Kocaeli University

Hip surgeries are one of the most painful surgical operations, and inadequate pain management increases postoperative morbidity and mortality.The incidence of chronic pain after hip surgery is quite high, at 11-40%.For this reason, hip surgeries are complex and specialized surgeries in terms of pain management.According to the surgical procedures pioneered by the European Society of Regional Anesthesia, Pericapsular nerve block (PENG) block is among the recommendations with a high level of evidence for hip surgery in the multimodal analgesia steps guide.In the literature, there are studies comparing the postoperative analgesic effectiveness of PENG block in hip surgeries, but the results are contradictory.In addition, intraoperative pain monitoring was not used in these studies, instead intraoperative analgesia management was provided according to hemodynamic parameters, which may not be objective.Opioid infusion is used in analgesia management during the intraoperative period.While not providing effective analgesia due to insufficient opioid use will have effects, excessive opioid use also has many side effects.Therefore, it would not be correct to administer the same dose of opioid infusion to every patient. As seen in the data in the literature and in daily practice, hemodynamic parameters (such as heart rate, blood pressure) are used for pain monitoring of the patient under general anesthesia, and these parameters may change depending on many other factors.Although some devices that aim to provide pain monitoring by evaluating the effects of pain on the sympathetic system are available on the market, their usage areas have remained limited since their reliability has not been fully demonstrated. Nociception level index (NoL) monitoring provides effective monitoring as it evaluates each patient separately using different parameters (heart rate, heart rate variability, photo-plethysmographic waveform amplitude, skin conductance level, number of skin conductance fluctuations and their time derivatives).While planning this study, İnvestigators aimed to use NoL monitoring in hip surgery, where postoperative pain management is quite challenging and important, as it provides objective and personalized pain management in patients under general anesthesia.When other studies in the literature are examined, the effects of regional techniques have been compared only in the postoperative period.Its effects in the intraoperative period have not been evaluated on a patient basis, and the opioid infusion rate has been adjusted with hemodynamic findings, which are affected by many parameters such as bleeding and drug use.In this study, İnvestigators aim to compare the effects of intraoperative pain monitoring and personalized analgesia treatment and the regional technique both in the intraoperative period and in the postoperative period.

In this context, this study aims to increase midwifery students' awareness of good and green health practices and to develop a measurement tool to evaluate their awareness of good health practices. This research is in two stages, the first stage is methodological type, and the second stage will be carried out as a pre-test post-test randomized controlled experimental research between September 2024-2025. In the first stage, the Good Health Practices Awareness Scale will be developed. In the second stage of the study, the Green Culture Scale (pre-test-post-test) will be filled in by the students. The population of this study, which will be carried out in the Midwifery Department of Çanakkale Onsekiz Mart University, Faculty of Health Sciences, will consist of 300 students studying in the 2nd, 3rd and 4th grades of the Midwifery Department of this university. Data of the research; It will be collected with the "Introductory Information Form, Green Culture Scale and Good Health Practices Awareness Scale". Before starting to collect data, an item pool of the Good Health Practices Awareness Scale will be created in line with the literature, the measurement method will be determined and sent to at least ten faculty members who are interested in the subject and experts in the field, their opinions will be taken and scale items will be created in line with their opinions. Then, the purpose of the research will be explained to the students by the researchers and the groups the students belong to will be determined. Before the training, students in all groups will be asked to take the Pretest. Students included in the training group will be trained in good and green health practices in the faculty's conference hall by expert researchers with Conscious Awareness training certificates and the university's green transformation coordinator. Three weeks after the training, all students will take the Green Culture Scale Post-Test. Students in the control group will also receive training at an appropriate time. IBM SPSS Statistics 29 package program will be used for statistical analysis. In evaluating the data obtained as a result of the research, percentage rates, arithmetic mean and standard deviation, t test in dependent and independent groups and Bonferroni analysis will be used to determine where the significance comes from. Results will be evaluated at the 95% confidence interval and significance level of p < .05.

In order to effectively manage postoperative analgesia in patients planned to undergo elective laparoscopic cholecystectomy, patients will be divided into 2 (two) groups and informed consent forms will be obtained after the necessary information is provided so that both groups can be included in the study. In the group planned to undergo erector spinae plane block, erector spinae plane block will be performed after monitoring and sedation in the operating room block unit before being taken to the surgical table preoperatively and postoperative PCA analgesia will be applied. In patients who will undergo subcostal transversus abdominis plane block, subcostal tap block will be performed after monitoring and sedation in the operating room block unit before being taken to the surgical table preoperatively and postoperative PCA analgesia will be applied. The patients' perioperative pain will be monitored with NOL (nociception level) monitor. Remifentanil dose will be adjusted to keep the NOL level between 10 and 25. After the patients are followed up for 24 hours postoperatively, their additional analgesia needs and amounts during this process will be compared. In this way, it is aimed to show that the analgesic method can be used effectively in the follow-up of pain management by comparing the Erector Spina Plane block and the Subcostal Transversus Abdominis Plane block as an effective analgesic application in laparoscopic cholecystectomy operations.