BackgroundThe combination of a thoracic paravertebral block (TPVB) and erector spinae plane block (ESPB) has not been investigated. We aimed to evaluate the effects of the combination of TPVB and ESPB particularly on postoperative pain scores in patients undergoing video-assisted thoracic surgery (VATS). MethodsFrom January 1, 2021, to March 1, 2021, 13 patients older than 18 years who underwent combined ESPB and TPVB for analgesic treatment after elective VATS were included in the study. Standard anesthesia induction was performed for all patients, and the block was performed in the lateral decubitis position before surgery. Using the in-plane technique, an ultrasound (US)-compatible 22-gauge, 8-mm nerve block needle was introduced 2-3 cm lateral to the spinous process of the T6 vertebra and advanced in the caudocranial direction. Fifteen (15) ml of 0.25% bupivacaine was administered and pleural depression was observed. The same needle was withdrawn from the paravertebral space and advanced into the interfascial plane above the transverse process and below the erector spinae muscle at the T5 level. Then, 15 ml of 0.25% bupivacaine was injected. ResultsThe combination of TPVB and ESPB was performed in 13 patients. The mean age was 44.3 (21-68) years. The mean body mass index (BMI) was 23.21 (16.9-35.9) kg/m 2 . Postoperative 24 hours morphine consumption was 24.5 (16-42) mg. In three cases, visual analog scale (VAS) scores at rest were ≥4; therefore, tramadol (25 mg, IV) was given as an additional analgesic. Nausea and vomiting were observed in only one case in the early postoperative period. ConclusıonsAs a new technique, the combination of TPVB and ESPB in this preliminary study provided effective postoperative pain management along with the use of morphine in acceptable quantities. Large-scale, randomized-controlled, and comparative studies are needed to demonstrate the efficacy of the combination of TPVB and ESPB.

Wernicke's encephalopathy occurs due to thiamine (vitamin B1) deficiency which is characterized by occulomotor dysfunction, confusion and ataxia. Although it is most common with alcoholism, can also be seen due to hyperemesis caused by chemotherapy, Crohn's disease, gastrointestinal system surgery, AIDS, bariatric surgery and longterm feeding with parenteral nutrition. In this case, a 51-year-old woman who was treated with longterm total parenteral nutrition due to hyperemesis and had the diagnosis of Wernicke's encephalopathy after admission to the intensive care unit is presented.

Postoperative efficacy of thoracic epidural analgesia (TEA) following thoracic surgery may vary in patients with different body mass index (BMI) values, regardless of the success of the method. This study aimed to investigate the effects of BMI on postoperative pain scores in patients who underwent thoracotomy with TEA. After obtaining the ethical committee approval (Date: May 11, 2021, Number: 2012-KEAK-15/2305) the data of 1326 patients, who underwent elective thoracic surgery in high volume tertiary thoracic surgery center between January 2017 and January 2021, were analyzed retrospectively. Patients between the age of 18 and 80 years, who underwent thoracotomy and thoracic epidural catheterization (TEC), and who were assigned American Society of Anesthesiologists I to III physical status were included to the study. Of the 406 patients, who underwent a successful TEC, 378 received postoperative analgesia for 72 hours. Visual analog scale (VAS) scores of these patients were evaluated statistically. Based on BMI, patients were categorized into the following 5 groups: Group I: BMI < 20 kg/m 2 , Group II: BMI = 20 to 24.9 kg/m 2 , Group III: BMI = 25 to 29.9 kg/m 2 , Group IV: BMI = 30 to 34.9 kg/m 2 , and Group V: BMI ≥ 35 kg/m 2 . There were no statistically significant differences in TEC success across different BMI groups ( P > .05). Catheter problems and VAS scores significantly increased with higher BMI values in the postoperative 72-hours period ( P < .05). Rates of rescue analgesic use were higher in BMI groups of 30 toto 34.9 kg/m 2 and ≥35 kg/m 2 compared to the other BMI groups. This study revealed that higher BMI in patients may increase VAS scores, who administered TEA for pain management following thoracotomy. This correlation was supported by the increased need for additional analgesics in patients with high BMI. Therefore, patients with high BMI values would require close monitoring and follow-up.

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Objective: Acute respiratory distress syndrome (ARDS) is regarded as a serious complication with high mortality rates and constitutes an important health problem during the COVID-19 pandemic. Therefore, a thorough bibliometric study on ARDS is needed. In this study, it was aimed to holistically summarize the articles published on ARDS between the years 1980 and 2020 using statistical methods and bibliometric analyses.Material and Methods: The literature was scanned using the Web of Science (WoS) database. Keywords used on WoS included “acute respiratory distress syndrome”, “adult respiratory distress syndrome” and “ARDS”. The search was carried out on the “titles” of the publications, and the articles obtained were bibliometrically analyzed. Linear and non-linear regression analysis was used in order to estimate the number of future studies.Results: A total of 11.934 publications were found. Of these publications, 5402 were articles (45.3%) on which the bibliometric analysis was performed. A high increase trend was observed in the number of publications during COVID-19. Most articles were published in the field of Critical Care Medicine (1965, 36.4%). The top four countries contributing to the literature were the USA (1967, 36.4%), Germany (534, 9.9%), France (534, 9.9%), and China (534, 9.9%). The most active 4 institutions were confirmed as theUniversity of Toronto (154), University of California San Francisco (153), University of Washington (153) and University of Harvard (151). The first 2 journals with the most publications were Critical Care Medicine (394) and Intensive Care Medicine (248).Conclusion: In this comprehensive bibliometric study on ARDS on which the number of research increases day by day with the effect of the COVID-19 pandemic, a summarized information of 5402 articles published between 1980 and 2020 was reported. This study will be a guide for scientists and clinicians regarding the global output of ARDS.