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Yayın Comparison of ultrasound-guided lumbar erector spinae plane block and transmuscular quadratus lumborum block for postoperative analgesia in hip and proximal femur surgery: A prospective randomized feasibility study(National Center for Biotechnology Information Search database, 2018) Tulgar, Serkan; Köse, Halil Cihan; Selvi, Onur; Şentürk, Özgür; Thomas, David Terence; Ermiş, Mehmet Nurullah; Özer, ZelihaStudy Objective: Lumbar Erector spinae Plane block (L?ESPB) is a modification of a recently described block. Both L?ESPB and Transmuscular Quadratus Lumborum block (QLB?T) have been reported to provide effective postoperative analgesia in hip and proximal femur surgery. Herein, we compare the effectiveness of L?ESPB and QLB?T in providing postoperative analgesia in patients undergoing hip and femur operations. Design: Double?blinded, prospective, randomized, feasibility study. Setting: Tertiary university hospital, postoperative recovery room and ward. Methodology: A total of 72 patients (American Society of Anesthesiology physical status classification II?III) were recruited. After exclusion, 60 patients were allocated to three equal groups (control, L?ESB and QLB?t). Interventions: Standard multimodal analgesia was performed in the control group while L?ESPB or QLB?T was performed in the block groups. Measurements: Pain intensity between groups was compared using Numeric Rating Scores. Furthermore, tramadol consumption and additional rescue analgesic requirement was measured. Results: There was no difference between demographic data or type of surgery. While there was no difference in Numeric Rating Scale (NRS) score at any hour between the block groups; NRS scores at the 1st, 3rd and 6th h, tramadol consumption during the first 12 h and total tramadol consumption, the number of patient required rescue analgesic in 24 h were significantly higher in the control group compared to both block groups. Conclusion: While L?ESPB and QLB?T have similar effect, they improve analgesia quality in patients undergoing hip and proximal femoral surgery when compared to standard intravenous analgesia regimen.Yayın The effects of dexmedetomidine based sedation for noninvasive mechanical ventilation(Maltepe Tıp Dergisi, 2017) Şentürk, Özgür; Demirkıran, Oktay; Utku, Tuğhan; Ürkmez, Seval; Dikmen, YalımAim: Noninvasive mechanical ventilation (NIMV) is associated with a large number of failures, and patient refusal. The purpose of the study was to assess the feasibilty and safety of dexmedetomidine during NIMV. Methods: The patients allocated randomly in to two groups; Dexmedetomidine (D) group and control (C) group. In D group, Dexmedetomidine infusion rate was set between 0,2-0,7 ?gr/kg/hour to reach a Ramsey sedation score (RSS) between 3-4. Mean arterial pressure, heart rate, respiratory rate, blood gas analysis, PaO2/FIO2 and RSS documented at 1 min, 10 min, 30 min,1 hour, 4 hour, 24 hours after Dexmedetomidine infusion started and after the end of infusion and at non invasive mechanical ventilation support cessation in any reason. Result: Thirty patients under NIMV support with agitation and ventilatory dyssynchrony were included in this study. In D group mean arterial pressure, heart rate, respiratory rate measurements were significantly lower than C group. RSS shown significant rises (1 to 3) at the period between 1th min to 10th min to the cessation time in D group (p<0.01) and PaO2/FIO2 values were significantly higher than control group. Conclusion: Dexmedetomidine is safe and effective agent for the sedation of the patients under NIMV support.Yayın Evaluation of ultrasound-guided transversalis fascia plane block for postoperative analgesia in caesarean section: a prospective, randomized, controlled clinical trial(Regional Anesthesia & Pain Medicine, 2019) Şerifsoy, Talat Ercan; Tulgar, Serkan; Selvi, Onur; Şentürk, Özgür; İlter, Erdin; Haliloğlu Peker, Berna; Özer, ZelihaBackground and aims: Caesarean section (C/S) is a commonly performed obstetric procedure causing a somatic pain and a visceral pain. Pain treatment leads to decreased maternal morbidity, early mobilization and increases patient satisfaction. Adding a regional anesthesia technique to multimodal analgesia in C/S, improves the quality of postoperative care. In this study, we evaluated the effectiveness of transversalis fascia plane block (TFPB) first time for postoperative analgesia management in C/S. Although it is an old and practical block currently it was only investigated in a few studies. Methods: The study was approved by the local ethics committee and the study was registered with clinicaltrials.gov (NCT03741452). Following exclusion, patients were randomized equally as block and control group. Standard multimodal analgesia was performed in Group C while TFPB block was also performed in the intervention (TFPB) group. Our primary outcome was to evaluate Tramadol consumption and additional rescue analgesic requirement. Our secondary outcome was to assess pain intensity between groups with numeric rating scores. Results: Seventy-five patients (ASA I-II) were recruited. NRS scores were lower in Group TFPB during the first 3 hours and at the 12th hour. Tramadol consumption at 3rd, 6th and 12th hours and in the first 24 hours was lower in Group TFPB (p<0.01) (figure 1). NRS scores were lower in the block group at 1st, 3rd and 12th hours (p<0.01, p<0.01 and p<0.01 respectively).Yayın FLUMAZENİL BENZODİAZEPİNLER DIŞINDAKİ ANESTEZİK AJANLARI DA ETKİLER Mİ?: OLGU SUNUMU(2015) Özer, Zeliha; Şentürk, Özgür; Selvi, OnurFlumazenil benzodiazepinlerin sedatif ve hipnotik etkilerini geri çevirmek için kullanılan bir imidazobenzodiazepindir.Yakın tarihlerde yayınlanan çalışmalarda, mekanizması tam açıklanamasa da, Flumazenilin di¤er genel anestezik ajanlar üzerine de etkili olabilece¤ine dikkat çekilmektedir. Bu nedenle, bu olgu sunumunda uyanmaları beklemedi¤imiz şekilde geciken iki hastada Flumazenil ile olan deneyimimizin paylaşılması amaçlanmıştır. Preoperatif muayenelerinde ASA I olarak de¤erlendirilen, 18 ve 19 yaşlarında iki erkek hasta sırasıyla, tonsillektomi, adenoidektomi ve septorinoplasti yapılmak üzere operasyona alındı. Hastalardan birine ameliyathaneye gelmeden 30 dk. önce yapılan Midazolam (1mg iv) dışında, anestezi indüksiyon (Propof ol, Fentanil) ve idamesinde (Sevof luran, Remif entanil) aynı ajanlar kullanıldı. Operasyonların sonunda anestezik ajanlar kesilip, kas gevşetici etkisini geri çevirmek için Atropin ve Neostigmin yapıldı; ancak 30-45 dk beklenmesine karşın uyanıklık belirtisi ve solunum ef oru saptanmadı. Bu klinik tabloyu açıklayacak bir neden bulunamaması üzerine Flumazenil (0,5mg iv) uygulandı. Her iki hasta da birkaç dakika içinde gözlerini açtı ve solumaya başladı. Bu iki olgudaki deneyimimiz, gecikmiş derlenmelerde Flumazenil kullanımının göz ardı edilmemesi gerekti¤ini ve etki mekanizmasının anlaşılması adına, detaylı araştırma yapılmasının yararlı olaca¤ını göstermektedir.Yayın Lomber spinal stenoz cerrahisinde intraoperatif nöromonitörizasyonun etkinliği(2012) Şentürk, Özgür; Ünsal, Faik Murat; Mangal, Ferit; Ermiş, Mehmet Nurullah; Polat, Ömer; Solakoğlu, CanAmaç: Lomber spinal stenoz nedeniyle posterior dekompresyon ve enstrümantasyon uygulanan hastaların ameliyat sırasında nöromonitörizasyon bulguları ile ameliyat sonrası 6. ay kontrolünde klinik bulgularının karşılaştırılması amaçlanmıştır Hastalar ve Metot: Mayıs 2011-Kasım 2011 tarihleri arasında lomber spinal stenoz nedeniyle opere edilen ve ameliyat sırasında nöromonitörizasyon uygulanan 20 hasta çalışmaya dâhil edilmiştir. Hastaların ortalama yaşı 69?dur, % 10?u (2 hasta) erkek, % 90?ı (18 hasta) bayandır. Hastaların ameliyat öncesi radyolojik değerlendirmeleri direk grafileri ve MR ile yapılmıştır. Ameliyat öncesi ve sonrası klinik değerlendirme SF36, Oswestry skoru ve Vizüel Analog Skor (VAS) ile yapılmıştır. Cerrahi tedavide bütün hastalara posterior enstrümantasyon yapıldıktan sonra dekompresyon uygulanmıştır. Bir hastaya cisimler arası füzyon uygulanmıştır. Nörolojik monitörizasyon için Transkortikal Motor Uyarılmış Potansiyeller kullanılmış, Amplitüd ve latans değişiklikleri kaydedilmiştir. Amplitüd değişikliklerin ile klinik sonuçların korelasyonu incelenmiştir. Sonuçlar: Hastaların ameliyat öncesi VAS skoru ortalaması 8 iken ameliyat sonrası ortalama skor 1.8?e gerilemiştir (p= 0,0001). Ameliyat öncesi SF 36 Skoru ortalaması 29,5 iken ameliyat sonrası 76,6?ya yükselmiştir (p= 0,0001). Ameliyat öncesi Oswestry skoru ortalaması 65,5 iken ameliyat sonrası 9,95?e gerilemiştir (p= 0,0001). Bütün hastalarda ameliyat sırasında TcMEP amplitüdlerinde artış saptanmıştır. 20 hastanın 14?ünde TcMEP amplitüdleri % 50?nin üzerinde artış göstermiştir. 6 hastada ise % 50?den az yükselme olmuştur. Amplitüd yükselmesinin az olduğu gruptaki hastaların stenoz seviyeleri veya ameliyat öncesi VAS skorlarıyla bir ilintisi bulunamamıştır. (p=0,156, p= 0.079)Sonuç: Bu çalışmada bütün hastalarda ameliyat sırasında motor evoked potansiyeli değerlerinde yükselme saptanmış ve bu değerdeki artışların ameliyat sonrası olumlu klinik sonuçlarda etkili olduğu fikri elde edilmiştir.Yayın The Maltepe combination: Novel parasacral interfascial plane block and lumbar erector spinae plane block for surgical anesthesia intransfemoral knee amputation(Elsevier, 2019) Tulgar, Serkan; Selvi, Onur; Şentürk, Özgür; Özer, Zeliha; Ünal, Ömer Kays; Thomas, David TerenceThe Maltepe combination: Novel parasacral interfascial plane block and lumbar erector spinae plane block for surgical anesthesia intransfemoral knee amputation. For patients undergoing transfemoral (above knee) amputation, anesthesia options are generally limited due to concomitant complex medical problems of the patients. In patients undergoing transfemoral amputation, regional anesthesia techniques may be life-saving when it is necessary to avoid general or neuraxial anesthesia. The blockage of lumbar and sacral plexus or their components are generally applied for thispurpose.Yayın Ultrasound guided blockade of thoracoabdominal nerves through perichondrial approach (TAPA) for postoperative analgesia in abdominal surgeries: case series(Regional Anesthesia & Pain Medicine, 2019) Tulgar, Serkan; Şentürk, Özgür; Selvi, OnurBackground and aims: Ultrasound guided (USG) ‘the blockade of ThoracoAbdominal nerves through Perichondrial Approach’(TAPA) is a new block we recently described. Its sensory block was reported between Th5-Th12 dermatomes from the mid-axillary line to mid-abdomen/sternum. The modification of TAPA (M-TAPA) was also effectively used in major abdominal surgeries. In this case series, we present TAPA and M-TAPA applied for postoperative analgesia in abdominal surgery patients. Methods: We performed TAPA and M-TAPA blocks unilaterally and bilaterally in abdominal surgery patients in our clinic after obtaining written informed consent. In M-TAPA, 20–30 mL of local anesthetic (LA) was applied interfascially between lower surface costochondral tissue and the upper fascia of the transversus abdominis muscle in the 9th and 10th midclavicular line. In TAPA, additional to this injection supplementary 10–20 mL of LA is applied between the upper surface of the condrium and the deep fascia of the external oblique muscle. Results: In 8 different operations, 4 patients had right, 9 patients had bilateral TAPA and 9 patients had M-TAPA. The types of surgery, ASA scores, 24-hour analgesic requirements, the numeric rating scale (NRS) scores followed for patients’ pain level are presented in table 1 and figure 1. The mean paracetamol and tramadol consumption were 2.36 ± 0.84 g/day 62.72 ± 49.29 mg/day respectively.
