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Basit ve ucuz bir tedavi yöntemi olan soðuk uygulamalar, aðrýnýn ilaç dýþý tedavisinde etkin bir yöntem olarak kabul edilmektedir. Bu uygulamalarýn aðrý eþiðini yükselttiði, inflamasyon ve spazmý azalttýðý gösterilmiþtir. Akut yumuþak doku yaralanmalarýnýn tedavisinde yaygýn olarak kullanýlan bu uygulamalarýn, ortopedik cerrahi iþlemler sonrasý aðrýnýn kontrolünde de etkin olduklarý gösterilmiþtir. Bununla birlikte, etkinliklerini gösteren bilimsel deliller yetersiz olup kaliteli, randomize kontrollü çalýþmalara ihtiyaç bulunmaktadýr. Bu yazýnýn amacý, soðuðun dokular üzerindeki fizyolojik etkilerinin, deðiþik uygulama yöntemlerinin aðrý üzerindeki etkinliðinin, ve uygulamanýn potansiyel komplikasyonlarýnýn literatür eþliðinde gözden geçirilmesidir

Cold application is a simple and inexpensive therapy which has been accepted for decades as an effective nonpharmacologic intervention for pain management. It increases the pain threshold, decreases the inflammatory reaction and spasm. Cold is commonly used in the treatment of acute soft tissue injuries and has been shown to reduce pain effectively in the post-operative period after orthopedic surgery procedures. However, the evidence base to support the common practice of superficial cold is limited and there is a need for future higher-quality randomised controlled trials. The purpose of this rewiev is to explore the literature regarding the physiologic effects of cold, the effectiveness of cold, different modalities used for cold application, and the potential complications associated with the use of cold application.

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Ýnvazif giriþimler günümüzde artýk aðrý tedavisinin ayrýlmaz bir parçasýdýr. Bunun gereði olarak floroskopi günlük uygulamalarýmýzda çok sýk kullanýlýr hale gelmiþtir. Ancak bu geliþme þu soruyu akla getirmektedir: Floroskop kullanýmý, iyonizan radyasyon ve radyasyondan korunma konusunda ne kadar bilgi sahibiyiz? Bu derlemede, önce
radyasyon fiziði ve iyonizan radyasyon hakkýnda temel bilgiler verilecek, daha sonra da radyasyon güvenliði konusunda bilinmesi gereken noktalar vurgulanmaya çalýþýlacaktýr.

Invasive procedures have been an inseparable part of contemporary pain medicine. As a result, flouroscope has been an indispensable equipment in our daily practice but this development brings some questions into mind like how much knowledge do we have about the operation of flouroscope, ionizing radiation and radiation safety? We
aimed to give basic information about radiation physics, ionizing radiation. Besides, important points about radiation safety will be specially emphasized.

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Saðlýklý eriþkin gönüllülerde yapýlan magnetik rezonans görüntüleme (MRG) çalýþmalarýnda infraklavikular blokta lateral sagittal yaklaþýmýn kolay ve emniyetli olduðu belirtilmiþtir. Biz bu yazýmýzda lateral sagittal yaklaþýmla infraklavikular blok uyguladýðýmýz 3 olguyu sunduk. Olgularýmýzdan biri dirsek ekleminde osteomiyelit tespit edilen yüksek riskli hasta, diðeri de Dupuytren kontraktürü açýlmasý gereken hastaydý. Üçüncü hasta açýk metakarp kýrýklarý nedeniyle acil servise kabul edilmiþti. Tüm hastalara lateral sagittal infraklavikular blok (LSÝB) planlandý. Lokal anestezik (LA) enjeksiyonundan 20 dakika sonra cerrahi anestezi geliþti. Hiçbir hastada damar ponksiyonu, LA toksisitesi ve pnömotoraks geliþmedi. Sonuç olarak LSÝB kolay, komplikasyonlarý az ve hasta tarafýndan kolay kabul edilebilir olmasý nedeniyle diðer yöntemlere bir alternatif olabilir.

Magnetic resonance imaging (MRI) analysis performed on healthy volunteers assessed the effectiveness of brachial plexus block via the lateral sagittal infraclavicular approach to be easy-performed and relatively safe. In this case report, we presented three cases to whom we performed infraclavicular block via the lateral sagittal approach. One of our cases was a high risk patient with osteomyelitis of the elbow joint and the other was a patient who had required surgery for Dupuytren's contracture. The third one was a patient admitted to emergency room who had got open metacarps fractures. Lateral sagittal infraclavicular block was planned in all of the patients. Twenty minutes after local anesthetic (LA) injection, sufficient surgical anesthesia was achieved. Non of the patients developed vascular puncture, LA toxicity and pneumothorax. In conclusion, LSIB appears to be an easy, a safe and a more acceptable approach for the patient, therefore a good alternative.

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Bu çalýþmanýn amacý lornoksikamýn postoperatif aðrýda ne derece etkili olduðunu ve tramadol kullanýmýný ne oranda azalttýðýný ortaya koymaktýr. Çalýþmaya elektif tiroidektomi ameliyatý yapýlan ASAI-II grubundan, 18-70 yaþ arasýnda, 40 hasta, randomize olarak kabul edildi. GrupL’deki hastalara operasyon bitiminde i.v. lornoksikam 8 mg uygulandý ve 12 saat arayla 2x8mg olacak þekilde postoperatif ilk 24 saatte verildi. GrupP’deki hastalara i.v. 4cc SF uygulandý ve 12 saat arayla 2x4cc olacak þekilde postoperatif ilk 24 saatte verildi. Ek analjezi (tramadol 100 mg) ihtiyacý olup olmamasý 0-6, 6-12, 12-24 saatlik periyotlarda takip edildi. Aðrý skoru VAS ile postoperatif 15. dk, 1, 2, 4, 6, 8, 12, 18 ve 24. saatlerde kaydedildi. Ýlk analjezik gereksinim zamaný GrupL’de ortalama 101.7 dakika iken GrupP’de 37.9 dakika bulundu, süre anlamlý þekilde artmýþtý (p<0.001). VAS GrupL’de 15. dakika, 1, 8, 12 ve 18. saatlerde anlamlý olarak düþük bulundu. Gruplarýn postoperatif 24 saat boyunca tüketilen toplam tramadol miktarý GrupP ile karþýlaþtýrýldýðýnda GrupL’de anlamlý olarak düþük bulundu (p<0.05). GrupL’de tüketilen tramadol miktarý GrupP’ye göre % 60 az olarak bulundu (100 mg, 250 mg (ortalama), sýrasýyla). GrupP’de hastalarýn %100’ü ek analjezik kullandý, GrupL’ de ise hastalarýn % 60’ý ek analjezik kullandý (p=0.002). GrupL’de hastalarýn % 95’i, GrupP’de ise % 25’i aðrý kontrolü için kullanýlan yöntemi mükemmel buldu (p<0.000). GrupP’de olgularýn onsekizinde, GrupL’de ise dokuzunda bulantý þikayeti oluþtu (p=0.002). GrupP’de olgularýn onbeþinde, GrupL’de ise sekizinde kusma görüldü (p=0.025). Troid ameliyatlarýnda lornoksikam kullanýmý; opioid ihtiyacýný ve bulantý kusma oranýný azaltmýþ, ilk analjezik gereksinim zamanýný uzatmýþ ve postoperatif aðrý skorlarýnda belirgin azalma saðlamýþtýr.

The purpose of the present study was to determine the postoperative analgesic effects of lornoxicam and the reduction in tramadol consumption. Fourty patients of ASA class I-II, 18-70 years of age, undergoing thyroidectomy were assigned in a randomized manner into two groups: GroupL received 8 mg of lornoxicam i.v. at the end of the operation followed by 8 mg of lornoxicam b.i.d., i.v. for 24 hours postoperatively. GroupP received 4 ml of saline solution i.v. at the end of the operation and the same amount b.i.d., i.v. for 24 hours postoperatively. The requirements for supplemental analgesics were recorded at 0-6, 6-12 and 12-24 hour intervals. Postoperative pain scores were evaluated at 15th min. and 1, 2, 4, 6, 8, 12, 18 and 24th hours using Visual Analogue Scale (VAS). The time to first analgesic requirement was significantly longer in GroupL compared to GroupP (101.7 vs 37.9 min, p<0.001). Pain scores were significantly lower in GroupL compared to GroupP at 15th min, 1, 8,12 and 18th hours. Twenty four hour analgesic consumption was significantly lower in GroupL compared to GroupP (p<0.05). The amount of tramadol consumed in GroupL was 60% lower compared to GroupP (100 mg and 250 mg (mean), respectively). 100% of the patients in GroupL and 60 % of the patients in GroupP needed supplemental analgesics. The degree of satisfaction with postoperative pain management was excellent in 95 % of patients in GroupL and 25 % of patients in GroupP. Eighteen patients in GroupP and 9 patients in GroupL had nausea (p=0.002), and fifteen patients in GroupP and 8 patients in GroupL had vomiting (p=0.025). Lornoxicam decreased the opioid need, the incidence of nausea and vomiting and postoperative pain scores. Moreover, it was observed that the time needed for the first analgesic requirement was prolonged following thyroidectomies.

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Tek merkezli, çift kör, açýk uçlu, randomize, kontrollü olarak yapýlan bu çalýþmada periferik nöropatili hastalarda bir antikonvülzan olan gabapentin (GBP), nöropatik aðrý tedavisinde halen klasik yerini korumakta olan amitriptilin (AMÝ) ile etkinlik ve emniyet açýsýndan karþýlaþtýrýlmýþtýr. Periferik nöropati tanýsý almýþ yanýcý-batýcý-çakýcý (elektrik çarpmasý) nitelikte aðrý özelliði olan 52 hasta GBP (grup GBP) ve AMÝ (grup AMÝ) tedavisi alacak þekilde ikiye ayrýldý. Yanýcý, batýcý ve çakýcý aðrý þiddeti görsel aðrý ölçütü (VAS; 0: aðrý yok, 10: dayanýlmaz aðrý) ile, allodini varlýðý nöropatik aðrý bölgesine pamuk temasý ile deðerlendirildi. Bu çalýþmanýn amacý her iki grubun çalýþma süresince tedaviye ortalama cevabýný karþýlaþtýrmak olduðundan birincil hedef yanýcý, batýcý ve çakýcý aðrý ölçütünün deðiþip deðiþmediðini incelemekti. Bu amaçla her hasta için yanýcý, çakýcý ve batýcý aðrýnýn VAS deðerlerinin ve çakýcý aðrýnýn günlük sýklýðýnýn baþlangýç ve 4. hafta farklarý hesaplandý ve aðrý düzelme derecesi olarak kabul edildi. Ýkincil hedef de çalýþma ilaçlarýnýn olasý yan etkilerinin günlük yaþamý etkileyip etkilemediðinin hasta memnuniyeti ölçütü ile belirlenmesi idi. Her iki grup karþýlaþtýrýldýðýnda, aðrý düzelme derecesi deðerinin çakýcý aðrý için grup GBP’de grup AMÝ’ye göre istatistiksel olarak anlamlý derecede yüksek olduðu gözlenmiþtir. Hasta memnuniyeti (yan etkilerin günlük yaþamý etkileme derecesi) skoru Grup GBP’de grup AMÝ’ye göre istatistiksel olarak ileri derecede anlamlý yüksek bulunmuþtur. GBP ve AMÝ’nin her ikisi de periferik nöropatik aðrýda etkin aðrý kontrolü saðlamýþtýr. Buna ek olarak GBP özellikle paroksismal çakýcý aðrý saðaltýmýnda daha etkin olmuþtur. Ayrýca GBP daha iyi tolere edilmektedir.

In this single center, double blind and randomized trial gabapentin as a new anticonvulsant was compared in efficacy and safety with amitriptyline which is a classic agent in neuropathic pain treatment. Fourty six patients with neuropathic pain which was burning, stabbing and shooting in quality were allocated to take gabapentin (group GBP) and amitriptyline (group AMI) monotherapy. The assesment variables were burning, stabbing, shooting pain on visual analog scale (VAS; 0: no pain, 10: worst pain imaginable), allodynia as present or not by lightly touching the skin with cotton. Primary efficacy variable was the degree of burning, stabbing and shooting pain improvement that was accepted as the difference of beginning and 4th week’s VAS of all pain qualities. The secondary efficacy variable was the patient satisfaction scale determined as whether possible side effects of study drugs affect the patients’ daily life. The degree of pain improvement was only seen in shooting pain and was statistically significantly high in group GBP. The patient satisfaction scale was also high in group GBP. Both gabapentin and amitriptyline provided effective pain control in peripheral neuropathic pain. Additionally gabapentin was more effective especially in paroxysmal shooting pain than other pain qualities. And also gabapentin was tolerated well.

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Epidural analjezi doðumda en çok tercih edilen analjezi metodudur. Bu çalýþmanýn amacý, Türk obstetrisyenlerin epidural analjezi ile ilgili bilgi ve yaklaþýmlarýný deðerlendirmenin yanýnda tereddütlerini irdelemektir. Türkiye’deki obstetrisyenler arasýnda (n=152) yürütülen prospektif bir anket ile doðumda epidural analjezi kullanýmý ile ilgili obstetrisyenlerin eðitim, bilgi ve yaklaþýmlarý hakkýnda bilgi toplanmýþtýr. Ankete katýlým oraný %94.7 olmuþtur. Katýlýmcýlarýn çoðu epidural analjezi hakkýnda sadece uzmanlýk eðitimi sonrasýndaki kurslarda bilgi edinmiþlerdir. Katýlýmcýlarýn %35’i yeterli bilgi skoruna eriþememiþlerdir. 6 ila 15 yýllýk deneyime sahip olanlarýn skorlarý anlamlý olarak daha yüksektir. Katýlýmcýlarýn %84’ü epidural uygulama öncesinde 20 dakikaya kadar olan gecikmeyi kabul edilebilir bulmuþlardýr. Kanýmýzca bu anketin sonuçlarý, gerek obstetrik eðitimi sýrasýnda gerekse de sonrasýnda, epidural analjezi ile ilgili eðitimin iyileþtirilebileceðini ve bu eðitimin en iyi obstetrisyenlerle iþbirliði yapan anestezi uzmanlarý tarafýndan verilebileceðine iþaret etmektedir. Anestezistler ve obstetrisyenlerin gerek uzmanlýk eðitimlerinde gerekse de devam eden uzmanlýk sonrasý eðitimlerinde karþýlýklý olarak iþbirliðine giriþmelerinin desteklenmesi umulmaktadýr.

Epidural analgesia is the most common preferred method of labor analgesia. The aim of this study is to evaluate the knowledge and attitudes of Turkish obstetricians and gynecologists concerning epidural analgesia and to reveal their doubts as well. A prospective survey amongst obstetricians and gynecologists in Turkey (n=152) was conducted to obtain information about obstetricians’ education, knowledge and attitudes with respect to epidural analgesia during labor. The response rate to the survey was 94.7 %. Most respondents only received lectures about epidural analgesia after their specialty training. 35 % of respondents did not achieve an adequate knowledge score. Those with six to fifteen years experience achieved significantly better scores. A delay up to twenty minutes before epidural placement is acceptable to 84 % of respondents. In our opinion, the results of this survey indicate that education regarding epidural analgesia, both during and after obstetric speciality training, could be improved, and this education would best be provided by anesthetists in collaboration with obstetricians. It is hoped that closer collaboration between anesthetists and obstetricians during their respective training and in continuing medical education can be fostered.

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Abstract | Full Text PDF