Agri: Agri (Algoloji) Dernegi'nin Yayin organidir = The journal of the Turkish Society of Algology

Online ISSN: 1300-0012
Publications
Article
Analgesic techniques after c-section must be effective producing early mobilisation to enable mothers to care effort their babies. In this study, the comparison of ropivacaine 0.2% alone, with ropivacaine 0.2%+sufentanil 0.75 microg mL-1 for patient controlled epidural analgesia (PCEA) was aimed. Fifty women (ASA-I) were enrolled in the study. All patients had combined spinal-epidural anaesthesia. Infusion of analgesic solutions was started when sensory level decreased by two dermatome levels. The patients randomly assigned, into two groups (n=25). In Group-I, ropivacaine 0.2% and sufentanil 0.75 microg mL-1, in Group-II, ropivacaine 0.2% alone were applied (bolus 1.25 mL, lockout 30 min, with 2.5 mL h-1 background infusion). Pain (Visual Analog Scale), motor blockage (Bromage scale) and sedation (Four point scale) were evaluated during 24 hours after Caesarean, using the scales of visual analogue, bromage, and four-point, respectively. Haemodynamic and respiratory parameters, side effects, total drug consumption and additional analgesic need, were recorded. Statistical analysis included student-t, chi-square, and Mann Whitney U tests. There was no difference in demographic data, sedation scores, haemodynamic and respiratory parameters, between the groups. Motor block and pain scores were significantly higher in Group-II than in Group-I at 2 and 4. h. Total drug consumption was 65.24+/-4.20 mL for Group-I and 81.1+/-6.44 mL for Group-II, (P<0.05). Four patients in Group-I and 21 patients in Group-II received additional analgesic. Pruritus was observed more frequently in Group-I. The addition of sufentanil 0.75 microg mL-1 to ropivacaine 0.2% for PCEA after Caesarean led to more effective analgesia and less motor weakness when compared to ropivacaine 0.2% alone, especially during early postoperative period.
 
Article
Total knee replacement (TKR) is one of the most painful orthopedic surgical procedures. This study was aimed to investigate the effect of a single-shot preoperative 3-in-1 femoral nerve block on postoperative pain by using 0.375% ropivacaine, and on the consumption of morphine by using PCA following the TKR surgery. Side effects were also evaluated in this setting. 34 patients were included in this study. Group R (n=17) received a 3-in-1 femoral nerve block (FNB) with 40 mll of ropivacaine 0.375%. Group S (n=17) received only a 2 mg loading dose of morphine 30 minutes before the end of surgery, and no block was performed. Both groups received general anesthesia and postoperatively had a PCA pump programmed to deliver morphine. VAS scores at rest, morphine consumption and adverse effects were recorded. Two patients were excluded from each group. Pain scores at 0, 1, 2, 3, 4, 6, 8 postoperative hours were significantly lower in group R in resting position (p<0.05). Group R experienced no pain at the recovery room and this state lasted 8 hours after the surgery while group S reached the acceptable score (VAS ? 3) one hour after leaving the recovery room. The morphine requirement was significantly lower in Group R at 12, 18, 24, 48 hr after TKR (p<0.001). Side effects were also lower in this group. Preoperative single-shot 3-in-1 FNB with 40 cc of ropivacaine 0.375% provides better VAS scores, less morphine consumption and fewer side effects in elderly patients when compared to the group with no block.
 
Article
In this study, the effects of preoperative 900 and 1200 mg single dose of gabapentin on postoperative pain relief and tramadol consumption in elective open cholecystectomies were investigated. Fourty-five ASA I-II patients were randomly divided into three groups. Group I was control group and patients in group II and III received 900 mg or 1200 mg gabapentin 1 hour before the operations respectively. All patients received intravenous tramadol at the end of surgery via a patient controlled analgesia (PCA) device. Pain scores were evaluated at the recovery room (0),1, 2, 3, 4, 6, 8, 12 and 24h postoperatively at rest and movement, using a 10 cm VAS. In the recovery room, VAS scores at rest were three times less (1,4+/-0.6 versus 4,9+/-1.0 and 4.4+/-1.1), and visual analogue scale (VAS) scores at movement were two times less (3.4+/-1.0 versus 6.8+/-1.8 ve 6.1+/-1.6) in group III when compared to group I and II respectively. Mean loading doses were significantly lower in group III (28.3+/-8.7) than group I (66.6+/-20.4) and II (61.6+/-20.8). VAS scores at rest during the postoperative first 6h and at movement during the postoperative first 8h were significantly lower in group III than group I and II. Total tramadol consumption was lower in group III (240.4+/-31.0), than group I (456.0+/-35.5) and group II (438.7+/-35.0). Additional meperidine was necessary for two patients both in groups I and II, although none of the patients needed in group III. Higher patient satisfaction scores were obtained in group III. Adverse effect incidences were higher in group I and II than in group III. As a result, we believe that to improve analgesic quality after open cholecystectomy, preoperative single dose of gabapentin should at least be 1200 mg.
 
Article
Objectives: The aim of this investigation is to examine the causes, clinical picture, treatment, and prognosis of spontaneous intracranial hypotension, a rare cause of orthostatic headache, among the cases presenting in our clinic. Methods: Thirteen cases (5 males and 8 females), diagnosed with spontaneous intracranial hypotension in our clinic between January 1st, 2009 and October 30th, 2011, were included in this study. The presenting symptoms, treatment, findings on cranial magnetic resonance imaging, cerebrospinal fluid pressure measured at lumbar puncture (in available patients), and the healing period of the patients were recorded. Results: Five patients with orthostatic headache and accompanying symptoms were treated with bed rest, increase in oral fluid intake, intravenous hydration and caffeine, and experienced a complete recovery. Complete recovery was observed in two patients (15.3%) within 10 days, in another two (15.3%) within 15 days and in one patient (7.6%) within 21 days. Headache and other clinical symptoms significantly regressed within 30 days in four patients (37.6%) who received similar treatment, but a mild headache persisted intermittently during follow-up in these individuals. As the headache had not resolved after 30 days, an epidural blood patch was applied in these four cases (37.6%) and the clinical picture completely improved within 10 to 15 days. Conclusion: Spontaneous intracranial hypotension should primarily be suspected in cases complaining about postural headache and contrast-enhanced cranial imaging should be performed. The presence of cranial nerve paralysis and pyramidal tract signs should b considered. Conservative treatments should be considered initially, however if conservative treatments fail, epidural blood patches must be applied.
 
Article
Objectives: The aim of this study is to evaluate the patients who admitted to algology polyclinic with malign and non-malign pain, sociodemographic characteristics, type of pain and pain management retrospectively. Methods: In this study we examined the medical assessement files of patients who admitted to our outpatient clinic of Algology Department for chronic pain between January 2000- December 2010. The sociodemographic characteristics of the patients, pain properties and treatments were reviewed retrospectively. Results: Within the eleven years period, a total of 6647 patients have been admitted to our clinic. 66.9% of the patients were between the ages of 19 and 64. There was no significant difference between gender. The most common causes of pain were myofascial pain, neuropathic pain, low back pain and headache. Among malignancy related cases the most common sources were gastrointenstinal system, lung and breast regions. In 83.4% of patients, pharmacological and invasive treatments were utilized. The most common invasive treatment modalities were, trigger point injection, dry needle application and epidural catheter application. Conclusion: In conclusion, pain treatments with multidisciplinary approach applied by the increasing number of pain clinics provide favorouble results and patients quality of life is also increased. We hope our retrospective study may provide helpful data for future studies on chronic pain with its comprehensive base of patient data which covers an eleven years period.
 
Article
Anesthesia and surgery are required in up to 1.5% to 2% of all pregnancies. Alterations in maternal anatomy and physiology create potential risks for both mother and fetus. The anesthetic considerations for any surgery during pregnancy must take both patients into account. Gastric adenocarcinoma presenting during pregnancy is a rare condition and has a poor prognosis. This report describes anaesthetic management of a woman who was diagnosed with gastric adenocarcinoma at 26 weeks' gestation. Distal subtotal gastrectomy was planned in an attempt to maximize the mother's life expectancy while maintaining the pregnancy until the fetus reached viable gestation. A combination of general anesthesia and thoracic epidural anesthesia was used. The goal was to reduce physiological stress and minimize anesthesia risk for both mother and fetus and also diminish the neuroendocrine response during the surgery. The patient was discharged from the hospital 10 days after the surgery and was then readmitted at 30 weeks' gestation for an elective cesarean section.
 
Article
This study was conducted to determine women's about attitudes child's teeth, abdomen and ear ache. Those who had lived in Antalya that 6 number primary health care center between March-May 2004 were enrolled in the study. As data collecting tools. A questionnaire prepared by the authors. This study was determined that 29.2 % of the mothers carried out mixture who had prepared at home to child's abdomen and foot base; 30.3 % were to put breast milk childs' ear; 38.9 % were placed aspirin, salt and salts of lemon to childs' teeth ache. The majority of the women make a wrong practices child that teeth, abdomen and ear ache. This traditional practice effecting factors were the women's educational status and age. The results of the study that education about child care, common health problems and incorrect applications shoud be given to women by nurse.
 
Article
In our study we aimed to reduce postoperative morphine consumption, prevent adverse effects of morphine, and improve analgesic quality via adding analgesic doses of ketamine infusion to intravenous morphine-patient controlled analgesia (PCA). After local ethics committee approval, 45 patients scheduled for total abdominal hysterectomy were included in the study. In the postoperative period the patients were separated into two groups randomly. After starting morphine-PCA in both groups, one group received ketamine infusion (Group K: n= 22), while the other group received saline infusion (Group S: n= 23) for 24 hours. There was no significant difference between the postoperative systolic and diastolic arterial pressures, heart rate and respiratory rate values. Visual Analogue Scale and Verbal Rating Scale measures was significantly lower in Group K (p<0.01). Total morphine consumption was higher in Group S (p<0.05). Sedation scores were significantly lower in Group K (p<0.05). When adverse effects were evaluated we found that nausea was higher in Group S (p<0.05), while there was no difference in the other side effects (p>0.05). Patient satisfaction was better in the 24th and 48th hours in Group K and was found to be statistically significant (p<0.05). Our results suggest that ketamine infusion added to opioids for postoperative analgesia, reduces total opioid requirement and prevents side effects.
 
Article
The aim of this study was to determine if preemptive use of the NMDA receptor antogonist ketamine decreases postoperative pain in patients undergoing abdominal hystrectomy. A total of 60 patients admitted for total abdominal hysterectomy were included in this study after the approval of the ethic committee, and the patients were randomly classified into three groups. After standart general anaesthesia, before or after incision patients received bolus saline or ketamine. Group S received only saline while Group Kpre received ketamine 0.4 mg/kg before incision and saline after incision, and Group Kpost received saline before incision and 0.4 mg/kg ketamine after incision. Postoperatif analgesia was maintained with i.v. PCA morphine. Pain scores were assessed with Vizüal Analog Scale (VAS), Verbal Rating Scale (VRS) at 1., 2, 3., 4., 8., 12. ve 24. hours postoperatively. First analgesic requirement time, morphine consumption and side effects were recorded. There were no significant differences between groups with respect to VAS / VRS scores, the time for first analgesic dose, and morphine consumption ( p>0.05). Patients in Group S had significantly lower sedation scores than either of the ketamine treated groups ( p<0.05). In conclusion, a single dose of ketamin had no preemptive analgesic effect in patients undergoing abdominal hysterectomy, but further investigation is needed for different operation types and dose regimens.
 
Article
In this study, we aimed to investigate the preemptive analgesic efficacy of epidural application of fentanly-bupivacaine combination. A total of 60 patients admitted for total abdominal hysterectomy were included in this study after the approval of the ethic committee, and the patients were randomly classified into three groups. An epidural catheter was inserted to all patients through L2-3 or L3-4 space before general anesthesia induction. 2 micrograms/kg fentanyl in 0.25% bupivacaine in 10 ml serum saline was applied to the preemptive analgesia group (Group P) 20 minutes before the incision, and to the post-incisional analgesia group (Group E) 20 minutes after the incision, whereas control group received 10 ml serum saline 20 minutes before the incision through the epidural catheter. Pain scores were assessed with 100 mm Visual Analogue Scale (VAS) and four point Verbal Rating Scale (VRS) at 1., 2., 4., 6., 12., 24., 48. hours postoperatively. First analgesic requirement time and total analgesic consumption for 48 hours were also recorded. The VAS and VRS values in the postoperative 48 hours were significantly lower in Group P compared with the other groups (p < 0.05). First analgesic requirement time was also significantly prolonged in Group P (p < 0.001). Total analgesic consumption in Group P was significantly lower than the other two groups (p < 0.05). As a result we observed that preemptive administration of epidural fentanyl-bupivacaine combination reduces the postoperative pain and analgesic consumption in lower abdominal surgery.
 
Article
Myofascial pain syndrome is a painful musculoskeletal condition, and a quite common cause of chronic pain. It is characterized by the development of trigger points that are locally tender when active, and refer pain through specific patterns to other areas of the body. Its etiological factors are various; trauma, vertebral column diseases, systemic disorders, psychological distress, lack of motion, and chilling of the body parts. Myofascial pain syndrome may be misdiagnosed as arising from a visceral source especially if its probability is not kept in mind and a proper patient examination is lacking. Although there are many therapeutic approaches, trigger point injections can be diagnostic and therapeutic.
 
Article
Dexketoprofen trometamol is a water-soluble salt of the dextrorotatory enantiomer of the nonsteroidal anti-inflammatory drug ketoprofen. The aim of this study was to investigate the effect of intravenous dexketoprofen on postoperative pain. This study was performed on 50 (ASA I-II) patients scheduled for abdominal hysterectomy. Fifty patients were randomized into two equal groups. Patients received saline solution (Group I) or 50 mg intravenous dexketoprofen (Group II) 1 hour (h) before surgery and 8-16 h after surgery. All patients received a standard anesthetic protocol. At the end of surgery, all patients received intravenous (IV) morphine via a PCA (patient- controlled analgesia) device. Pain scores were assessed at 2, 6, 12 and 24 h after surgery. Morphine consumption and adverse effects were noted during the first 24 h after the surgery. The pain scores were significantly lower in the dexketoprofen group compared with the control group (p<0.05). The cumulative morphine consumption was also lower in the dexketoprofen group than the control group (p<0.05). No significant difference was observed in adverse effects between the groups (p>0.05). We conclude that the administration of IV dexketoprofen provided a significant analgesic benefit and decreased the morphine requirements in patients undergoing abdominal hysterectomy.
 
Article
Although abdominal cutaneous nerve entrapment syndrome (ACNES) is accepted as a rare condition, it is a syndrome that should be diagnosed more commonly when the clinical signs cannot explain the cause of abdominal pain. Abdominal pain is commonly considered by physicians to be based on intra-abdominal causes. Consequently, redundant tests and consultations are requested for these patients, and unnecessary surgical procedures may be applied. Patients with this type of pain are consulted to many clinics, and because their definitive diagnoses cannot be achieved, they are assessed as psychiatric patients. Actually, a common cause of abdominal wall pain is nerve entrapment on the lateral edge of the rectus abdominis muscle. In this paper, we would like to share information about the diagnosis and treatment of a patient who, prior to presenting to us, had applied to different clinics for chronic abdominal pain and had undergone many tests and consultations; abdominal surgery was eventually decided.
 
Article
Paracetamol is primarily thought to be a cyclooxygenase inhibitor acting through the central nervous system. Indirect effects of paracetamol are through the serotoninergic system as a non-opioid analgesic. In this study, total abdominal hysterectomy patients were given intravenous (iv) paracetamol 1 g preoperatively or intraoperatively to assess its postoperative analgesic effects. 90 patients undergoing total abdominal hysterectomy were enrolled into the study. Patients were randomized into three groups: in Group I, iv paracetamol 1 g was given 30 minutes prior to induction. In Group II, iv paracetamol 1 g was given prior to skin closure. Group III served as the control group and received saline as placebo. Postoperatively, all patients received morphine via patient-controlled analgesia pump. Postoperatively, rest and activity pain scores, sedation scores, hemodynamic parameters, postoperative morphine consumption, side effects, patient satisfaction, and total hospital stay were recorded. In the control group, at rest and movement pain scores and total morphine consumption via patient-controlled analgesia were higher than in Groups I and II. When Groups I and II were compared, total morphine consumption was much greater in Group II. Intravenous paracetamol intraoperatively and postoperatively did not result in any hemodynamic effects. In total abdominal hysterectomy, preemptive iv paracetamol 1 g provided good quality postoperative analgesia, with decreased consumption of morphine and minimal side effects.
 
Article
Although Endoscopic Thoracic Sympathectomy is a widely accepted treatment method for patients with palmar hyperhidrosis, compensatory hyperhidrosis of the trunk remains a challenging side effect of the procedure. No satisfactory treatment options for this side effect were available until now. In this study, we aimed to define a new procedure for the treatment of compensatory hyperhidrosis of the trunk. A total of 10 patients admitted our institution for the treatment of compensatory hyperhidrosis of the trunk were enrolled in the study between November 2010 and January 2012 in a prospective manner. Sympathetic blockage was achieved via radiofrequency thermo-ablation technique. The results of treatment were evaluated via telephone calls. Ten patients (2 females, 8 males) underwent radiofrequency thermo-ablation of T6 sympathetic ganglion for compensatory hyperhidrosis of the trunk. The mean age was 29.2 years and the median duration of symptom was 10.5 months. The median follow-up period was 14 months. Six of ten patients (60%) were treated successfully. There was no procedure related complication. The radiofrequency treatment for patients with compensatory hyperhidrosis of the trunk is an alternative option with promising results.
 
Article
Although the vast majority of chronic headache is idiopathic in origin, child abuse can be a very rare cause of paroxysmal headaches in children. The aim of this report was to present a case of migraine headache aggravated after sexual abuse, which did not respond to treatment. An 11-year-old girl admitted to the outpatient department of the Neurology Clinic with headache complaint for the past two years. Neurological examination, neuroimaging and laboratory tests were normal. According to the International Classification of Headache Disorders (ICHD)-II criteria, the headache was diagnosed as migraine without aura and treatment as prophylaxis was planned. Her headache did not respond to treatment, so she was consulted with the Department of Child and Adolescent Psychiatry and diagnosed as major depressive disorder. During one of the psychological interviews, she confessed that she had been sexually abused by her mother's boyfriend for two years. After this confession and punishment of the abuser, her headache improved dramatically. The prevalence of physical, sexual, and emotional abuse during childhood has been estimated between 13% and 27%, and these children may suffer chronic pain, headache or depression. Sexual abuse has been strongly associated with the migraine-depression phenotype when abuse first occurred before the age of 12 years. Despite the high prevalence of abuse, many physicians do not routinely ask about abuse history. In conclusion, child abuse must be kept in mind in intractable childhood headache. A multidisciplinary approach with the Departments of Forensic Sciences and Child and Adolescent Psychiatry and detailed psychiatric evaluation should be useful in these cases.
 
Article
This study aimed at determining the short-, mid- and long-term effects of a triple shoulder injection accompanied by fluoroscopy on Visual Analogue Scale (VAS) values in patients with chronic shoulder pain. The study was conducted by retrospective investigation of the files of 92 patients experiencing chronic shoulder pain, and on whom a triple shoulder injection with 40 mg methylprednisolone and 25 mg bupivacaine accompanied by fluoroscopy was applied between January 01, 2011 and August 31, 2012. 1st week, 1st - 6th month, and 1st year VAS values were significantly lower when compared to the basal VAS values from a statistical point of view (p<0.001). However, VAS values corresponding to the 6th month and 1st year were significantly higher than the VAS values corresponding to the 1st week and 1st month when considered statistically (p<0.001). Triple shoulder injection accompanied by fluoroscopy applied on patients with chronic shoulder pain is effective in short-, mid- and long-term, but its mid- and long-term effectiveness is less than its short-term effectiveness.
 
Article
Complex regional pain syndrome (CPRS) and Raynaud's disease are disorders characterized by vasomotor disturbances associating with abnormal autonomic nervous system. We present a case of CRPS involving a history of recurrence and no initiating event. Raynaud's disease accompanying CRPS was diagnosed clinically in the patient. We propose that a sympathetic dysfunction underlies the pathophysiologies of both disorders and may be responsible for the coexistence of these two distinct entities. Recurrence and unknown etiology of CRPS might account for temporary alterations in sympathetic function.
 
Article
Spontaneous intracranial hypotension was first described by Schalternbarn. Severe complications like cerebral venous thrombosis and subdural hemorrhage are seldomly seen. A 40-year-old man was examined for weakness of right arm started 9 months earlier and aggravated in last 3 months. He was undergo a lumbar punction because of a demyelinating plaque at C2 level in MRI. After 10 days of lumbar punction he experienced a generalised tonic clonic seizure. At cranial MRI and venography thrombosed superior sagittal and right transverse sinus and image of pachymeningitis, caused by intracranial hypotension were observed. Coincidence of these two situations together was seldomly found at literature. Thrombosis can both effect the sinuses and cortical veins. Spontaneous intracranial hypotension is a risk factor for CVT, but at only 2% CVT is seen as a complication. We think that our case can add addition to literature by having this coincidence.
 
Article
This definitive study has been performed to assess the approach to pain relief in emergency trauma units. The study population consisted of patients seen at the emergency trauma clinics of three different, state-owned, research hospitals in the city of Istanbul. A total of 375 patients with an age range of 18-65 were included. The data were obtained from an 18 question data sheet. Trauma was caused by a fall in 46.1% of the patients and 66.7% of the cases were out of building. Blunt trauma was the cause in 85.6%, 31.2% had head trauma, 38.1% extremity injuries. Of the patients enrolled in the study, only 17.1% (64 patients) had received analgesics. The most common analgesic medication group used was Nonsteroid Anti Inflammatory Drugs (NSAID). According to these results, 82.9% of patients with pain due to trauma had not received analgesics and it can be concluded that pain in trauma patients is undertreated.
 
Article
Foreign bodies in the external auditory canal may cause otalgia, and live insects have been reported among the causes. A number of methods have been used to immobilize the live insects. In our manuscript, we describe immobilization of an insect and provision of analgesia using EMLA cream.
 
Article
Transdermal nitroglycerine can improve analgesic effects when used with other analgesics. The aim of the study was to investigate the additive effects of nitroglycerine combined with lornoxicam for acute pain in rats. Thirty-nine Wistar male rats were divided into five groups; Group SF (n=8, saline), Group L-1 (n=8, lornoxicam 1.3 mg/kg), Group L-2 (n=8, lornoxicam 2.6 mg/kg), Group LNO (n=8, nitroglycerine and lornoxicam, 1 mg/kg+1.3 mg/kg), and Group LNO-2 (n=8, nitroglycerine and lornoxicam, 1 mg/ kg+2.6 mg/kg). Tail flick and hot plate tests were measured in all groups before the intraperitoneal injections of drug and 30, 60 and 90 minutes after the injections. Cut-off time was 20 s and 60 s in tail-flick and hot-plate tests. Although there were significant differences between the groups according to hot-plate test at the 30th, 60th and 90th minutes (p<0.05), there was no difference between the groups with tail flick test. The most increasing of latency response in hot-plate assays was seen in Group LNO-1 compared to other groups at the 30th minute (p<0.05). The latency response increased significantly in Group L-1, L-2, LNO-1 and LNO-2 compared with saline group at the 60th and 90th minutes (p<0.05). There were significant differences in latency responses in Group L-1 and Group LNO-1 compared to Group L-2 and Group LNO-2 at the 60th and 90th minutes. In conclusion, 1.3 mg/kg dose of lornoksicam with the use of nitrogliserine provided early and efficient analgesia, but the increasing dose of lornoksicam did not maintain better analgesia.
 
Article
The aim of the present study was to investigate the possible antinociceptive effects of systemic administration of tramadol and gabapentin either alone or in combination on acute pain models in mice. After obtaining the approval of Animal Ethics Committee; 96 BALB/c albino male mice were divided into 12 groups: (I) control without injection, (II) control treated with saline, (III)-(IV) mice treated with tramadol 10 mg/kg or 30 mg/kg, (V)-(VIII) mice treated with gabapentin; 30, 100, 200, 300 mg/kg respectively. In order to determine possible interactions between tramadol gabapentin and; mice received four different combinations of tramadol + gabapentin (30+30, 30+100, 30+200 and 30+300 mg/kg) (Groups IX-XII respectively). Mice received 0.1 ml solution for every 10 g of their weight. The drug was injected into peritonea. Thirty minutes after the drug injection, tail-flick and hot-plate tests were conducted. Ten and 30 mg/kg tramadol produced dose dependent antinociceptive effect in tail-flick and hot plate tests. Gabapentin had no antinociceptive effect in the tail flick test except 300 mg/kg dose, and had dose dependent antinociceptive effect in hot-plate test. In both tests, various combinations of tramadol and gabapentin produced an antinociceptive effect that is greater than that produced by tramadol and gabapentin alone. But, just 30 mg/kg tramadol + 300 mg/kg gabapentin combination caused statistically significant increase in both tests (p<0.05). When gabapentin and tramadol were used in combination, gabapentin had no additive antinociceptive effect except for 300 mg/kg in tail-flick and hot-plate tests. Tail-flick test showed that tramadol produced better antinociceptive effect than gabapentin.
 
Article
Myofascial pain syndrome is a disorder characterized by hypersensitive sites called trigger points at one or more muscles and/or connective tissue, leading to pain, muscle spasm, sensitivity, rigor, limitation of movement, weakness, and rarely, autonomic dysfunction. Various treatment methods have been used in the treatment of myofascial pain syndrome. Among these, stretch and spray technique, trigger point injection, dry needling, pharmacological agents, and physical therapy modalities have been proven effective. Sixty-five patients with acute myofascial pain syndrome were recruited into the study. Patients were randomized into three groups. The first group received thiocolchicoside ointment onto the trigger points, the second group received 8 mg thiocolchicoside intramuscular injection to the trigger points, and the third group received both treatments. Treatment was applied for 5 consecutive days. Algometric and goniometric measurements and pain severity assessments with visual analog scale (VAS) were repeated on the first, third, and fifth days of the treatment. Pain severity measured with VAS significantly improved after the first day in the mono-therapy groups and after the third day in all groups. While significant improvement was observed in all three groups in right lateral flexion measurements, no significant changes were observed in the combined treatment group in left lateral flexion measurements. Thiocolchicoside can be used in the treatment of myofascial pain syndrome. The ointment form may be a good alternative, particularly in patients who cannot receive injections.
 
Systolic blood pressure values: 1: preoperative; 2: prior to caudal block; 3: after caudal block; 4: immediately after started of operation; 5, 6, 7, 8: at the intraoperative 5th, 15th, 30th, 45th min respectively; 9, 10, 11, 12, 13, 14, 16, 17, 18: at the postoperative 5th, 15th, 30th and 60th min and the 2nd, 3rd, 4th, 6th, 12th and 24th h respectively.  
Dyastolic blood pressure values: 1: preoperative; 2: prior to caudal block; 3: after caudal block; 4: immediately after started of operation; 5, 6, 7, 8: at the intraoperative 5th, 15th, 30th, 45th min respectively; 9, 10, 11, 12, 13, 14, 16, 17, 18: at the postoperative 5th, 15th, 30th and 60th min and the 2nd, 3rd, 4th, 6th, 12th and 24th h respectively.  
Postoperative side effects
Analgesic durations of the groups and number of patients that required analgesia
Article
We aimed to determine the hemodynamic effects and postoperative pain control quality of ropivacaine and ketamine addition to ropivacaine in children undergoing inguinal hernia repair with caudal anesthesia. A total of 45 patients (1-4 years) scheduled to undergo inguinal hernia repair were studied. Anesthesia was induced with sevoflurane in O2/N2O and vecuronium was administered to facilitate endotracheal intubation. Anesthesia was maintained with sevoflurane in O2/N2O. Patients were randomly divided into three groups. Following endotracheal intubation, we administered 2 mg/kg 0.2% ropivacaine to Group R; 0.5 mg/kg ketamine to Group K; and 2 mg/kg 0.2% ropivacaine plus 0.5 mg/kg ketamine to Group R+K caudally. Pain levels were evaluated via modified CHEOPS, and sedation levels were assessed by the Wilson Sedation Scale. At the postoperative 45th minute (min), the CHEOPS score was significantly higher in Group R compared to Group K and Group R+K (p<0.05). This score was significantly higher in Group R than in Group R+K at the postoperative 60th min (p<0.05). The effective analgesic period was significantly higher in Group K (852+/-309 min) and Group R+K (1032+/-270 min) than in Group R (435.5+/-273 min) (p<0.05). The analgesic requirement in the first 24 hours postoperatively was lower in Group R+K than the other groups. Sedation scores were below 2 in all groups. There were no significant differences between groups regarding adverse events. The results of the present study indicate that caudal ropivacaine, ketamine and ropivacaine plus ketamine provided effective postoperative analgesia. Additionally, ketamine combined with ropivacaine lengthened the duration of analgesia while lowering analgesic requirements.
 
Article
The aim of this study is to examine the effects of sufentanil added to low-dose hyperbaric bupivacaine in unilateral spinal anaesthesia for outpatients undergoing knee arthroscopy. Sixty two patients (ASA I-II) aged 20 to 50 who were planning on undergoing a knee arthroscopy were enrolled in this study. Patients were randomly divided into two groups. Unilateral spinal anaesthesia with 1ml 0.5% hyperbaric bupivacaine was administered to Group B (n=33); and unilateral spinal anaesthesia with 0.5ml (2.5µg) sufentanil added to 1ml hyperbaric bupivacaine was administered to Group BS (n=29). There were no statistically significant differences observed between the groups in terms of demographic data, hemodynamic parameters, maximum sensorial, sympathetic and motor block levels, time to motor block resolution, and time of discharge (p>0.05). There were statistically significant differences between the groups in terms of two segments regression time (Group B=52 min., Group BS=59 min.), ambulation time (Group B=147 min., Group BS=157 min.) and urination time (Group B=136 min., Group BS=149 min.) (p<0.05). In this study, no itching was observed in Group B, whereas seven patients in Group BS were observed as having postoperative itching (p<0.05). All patients were successfully given unilateral spinal anaesthesia with sufentanil added to low-dose hyperbaric bupivacaine for an outpatient knee arthroscopy, without affecting the time of discharge. However, for one-day interventions such as arthroscopy, it was concluded that administration of only low-dose hyperbaric bupivacaine was sufficient.
 
Article
This randomized double-blind controlled trial examined the effects of fentanyl and morphine, alone and in combination, as adjuncts to spinal anesthesia for elective cesarean section. Sixty women undergoing elective cesarean section, with spinal anesthesia using 0.5% hyperbaric bupivacaine, were randomly allocated to receive morphine 0.2 mg, fentanyl 25 µg, or fentanyl 12.5 µg plus morphine 0.1 mg, intrathecally. The start of spinal block, the time to T10 level, the highest sensorial and motor block level, time to regression of sensory block to T10, time to resolution of motor block, surgical characteristics, maternal side effects, Apgar and NACS scores, umbilical blood gas evaluations, and time to first analgesic requirement were recorded. No patient experienced pain during the intraoperative period. The degree and time of sensorial and motor block were similar in both groups, and there was no difference in time to T10 level and time to reversal of motor block. The difference in time to first postoperative analgesic requirement was statistically significant. There was no difference between groups in postoperative side effects. There were no neonatal differences in Apgar and NACS scores or umbilical blood gas evaluations. The quality of postoperative analgesia with morphine, when used alone, was found to be superior to that with fentanyl. The combination of opioids offered no advantages over morphine alone.
 
Article
Pain treatment of patients with opioid addiction and tolerance may be challenging due to their unexpectedly higher pain sensitivities and opioid requirements. It has been reported that the N-methyl-D-aspartate receptor is involved in mechanisms of tolerance to opioid analgesics. Recently enhancement of morphine induced analgesia by low dose ketamine addition to the treatment regimen has been reported. We report a cancer patient with meperidine tolerance and psychological dependency to the agent who was afterwards successfully treated with morphine-ketamine combination.
 
VAS scores. 
Demand values (Average±Standard Deviation [Median]) 
Patient satisfaction (Likert scale) 
Article
Pain treatment in laparoscopic cholecystectomy, which is performed in increasing numbers as an ambulatory procedure, is an important issue.Although laparoscopic cholecystectomy is regarded as an ambulatory procedure, patients are often hospitalized due to pain and this increases opioid consumption and side effects caused by opioids. This study aims at evaluating the efficacy of adding dexketoprofen trometamol to tramadol with patient controlled analgesia (PCA) in postlaparoscopic cholecystectomy pain treatment. 40 patients in ASA I-II risk groups aged between 18-65 years were enrolled in the study and were randomized using closed envelope method. In Group TD 600 mg tramadol and 100 mg dexketoprofen trometamol, in Group T 600 mg tramadol was added to 100 ml 0.9% normal saline for PCA. 8 mg lornoxicam iv was given if VAS >40 in the postoperative period. There was no statistically significant difference in terms of adverse effects (hypotension, bradycardia, sedation) but in Group T 4 patients complained of nausea and 3 complained of vomiting. Opioid consumption was lower and patient satisfaction was higher in group TD. This study has shown that adding dexketoprofen trometamol to tramadol in patient controlled analgesia following laparoscopic cholecystectomy lowers VAS scores, increases patient satisfaction and decreases opioid consumption.
 
Article
The term adjuvant analgesics describes any drug with a primary indication other than pain, but with analgesic properties in some painful conditions. Adjuvant analgesics often are administered as first-line drugs in the treatment of chronic non-malignant pain. The group includes numerous drugs in diverse classes. Some adjuvant analgesics possess analgesic properties in several types of pain, whereas others are specific for neuropathic pain, or nociceptive pain. Antidepressants, anticonvulsants, neuroleptics, antiarrythmics, antihistaminics, NMDA receptor-antagonists, steroids, muscle relaxants, bisphosphonates, and radiopharmaceuticals are adjuvant agents. This article reviews the evidence supporting the use of adjuvant analgesics for the treatment of pain and emphasizes medical dosages, side effects, and drug interactions.
 
Article
Comparison of tramadol, tramadol-metamizol and tramadol-lornoxicam administered by intravenous PCA in management of postoperative pain. The aim of the present study was to compare of the postoperative analgesic effects of tramadol, combinations of tramadol-metamizol and tramadol-lornoxicam administered by intravenous Patient Control Analgesia (PCA) in lower abdominal surgery. Sixty adult, female patients who undergoing lower abdominal surgery, were included in this study. Patients were randomized to three groups. The solutions were prepared containing 500 mg tramadol in 50 ml saline (10 mg/ml tramadol) for Group I, 250 mg tramadol+3000 mg metamizol in 50 ml saline (5 mg/ml tramadol+60 mg/ml metamizol) for Group II and 250 mg tramadol+20 mg lornoxicam in 50 ml saline (5mg/ml tramadol + 0.4 mg/ml lornoxicam) for Group III. Loading dose 10 ml was administrated within 30 min 30 to 40 min before the end of the surgery. PCA was started at the first complaint of pain. Pain was evaluated by VAS in every 15 minute intervals at the first hour and later at 2nd, 4th, 8th, 12th, 18th and 24th hours postoperatively. Vital parameters, side-effects, sedation scores and total analgesic consumptions were also recorded concurrently. Total tramadol and anti-emetic consumption, the incidence of postoperative nausea and vomiting (PONV) were significantly higher in group I than the other groups (p<0.05). In conclusion; Tramadol-metamizol and tramadol-lornoxicam combinations administered by intravenous PCA provide efficient postoperative analgesia with less side effects.
 
Article
Objectives: We aimed to compare the efficacies of patient controlled bolus administration and continuous infusion of low dose Fentanyl and Levobupivacaine combination by epidural catheter during vaginal labor on mother, baby and the duration of labor. Methods: The 45 pregnant women involved in the study were divided randomly into two groups, Group HKEB (patient controlled epidural bolus) and Group SEI (continuous epidural infusion). Hemodynamic parameters and VAS values of the pregnant women, fetal heart rate, Apgar scores, duration of labor stages, types of delivery and side effects were recorded. Time to reach the T10 dermatome was determined. Motor block was evaluated with modified Bromage scale. Additional analgesic needs were followed up and total drug consumptions were compared. Results: Drug consumption was found to be significantly lower in HKEB administration (p<0.01). Conclusion: Bolus administration of a basal dose that will keep the analgesia level constant and additional drugs administered upon patient requests will prevent pregnant women from experiencing a painful period, and will provide confidence and comfort to patients who need to ask for drugs according to their pain characteristics.
 
Article
Postoperative abdominal and shoulder pain are common complications after laparoscopy. The aim of this study is to compare the effects of intraperitoneal local anesthetics on postoperative abdominal and shoulder pain after laparoscopy. 55 women, physical status ASA I, who were undergoing diagnostic or minor gynecologic surgery, was enrolled to the study. In Group 1 (Bupivacaine, n: 17) and Group 2 (Ropivacaine, n: 18), 80 ml solution which contains one of the local anesthetics (60 ml saline and 20 ml %0.5 bupivacaine in Group 1, 60 ml saline and 20 ml %0.75 ropivacaine in Group 2), was injected into the right subdiaphragmatic (30 ml) and abdominopelvic space (50 ml) at the beginning of the surgical procedure. Patients in Group 3 (Control, n: 20) didn't received any solution intraperitoneally. Shoulder and abdominal pain was assessed with a visual analogue scale, and any other complications were noted during the first 24 hours after surgery. Shoulder and abdominal pain intensity and frequency were significantly less in the local anesthetic groups than control group, similar between ropivacaine and bupivacaine groups.
 
Article
In this study, the effects of administration of subfacial levobupivacaine infusion with the ON-Q pain pump system were investigated in elective cesarean operations for postoperative pain control and tramadol-sparing effect. Fifty ASA I-II patients scheduled for cesarean operation were enrolled into this study. Patients were randomly divided into two groups: Group I served as a control group, without the ON-Q pain pump system, whereas Group II received the ON-Q pain pump system with subfacial 0.25% levobupivacaine infusion for 24 hours at 4 ml/hour. All patients received a standard anesthetic protocol. At the end of the surgery, all patients received tramadol i.v. Via a PCA (Patient Controlled Analgesia) device. Pain scores were assessed at 2, 6, 12 and 24 hours postoperatively. Tramadol consumption and adverse effects were noted in the first 24 hours following surgery. The pain scores were significantly lower in the levobupivacaine group when compared with the control group (p<0.05). The cumulative tramadol consumption was lower in the levobupivacaine group than in the control group (p<0.05). Group II used less antiemetic and had less postoperative nausea and vomiting, and the difference was statistically significant (p<0.05). No complication occurred as a result of the ON-Q pain pump system. Subfacial levobupivacaine infusion with the ON-Q pain pump system diminished postoperative pain and the need for tramadol use following cesarean operations.
 
Article
In this study we evaluated the postoperative analgesic efficacy of lornoxicam PO, IM and IV administration preoperatively. Fourty patients, aged between 18-65 years, ASA I-II class, were randomized to four groups. Lornoxicam 8 mg was administired PO, IM, IV (Group PO, Group IM, Group IV) 1 hour before the operation. Analgesia was not performed in control group (Group C). First analgesic requirement time, analgesic consumption and the VAS and VRS pain scores were recorded postoperatively. When VAS 3 patient controlled analgesia with lornoxicam was begun. We found that first analgesic requirement time was shorter, postoperative 2nd hour VAS and VRS scores and drug consumptions were higher in Grup C cases according to the other groups. There was no significant difference in first analgesic requirement time and analgesic consumption. Preoperative administration of 8 mg lornoxicam delayed the first analgesic requirement time and decreased total analgesic requirement. There was no difference on analgesic effect between PO, IM, and IV administrations.
 
Article
Psychological status of patients during epidural and intravenous (i.v.) morphine administration are not known enough. It's known that after administration of morphine epidurally and intravenously plasma concentrations are similar but the concentrations in cerebrospinal fluide are different. The effects of two postoperative analgesia treatment regimens on the psychological and mental functions of the elderly after major orthopedic surgery were investigated in this randomized, blinded study. Morphine was used epidurally in Group E and intravenously in Group IV with patient controlled analgesia method for postoperative analgesia treatment. All patients were assessed for psychological status the day before surgery and 2 days after surgery using the Brief Symptom Inventory (BSI). The results of the BSI were assessed with the Global Severity Index (GSI). Nine subscales were also derived: depression, somatization, obsessive-compulsive, anxiety, interpersonal sensitivity, hostility, phobic anxiety, paranoid ideation, and psychoticism. There was not significant difference between the groups for preoperative and postoperative GSI results (p>0.05). Only interpersonal sensitivity subscale results in Group i.v. were decreased compared to the baseline (p<0.001). Preoperative BSI and submeasurement test scores revealed no correlation with total morphine consumption in both groups (p>0.05). Mental changes like agitation, time and place disorientation were seen equally in both groups. This study showed that after epidural and intravenouse morphine administration, no psychologycal changes were observed in the postoperative period compared with baseline. Patients who received morphine intravenously were showed less interpersonal sensitivity in the postoperative period.
 
Visual Analog Scale scores during active movement. 
Patient characteristics (Mean±SD) 
VAS scores at rest (Mean±SD) 
Article
Objective: Non-steroidal anti-inflammatory drugs (NSAIDs) are recommended for multimodal postoperative pain management. The purpose of this study was to evaluate the postoperative pain relief and opioid-sparing effects of dexketoprofen and lornoxicam after major orthopedic surgery. Methods: After obtaining ethical committee approval and informed consent, 120 patients undergoing elective hip or knee replacement under general anesthesia were randomized to receive two intravenous injections of 50 mg dexketoprofen (GD), 8 mg lornoxicam (GL) or saline as placebo (GP) intravenously. Postoperatively, patient-controlled analgesia (PCA) morphine was started as a 0.01 mg.kg-1 bolus dose, with lockout time of 10 minutes without continuous infusion. Pain assessment was made using the Visual Analogue Scale (VAS) at rest or during movement at postoperative 1, 2, 4, 6, 8, 12, and 24 hours. Results: The three groups were similar in terms of age, gender, American Society of Anesthesiologists (ASA) class, number of patients who underwent hip or knee surgery, weight, height, and operation duration. Patients in GD and GL demonstrated significantly reduced pain scores at rest and active motion compared to GP, with lower scores in the dexketoprofen group. Patients in GD and GL used significantly less morphine in the postoperative period compared to GP. The total morphine consumption of patients in GD was lower than in GL. Conclusion: Intravenous application of 50 mg dexketoprofen twice a day and 8 mg lornoxicam twice a day improved analgesia and decreased morphine consumption following major orthopedic surgery. When the two active drugs were compared, it was found that dexketoprofen was superior to lornoxicam in terms of analgesic efficacy and opioid consumption.
 
Article
We aimed to assess the sedative effects of midazolam and dexmedetomidine and their effects on hemodynamics and the cardiovascular system under epidural anesthesia. This study included 50 patients. Approval of the ethics committee and written consent from patients were obtained. The patients were separated into two groups to receive dexmedetomidine (D group) or midazolam (M group). Perifix no. 18 was placed in the epidural space from the L(3-4) interspace. After lidocaine 60 mg/3 ml was applied, isobaric bupivacaine 0.5% was given as 1 ml per segment. After block reached the T10 level, midazolam was given to the M group as a bolus of 0.015 mg kg(-1) in 10 minutes until beginning the operation, followed by continuous infusion as 0.1-0.2 mg kg(-1)h(-1) dosage. Dexmedetomidine 1 mcq kg(-1) was given to the D group as a bolus dosage in 10 minutes until beginning the operation, followed by continuous infusion as 0.4-0.7 mcq kg(-1) h(-1) dosage. Systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate (HR), SpO(2), Ramsay Sedation Score (RSS), bispectral index (BIS), and respiratory rate (RR) were recorded. Sedative infusion was stopped when skin suture was closed. Adverse effects were also recorded. In group D, MAP was significantly higher and HR was significantly lower than in group M (p<0.05). We concluded that both drugs provided good sedation with no respiratory depression, stable hemodynamics and alertness with good cooperation. However, we consider midazolam as the first option due to its cost benefit.
 
Article
To investigate the differences and similarities of sociodemographic properties and pain conditions of patients seen at our institution compared to other studies conducted throughout the world. Our study included the results of 772 patients who applied to our polyclinic between 1 January 2006 and 31 December 2007. In our polyclinic, all patients are queried with respect to the items contained on the "Pain Assessment Form" before the diagnosis and their answers are recorded. Their demographic characteristics, such as age, gender, occupation, marital status, education, and economic status, are also recorded on the forms. For the detailed pain anamnesis, the following factors are questioned and recorded on the pain assessment form: the location, quantity and starting time of pain, its period, the factors that increase and decrease the pain, duration of pain, and prior medication. The most frequent complaints were in the low back, shoulder and head. The three most frequent diagnoses were low back pain, musculoskeletal pain and headache. Visual analogue scale (VAS) value was found to be 7.3. Seventy-three percent of patients suffered from chronic pain. Pain was mostly accompanied by weakness, muscle weakness, insomnia, nausea, and vomiting. The most frequent treatments were medical treatments along with invasive pain therapy. Knowledge of sociodemographic characteristics and close investigation of patients' responses to the treatments are important. When medical treatment is insufficient, invasive pain treatment should be administered by an experienced pain therapy practitioner. Informing patients and their relatives about the applied treatment may increase treatment success.
 
Article
This study assessed the efficacy and adverse effects of preoperatively administered lornoxicam versus tramadol in adults, for post-tonsillectomy pain. This prospective, double blind, randomized, clinical research was performed in the Ear, Nose and Throat Surgery Room in the Department of Anesthesia and Reanimation, Gazi University Faculty of Medicine. Forty American Society of Anesthesiologists (ASA) status I-II patients of both gender, aged 18-55 years, were included. Tonsillectomy patients were divided into two groups: Those in Group L received 8 mg lornoxicam and in Group T received 50 mg tramadol intravenously just before induction of general anesthesia. Induction and maintenance of anesthesia (propofol, atracurium, nitrous oxide and sevoflurane) were standardized. Heart rate and systolic and diastolic arterial pressure data were monitored during the anesthesia. Intra-operative bleeding was scored by the same operator using a 5-point scale at the end of the surgery. Postoperative pain on swallowing was scored by a blinded anesthesiologist using Verbal Rating Scale (VRS) on arrival in the Post Anesthesia Care Unit (T(0)), at 30 min (T(1)), 1h (T(2)), 2h (T(3)), 3h (T(4)), 4h (T(5)), 5h (T(6)), and 6h (T(7)) thereafter. During the first postoperative 6 hours, when VRS >/=2, 1mg.kg(-1) im meperidine was used as a rescue analgesic. Adverse effects in the postoperative 6h period were noted. T(1) and T(2) pain scores in Group T were higher than in Group L (p=0.049, p=0.007, respectively). The number of patients requiring rescue analgesics during the first 6 hours in Group L was lower than in Group T. Nausea-vomiting, bleeding and postoperative hemorrhage values were similar between Group L and Group T. Preoperative 8 mg lornoxicam was more effective than 50 mg tramadol with respect to early postoperative tonsillectomy pain in adult patients, and side effects were similar.
 
Article
In order to control pain, which is a prevalent problem, gathering knowledge regarding pain and pain beliefs is crucial. The aim of this study was to evaluate the correlation between pain and pain beliefs and the sociodemographic and economic characteristics of an adult population. This descriptive, cross-sectional study was completed with 131 individuals aged between 18-65 years. A questionnaire evaluating sociodemographic and economic status and pain characteristics and the Pain Beliefs Scale were used for data collection. 78.6% of the research group experienced pain within the last year; of them, 38.8% suffered from chronic pain. According to the results of logistic regression analysis, the risk factors were determined as age between 30-65 years (odds ratio [OR]: 0.215; p=0.008) and graduation from elementary school and lower education level (OR=3.427; p=0.021) for experiencing lifelong frequent pain; being female (OR=3.003; p=0.016) and married (OR=4.550; p=0.005) for experiencing pain within the last year; and age between 30-65 years (OR=3.027; p=0.027) and lower income (OR=4.932; p=0.001) for chronic pain. The organic and psychological pain beliefs scores were similar. Sociodemographic and economic determinants were not significant for the organic subscale (p>0.05), but lower income determined 11% of the psychological subscale (R2=0.115; p<0.05). Sociodemographic and economic status were determined to be risk factors for experiencing pain, and cultural factors related to pain beliefs warrant investigation.
 
Article
This study was carried out descriptive for determine trauma patient's pain severity and pain relief approaches. This scope of the research covered 418 patients who were between 18-65 years and applied to emergency unit of two training hospitals because of the trauma in Istanbul. The data of the research were collected by using individual characteristics form and forth section of Mc Gill Pain Questionnaire form. It was determined that all patients had pain after trauma. Moreover, 14.6 % (n=61) of the patients defined the pain "severe", 51.7 % (n=216) that they defined the pain "much severe" and 33.7 %(n=141) that they defined the pain "unbearable". Nonsteroid Antiinflammatory Drugs (NSAID) were given only 85.9 % (n=359) that they had pain. Besides, being extra to NSAID opioid was given to 14.1% (n=59) of the patients by 95.5% (n=416) intramuscular approach and 62.9 % (n=293) of the patients, whose pains were not over in spite of the pain treatment Based on these results, trauma patients' pains still haven't been handled as a serious problem. Also, it can be said that there is hot any effective pain relief approach at emergency units yet.
 
Article
In the cancer therapy, the role of central venous access device has been increased because of factors; such as accessing to vein frequently, having long term therapy, using of sclerosan agents, giving much fluid. A chemoport is a thin, soft, plastic tube surgically implanted into a vein in chest or arm. Portacath doesn't have a huge size and it can generate numerous advantages. All the same, portacaths have risks such as infection, thrombosis, mechanical failure, pneumothorax, arterial injury. A retrospective study was performed with analysis of records of 82 patients admitted to our clinics between December 2006 and November 2008 for permanent catheterisation via subclavian vein. The most frequent complication was occlusion of port (3.66%). Further complications were infection (2.43%), migration out of the blood vessel (1.22%), and catheter rupture (1.22%). As a result, made by people who experienced venous ports inserted, provided the opinion that a safe and comfortable method.
 
Article
Childhood migraine is a common problem among the primary complaints of the pediatric population. But for the general practitioners there are little known about clinical characteristics and management strategies. Headache practitioners commonly notice the age related differences of headache characteristics and management schedules. This paper primarily aimed to answer the question if pediatric migraine is an unmaturated form of adult migraine, by discussing the pathophysiological basis, clinical forms and management strategies.
 
Article
The aim of this study was to determine prevalence of pain (p) in adults and their preference for pain treatment, by using questionnaire. First 7 questions of "Brief Pain Inventory-Short Form" and "Cornell Musculoskeletal Discomfort Questionnaire" were applied to 250 participants in face to face interview. A hundred eighty of the individuals were women (38.3±14.0 years old) and 70 were men (36.6±13.2 years old). Data analysis were performed using SPSS, version 10. Eighteen individuals (7.2%) had no pain and 232 (92.8%) of them had pain in different parts of the body. A hundred fourty five individuals had lowback p, 116 neck p, 101 dorsal p, 152 shoulder p, 69 upperarm p, 66 forearm p, 75 wrist p, 59 hip p, 69 upper leg p, 98 knee p, 81 crus pain. Their mean pain score was 3.6±1.8, mean pain score at its worst in the last 24 hours was 4.4±2.6. Thirty three percent of individuals had used non-steroidal anti-inflammatory and/or analgesic drugs to relieve pain, 22.7% had physical therapy, 4.1% had other pain-relief methods, 1.2% had surgery, and 38% had nothing. Our results showed that 92.8% adults had pain. Although shoulder has highest pain prevalance, severe pain was mostly described in lowback area. Knee pain was largely interfered work ability. An important percent of persons experiencing pain has recieved no treatment and first preference for treatment was drug. Inspite of high pain prevalence in our study, slightly uncomfortable pain severity and no need for treatment can be explain a result of individual differences in pain perception.
 
Article
The transdermal fentanyl (TDF) patch has become widely used in the treatment of cancer pain. We aimed to compare the analgesic efficiency, side effects and patient satisfaction of TDF in adult and geriatric patients. The data of 181 patients who were observed in our pain clinic were included in this retrospective study. There were 95 patients in the adult group (Group A) and 86 patients in the geriatric group (Group G). Demographic data, cancer type, duration of pain, side effects, visual analog scale (VAS) score, treatment assessment scale (TAS) score, TDF dosage, and the number of patients in whom therapy has been terminated were recorded. After the usage of TDF, reduction in pain score was observed in both groups (p<0.001). The TAS score was similar between the groups at the end of the first month, but it was lower in Group G in the following months. Constipation, dry mouth, somnolence, and dyspnea were seen more frequently in Group G. Because of these side effects, the number of patients in whom therapy was terminated was higher in Group G. The TDF patch is a good choice for cancer pain treatment for both adult and geriatric patients. Since it was observed that the incidence of side effects was higher in the geriatric patients, they should be treated more carefully.
 
Article
Hyaluronic acid (HA) is used for intraarticular treatment of hip osteoarthritis (OA). The objective of this study was to determine the efficacy of intraarticular injection of HA through a lateral approach under fluoroscopic control for advanced hip OA. The study included 21 patients with advanced hip OA. All patients received 2.5 ml HA injection once a week for 3 weeks by lateral approach under fluoroscopic control. Disability (Lequesne index), pain scores (visual analog scale-VAS) and analgesic use of patients were assessed before treatment and 1, 3 and 6 months after the treatment. Lequesne index and VAS pain scores measured 1, 3 and 6 months after treatment were significantly lower compared to baseline scores (p<0.001). Although analgesic use was significantly reduced 1 and 3 months after treatment compared to baseline (p<0.05), no difference was determined in analgesic use at the 6th month (p>0.05). No side effect was observed. In conclusion, intraarticular HA injection through a lateral approach under fluoroscopic control was shown to be a safe and effective method for patients with advanced hip OA.
 
Top-cited authors
Gürkan Türker
  • Uludag University
Sükran Sahin
  • Uludag University
Nurten Inan
  • Gazi University
Semih Arici
  • Gaziosmanpasa University
Yasemin Yıldırım
  • Ege University