BACKGROUND: In this rat model study, we examined the effects of topical and systemic nintedanib treatment on the development of post-laminectomy epidural fibrosis.
METHODS: Thirty-two rats were divided into four equal groups (n=8 per group). An L1–L2 laminectomy was performed using standard microsurgical procedures. The control group underwent laminectomy only; the sterile saline group underwent laminectomy followed by sterile saline irrigation; the topical nintedanib group underwent laminectomy followed by topical nintedanib application; and the systemic nintedanib group underwent laminectomy followed by oral nintedanib administration. The degree of fibrosis was evaluated by histological examination. Plasma levels of matrix metalloproteinase-9 (MMP-9), interleukin-6 (IL-6), vascular endothelial growth factor (VEGF), transforming growth factor beta-1 (TGF-β1), tumor necrosis factor-alpha (TNF-α), hydroxyproline (HYP), and myeloperoxidase (MPO) were compared among the groups.
RESULTS: In the control group, two rats developed grade 2 epidural fibrosis, while six animals developed grade 3 fibrosis. The sterile saline group demonstrated a similar degree of fibrosis to the control group. In the topical nintedanib group, three, four, and one rat developed grade 1, grade 2, and grade 3 epidural fibrosis, respectively. In the systemic nintedanib group, five rats had grade 1 epidural fibrosis, whereas three rats had grade 2 fibrosis. Groups 3 and 4 showed significantly decreased plasma levels of MMP-9, IL-6, VEGF, TGF-β1, TNF-α, and HYP compared to Groups 1 and 2 (p<0.05). Plasma levels of these markers were lower in Group 4 than in Group 3; however, the difference was not statistically significant (p>0.05). Plasma MPO activity in the study groups was not altered following nintedanib treatment (p>0.05).
CONCLUSION: The histological and biochemical findings of the present study indicate that nintedanib is a promising pharmacological agent for the prevention of post-laminectomy epidural fibrosis. Further studies with larger sample sizes and interval assessments are needed to clarify the effects of different dosages.

BACKGROUND: Fracture healing may be influenced by concomitant traumatic brain injury (TBI). Both clinical and experimental studies have reported accelerated union and enhanced callus formation in the presence of TBI. The Wnt/β-catenin signaling pathway is thought to play a role in this process; however, the relationship between serum β-catenin mRNA relative expression and fracture healing in the context of TBI remains unclear.
METHODS: Thirty-six female Wistar albino rats were randomly assigned to four groups: control, TBI only, femoral fracture only, and combined TBI + femoral fracture. Radiographic healing was evaluated using the Radiographic Union Scale for Tibial fractures (RUST) at weeks 3 and 6. Serum β-catenin mRNA relative expression was quantified by real-time polymerase chain reaction at baseline (week 0) and during follow-up (weeks 3 and 6). Histological analysis was performed at week 6.
RESULTS: Radiographic evaluation demonstrated progressive healing in all fracture groups, with significantly higher RUST scores in the TBI + fracture group compared to the fracture-only group at both time points (p<0.05). Serum β-catenin mRNA relative expression decreased significantly over time in both fracture groups, whereas no significant temporal changes were observed in the control or isolated TBI groups. Because this decline occurred in both fracture groups, it did not indicate a TBI-specific molecular effect. Histologi-cal analysis showed a tendency toward more mature osseous callus formation in the TBI + fracture group; however, these differences were not statistically significant.
CONCLUSION: Concomitant TBI was associated with enhanced radiographic fracture healing and showed a non-significant trend toward more advanced osseous callus formation. The observed decline in serum β-catenin mRNA relative expression in the fracture groups suggests phase-dependent regulation of Wnt/β-catenin–related activity during repair. However, serum β-catenin mRNA represents an indirect systemic marker and does not establish a mechanistic, TBI-specific pathway. These findings highlight the complex systemic influence of TBI on skeletal repair and support further mechanistic studies—particularly those incorporating fracture-site (local) analyses—to clarify the biological pathways underlying the observed radiographic association.

BACKGROUND: A substantial proportion of earthquake-related fatalities result from severe trauma at the time of the event and entrapment under debris. Prolonged compression significantly increases the risk of developing crush syndrome, which is considered a critical determinant of mortality and morbidity. This study aimed to develop and evaluate a scale designed to assess pediatric surgical nurses' knowledge of earthquake-related crush syndrome.
METHODS: This methodological study was conducted between August and September 2023. The sample consisted of 77 pediatric surgical nurses working in pediatric surgery units of a city hospital who voluntarily participated in the study. Data were collected using a data collection form and a draft 30-item version of the scale. Content and construct validity were assessed to validate the instrument. Tetrachoric factor analysis was used to examine construct validity. Reliability was evaluated using the Kuder–Richardson Formula 20 coefficient and the person reliability coefficient. Rasch analysis was performed to assess item difficulty and discrimination.
RESULTS: The Content Validity Index for the Earthquake-Related Crush Syndrome Knowledge Scale was 0.99. Tetrachoric factor analysis revealed two subdimensions comprising nine items. Goodness-of-fit indices for the confirmatory two-factor model indicated an acceptable to excellent fit. The Kuder–Richardson Formula 20 reliability coefficients were 0.90 for Factor 1 and 0.88 for Factor 2. According to Rasch analysis, the scale demonstrated a two-subdimension structure comprising seven items, with factor loadings ranging from 0.59 to 0.90; the factors were interrelated. In the Rasch model, the person reliability coefficient was 0.433, indicating low reliability. The mean absolute deviation of Q3 residual correlations (MADaQ3), used to assess model fit, was 0.116, while the information-weighted fit (infit) and outlier-sensitive fit (outfit) statistics were within the acceptable range (0.5–1.5).
CONCLUSION: Preliminary findings suggest that the scale demonstrates acceptable validity and reliability for assessing pediatric surgical nurses’ knowledge of earthquake-related crush syndrome.

BACKGROUND: This study aimed to compare the incidence of postoperative ileus (POI) between end-to-end hand-sewn and side-to-side stapled ileo-ileal anastomoses and to identify independent risk factors associated with POI.
METHODS: We conducted a retrospective analysis of patients who underwent radical cystectomy with urinary diversion at Ankara Etlik City Hospital between October 2022 and October 2024. Patients were categorized according to the anastomosis technique used: end-to-end hand-sewn or side-to-side stapled. Perioperative data, including demographic characteristics, comorbidities, preoperative laboratory parameters, operative variables, and postoperative outcomes, were collected. POI was defined as intolerance to oral intake accompanied by abdominal distension and absence of flatus or stool beyond postoperative day five, requiring medical or surgical management. Univariable and multivariable logistic regression analyses were performed to identify risk factors for POI.
RESULTS: A total of 71 patients were included in the analysis. POI occurred in nine patients (23.7%) in the hand-sewn group and in four patients (12.1%) in the stapled group, indicating a significantly lower incidence in the stapled group. Multivariable analysis identified side-to-side stapled anastomosis as an independent protective factor against POI. Additional independent predictors included age ≥65 years, abnormal body mass index (BMI), preoperative constipation, hypoalbuminemia, and prolonged operative time. Receiver operat-ing characteristic (ROC) curve analysis demonstrated good predictive performance of the model.
CONCLUSION: Side-to-side stapled ileo-ileal anastomosis is associated with a lower risk of POI compared to end-to-end hand-sewn anastomosis in patients undergoing radical cystectomy with urinary diversion.

BACKGROUND: This study aimed to investigate the role of the HALP (hemoglobin, albumin, lymphocyte, platelet) score and inflammatory biomarkers C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) in distinguishing between complicated and uncomplicated acute appendicitis.
METHODS: This retrospective study was conducted between May and August 2024 at Ankara Etlik State Hospital and included patients diagnosed with acute appendicitis who were treated surgically. HALP score, CRP, NLR, and PLR were calculated using preoperative laboratory results. Patients were categorized into complicated and uncomplicated appendicitis groups based on intraoperative and histopathological findings. Statistical analyses included the independent samples t-test, Mann–Whitney U test, and chi-square test. A p-value <0.05 was considered statistically significant.
RESULTS: A total of 208 patients were analyzed. HALP scores were significantly lower in the complicated appendicitis group (4.6 vs. 5.8, p=0.002), while CRP levels were significantly higher (84.9 vs. 38.7 mg/L, p<0.001). NLR (7.0 vs. 6.9, p=0.091) and PLR (165 vs. 170, p=0.767) did not differ significantly between the groups.
CONCLUSION: CRP and HALP score are useful parameters for predicting complicated appendicitis. The HALP score, reflecting both systemic inflammation and nutritional status, may serve as a novel and cost-effective tool in clinical assessment.

BACKGROUND: Trauma is a leading cause of mortality worldwide. Accurate prognostic assessment in emergency departments and intensive care units is essential for effective triage and management. Consequently, various prognostic markers have been explored in trauma populations. The pan-immune-inflammation (PIV) is a biomarker derived from a complete blood count (CBC) and can be rapidly obtained in clinical settings. This study aimed to evaluate the role of PIV in predicting the prognosis of trauma patients.
METHODS: This study examined patients admitted to a tertiary-level intensive care unit due to trauma at a training and research hospital. Established prognostic parameters, including the Revised Trauma Score (RTS), Glasgow Coma Scale (GCS), and Acute Physi-ology and Chronic Health Evaluation II (APACHE II) scores, were evaluated. PIV values were calculated from laboratory data. Mortality, morbidity, and length of hospital stay were retrospectively analyzed. The predictive value of PIV for mortality was assessed using statistical methods.
RESULTS: A total of 74 patients were included. The survivor group comprised seven females (11.5%) and 54 males (88.5%), while the non-survivor group included one female (7.7%) and 12 males (92.3%). PIV, RTS, GCS, and APACHE II scores were effective in predicting mortality (p<0.001). The cut-off value for PIV was 6367.5; patients with PIV values below this threshold had a higher risk of mortality compared to those with higher values.
CONCLUSION: Rapid and reliable prognostication is essential in emergency settings. PIV demonstrates predictive performance comparable to established prognostic scoring systems. Early assessment of PIV in trauma patients may support more effective triage and treatment planning.

BACKGROUND: Hand injuries, particularly tendon injuries, are a common reason for emergency department visits and may significantly impact daily functioning. Traditional diagnostic approaches may fail to detect partial tendon injuries, highlighting the need for alternative imaging techniques. Ultrasonography (USG) has emerged as a rapid, non-invasive, and effective diagnostic tool for tendon injuries, particularly in emergency settings where magnetic resonance imaging (MRI) may not be readily available. This study evaluates the diagnostic effectiveness of ultrasonography in assessing tendon injuries among patients presenting with hand trauma in the emergency department (ED). Ultrasonography findings were compared with clinical evaluations to determine its role in diagnosing tendon injuries and guiding surgical management. This prospective observational study was conducted in the ED of a single tertiary-care hospital over a one-year period and included adult patients presenting with hand injuries.
METHODS: Patients who met the inclusion criteria underwent both clinical evaluation and ultrasonographic examination. A total of 68 patients were included in the study. All assessments were performed by an experienced emergency medicine physician using a Philips Affinity S70 ultrasonography system (Philips Healthcare, Bothell, WA, USA). Collected data included patient demographics, injury characteristics, ultrasonographic findings, and the need for surgical intervention. Statistical analyses were performed using the chi-square test and binary logistic regression to compare the diagnostic performance of the two methods.
RESULTS: Ultrasonography demonstrated a sensitivity of 82.6% (95% confidence interval [CI]: 0.69–0.91), specificity of 90.9% (95% CI: 0.70–0.98), and an overall accuracy of 85.3% (95% CI: 0.75–0.92) in predicting the need for tendon repair. Clinical evaluation showed slightly lower diagnostic performance, with a sensitivity of 80.4% (95% CI: 0.67–0.89) and an accuracy of 80.9% (95% CI: 0.70–0.89).
CONCLUSION: Regression analysis indicated that ultrasonography increased the likelihood of accurately diagnosing tendon injuries by 21.8 times compared to clinical assessment. Together, clinical evaluation and ultrasonography predicted 61% of all cases requiring tendon repair.

BACKGROUND: Liver trauma remains a major contributor to morbidity in patients with abdominal injuries. Although nonoperative management (NOM) is widely accepted in hemodynamically stable patients, the relationship between American Association for the Surgery of Trauma (AAST) injury grade, laboratory parameters, transfusion requirements, and the need for surgical intervention remains unclear.
METHODS: This retrospective observational study included 53 patients with radiologically or intraoperatively confirmed liver lacerations treated at a tertiary surgical center between October 2024 and May 2025. Data collected included demographics, vital signs, AAST injury grade, laboratory values, transfusion requirements, imaging use, and clinical outcomes. Statistical analyses were performed using analysis of variance (ANOVA), chi-square/Fisher’s exact tests, and logistic regression.
RESULTS: The mean age was 41.4 years, with 67.9% of patients being male. The most common mechanism of injury was motor vehicle accidents (56.6%). On admission, 64.2% of patients had AAST grade I–II injuries, while 7.5% had grade IV injuries. NOM was successful in 81.1% of cases, with 18.9% requiring operative intervention. No in-hospital mortality was observed. Changes in hemoglobin and hematocrit levels were not significantly associated with injury grade or the need for surgery. However, transfusion requirements increased with injury severity, including erythrocyte suspension (p=0.006) and fresh frozen plasma (p<0.001). Follow-up imaging (n=25) demonstrated stable or improved findings in 96% of patients. Logistic regression analysis did not identify independent predictors of surgical intervention.
CONCLUSION: NOM of liver lacerations is safe and effective, with excellent outcomes and no mortality observed in this cohort. Although AAST injury grade alone did not predict the need for surgery, transfusion requirements correlated with injury severity, high-lighting their value as practical indicators in clinical decision-making.

BACKGROUND: Bezoars are masses formed by the accumulation of indigestible food or foreign materials within the gastrointestinal (GI) tract. This study aimed to compare the outcomes of fragmentation and milking (FM) versus enterotomy in patients with bezoarinduced GI obstruction and to evaluate these findings in the context of the literature.
METHODS: This retrospective study analyzed data from 44 patients who underwent surgery for mechanical intestinal obstruction between 2009 and 2021 at our institution, in whom bezoars were identified as the etiological factor during the perioperative period. Demographic characteristics, comorbidities, history of previous abdominal surgery, localization of the bezoar, postoperative complications, and follow-up outcomes were evaluated. Patients with bezoars were divided into two groups: those who underwent FM and those who underwent enterotomy. Categorical variables were analyzed using the chi-square tests and are presented as frequencies and percentages. A p value <0.05 was considered statistically significant.
RESULTS: Of the patients, 25 (54.3%) were male, and the median age was 65 years (range: 56–73). Thirty patients (65.2%) underwent FM, and 16 patients (34.8%) underwent enterotomy. Severe complications (Clavien–Dindo grade IIIb–V) were observed in the enterotomy group, whereas no such complications occurred in the FM group (p=0.034). Additionally, postoperative bridal intestinal obstruction developed in six patients (37.5%) in the enterotomy group after discharge (p=0.025).
CONCLUSION: Fragmentation and milking appears to be the preferred first-line surgical approach in patients undergoing emergency surgery for bezoar-induced gastrointestinal obstruction, as it is less invasive and associated with reduced postoperative morbidity. Furthermore, FM may decrease the risk of postoperative obstruction compared with the enterotomy technique.

BACKGROUND: This study aimed to investigate whether the severity of attention-deficit/hyperactivity disorder (ADHD) symptoms, particularly inattention and impulsivity, is associated with extremity fractures in children. Additionally, ADHD symptom scores were compared between surgically and conservatively treated fracture cases, and the relationship between trauma energy level and ADHD symptoms was evaluated.
METHODS: In this cross-sectional study, 160 children aged 7–17 years were evaluated. Participants were divided into three groups: children with surgically treated fractures (n=40), children with conservatively treated fractures (n=40), and fracture-free controls (n=80). ADHD symptoms were assessed using a parent-completed Screening and Assessment Scale based on the Diagnostic and Sta-tistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Sociodemographic data, trauma mechanisms, and fracture characteristics were also documented.
RESULTS: Children with fractures had significantly higher inattention scores (6.13±3.44 vs. 4.26±2.34; p<0.001), impulsivity scores (6.50±4.70 vs. 4.45±2.10; p=0.001), and total ADHD scores (12.60±6.41 vs. 8.74±3.62; p<0.001) compared with controls. No significant differences were observed between the surgical and conservative treatment groups or between low- and high-energy trauma subgroups. Sociodemographic variables and fracture history among siblings did not differ significantly between the groups.
CONCLUSION: Higher ADHD symptom scores were significantly associated with the occurrence of extremity fractures in children. These findings suggest that assessing ADHD-related symptoms may provide useful insights during pediatric trauma evaluations. However, due to the cross-sectional design, temporality and causality cannot be established. Longitudinal studies are needed to confirm these associations.

BACKGROUND: Eid al-Adha is an important religious holidays celebrated annually in Muslim communities, during which the ritual of animal sacrifice is performed. The demand for butchery services rises significantly during this period; however, due to the limited availability of professional butchers, many individuals undertake the slaughter themselves. This practice is associated with an increased incidence of traumatic injuries, particularly involving the hands and upper extremities. This study aims to characterize the pattern of hand and upper limb injuries associated with non-professional animal slaughter during Eid al-Adha and to raise awareness of these preventable traumas.
METHODS: In this retrospective study, we evaluated patients who presented to our clinic with hand injuries requiring surgical intervention during multiple Eid al-Adha periods. The study population primarily consisted of individuals injured during animal slaughter who were admitted to the hospital for hand or upper extremity trauma. Demographic data and injury types were evaluated.
RESULTS: Over an eight-year period, a total of 259 extensor tendon injuries, 76 flexor tendon injuries, and 275 superficial soft tissue injuries related to Eid al-Adha were surgically treated at our clinic.
CONCLUSION: This study provides a retrospective analysis of hand tendon and superficial tissue injuries observed over eight Eid al-Adha periods. The findings indicate that non-professional slaughter of sacrificial animals poses a significant risk, particularly for hand and tendon injuries. Ensuring that slaughter procedures are performed by trained individuals, along with the use of protective measures, may play an important role in reducing these preventable injuries.

BACKGROUND: This study aimed to compare the radiological and functional outcomes of autologous iliac bone grafting and tricalcium phosphate synthetic grafting in the treatment of tibial plateau fractures (TPFs) with articular depression.
METHODS: In this retrospective comparative study, 94 patients who underwent surgical treatment for Schatzker type II–III tibial plateau fractures with metaphyseal depression between January 2015 and June 2022 were evaluated. Patients were divided into two groups according to the graft material used: autologous iliac bone graft (n=42) and tricalcium phosphate (TCP) synthetic graft (n=52). Radiological evaluation included measurement of articular depression (mm) and the modified Rasmussen Radiological Score (RRS) preoperatively, postoperatively, and at final follow-up (≥36 months). Functional outcomes were assessed using the Lysholm Knee Score and the modified Rasmussen Functional Score (RFS). The minimum follow-up duration was 36 months.
RESULTS: Both groups achieved satisfactory initial correction of articular depression. At final follow-up, depression was smaller in the autograft group (2.10 [0.00–2.60] mm) than in the TCP group (2.50 [1.68–3.75] mm; U=771.5, p=0.014), indicating better maintenance of reduction. RRS values were comparable between groups preoperatively and immediately postoperatively, but were higher in the autograft group at final follow-up (16 [16–18] vs. 16 [14–16]; U=1453.5, p=0.002). Consistent with this finding, a greater proportion of excellent RRS outcomes was observed in the autograft group (40.5% vs. 21.2%; χ²(1)=4.15, p=0.042). Functional outcomes were similar between groups (RFS: 27 [26–28] vs. 26 [26–28]; U=1285, p=0.136; Lysholm: 86 [81–90] vs. 86 [81–90]; U=1271.5, p=0.159). Donorsite morbidity occurred in 4.7% of patients in the autograft group, whereas no graftrelated complications were observed in the TCP group.
CONCLUSION: In Schatzker type II–III TPFs with articular depression, autologous iliac crest bone grafting demonstrated better radiological maintenance of reduction and higher final RRS compared to TCP grafting, although midterm functional scores were similar. These level III data suggest that autograft remains a reliable option for structural support in metaphyseal defects; however, prospective randomized comparative studies are needed to confirm any potential advantage over tricalcium phosphate grafts.

BACKGROUND: High-energy gunshot injuries to the distal humerus frequently result in extensive comminution, severe soft-tissue damage, and contamination, making definitive fixation both technically demanding and biologically challenging. During staged management with temporary stabilization, extra-articular callus formation may occur prior to definitive fixation, potentially influencing the surgical decision to preserve or excise this tissue. This study aimed to evaluate the clinical and radiological outcomes of a fixation strategy that preserves extra-articular callus in high-energy distal humerus fractures caused by gunshot injuries.
METHODS: This retrospective study included 21 male patients with Gustilo–Anderson type IIIA distal humerus fractures caused by high-velocity gunshot injuries, treated between 2016 and 2024. All patients initially underwent temporary stabilization followed by definitive fixation. Patients were stratified according to whether the extra-articular callus tissue was preserved (n=9) or excised (n=12) during surgery. Functional outcomes were assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) score and the Mayo Elbow Performance Index (MEPI), and radiographic union time was recorded.
RESULTS: The mean patient age was 28 years (range, 22–43). According to the AO/OTA (Arbeitsgemeinschaft für Osteosynthe-sefragen/Orthopaedic Trauma Association) classification system, 81% of fractures were type 13C3. Nerve injury was present in five patients (23.8%), and heterotopic ossification developed in five patients (23.8%). No significant intergroup differences were observed in DASH scores, MEPI scores, range of motion, or infection rates (all p>0.05). However, union time was significantly shorter in the callus-preserved group compared with the excision group (18.0±3.1 vs. 23.5±3.3 weeks, p=0.004). Nerve injury (p=0.043) and heterotopic ossification (p=0.025) were associated with higher DASH scores, indicating poorer functional outcomes.
CONCLUSION: A callus-preserving fixation approach may offer a biological advantage in the management of high-energy distal humerus gunshot fractures by promoting earlier bone healing without compromising functional outcomes. When extra-articular callus does not interfere with anatomical reduction, preserving it in situ may be considered as part of a staged damage-control–to–definitive fixation strategy.

Eosinophilic esophagitis (EoE) is a chronic inflammatory disorder of the esophagus characterized by dysphagia and food impaction. Although uncommon, spontaneous esophageal perforation may occur, most frequently involving the distal esophagus and the gastroesophageal junction. These perforations are typically managed with surgical or endoscopic interventions. Early diagnosis and prompt initiation of treatment within the first 24 hours significantly reduce morbidity and mortality. The aim of this report is to demonstrate that gastroesophageal junction perforation secondary to eosinophilic esophagitis can be successfully managed conservatively, even in delayed presentations, and to contribute to the understanding of treatment strategies for this rare but potentially life-threatening complication. We report the case of a 35-year-old male with a 12-year history of EoE who presented to the emergency department with retrosternal pain, dyspnea, and hematemesis. Five days prior to presentation, he developed a sore throat and cherry-colored diarrhea after consuming grilled chicken and self-administered ibuprofen for symptom relief. Contrast-enhanced imaging and upper endoscopy revealed a perforation at the gastroesophageal junction. Due to the location of the lesion, endoscopic stenting or clipping was considered inappropriate. In the absence of signs of acute abdomen, mediastinitis, or significant fluid collection, a conservative management strategy was adopted. The patient was admitted to the intensive care unit and initially treated with intravenous ceftriaxone (2 g/day) and metronidazole (1.5 g/day), which were later changed to piperacillin–tazobactam (4.5 g every 6 hours) following infectious disease consultation. The patient remained clinically stable, and oral intake was initiated on day 6. Antibiotic therapy was discontinued on day 10, and the patient was discharged without complications. At the three-month follow-up, the patient reported recurrent and progressively worsening dysphagia. Control endoscopy performed at the previously visited center revealed a distal esophageal stricture preventing passage of the gastroscope; therefore, a 12-cm fully covered self-expandable esophageal stent was placed. The stent was removed 20 days later, and the patient remained asymptomatic during the subsequent six-month follow-up period. Spontaneous esophageal perforation secondary to EoE is a rare but potentially life-threatening complication. This case highlights that conservative management may be a viable alternative to surgical or endoscopic intervention not only in early-detected cases but also in carefully selected delayed presentations managed in a multidisciplinary setting. Long-term follow-up remains essential for the early detection and treatment of late complications, such as stricture formation.

Effective pain management is a cornerstone in the treatment of patients with multiple rib fractures, as inadequate analgesia can impair ventilation and increase the risk of pulmonary complications. Bilateral rib fractures, in particular, can significantly compromise respira-tory mechanics, leading to hypoventilation, atelectasis, and hypoxemia. Regional analgesic techniques play a crucial role in improving respiratory function while reducing reliance on opioids and their associated adverse effects. We report the case of a patient with multiple bilateral rib fractures following thoracic trauma who presented with severe pain and compromised respiratory function. Initial management with systemic analgesic proved inadequate. Multimodal regional analgesia was therefore initiated with a bilateral erector spinae plane block, resulting in rapid pain relief and improved oxygenation. Given the limited duration of analgesia provided by a single-shot erector spinae plane block, thoracic epidural analgesia was subsequently established via epidural catheter. Continuous low-dose epidural local anesthetic infusion ensured sustained analgesia, prevented pain recurrence, and supported ongoing improvement in respiratory function throughout the clinical course. This case highlights that a multimodal regional analgesic approach, combining an erector spinae plane block followed by thoracic epidural analgesia, may represent an effective and feasible strategy for optimizing pain control and respiratory outcomes in patients with bilateral rib fractures. Such an approach may also reduce the need for systemic opioid therapy while optimizing clinical outcomes and minimizing associated risks.