Effective analgesia in chaotic and resource-limited trauma settings is important beyond patient comfort, as it may influence airway safety, haemodynamic stability, transport, and opioid-sedative exposure. The increasing availability of portable ultrasonography, the development of fascial plane blocks, and the integration of emergency department and prehospital protocols have strengthened the role of regional anesthesia in out-of-operating-room trauma care. However, these applications must be considered together with patient selection, coagulopathy, acute compartment syndrome, pre-existing nerve injury, informed consent, local anesthetic systemic toxicity, rebound pain, and catheter-related infection risk. This narrative review aims to summarise current evidence on regional anesthesia in chaotic and resource-constrained trauma settings, discuss block selection across different clinical contexts, and provide practical decision points for safe implementation. Current evidence suggests clinically relevant potential for early analgesia and opioid sparing, particularly in hip/femur fractures and selected thoracic trauma. However, the evidence regarding long-term patient-centered outcomes, mortality, morbidity, and block-specific advantages is heterogeneous. Regional anesthesia should be regarded not as an isolated technical procedure, but as a strategic clinical decision tool that requires appropriate patient selection, equipment, training, and safety governance.

Objective: Inflammatory responses play a critical role in postoperative outcomes following coronary artery bypass graft (CABG) surgery. Total intravenous anesthesia (TIVA) and inhalation anesthesia may differently influence inflammatory processes. This study aimed to evaluate the effects of these anesthetic techniques on inflammatory biomarkers and to assess their potential in predicting early postoperative complications.
Method: In this prospective observational study, 228 patients undergoing CABG surgery were enrolled (111 in Group T: TIVA, 117 in Group I: Inhalation anesthesia). The systemic immune-inflammation index (SII), systemic inflammatory response index, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), Creactive protein (CRP), and procalcitonin (PCT) were measured preoperatively and postoperatively. Complications within the first 24 hours after surgery were recorded.
Results: Demographic characteristics, operation times, and overall complication rates were similar between the groups. Postoperative inflammatory biomarkers significantly increased in both groups (p < 0.05). Group I exhibited higher postoperative PCT values and greater PCT changes (p < 0.05). Elevated preoperative NLR and SII were associated with postoperative atrial fibrillation, while patients with delirium or requiring additional inotropes showed significantly higher postoperative PCT levels and changes (p < 0.05).
Conclusion: Inhalation anesthesia and TIVA present comparable safety profiles regarding early postoperative complications. Biomarkers such as PCT, NLR, and SII may serve as useful indicators for predicting early adverse outcomes, supporting their potential use in routine clinical practice for early detection and management of complications.

Objective: Genicular nerve interventions have emerged as effective minimally invasive treatment options for knee osteoarthritis (KOA). Pulsed radiofrequency (PRF) and radiofrequency ablation (RA) are increasingly used techniques; however, comparative evidence between these two approaches remains limited. The aim of this study is to compare the clinical efficacy of ultrasound-guided genicular nerve pulsed radiofrequency and genicular nerve radiofrequency ablation in patients with KOA.
Method: This randomized study was conducted at a tertiary pain clinic between May 2024 and January 2025. Initially, 142 patients with KOA-related knee pain were evaluated. After screening, 121 patients were included. And 109 patients who demonstrated ≥50% pain relief following a diagnostic genicular nerve block were randomized into two groups: the genicular nerve pulsed radiofrequency group (GPRF, n=52) and the genicular nerve radiofrequency ablation group (GRA, n=57). During follow-up, 5 patients in the GPRF group and 4 patients in the GRA group were lost to follow-up, leaving 47 and 53 patients respectively for final analysis. Pain intensity was evaluated by using the Visual Analog Scale (VAS), and functional status was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Assessments were performed before treatment, at the 3ʳᵈ week, and at the 3ʳᵈ month.
Results: Both treatment groups demonstrated significant improvements in VAS and WOMAC scores compared with baseline at both follow-up periods (p < 0.001). However, no statistically significant differences were observed between both groups regarding pain reduction or functional improvement. The overall meaningful pain response rate (≥50% pain reduction) was 58% at 3ʳᵈweek and 48% at 3ʳᵈ months.
Conclusion: Both GPRF and GRA significantly reduced pain and improved functional outcomes in patients with KOA. Neither technique showed superiority over the other, suggesting that both may be considered effective treatment options in clinical practice.

Objective: This retrospective study aimed to evaluate the effects of dexmedetomidine administered before extubation on emergence agitation (EA) and postoperative pain in pediatric patients aged 2-12 years undergoing elective otorhinolaryngologic or ophthalmologic surgery under general anesthesia.
Method: A total of 139 pediatric patients who underwent surgery at İzmir City Hospital between January 2024 and January 2026 were retrospectively analyzed. Patients who received dexmedetomidine before extubation were assigned to Group 1 (n = 75), while those who did not receive dexmedetomidine were assigned to Group 2 (n = 64). Emergence agitation was assessed using the Pediatric Anesthesia Emergence Delirium (PAED) scale, and postoperative pain was evaluated using the Face, Legs, Activity, Cry, Consolability (FLACC) scale at 0, 5, 15, and 30 minutes in the post-anesthesia care unit (PACU).
Results: The incidence of EA was significantly lower in Group 1 compared with Group 2 (36% vs. 56.3%, p = 0.017). The PAED scores were significantly lower in the dexmedetomidine group at all assessment time points (p < 0.001). The FLACC pain scores at 0, 5, and 30 minutes, as well as the requirement for additional analgesics (17.3% vs. 35.9%), were significantly lower in Group 1 (p < 0.05). Although extubation time was significantly longer in the dexmedetomidine group (7.09 ± 1.61 min vs. 5.45 ± 1.75 min; p < 0.001), no significant difference was observed in PACU length of stay between the groups (p = 0.567).
Conclusion: Dexmedetomidine administered prior to extubation may alleviate EA and postoperative pain in pediatric patients; despite a marginal increase in extubation time, it may facilitate a superior quality of recovery without prolonging the PACU stay.

Objective: Hip fracture surgery is associated with considerable early mortality, particularly among older and frail patients. Although anesthetic technique is considered a potentially modifiable perioperative factor, randomized trials have not consistently demonstrated a survival advantage of spinal over general anesthesia. In real-world practice, anesthetic choice is often influenced by baseline frailty and comorbidity burden, which may complicate the interpretation of associations between anesthesia type and outcomes.
Method: This retrospective observational cohort study included adult patients who underwent hip fracture surgery at a tertiary care center between January 2021 and May 2025. Patients were categorized according to anesthetic technique as spinal or general anesthesia. The primary outcome was in-hospital mortality. Multivariable logistic regression analysis was performed to identify independent predictors of mortality, including anesthetic technique, age-adjusted Charlson Comorbidity Index, and physiological markers of frailty.
Results: A total of 665 patients were included; 514 received spinal anesthesia and 151 received general anesthesia. In-hospital mortality was higher in the general anesthesia group than in the spinal anesthesia group (7.9% vs. 3.7%; p=0.037). However, after adjustment for comorbidity burden using the age-adjusted Charlson Comorbidity Index, the association between general anesthesia and in-hospital mortality was attenuated and was no longer statistically significant (adjusted OR 1.68; 95% CI 0.84–3.38). In contrast, higher Charlson Comorbidity Index score, lower preoperative serum albumin level, and dialysis dependence remained strong independent predictors of in-hospital mortality.
Conclusion: In this real-world cohort of patients undergoing hip fracture surgery, the association between general anesthesia and increased in-hospital mortality appeared to be largely explained by underlying frailty rather than a direct effect of anesthetic technique. Hypoalbuminemia and dialysis dependence were among the strongest predictors of early postoperative death. These findings suggest that preoperative risk assessment should extend beyond anesthetic technique and include frailty, nutritional status, and organ dysfunction.

Objective: Copper exhibits potent antibacterial, antifungal, antiviral and anti-inflammatory effects by supporting the host’s immune-response. Our study aimed to investigate the clinical and prognostic effects of copper and ceruloplasmin levels in critically ill patients with confirmed or suspected COVID-19 in the intensive care unit (ICU).
Method: After obtaining ethical committee approval, adult patients admitted to the Hacettepe University Hospital Anesthesiology Intensive Care Unit from November 15, 2021 to June 15, 2022, were included. Patients were divided into two groups: COVID-19-positive and negative. The criteria for the COVID-19-negative group included four consecutive negative Polymerase Chain Reaction (PCR) results and symptoms explainable by other clinical conditions. Demographic data, comorbidities, admission symptoms, COVID-19-PCR results, APACHE-II and SOFA-scores, length of stay, laboratory results, copper and ceruloplasmin levels at admission, mechanical ventilation requirements,vasopressor needs and mortality data were prospectively recorded. The normal serum range for copper was determined as 13.3-26.7 µmol L-1 and for ceruloplasmin as 22-58 mg dL⁻¹.
Results: The median age of all patients (n=107) was 73 years (20-91) with 60 (56%) females and 47 (44%) males. Fifty-seven patients were COVID-19-positive and fifty were negative. The median copper and ceruloplasmin levels for the COVID-19- positive group were 22.44 µmol L⁻¹ (4.15-42.26) and 44.3 mg dL⁻¹ 23.2-87), respectively while for the COVID-19-negative group they were 23.185 µmol L⁻¹ (11.23-39.9) and 45 mg dL⁻¹ (20.6-82.2) (p=0.62, p=0.753). No significant relationship was found between copper and ceruloplasmin levels and gender, statin and food supplement usage, malnutrition, oxygen, mechanical ventilation, vasopressor and renal replacement therapy needs, ICU and hospital length of stay and mortality. Four (4%) patients had low copper levels, 80 (75%) had normal levels and 23 (21%) had high levels. The high copper group showed significantly higher GGT (gamma glutamyl transferase) levels (59 (13-315) vs. 39 (8-369), p=0.049) and leukocyte counts 9.7 (4.8-37.4) vs. 8.25 (1.6-29.2) (103 microL⁻¹) (p=0.028) compared to the normal copper group but there was no significant impact on mechanical ventilation, vasopressor and renal replacement therapy needs, ICU and hospital length of stay, and mortality.
Conclusion: Monitoring copper and ceruloplasmin levels in COVID-19 patients in the ICU is important; however, it was concluded that these parameters do not have a direct effect on disease prognosis. Controlling copper levels and managing inflammatory conditions may be supportive during the clinical recovery process. These findings need to be validated in larger patient groups and across different disease severities.

Objective: To compare dexmedetomidine and fentanyl as intrathecal adjuvants to hyperbaric levobupivacaine during elective gynecological surgery.
Method: This prospective, randomized, double-blind trial enrolled 60 women aged 18–60 years with American Society of Anesthesiologists physical status I or II. Participants were assigned equally to receive 3 mL of 0.5% hyperbaric levobupivacaine with either dexmedetomidine 5 μg (Group LD) or fentanyl 25 μg (Group LF). Sensory and motor block characteristics, hemodynamic and respiratory variables, pain, sedation, rescue analgesia, and adverse events were assessed. Repeated outcomes were compared between groups at prespecified time points using Welch independent-samples t-tests with Bonferroni adjustment.
Results: All 60 participants completed the trial. Baseline characteristics were comparable between groups. Sensory-block onset was similar in Groups LD and LF (3.10 ± 0.80 vs 2.92 ± 0.50 minutes; p=0.301). Dexmedetomidine significantly prolonged sensory-block duration (540.45 ± 60.45 vs 420.12 ± 70.34 minutes; p<0.001) and motor-block duration (360.45 ± 56.34 vs 300.23 ± 45.69 minutes; p<0.001). Time-specific differences were observed in hemodynamic, respiratory, and pain measurements, although oxygen saturation remained approximately 99%–100% and pain-score differences were small. Sedation did not differ significantly after adjustment for multiple comparisons. Rescue-dose requirements numerically favored dexmedetomidine, but the difference was not statistically significant (p=0.078). All adverse events were manageable with standard treatment.
Conclusion: Intrathecal dexmedetomidine prolonged sensory and motor blockade compared to fentanyl without clinically important respiratory compromise. Both adjuvants demonstrated acceptable safety profiles.

Objective: This study aimed to identify preoperative clinical and laboratory risk factors associated with postoperative intensive care unit (ICU) admission after geriatric hip fracture surgery, and to evaluate independent preoperative risk factors predicting ICU admission and prolonged ICU stay.
Method: The electronic medical records of 811 patients aged 65 years and older who underwent surgery for hip fracture between November 2022 and November 2025 were retrospectively analyzed. Demographic data, American Society of Anesthesiologists (ASA) physical status classification, comorbidities, laboratory parameters, ICU admission status, ICU length of stay, and 6-month mortality data were recorded. Patients were divided into two groups according to postoperative ICU admission status.
Results: Data from 811 patients were evaluated. Of these, 691 patients (85.2%) were admitted to the ICU postoperatively. In multivariable logistic regression analysis, advanced age (OR: 1.075, 95% CI: 1.039–1.112), ASA III–IV class (OR: 1.792, 95% CI: 1.028–3.122), hypoalbuminemia (OR: 0.924, 95% CI: 0.874–0.977), elevated C-reactive protein (CRP) level (OR: 1.009, 95% CI: 1.004–1.015), and the presence of diabetes mellitus (DM) (OR: 2.243, 95% CI: 1.182–4.256) were independently associated with ICU admission. Hypoalbuminemia (OR: 0.931, 95% CI: 0.902–0.961), congestive heart failure (OR: 3.391, 95% CI: 1.858–6.188), dementia (OR: 1.866, 95% CI: 1.172–2.970), and chronic obstructive pulmonary disease (OR: 1.771, 95% CI: 1.060–2.958) were independent predictors of prolonged ICU stay.
Conclusion: Advanced age, ASA III–IV physical status classification, hypoalbuminemia, elevated CRP level, and the presence of DM may be important predictors of postoperative ICU admission after geriatric hip fracture surgery.

The duration of motor and sensory block resolution after spinal anesthesia may vary depending on patient characteristics and the local anesthetic administered. However, when the block persists longer than expected, reassessment for underlying neuraxial complications and spinal pathologies is essential. We report a 65-year-old patient who underwent transurethral resection of a bladder tumor for bladder cancer. Following spinal anesthesia, the patient exhibited persistent motor and sensory block without the expected regression pattern, prompting further neurological evaluation. Emergency magnetic resonance imaging revealed a metastatic lesion at the mid-thoracic level causing spinal cord compression. The patient was evaluated by the neurosurgery department and high-dose corticosteroid therapy was initiated. Surgical decompression was not considered appropriate because of the characteristics of the neurological presentation. This case highlights that persistent motor or sensory block after spinal anesthesia should not be attributed solely to prolonged local anesthetic effect, and that serious neurological conditions such as spinal cord compression must be considered in the differential diagnosis.