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Anesthesia Management in Trauma Trauma, which means wound in ancient Greek, is the leading cause of death in the 1-44 age group, and the third cause of death following cancer and cardiovascular disease in all age groups. Trauma is defined as tissue damage characterized by structural changes and physiological disorders due to mechanical, thermal, electrical and chemical energies, ionized or nuclear radiation or absence of essential elements of life such as oxygen and heat. Trauma has many reasons such as traffic accidents, work accidents and falling from height (1,2). These patients need a systematic anesthesia management in posttraumatic evaluation, airway management, resuscitation, possible preoperative and postoperative surgical process, intensive care follow-up and treatment (3). The nature of trauma, uncontrollable bleeding after trauma, coagulation anomalies, hypothermia, shock, acidosis disrupt the normal homeostatic mechanism. Acute coagulopathy caused by high blood loss in major traumas is often associated with poor clinical course in trauma patients (4,5). Another paradox is the nature of unexplained events, insufficient anamnesis information and the necessity of emergency intervention in trauma cases. Initial Assessment of Trauma Algorithms have been defined for systemic approach to trauma patients and more than fifty scoring systems have been developed. The Trauma score, which was defined in 1981 by adding respiratory rate and systolic blood pressure to the Triage index, is a widely used scoring system. It was revised in 1989 and Revised Trauma score was formed (Table 1). In order for the trauma centers to systematically engage a modern trauma approach in harmony between the other disciplines, it is necessary to establish national guidelines tailored to the needs and ensure their widespread use. Airway obstruction, severe hemorrhage and hypoxia due to tension pneumothorax may be among the causes of early death due to trauma (6-8). From the moment the trauma patient is met, the first step is to apply the

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<b><i>Background:</i></b> Circumcision is a painful day-case surgery. Regional anesthesia techniques are used effectively for anesthesia and postoperative analgesia after pediatric circumcision surgery. <b><i>Objective:</i></b> Our prospective observational study aimed to compare postoperative analgesic efficiency of a dorsal penile nerve (DPN) block with a transversus abdominis plane (TAP) block after male pediatric circumcision surgery and complications related to each block. <b><i>Study Design:</i></b> We enrolled 80 male children under the age of 10 years with American Society of Anesthesiologists I–II status scheduled for circumcision in this prospective observational study. A TAP or DPN block was performed after induction of general anesthesia before surgery with ultrasound (US) guidance. Postoperative pain was assessed with Faces Pain Scale-Revised and the Faces, Legs, Activity, Cry and Consolability scale. <b><i>Results:</i></b> There was no statistically significant difference between the groups regarding 30-min pain score levels (<i>p</i> &#x3e; 0.05). But, the 1st hour, 2nd hour, 6th hour, 12th hour, and 24th-hour pain score levels in the TAP block group were statistically significantly higher than those of the DPN block group (<i>p</i> &#x3c; 0.05). The 1st rescue analgesic requirement in the TAP block group was at the 6th hour postoperative. There was no need for rescue analgesia in the DPN block group during the postoperative 24-h follow-up. <b><i>Discussion:</i></b> A US-guided DPN block provided effective and long-lasting postoperative analgesia for circumcision surgery with statistically significantly lower pain score levels than a US-guided TAP block. <b><i>Conclusion:</i></b> This study found that a TAP block alone was insufficient to provide adequate postoperative analgesia for circumcision surgery compared to DPN block.