The comparison of preemptive analgesic effectiveneas of epidural and intravenous fentanil

Bu çalışmada, total abdominal histerektomilerde epidural ve intravenöz olarak uygulanan fentanilin preemptif analjezik etkinliğinin karşılaştırılması amaçlandı. ASA I-II grubu, total abdominal histerektomi yapılacak 54 hasta çalışmaya alındı ve randomize olarak üç gruba ayrıldı. Bütün hastalara standart genel anestezi uygulandı. Kontrol grubuna (Grup K, n18), sadece genel anestezi verildi. Epidural analjezi grubuna (Grup E, n18), preoperatif olarak L2-3 veya L3-4 aralıklarından yerleştirilen epidural kateterden 10 mL % 0.9 NaCl içinde 4 µg kg-1 fentanil, insizyondan 30 dakika önce uygulandı. İntravenöz analjezi grubuna (Grup İ, n18), insizyondan 5 dakika önce 4 µg kg-1 İV fentanil uygulandı. Postoperatif ağrı, 1.,2., 4., 6., 12. ve 24. saatlerde VAS ağrı skalası ile değerlendirildi. İlk analjezik istem zamanları ve 24 saatlik toplam analjezik tüketimleri kaydedildi. Ayrıca insizyon öncesi ve postoperatif 4. saatteki kan glukoz ve kortizol düzeylerine bakıldı. Postoperatif bütün evrelerdeki VAS skorları ve toplam analjezik gereksinimi Grup E'de diğer iki gruba göre anlamlı derecede düşük bulundu (p0.05). İlk analjezik istem zamanı da Grup E'de belirgin olarak uzundu (p0.05). Preinsizyonel kan glukoz ve kortizol değerlerinde gruplar arasında farklılık yok iken, postoperatif 4. saatte Grup E'de diğer iki gruba göre anlamlı derecede düşük bulundu (p0.05). Ancak bütün grupların postoperatif 4. saatteki değerleri preinsizyonel değerlerle karşılaştırıldığında, anlamlı bir artış tespit edildi (p0.05). Sonuç olarak total abdominal histerektomi ameliyatlarında preemptif epidural fentanilin akut postoperatif ağrı ve cerrahi stres yanıtın kontrolünde intravenöz fentanilden daha etkili olduğunu düşünmekteyiz.In this study, we aimed to compare the preemptive analgesic effect of fentanyl, which is used by intravenous or epidural route, in total abdominal hysterectomy (TAH). Fifty-four ASA I-II patients who admitted for total abdominal hysterectomy were included to this study and patients were randomly separated into three groups. All patients were given standard general anesthesia. General anesthesia alone was given in control group (Group K). In epidural analgesia group (Group E), epidural catheter was inserted preoperatively through L2-3 interspace and 4 µg kg-1 fentanyl in 10 mL0.9 % NaCl was administered 30 min. before incision. In intravenous analgesia group (Group I), fentanyl 4 µg kg-1 was administered intravenously 5 min. before skin incision. Pain scores were assessed with visual analogue scale (VAS) at 1st, 2nd, 4th, 6th, 12th and 24th hours postoperatively. First analgesic requirement time and total analgesic consumption were also recorded. Surgical stress response was evaluated with the blood glucose and plasma cortisol levels of patients whom were obtained before the incision and postoperative 4th hour. Compared to the other two groups, we observed that remarkable lower VAS pain scores and total analgesic consumption was provided in Group E (p<0.05). First analgesic requirement time was also significantly prolonged in Group E (p<0.05). The blood glucose and plasma cortisol levels at 4th hour postoperatively were significantly lower in Group E when compared to the other two groups (p<0.05). As a result we suggested that preemptive epidural fentanyl administration was more effective than preemptive intravenous fentanyl in postoperative acute pain and surgical stress response control at total abdominal hysterectomy

Weill marchesani sendromunda uzamış postoperatif apne

Weill Marchesani Sendromu (WMS), nadir, görülen bir sistemik konnektif doku hastalığıdır. Sendrom karakteristik olarak mikroseferofaki, ektopik lens, glokom, brakiodaktili ve brakiomorfı içermektedir. Bu olgu sunumunda, glokom cerrahisi geçiren, belirgin rezidüel blok ve postoperatif apne gelişen 17 ve 18 yaşlarında iki kız kardeş bildirilmektedir. Her iki hastamnda bir sonraki anestezi uygulamaları farklı anestezîk ajanlar kullanılarak sorunsuz tamamlanmıştır. Bu yazıda, uygulanan ilaçlar arasındaki muhtemel reaksiyonlar, konjenital sendrom ve uzamış apne nedenleri araştırılarak, tartışılmıştır.Weill Marchesani Syndrome (WMS) is an unusual systemic connective tissue disorder. This case report describes two sisters, 17 and 18 years old, with WMS. Both patients underwent glaucoma surgery and had prolonged postoperative recovery times because of apnea and an apparent residual neuromuscular block. Additional anesthetic exposures with different anesthetic drugs in both patients were uneventful. In this report, the possible interactions among the applied drugs, the hereditary syndrome and prolonged apnea were discussed

Comparison of single and repeated blockade of the greater occipital nerve in migraine treatment

Objective: Migraine is a neurovascular syndrome that can be triggered by several conditions such as increased stress levels, sleep disorders, some foods, hormonal abnormalities, and weather changes. In this study, the efficacy of single and repetitive greater occipital nerve blockade on patients with migraine were investigated. Methods: Forty migraineurs were divided into 2 groups randomly. Group 1 (n=20) received 1 session of blockade and group 2 (n=20) received 3 sessions of blockade per week with 2.5 cc 1\% lidocaine. The number of attacks monthly, duration of attacks (in hours), and pain severity using a visual analogue scale (VAS) were recorded, then compared with the pretreatment values and at the 6th and 12th weeks after treatment. Results: Group 1 showed a statistically significant decrease for all parameters compared with the 6th week values (p<0.05). Group 2 also showed a statistically significant decrease both at the 6th and 12th weeks for all parameters (p<0.05). The decrease in the frequency of pain at the 6th week between group 1 and 2 was statistically significant. The decrease in pain intensity (VAS) at the 12th week in group 2 was more significant (p<0.05). Conclusion: Greater occipital nerve blockade seems to be effective in the treatment of migraine and repeated blockade can be more effective in migraine treatment

Effectiveness of Greater Occipital Nerve Blocks in Migraine Prophylaxis.

Peripheral nerve blocks have been used in primary headache treatment since a long time. In this study, we aimed to examine the efficiency of greater occipital nerve (GON) block in migraine prophylaxis

Neck Tongue Syndrome; Started During Childhood and Still Existing

A sydrome, unilateral upper nuchal or occipital pain with or without numbness in these areas, accompanied by simultaneous ipsilateral numbness of the tongue is explicable by compresion of the second cervical root in the atlantoaxial space on sharp rotation of the neck as published justly by Lance JW and Anthony M in 1980. Since then totaly few papers were published about this syndrome. The patient is 15 years old girl and she has been suffering from ipsilateral numbness and pain on the neck and tongue during sharp rotation of the neck for ten years. She has no history of neck travma. In this case report we discussed rarely seen neck tongue syndrome patien

Comparison of One Day Pain Evaluation Questionnairre of Inpatients in 2007 and 2012 in a University Hospital

Amaç: Ağrı kontrolünün hastanede yatan hastalarda evde takip edilen hastalara göre daha etkin olduğu düşünülmektedir. Hastaların ağrı düzeylerinin belirlenmesi, ağrı kontrolüne ilişkin uygulamaların geliştirilmesi açısından önemli bir göstergedir. Bu çalışmada, üniversite hastanemizde yatan hastalarda bir günlük ağrı anketi 5 yıl ara ile uygulanmış ve sonuçlarının karşılaştırılması amaçlanmıştır. Yöntemler: Hastane yönetiminin onayı alınarak tanımlayıcı ve kesitsel olarak planlanan araştırmalardan ilki 7 Mayıs 2007'de, ikincisi ise 15 Mart 2012'de Üniversite Hastanemizde dahili ve cerrahi kliniklerinde yatan ve çalışmaya katılmayı kabul eden hastalar ile yapılmıştır. Her iki araştırmada da 'Bir Günlük Ağrı Anketi' uygulanmıştır. Ankette araştırmanın yapıldığı klinik, hastaların ağrı düzeyi , ağrı nedenleri ve ağrıya bağlı komplikasyonlar karşılaştırılmıştır. Bulgular: Anket 2007 yılında 511, 2012 yılında ise 391 hastaya uygulanmıştır. Hastalarda orta ve şiddetli ağrı 2007 yılında % 42.6 (%36'sı postoperatif ağrı) iken, 2012 yılında %53.5 (%22'si postoperatif ağrı) olarak tespit edilmiştir. Ameliyat sonrası ağrı incelendiğinde orta ve şiddetli ağrısı olan hastaların 2007 yılında NRS ortalaması 7.1±2.4 iken, 2012 yılında 5.1±2.2 bulunmuştur. Ağrı nedeniyle en fazla görülen komplikasyon uykusuzluk olmakla birlikte, ağrı nedeniyle uykusuzluk oranları 2007 yılında %38,7, 2012 yılında ise %25,8 olarak saptanmıştır. İki anket kıyaslandığında 2012'de postoperatif ağrı sıklığında istatistiksel olarak anlamlı bir azalma kaydedilmiştir (p<0.05); ancak ortalama ağrı şiddetinde anlamlı bir fark bulunmamıştır. Sonuç: Araştırmanın sonuçları, geçen 5 yılda yatan hastalarda postoperatif ağrıda iyileşme olmakla birlikte ağrının yeterince kontrol altına alınamadığını göstermektedir. Algoloji Bilim Dalı olarak hedefimiz hastanemizi 'Ağrısız Hastane'ye dönüştürmektir. Tüm hastanelerde bu tür taramaların ağrı yönetimine yönelik uygulamaları geliştireceği düşünülmektedir.Objective: It is assumed that pain control is better in inpatients compared to patients at home. Pain assessment is an important tool to improve pain management. In this study, 'One Day Pain Evaluation Questionnairre' was given to inpatients twice in 5 years. The aim was to evaluate and compare results of one day pain evaluation questionnairre. Methods: This descriptive and cross-sectional study was approved by the hospital administration and performed in May 7th in 2007 and March 15th in 2012 in Gazi University Hospital patients in medical and surgical clinics who accepted to participate in the study. One day pain questionnairre was developed by researchers and included patient's ward, pain scores (NRSNumeric Rating Scale 0-10), causes of pain (operation, disease etc.) and pain related complications. Both questionnairres were evaluated and compared. Results: This questionnairre was administered in non-surgical and surgical wards; to 511 and 391 patients in 2007 and 2012, respectively. In 2007, moderate to severe pain (NRS=4-7) was 42.6% (36% postoperative pain) and in 2012 53.5% (22% postoperative pain). Postoperative pain score of patients with moderate to severe pain (NRS=4-7) was NRS 7.1±2.4 in 2007 and NRS 5.1±2.2 in 2012. The most common complication related to pain was sleep loss. Sleeplessness was 38.7% in 2007, compared to 25.8 in 2012. In 2012 postoperative pain was statistically less common compared to 2007 (<0.05), but there was no difference in mean pain severity. Conclusion: The results of the study indicates that although postoperative pain is reduced, pain of inpatients couldn't be controlled enough in 5 years. Our aim as an Algology Department is to transform our university hospital to a 'Painless Hospital'. We call all hospitals to investigate pain score to serve pain management strategies in our country

Is there a role for nitric oxide activity in cervicogenic headache?

Cervicogenic headache (CEH) is a unilateral headache that can be provoked by neck movement, awkward head positions or pressure on tender points in the neck. The mechanisms underlying the stimulation of pain in CEH are not clearly known. In this study, we measured serum nitrate and nitrite levels as an index of nitric oxide (NO) activity in 15 patients with CEH during headache and headache-free periods and in 15 healthy controls. Total nitrate+nitrite levels were found to be higher in CEH patients during headache periods than in healthy controls (20.7±3.8 µmol/l vs 14.4±3.6 µmol/l, p0.05). In the patients with CEH, serum total nitrate+nitrite levels were found to be higher during headache periods than during headache-free periods (p=0.001). It can thus be hypothesized that the changes observed are a cause of the attack rather than a consequence of the disease process

Effectiveness of Greater Occipital Nerve Blocks in Migraine Prophylaxis

Introduction: Peripheral nerve blocks have been used in primary headache treatment since a long time. In this study, we aimed to examine the efficiency of greater occipital nerve (GON) block in migraine prophylaxis. Methods: Data from migraine without aura patients who had GON block were collected and divided into two groups: Group PGON (n=25), which included patients who were under medical prophylaxis and had GON block, and Group GON (n=53), which included patients who had only GON blocks. Migraine was diagnosed using International Headache Society (IHS) classification. Data of 78 patients were analyzed. Headache attack frequency, headache duration, and severity were compared between and within groups in a 3-month follow-up period. Results: The decrease in headache parameters after GON block in both groups was significantly similar. Headache attack frequency decreased from 15.73 +/- 7.21 (pretreatment) to 4.52 +/- 3.61 (3rd month) in Group GON and from 13.76 +/- 8.07 to 3.28 +/- 2.15 in Group PGON (p<0.05). Headache duration decreased from 18.51 +/- 9.43 to 8.02 +/- 5.58 at 3rd month in Group GON and from 15.20 +/- 9.16 to 7.20 +/- 4.16 in Group PGON (p<0.05). Headache severity decreased from 8.26 +/- 1.32 to 5.16 +/- 2.64 in Group GON and from 8.08 +/- 0.90 to 5.96 +/- 1.20 in Group PGON (p<0.05). There was no statistically significant difference between the groups in 3rd month after treatment (p>0.05). Conclusion: This study showed significant decreases in headache parameters in both groups. As GON blocks were performed in patients unresponsive to medical prophylaxis, a decrease in the headache parameters in Group PGON similar to that in Group GON can be attributed to GON blocks. Consequently, these results show that repeated GON blocks with local anesthetic can be an effective alternative treatment in migraine patients who are unresponsive to medical prophylaxis or who do not prefer to use medical prophylaxis

The Effects of Pregabalin on Kidney Tissue of the Rats those have Ureter Obstruction

Arslan, Mustafa/0000-0003-4882-5063WOS: 000454502900014Background: Various algorithms and treatment guidelines have been established for the treatment of neuropathic pain. In summary, tricyclic antidepressants, anticonvulsants, serotonin reuptake inhibitors and opioids are used in these algorithms. Pregabalin is an anticonvulsant drug that is frequently used in the treatment of neuropathic pain. During the use of kidneys in patients with renal insufficiency due to the need to change the dose was taken attention. Therefore, in our study, we aimed to investigate the effects of pregabalin on renal tissue in rats with renal failure due to ureter obstruction. Materials and Methods: After the approval of the ethics committee, 24 rats were randomly divided into four groups: Group C: Control, Group P: Pregabalin, Group UO: Ureter Obstruction, UO-P Group: Ureter Obstruction Pregabalin. Urinary obstruction groups underwent a low abdominal incision under ketamine anesthesia to reach the distal right ureter and suture was placed with 2.0 mersilene and was waited for 3 weeks for late stage renal failure. In group P and UO-P rats, pregabalin was administered intraperitoneally at a dose of 100 mg / kg. After the twenty-four hour followup period, rats were sacrificed with the blood taken from the intraabdominal aorta by intraperitoneal ketamine (100 mg / kg). Blood samples were stored at -20 degrees C and urea, creatinine, MDA and NO were studied. In the kidney tissue, caspase 3, 8 enzymes and histopathological evaluation were performed.. Results: Caspase 3 enzyme activity was significantly increased in UO groups. In addition, pregabalin administration significantly increased the activity of caspase 3 in the UO-P group compared to the P group. The enzyme activity of caspase 8 was similar between the groups. Light microscopy revealed significant changes in UO groups, especially in the kidney tissue, which was obstructed. NO and MDA enzyme activities increased significantly in UO groups. In addition, pregabalin administration significantly increased NO and MDA enzyme activities in UO-P group compared to P group. Urinary obstruction significantly increased urea and creatinine levels. Pregabalin administration also increased urea and creatinine levels in the UO-P group compared to the P group. Conclusion: Pregabalin, which is frequently used in the treatment of neuropathic pain, has not been found to increase the renal damage that occurs experimentally in renal failure rats. We believe that our findings should be supported by a wide range of experimental and clinical studies