procedure time, complications, pain medication consumption, and patient satisfaction were also recorded. Patients experienced significant improvement in pain, disability, and quality of life scores up to 6 months after the procedure ( p < 0.001). Treatment success rate was achieved in 56.6% of the IL-CESI group and 50% of the CSNRB group without any significant difference between the study arms ( p = 0.617). US-guided CSNRB was shown to be as effective as the FL-guided IL-CESI in the treatment of cervical radicular pain, in addition to the absence of radiation exposure and requiring less procedure time.

The parasternal blocks cannot cover the T7 and lower anterior and lateral branches of the thoracoabdominal nerves. In the open heart surgeries, chest drainage tubes are generally outside the target of the parasternal blocks. Recently, Tulgar et al described a novel interfascial plane block technique named "recto-intercostal fascial plane block" (RIFPB). RIFPB is performed between the rectus abdominis muscle and the sixth to seventh costal cartilages. RIFPB targets the anterior and lateral cutaneous branches of the T6-T9 thoracoabdominal nerves. In this clinical report, we want to share our experiences about pectointercostal plane block and RIFPB combination (Medipol Combination) after cardiac surgery., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 International Anesthesia Research Society.)