Giriş: Pulse radyofrekans (PRF) tedavisi myofasyal ağrı sendromu için uzun süreli analjezi sağlam... more Giriş: Pulse radyofrekans (PRF) tedavisi myofasyal ağrı sendromu için uzun süreli analjezi sağlamada alternatif tedavi olarak önerilmektedir. PRF'ın tetik nokta enjeksiyonları ile karşılaştırıldığında uzun süreli analjezi sağlama potansiyeli gösterilmiştir. Gereç ve Yöntem: Semptomatik olan tetik noktalar belirlendi ve tetik noktaların olduğu alanlar alkolle temizlenerek hazırlandı. Tetik nokta içine 22-gauge, 5 mm aktif uçlu, 5 cm uzunlukta izolasyonlu radyofrekans iğnesi sokuldu. İğne daha sonra PRF 2 dakika süre ile kullanılarak 42 ºC'ye getirildi. Bu tedavi daha sonra tekrar edildi. Bulgular: 10 hasta tedavi edildi. Uygulanan PRF sayısı ortalama(minimum-maksimum) 3.5 (2-6) olarak saptandı. Tedavi öncesi ve tedavi sonrası VAS değerleri ortalaması(±sd) sırasıyla; 8.3±1.2 ve 2.7±1.3 olarak saptandı. Tedavi öncesi ve sonrası VAS değerlerindeki fark istatistiksel olarak anlamlıydı (p<0.05). PRF uygulaması ile hastalarda ortalama 4.4±2.1 ay olacak şekilde uzun süreli analjezi sağlandı. Komplikasyon saptanmadı. Sonuç: Bizim çalışmamız, PRF'nin myofasiyal ağrı sendromu için minimal invaziv ve etkili bir tedavi yöntemi olabileceğini düşündürmektedir Anahtar kelimeler: myofasial ağrı, tetik nokta enjeksiyonu, pulsed radyofrekans.
parameters, quality of anaesthesia and analgesia. The added benefits were rapid onset and less mo... more parameters, quality of anaesthesia and analgesia. The added benefits were rapid onset and less motor block. That allows the parturient to ambulate during the period of labour and immediately after delivery. Vomiting and pruritus were seen in fentanyl group. Apgar Score of the baby at delivery was in between 7−10. Conclusion: It can be recommended that labour pain can be effectively treated by the bupivacaine-tramadol regimen which is a good choice for labour analgesia by combined spinal epidural technique.
Background and objectives: This is a prospective, randomized, single-blind study. We aimed to com... more Background and objectives: This is a prospective, randomized, single-blind study. We aimed to compare the tracheal intubation conditions and hemodynamic responses either remifentanil or a combination of remifentanil and lidocaine with sevoflurane induction in the absence of neuromuscular blocking agents. Methods: Fifty intellectually disabled, American Society of Anesthesiologists I-II patients who underwent tooth extraction under outpatient general anesthesia were included in this study. Patients were randomized to receive either 2 g kg −1 remifentanil (Group 1, n = 25) or a combination of 2 g kg −1 remifentanil and 1 mg kg −1 lidocaine (Group 2, n = 25). To evaluate intubation conditions, Helbo-Hansen scoring system was used. In patients who scored 2 points or less in all scorings, intubation conditions were considered acceptable, however if any of the scores was greater than 2, intubation conditions were regarded unacceptable. Mean arterial pressure, heart rate and peripheral oxygen saturation (SpO 2) were recorded at baseline, after opioid administration, before intubation, and at 1, 3, and 5 min after intubation. Results: Acceptable intubation parameters were achieved in 24 patients in Group 1 (96%) and in 23 patients in Group 2 (92%). In intra-group comparisons, the heart rate and mean arterial pressure values at all-time points in both groups showed a significant decrease compared to baseline values (p = 0.000) Conclusion: By the addition of 2 g/kg remifentanil during sevoflurane induction, successful tracheal intubation can be accomplished without using muscle relaxants in intellectually disabled patients who undergo outpatient dental extraction. Also worth noting, the addition of 1 mg/kg lidocaine to 2 g/kg remifentanil does not provide any additional improvement in the intubation parameters.
Introduction: To investigate the validity and reliability of the "Global Pain Scale" for Turkish ... more Introduction: To investigate the validity and reliability of the "Global Pain Scale" for Turkish population . Methods: The cross-sectional study was conducted at the Algology outpatient clinic of a university hospital in Izmir, Turkey, between March and December 2015, and comprised patients with chronic pain aged at least 18 years. Linguistic equivalence, content validity and construct validity were used for establishing the validity of the Global Pain Scale, while the Content Validity Index was used for the assessment of expert views. SPSS 16was used for data analysis. Results: Of the 222 subjects, 142(64%) were females. Overall mean age of the sample was 54.22±13.79 years. Cronbach's alpha coefficient for the entire scale was 0.95. Total item correlation coefficients of the items in the scale ranged between 0.502 and 0.794, and no items were removed from the scale. Conclusions: The Global Pain Scale was found to have adequate validity and reliability indicators, and can be used with confidence in patients experiencing chronic pain.
The objective of the present study was to compare the postoperative analgesic effects of pre-empt... more The objective of the present study was to compare the postoperative analgesic effects of pre-emptive intravenous (IV) paracetamol, lornoxicam and placebo following third molar surgery. Materials and Methods: This was a prospective, double-blind, randomized, placebo-controlled study where 50 patients had both of their identical impacted mandibular third molars impacted. Before the removal of the impacted third molar tooth on one side either of the two drug regimens (1g paracetamol or 8 mg lornoxicam) administered preemptively and 15 days later second surgical approach was performed but this time for comparison the other drug regimen (which was not chosen initially) was carried out as the preemptive agent; and all of the operations were performed by the same surgeon. Diclofenac sodium up to 75 mg daily was provided as rescue medication. The postoperative rescue analgesic consumption was recorded and pain scores were evaluated with a Verbal Rating Scale (VRS) at 15,30 min and 1,2, 4, 6, 12, 24 h postoperatively. Results: There was a significant difference in mean second hour VRS scores between paracetamol and lornoxicam group in favor of the lornoxicam (p<0.05). But, conversely, there was no statistically significant difference in the need of use and the consumption of rescue analgesic medication between two drug groups. Conclusion: Pre-emptive IV paracetamol and lornoxicam effectively decreased the pain scores as compared to placebo in third molar surgery.
The aim of this study was to evaluate the validity and reliability of the Turkish version of the ... more The aim of this study was to evaluate the validity and reliability of the Turkish version of the Brief Pain Inventory-Short Form for patients with chronic nonmalignant pain. Methods: An analytical design was used. A total of 192 patients were included in the study. A demographic questionnaire and the Brief Pain Inventory-Short Form were used to collect data. Content validity was assessed by experts and construct validity was tested using exploratory factor analysis. Reliability analyses estimated the internal consistency and test-retest reliability. Cronbach's alpha and the item-total correlations were calculated for the subscales to examine internal consistency. Results: Exploratory factor analysis yielded 2 factors: pain severity and pain interference, which accounted for 68.81% of the total variance. The coefficient alpha of both subscales demonstrated good internal consistency. The item-total correlations of the scale ranged between 0.56 and 0.87. The test-retest reliability was r=0.774 for pain severity and r=0.808 for pain interference (p=0.001). Conclusion: The Turkish version of the Brief Pain Inventory-Short Form is a valid and reliable instrument to assess chronic nonmalignant pain.
Objectives: The objective of this study was to investigate whether electro acupuncture, when comp... more Objectives: The objective of this study was to investigate whether electro acupuncture, when compared to TENS, had a reasonable effect on functional scores and pain in patients with prolapsed of lumbar intervertebral disc. Design-subjects: A single site, randomised trial of 60 participants, diagnosed as prolepses of lumbar intervertebral disc by x-rays and MRI, was performed. Intervention: Participants were randomised into two groups. In-group one (n = 30) silver needles placed in lumbar paravertabral and lower extremity and electro stimulation and in the second group (n = 30) low frequency high intensity TENS was used three times a week. All groups received treatment for a total of fifteen sessions. Outcome measures: Visual analogue scale (VAS) was used to evaluate pain, Modified Oswestry Disability Questionnaire (MODQ) and Low Back Pain Sequence Scale (LPSS) were used to evaluate physical functions of the patients. Results: In our work where TENS and acupuncture treatment were compared on 60 patients with prolepses of lumbar intervertebral disc, results of both TENS and acupuncture groups were statistically significant when compared with pre treatment to post treatment and one-month post treatment period (p< 0.005). But no statistically significant difference of recovery in visual analogue scale, Oswestry disability questionnaire and back pain sequence scale test, had been detected between the groups (p< 0.005). In conclusion we found acupuncture as effective as TENS in the treatment of lumbar disc prolepses.
Background/aim: Pulsed radiofrequency (PRF) has been reported to be a safe and reliable method fo... more Background/aim: Pulsed radiofrequency (PRF) has been reported to be a safe and reliable method for the management of a variety of chronic pain syndromes. It is not known whether the preadministration of local anesthetic increases the size of the electrical field. We revealed the effects of administering local anesthetic on PRF and investigated whether they were related to local anesthetic or fluid effects. Materials and methods: Group 1 (n = 18) received PRF to the suprascapular nerve with 1 mL of bupivacaine, group 2 (n = 20) received PRF with 1 mL of physiological saline solution, and group 3 (n = 18) received PRF only. Results: There were significant improvements in visual analog scale (VAS) scores at 30 min, 1 month, and 3 months after treatment in group 1 (P < 0.05) and at 1 month and 3 months in groups 2 and 3 (P < 0.05). There was a significant improvement in VAS scores in group 1 compared with groups 2 and 3 at 30 min after treatment. Conclusion: PRF applied to the nerve along with local anesthetic may increase pain relief, especially in the early posttreatment period. The favorable effects may depend on the pharmacodynamic features of the local anesthetic.
Remifentanilo; Lidocaína; Intubación endotraqueal; Sin bloqueo neuromuscular Resumen Justificació... more Remifentanilo; Lidocaína; Intubación endotraqueal; Sin bloqueo neuromuscular Resumen Justificación y objetivos: este es un estudio prospectivo, aleatorizado y doble ciego. Nuestro objetivo fue comparar las condiciones de intubación endotraqueal y las respuestas hemodinámicas con el uso de remifentanilo o la combinación de remifentanilo y lidocaína en inducción anestésica con sevoflurano sin agentes bloqueantes neuromusculares. Métodos: cincuenta pacientes intelectualmente discapacitados, estado físico ASA I-II, sometidos a la extracción dental bajo anestesia general en ambulatorio fueron incluidos en este estudio. Los pacientes fueron aleatorizados para recibir 2 g/kg −1 de remifentanilo (grupo 1, n = 25) o una combinación de 2 g/kg −1 de remifentanilo y 1 mg/kg −1 de lidocaína (grupo 2, n = 25). Para evaluar las condiciones de intubación se usó el sistema de puntuación de Helbo-Hansen. En pacientes con 2 o menos puntos en todas las puntuaciones, las condiciones de intubación fueron consideradas aceptables, sin embargo, si cualquiera de las puntuaciones fuese superior a 2 las condiciones de intubación serían consideradas inaceptables. La presión arterial media, frecuencia cardíaca y la saturación periférica de oxígeno, fueron registradas al inicio del estudio, después de la administración de opiáceos, antes de la intubación y en los minutos 1, 3 y 5 después de la intubación. Resultados: se obtuvieron parámetros aceptables de intubación en 24 pacientes del grupo 1 (96%) y en 23 pacientes del grupo 2 (92%).En las comparaciones intragrupo, los valores de la frecuencia cardíaca y la presión arterial media en todos los momentos en ambos grupos arrojaron una reducción significativa con relación a los valores basales (p = 0,000). Conclusión: con la adición de 2 g/kg de remifentanilo durante la inducción con sevoflurano pudimos obtener una intubación endotraqueal exitosa sin usar relajantes musculares en pacientes intelectualmente discapacitados que se someten a extracción dental en ambulatorio. También es importante resaltar que la adición de 1 mg/kg de lidocaína a 2 g/kg de remifentanilo no presenta ninguna mejoría adicional en los parámetros de intubación.
The journal of the Turkish Society of Algology, Oct 1, 2010
Objectives: Hyaluronic acid (HA) is used for intraarticular treatment of hip osteoarthritis (OA).... more Objectives: 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. Methods: 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. Results: 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. Conclusion: 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.
Tüm çabalara karşın, kanser ağrısı yaşlı hastalarda yeterince tedavi edilememektedir. Yaşlı kanse... more Tüm çabalara karşın, kanser ağrısı yaşlı hastalarda yeterince tedavi edilememektedir. Yaşlı kanser hastalarının %42'si yeterince giderilmemiş ağrı bildirmektedir. Ağrı tedavisinin yetersizliğine birçok faktör katkıda bulunmaktadır. Yaşlı hastalarda eşlik eden yandaş hastalıklar, bu grup hastaya ait bilgi eksikliği, standart ağrı değerlendirme skalalarının olmaması, çoklu ilaç kullanımına ait korkular başarılı ağrı tedavisini kısıtlamaktadır. En sık kullanılan tedavi oral yolla verilen parasetamol, nonsteroidal anti-inflamatuvar (NSAİ) ilaçlar, opioidler gibi analjezik tedavi uygulamasıdır. NSAİ ilaçlara ait artmış toksisite riski kırılgan yaşlı hasta grubunda bu ilaçların emniyetli bir şekilde kullanımını riskli hale getirmektedir. Yaşlı hastalarda opioidlerin düşük dozu ile klinik olarak en uygun yanıtı oluşturacak dikkatli titrasyon yapılmalıdır. Antiepileptikler, antidepresanlar, kortikosteroidler gibi adjuvan analjezikler kronik ağrı tedavisinin belirli tiplerinde yararlı olabilir. Uygun ve dikkatli yaklaşımla yaşlı hastalarda giderilememiş kanser ağrısını ortadan kaldırmak veya azaltmak bunun sonucu olarak yaşam kalitesini arttırmak mümkündür.
Aim: This study aimed to determine preoperative anxiety and pain levels in patients who underwent... more Aim: This study aimed to determine preoperative anxiety and pain levels in patients who underwent craniotomy and investigate the effects on the development of postoperative acute-chronic pain. Materials and Methods: In this prospective, observational study, STAI-I (State-Trait Anxiety Inventory) and STAI-II were used to measure preoperative anxiety levels in a total of 104 patients who underwent craniotomy, and a visual analog score (VAS) was used to determine pain. Demographic data of the patients, ASA (American Society of Anesthesiologists) scores, comorbidities, preoperative and postoperative VAS scores, cause of preoperative anxiety, type, and duration of operation were recorded. Results: The mean values of STAI tests showed that 31.3% of our patients had mild preoperative anxiety, 58.7% had moderate and 10% had severe preoperative anxiety. In the STAI tests we performed before the operation, the mean values were 44 ± 11.2 for STAI-I and 44.5 ± 9.4 for STAI-II. The causes of pre...
Aim: During the Covid-19 pandemic, the number of patients examined in the outpatient clinic of ma... more Aim: During the Covid-19 pandemic, the number of patients examined in the outpatient clinic of many health institutions was limited and some changes were made in the treatment protocols. Regional Anesthesia and Pain Associations also recommended steroid administration and opioid use restriction, especially in chronic pain. In our study, we aimed to evaluate the clinical diagnosis of the patients who applied to our clinic with complaints of pain, the treatments they received, and whether our approach to chronic pain was by the guidelines during the Covid-19 pandemic period. Material and Methods: Demographic data, clinical diagnoses, interventional procedures, and medical treatments given to the patients who applied to the Ege University Faculty of Medicine, Algology Department outpatient clinic between March 2020 and May 2021 were evaluated statistically by retrospective analysis. Results: The mean age of 444 patients included in the study was 56.8±15.9 years. It was found that 29 (6.5%) of the patients applied for acute pain and 415 patients (93.5%) for chronic pain. While the number of patients who received only pharmacological treatment was 230 (51.8%), it was determined that 199 (44.8%) patients received both pharmacological treatment and interventional procedure, and 15 (3.3%) patients received only interventional procedure. When the patients were investigated in terms of pharmacological treatment, we observed that 229 (57.1%) patients received only paracetamol treatment, 99 (24.6%) patients received only non-steroidal anti-inflammatory (NSAI) drug therapy, and 73 (18.2%) patients received both paracetamol and NSAI therapy. It was determined that 243 (96.8%) of the patients who received medical treatment received weak opioids, 3 (1.3%) patients received strong opioids, and 5 (1.9%) patients received both weak and strong combined opioid treatment. Steroid injection was observed in only 16.3% of 214 patients who underwent interventional procedures. Conclusion: It was observed that chronic pain patients were in the majority during the pandemic period and the use of strong opioids and steroid injections were minimized in these patients. Since it may cause changes in immune responses, applications that will pose the least risk in pain patients should be chosen during the pandemic period.
BACKGROUND: There are many different treatment methods available in terms of complex regional pai... more BACKGROUND: There are many different treatment methods available in terms of complex regional pain syndrome (CRPS). In patients who do not respond to medical treatments, treatment is first started with sympathetic blocks and somatic nerve blocks are added when necessary. Epidural catheter applications can be practised if sufficient results cannot be obtained from the blocks in very few patients. Continuous epidural block application allows both sympathetic and somatic nerve block, allowing the patient to recover, as well as pain palliation, and adequate physical therapy and rehabilitation. CASE REPORT: In this case report, although partial pain palliation was provided with sympathetic and somatic blocks in a female patient with a diagnosis of CRPS for a long time, especially in physical therapy and rehabilitation applications, due to the inadequate response due to pain, even in the late period, a subcutaneous tunnel epidural catheter was used. CONCLUSION: We present the use of conti...
Romatolojik hastalıkların klinik seyrinde sıklıkla kas-iskelet sistemine lokalize romatizmal ağrı... more Romatolojik hastalıkların klinik seyrinde sıklıkla kas-iskelet sistemine lokalize romatizmal ağrılar ortaya çıkmaktadır. Yeterli ve etkin ağrı palyasyonu yapılmayan romatizmal ağrılar kronikleşerek hastalarda fonksiyonel yetersizlik ve yaşam kalitesinde azalmaya yol açmaktadır. Romatizmal ağrıların tedavisi altta yatan romatolojik hastalığın nedenine göre değişmekle birlikte başlıca fizik tedavi, farmakoterapi, girişimsel ağrı tedavileri ve cerrahi seçenekleri kapsamaktadır. Romatizmal ağrılarda girişimsel ağrı tedavileri, farmakoterapi ve fizik tedavi gibi non-invaziv olan diğer tedavi seçeneklerinin yetersiz kaldığı durumlarda kullanılmaktadır. Bu makalede romatizmal ağrıların girişimsel ağrı tedavisi üzerinde durulacaktır.
Giriş: Pulse radyofrekans (PRF) tedavisi myofasyal ağrı sendromu için uzun süreli analjezi sağlam... more Giriş: Pulse radyofrekans (PRF) tedavisi myofasyal ağrı sendromu için uzun süreli analjezi sağlamada alternatif tedavi olarak önerilmektedir. PRF'ın tetik nokta enjeksiyonları ile karşılaştırıldığında uzun süreli analjezi sağlama potansiyeli gösterilmiştir. Gereç ve Yöntem: Semptomatik olan tetik noktalar belirlendi ve tetik noktaların olduğu alanlar alkolle temizlenerek hazırlandı. Tetik nokta içine 22-gauge, 5 mm aktif uçlu, 5 cm uzunlukta izolasyonlu radyofrekans iğnesi sokuldu. İğne daha sonra PRF 2 dakika süre ile kullanılarak 42 ºC'ye getirildi. Bu tedavi daha sonra tekrar edildi. Bulgular: 10 hasta tedavi edildi. Uygulanan PRF sayısı ortalama(minimum-maksimum) 3.5 (2-6) olarak saptandı. Tedavi öncesi ve tedavi sonrası VAS değerleri ortalaması(±sd) sırasıyla; 8.3±1.2 ve 2.7±1.3 olarak saptandı. Tedavi öncesi ve sonrası VAS değerlerindeki fark istatistiksel olarak anlamlıydı (p<0.05). PRF uygulaması ile hastalarda ortalama 4.4±2.1 ay olacak şekilde uzun süreli analjezi sağlandı. Komplikasyon saptanmadı. Sonuç: Bizim çalışmamız, PRF'nin myofasiyal ağrı sendromu için minimal invaziv ve etkili bir tedavi yöntemi olabileceğini düşündürmektedir Anahtar kelimeler: myofasial ağrı, tetik nokta enjeksiyonu, pulsed radyofrekans.
parameters, quality of anaesthesia and analgesia. The added benefits were rapid onset and less mo... more parameters, quality of anaesthesia and analgesia. The added benefits were rapid onset and less motor block. That allows the parturient to ambulate during the period of labour and immediately after delivery. Vomiting and pruritus were seen in fentanyl group. Apgar Score of the baby at delivery was in between 7−10. Conclusion: It can be recommended that labour pain can be effectively treated by the bupivacaine-tramadol regimen which is a good choice for labour analgesia by combined spinal epidural technique.
Background and objectives: This is a prospective, randomized, single-blind study. We aimed to com... more Background and objectives: This is a prospective, randomized, single-blind study. We aimed to compare the tracheal intubation conditions and hemodynamic responses either remifentanil or a combination of remifentanil and lidocaine with sevoflurane induction in the absence of neuromuscular blocking agents. Methods: Fifty intellectually disabled, American Society of Anesthesiologists I-II patients who underwent tooth extraction under outpatient general anesthesia were included in this study. Patients were randomized to receive either 2 g kg −1 remifentanil (Group 1, n = 25) or a combination of 2 g kg −1 remifentanil and 1 mg kg −1 lidocaine (Group 2, n = 25). To evaluate intubation conditions, Helbo-Hansen scoring system was used. In patients who scored 2 points or less in all scorings, intubation conditions were considered acceptable, however if any of the scores was greater than 2, intubation conditions were regarded unacceptable. Mean arterial pressure, heart rate and peripheral oxygen saturation (SpO 2) were recorded at baseline, after opioid administration, before intubation, and at 1, 3, and 5 min after intubation. Results: Acceptable intubation parameters were achieved in 24 patients in Group 1 (96%) and in 23 patients in Group 2 (92%). In intra-group comparisons, the heart rate and mean arterial pressure values at all-time points in both groups showed a significant decrease compared to baseline values (p = 0.000) Conclusion: By the addition of 2 g/kg remifentanil during sevoflurane induction, successful tracheal intubation can be accomplished without using muscle relaxants in intellectually disabled patients who undergo outpatient dental extraction. Also worth noting, the addition of 1 mg/kg lidocaine to 2 g/kg remifentanil does not provide any additional improvement in the intubation parameters.
Introduction: To investigate the validity and reliability of the "Global Pain Scale" for Turkish ... more Introduction: To investigate the validity and reliability of the "Global Pain Scale" for Turkish population . Methods: The cross-sectional study was conducted at the Algology outpatient clinic of a university hospital in Izmir, Turkey, between March and December 2015, and comprised patients with chronic pain aged at least 18 years. Linguistic equivalence, content validity and construct validity were used for establishing the validity of the Global Pain Scale, while the Content Validity Index was used for the assessment of expert views. SPSS 16was used for data analysis. Results: Of the 222 subjects, 142(64%) were females. Overall mean age of the sample was 54.22±13.79 years. Cronbach's alpha coefficient for the entire scale was 0.95. Total item correlation coefficients of the items in the scale ranged between 0.502 and 0.794, and no items were removed from the scale. Conclusions: The Global Pain Scale was found to have adequate validity and reliability indicators, and can be used with confidence in patients experiencing chronic pain.
The objective of the present study was to compare the postoperative analgesic effects of pre-empt... more The objective of the present study was to compare the postoperative analgesic effects of pre-emptive intravenous (IV) paracetamol, lornoxicam and placebo following third molar surgery. Materials and Methods: This was a prospective, double-blind, randomized, placebo-controlled study where 50 patients had both of their identical impacted mandibular third molars impacted. Before the removal of the impacted third molar tooth on one side either of the two drug regimens (1g paracetamol or 8 mg lornoxicam) administered preemptively and 15 days later second surgical approach was performed but this time for comparison the other drug regimen (which was not chosen initially) was carried out as the preemptive agent; and all of the operations were performed by the same surgeon. Diclofenac sodium up to 75 mg daily was provided as rescue medication. The postoperative rescue analgesic consumption was recorded and pain scores were evaluated with a Verbal Rating Scale (VRS) at 15,30 min and 1,2, 4, 6, 12, 24 h postoperatively. Results: There was a significant difference in mean second hour VRS scores between paracetamol and lornoxicam group in favor of the lornoxicam (p<0.05). But, conversely, there was no statistically significant difference in the need of use and the consumption of rescue analgesic medication between two drug groups. Conclusion: Pre-emptive IV paracetamol and lornoxicam effectively decreased the pain scores as compared to placebo in third molar surgery.
The aim of this study was to evaluate the validity and reliability of the Turkish version of the ... more The aim of this study was to evaluate the validity and reliability of the Turkish version of the Brief Pain Inventory-Short Form for patients with chronic nonmalignant pain. Methods: An analytical design was used. A total of 192 patients were included in the study. A demographic questionnaire and the Brief Pain Inventory-Short Form were used to collect data. Content validity was assessed by experts and construct validity was tested using exploratory factor analysis. Reliability analyses estimated the internal consistency and test-retest reliability. Cronbach's alpha and the item-total correlations were calculated for the subscales to examine internal consistency. Results: Exploratory factor analysis yielded 2 factors: pain severity and pain interference, which accounted for 68.81% of the total variance. The coefficient alpha of both subscales demonstrated good internal consistency. The item-total correlations of the scale ranged between 0.56 and 0.87. The test-retest reliability was r=0.774 for pain severity and r=0.808 for pain interference (p=0.001). Conclusion: The Turkish version of the Brief Pain Inventory-Short Form is a valid and reliable instrument to assess chronic nonmalignant pain.
Objectives: The objective of this study was to investigate whether electro acupuncture, when comp... more Objectives: The objective of this study was to investigate whether electro acupuncture, when compared to TENS, had a reasonable effect on functional scores and pain in patients with prolapsed of lumbar intervertebral disc. Design-subjects: A single site, randomised trial of 60 participants, diagnosed as prolepses of lumbar intervertebral disc by x-rays and MRI, was performed. Intervention: Participants were randomised into two groups. In-group one (n = 30) silver needles placed in lumbar paravertabral and lower extremity and electro stimulation and in the second group (n = 30) low frequency high intensity TENS was used three times a week. All groups received treatment for a total of fifteen sessions. Outcome measures: Visual analogue scale (VAS) was used to evaluate pain, Modified Oswestry Disability Questionnaire (MODQ) and Low Back Pain Sequence Scale (LPSS) were used to evaluate physical functions of the patients. Results: In our work where TENS and acupuncture treatment were compared on 60 patients with prolepses of lumbar intervertebral disc, results of both TENS and acupuncture groups were statistically significant when compared with pre treatment to post treatment and one-month post treatment period (p< 0.005). But no statistically significant difference of recovery in visual analogue scale, Oswestry disability questionnaire and back pain sequence scale test, had been detected between the groups (p< 0.005). In conclusion we found acupuncture as effective as TENS in the treatment of lumbar disc prolepses.
Background/aim: Pulsed radiofrequency (PRF) has been reported to be a safe and reliable method fo... more Background/aim: Pulsed radiofrequency (PRF) has been reported to be a safe and reliable method for the management of a variety of chronic pain syndromes. It is not known whether the preadministration of local anesthetic increases the size of the electrical field. We revealed the effects of administering local anesthetic on PRF and investigated whether they were related to local anesthetic or fluid effects. Materials and methods: Group 1 (n = 18) received PRF to the suprascapular nerve with 1 mL of bupivacaine, group 2 (n = 20) received PRF with 1 mL of physiological saline solution, and group 3 (n = 18) received PRF only. Results: There were significant improvements in visual analog scale (VAS) scores at 30 min, 1 month, and 3 months after treatment in group 1 (P < 0.05) and at 1 month and 3 months in groups 2 and 3 (P < 0.05). There was a significant improvement in VAS scores in group 1 compared with groups 2 and 3 at 30 min after treatment. Conclusion: PRF applied to the nerve along with local anesthetic may increase pain relief, especially in the early posttreatment period. The favorable effects may depend on the pharmacodynamic features of the local anesthetic.
Remifentanilo; Lidocaína; Intubación endotraqueal; Sin bloqueo neuromuscular Resumen Justificació... more Remifentanilo; Lidocaína; Intubación endotraqueal; Sin bloqueo neuromuscular Resumen Justificación y objetivos: este es un estudio prospectivo, aleatorizado y doble ciego. Nuestro objetivo fue comparar las condiciones de intubación endotraqueal y las respuestas hemodinámicas con el uso de remifentanilo o la combinación de remifentanilo y lidocaína en inducción anestésica con sevoflurano sin agentes bloqueantes neuromusculares. Métodos: cincuenta pacientes intelectualmente discapacitados, estado físico ASA I-II, sometidos a la extracción dental bajo anestesia general en ambulatorio fueron incluidos en este estudio. Los pacientes fueron aleatorizados para recibir 2 g/kg −1 de remifentanilo (grupo 1, n = 25) o una combinación de 2 g/kg −1 de remifentanilo y 1 mg/kg −1 de lidocaína (grupo 2, n = 25). Para evaluar las condiciones de intubación se usó el sistema de puntuación de Helbo-Hansen. En pacientes con 2 o menos puntos en todas las puntuaciones, las condiciones de intubación fueron consideradas aceptables, sin embargo, si cualquiera de las puntuaciones fuese superior a 2 las condiciones de intubación serían consideradas inaceptables. La presión arterial media, frecuencia cardíaca y la saturación periférica de oxígeno, fueron registradas al inicio del estudio, después de la administración de opiáceos, antes de la intubación y en los minutos 1, 3 y 5 después de la intubación. Resultados: se obtuvieron parámetros aceptables de intubación en 24 pacientes del grupo 1 (96%) y en 23 pacientes del grupo 2 (92%).En las comparaciones intragrupo, los valores de la frecuencia cardíaca y la presión arterial media en todos los momentos en ambos grupos arrojaron una reducción significativa con relación a los valores basales (p = 0,000). Conclusión: con la adición de 2 g/kg de remifentanilo durante la inducción con sevoflurano pudimos obtener una intubación endotraqueal exitosa sin usar relajantes musculares en pacientes intelectualmente discapacitados que se someten a extracción dental en ambulatorio. También es importante resaltar que la adición de 1 mg/kg de lidocaína a 2 g/kg de remifentanilo no presenta ninguna mejoría adicional en los parámetros de intubación.
The journal of the Turkish Society of Algology, Oct 1, 2010
Objectives: Hyaluronic acid (HA) is used for intraarticular treatment of hip osteoarthritis (OA).... more Objectives: 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. Methods: 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. Results: 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. Conclusion: 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.
Tüm çabalara karşın, kanser ağrısı yaşlı hastalarda yeterince tedavi edilememektedir. Yaşlı kanse... more Tüm çabalara karşın, kanser ağrısı yaşlı hastalarda yeterince tedavi edilememektedir. Yaşlı kanser hastalarının %42'si yeterince giderilmemiş ağrı bildirmektedir. Ağrı tedavisinin yetersizliğine birçok faktör katkıda bulunmaktadır. Yaşlı hastalarda eşlik eden yandaş hastalıklar, bu grup hastaya ait bilgi eksikliği, standart ağrı değerlendirme skalalarının olmaması, çoklu ilaç kullanımına ait korkular başarılı ağrı tedavisini kısıtlamaktadır. En sık kullanılan tedavi oral yolla verilen parasetamol, nonsteroidal anti-inflamatuvar (NSAİ) ilaçlar, opioidler gibi analjezik tedavi uygulamasıdır. NSAİ ilaçlara ait artmış toksisite riski kırılgan yaşlı hasta grubunda bu ilaçların emniyetli bir şekilde kullanımını riskli hale getirmektedir. Yaşlı hastalarda opioidlerin düşük dozu ile klinik olarak en uygun yanıtı oluşturacak dikkatli titrasyon yapılmalıdır. Antiepileptikler, antidepresanlar, kortikosteroidler gibi adjuvan analjezikler kronik ağrı tedavisinin belirli tiplerinde yararlı olabilir. Uygun ve dikkatli yaklaşımla yaşlı hastalarda giderilememiş kanser ağrısını ortadan kaldırmak veya azaltmak bunun sonucu olarak yaşam kalitesini arttırmak mümkündür.
Aim: This study aimed to determine preoperative anxiety and pain levels in patients who underwent... more Aim: This study aimed to determine preoperative anxiety and pain levels in patients who underwent craniotomy and investigate the effects on the development of postoperative acute-chronic pain. Materials and Methods: In this prospective, observational study, STAI-I (State-Trait Anxiety Inventory) and STAI-II were used to measure preoperative anxiety levels in a total of 104 patients who underwent craniotomy, and a visual analog score (VAS) was used to determine pain. Demographic data of the patients, ASA (American Society of Anesthesiologists) scores, comorbidities, preoperative and postoperative VAS scores, cause of preoperative anxiety, type, and duration of operation were recorded. Results: The mean values of STAI tests showed that 31.3% of our patients had mild preoperative anxiety, 58.7% had moderate and 10% had severe preoperative anxiety. In the STAI tests we performed before the operation, the mean values were 44 ± 11.2 for STAI-I and 44.5 ± 9.4 for STAI-II. The causes of pre...
Aim: During the Covid-19 pandemic, the number of patients examined in the outpatient clinic of ma... more Aim: During the Covid-19 pandemic, the number of patients examined in the outpatient clinic of many health institutions was limited and some changes were made in the treatment protocols. Regional Anesthesia and Pain Associations also recommended steroid administration and opioid use restriction, especially in chronic pain. In our study, we aimed to evaluate the clinical diagnosis of the patients who applied to our clinic with complaints of pain, the treatments they received, and whether our approach to chronic pain was by the guidelines during the Covid-19 pandemic period. Material and Methods: Demographic data, clinical diagnoses, interventional procedures, and medical treatments given to the patients who applied to the Ege University Faculty of Medicine, Algology Department outpatient clinic between March 2020 and May 2021 were evaluated statistically by retrospective analysis. Results: The mean age of 444 patients included in the study was 56.8±15.9 years. It was found that 29 (6.5%) of the patients applied for acute pain and 415 patients (93.5%) for chronic pain. While the number of patients who received only pharmacological treatment was 230 (51.8%), it was determined that 199 (44.8%) patients received both pharmacological treatment and interventional procedure, and 15 (3.3%) patients received only interventional procedure. When the patients were investigated in terms of pharmacological treatment, we observed that 229 (57.1%) patients received only paracetamol treatment, 99 (24.6%) patients received only non-steroidal anti-inflammatory (NSAI) drug therapy, and 73 (18.2%) patients received both paracetamol and NSAI therapy. It was determined that 243 (96.8%) of the patients who received medical treatment received weak opioids, 3 (1.3%) patients received strong opioids, and 5 (1.9%) patients received both weak and strong combined opioid treatment. Steroid injection was observed in only 16.3% of 214 patients who underwent interventional procedures. Conclusion: It was observed that chronic pain patients were in the majority during the pandemic period and the use of strong opioids and steroid injections were minimized in these patients. Since it may cause changes in immune responses, applications that will pose the least risk in pain patients should be chosen during the pandemic period.
BACKGROUND: There are many different treatment methods available in terms of complex regional pai... more BACKGROUND: There are many different treatment methods available in terms of complex regional pain syndrome (CRPS). In patients who do not respond to medical treatments, treatment is first started with sympathetic blocks and somatic nerve blocks are added when necessary. Epidural catheter applications can be practised if sufficient results cannot be obtained from the blocks in very few patients. Continuous epidural block application allows both sympathetic and somatic nerve block, allowing the patient to recover, as well as pain palliation, and adequate physical therapy and rehabilitation. CASE REPORT: In this case report, although partial pain palliation was provided with sympathetic and somatic blocks in a female patient with a diagnosis of CRPS for a long time, especially in physical therapy and rehabilitation applications, due to the inadequate response due to pain, even in the late period, a subcutaneous tunnel epidural catheter was used. CONCLUSION: We present the use of conti...
Romatolojik hastalıkların klinik seyrinde sıklıkla kas-iskelet sistemine lokalize romatizmal ağrı... more Romatolojik hastalıkların klinik seyrinde sıklıkla kas-iskelet sistemine lokalize romatizmal ağrılar ortaya çıkmaktadır. Yeterli ve etkin ağrı palyasyonu yapılmayan romatizmal ağrılar kronikleşerek hastalarda fonksiyonel yetersizlik ve yaşam kalitesinde azalmaya yol açmaktadır. Romatizmal ağrıların tedavisi altta yatan romatolojik hastalığın nedenine göre değişmekle birlikte başlıca fizik tedavi, farmakoterapi, girişimsel ağrı tedavileri ve cerrahi seçenekleri kapsamaktadır. Romatizmal ağrılarda girişimsel ağrı tedavileri, farmakoterapi ve fizik tedavi gibi non-invaziv olan diğer tedavi seçeneklerinin yetersiz kaldığı durumlarda kullanılmaktadır. Bu makalede romatizmal ağrıların girişimsel ağrı tedavisi üzerinde durulacaktır.
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