Postoperative Pain in Children

Postoperative pain is an acute pain that starts with surgical trauma and gradually decreases with healing of the tissue. The mechanism of pain perception in the pediatric population is different and poorly understood. Difficulties in defining and grading pain in pediatric patients also complicate treatment. Postoperative pain management in children should be planned with a multidisciplinary and multimodal approach. In this article, it is aimed to review up-to-date information on pediatric postoperative pain management

Evaluation of the effectiveness of ultrasound-guided transversus abdominis plane (TAP) block for chronic pain after lower abdominal surgery

Aim: This study aimed to evaluate the effectiveness of ultrasound-guided transversus abdominis plane (TAP) block in patients diagnosed with chronic pain after undergoing lower abdominal surgery. Methods: Patients who were admitted to the pain medicine clinic between January 1, 2016, and January 1, 2020, and underwent TAP block with the diagnosis of chronic pain after undergoing lower abdominal surgery were retrospectively analyzed. The visual analog scale (VAS) score was measured before the procedure and at the 1-month and 3-month follow-ups. Results: The proportion of patients with a reduction in VAS scores of >50% after TAP block application was 50% at the 1-month follow-up and 72.5% at the 3-month follow-up. The changes in the VAS score was found to be statistically significant (p < 0.05). Conclusion: Although ultrasound-guided TAP block seems to be an effective treatment method for chronic pain after lower abdominal surgery, further studies and clinical trials investigating different types of surgeries and including a larger number of patients are warranted

Effect of Intrathecal Morphine on Postdural Puncture Headache in Obstetric Anaesthesia

Objective:Intrathecal morphine is used as an effective component of multimodal analgesia in postoperative analgesia in cesarean section patients. We aimed to analyze the relationship between intrathecal morphine administration and postdural puncture headache (PDPH), pain score and analgesia consumption in the postoperative period, and maternal fetal effects.Methods:One hundred four pregnant women aged ≥18 years (American Society of Anesthesiology physical status I or II, >36 weeks gestation) who were scheduled for elective cesarean section under spinal anaesthesia were included in this study. Spinal anesthesia consisted of bupivacaine with or without morphine (Group M: 10 mg heavy marcaine + 25 mcg fentanyl + 100 mcg morphine; Group F: 10 mg heavy marcaine + 25 mcg fentanyl). The effect of intrathecal morphine on PDPH, postoperative pain score, analgesia consumption, and maternal and fetal effects were recorded for 5 days.Results:PDPH developed in a total of 33 patients (Group M: 18 and Group F: 15, P=0.274). When we evaluated PDPH with the VAS, there was no significant difference between the groups. The postoperative visual analogue scale (VAS) was lower in the morphine group, and no statistically significant difference was found in the VAS 1st hr and VAS 2nd hr, whereas the VAS 6th hr and VAS 24th hr were found to be statistically significant. There was no difference in terms of PDPH, the first analgesic requirement and postoperative nausea-vomiting, but meperidine consumption was lower in the morphine group.Conclusion:Low-dose intrathecal morphine did not affect the incidence of PDPH. It is an effective method that can be used in cesarean section patients without increasing the maternal and fetal side effects from postoperative analgesia

Results of sphenopalatine ganglion pulsed radio- frequency treatment in patients suffering from episodic cluster headache

Background &amp; Objective: The aim of this study was to investigate the short- to medium-term effects of pulsed radiofrequency (PRF) of the sphenopalatine ganglion on episodic cluster headache. Methods: This is a retrospective observational study, 26 patients who underwent PRF of the sphenopalatine ganglion were retrospectively evaluated. The Visual Analogue Scale (VAS) score, number of headache attacks per week, autonomic symptoms and medication use were recorded at 1, 3 and 6 months after the procedure. Results: The mean VAS scores were significantly lower at the 1-, 3-, and 6-month evaluations compared with pre-procedure values (P &lt; 0.001). At the 6th month after the procedure, the proportion of subjects who completely stopped using medications was 26.9%, and the proportion with a decrease in autonomic symptoms was 61.5%. No complications were encountered as a result of the procedure. Conclusion: The application of PRF to the sphenopalatine ganglion is an effective and safe treatment option for episodic cluster headache in the short to medium term.</jats:p

Investigation of in vitro and in silico effects of some novel carbazole Schiff bases on human carbonic anhydrase isoforms I and II

Carbonic anhydrases (CAs, EC4.2.1.1) are metalloenzymes that catalyse reversible hydration reaction of carbon dioxide to bicarbonate and protons. In recent years, there has been a great interest in inhibitors/activators of carbonic anhydrase isoenzymes. Therefore, we investigated the effects of four different carbazole Schiff base derivatives, which are believed to have a potential to be used as a drug, on human carbonic anhydrase (hCA) isoenzymes I and II under in vitro conditions. The IC50 values of carbazole Schiff base derivatives were found to be in the range of 32.09-151.2 μM for hCA isoenzyme I and 21.82-40.54 μM for hCA isoenzyme II. Among all compounds, (E)-3-(((9-Octyl-9H-carbazole-3-yl)imino)methyl)benzene-1,2-diol (C3) had the strongest inhibitory effect on hCA isoenzyme II. It was determined that 2,3,4-trimethoxy and 4-hydroxy phenyl containing carbazole compounds have selective inhibition against hCA II isoenzyme. Docking studies were performed against hCA I and II receptors using induced-fit docking method. The compounds had affinity scores varying from -7.74 ± 0.27 to -6.27 ± 0.07 kcal/mol for hCA I and from -8.04 ± 0.17 to -7.27 ± 0.18 kcal/mol for hCA II.Communicated by Ramaswamy H. Sarma