Yoðun bakým ünitelerinde son yýllarda ileri teknoloji kullanýlarak hastalarýn klinik sonuçlarýnda belirgin iyileþme saðlayan tedavi ve bakým uygulamalarý gerçekleþtirilmektedir. Ancak, bu uygulamalar yoðun bakým hastalarýn aðrý ve anksiyete yaþamalarýna neden olmaktadýr. Hastalarýn deneyimlediði aðrý ve anksiyetenin kontrol altýna alýnmasý için birtakým farmakolojik giriþimler uygulanmaktadýr. Farmakolojik giriþimlerin kullanýlmadýðý ya da etkilerinin yetersiz kaldýðý durumlarda ise doktolar, hemþireler tarafýndan aðrý ve anksiyete kontrolünde müzik terapi gibi özel, non-farmakolojik uygulamalar da kullanýlmaktadýr. Yapýlan araþtýrmalar müzik terapinin yoðun bakým hastalarýn aðrý þiddetinin ve anksiyete düzeyinin azalmasýnda etkili bir yöntem olduðunu ortaya koymaktadýr. Bu nedenle yoðun bakým hastalarýnda müzik terapinin kullanýmý önemlidir. Bu makalede müzik terapinin yoðun bakým hastalarýn aðrý ve anksiyete yönetiminde ki etkinliðine yer verilecektir.

In recent years intensive care units have been using advanced technology that provides significantly improved results in clinical treatment and care practices. However, this results in intensive care patients experiencing pain and anxiety. This pain and anxiety experienced by patients is generally brought under control by various pharmacological preparations. When a pharmacological approach is not used or is ineffective, doctors and nurses also use non-pharmacological approaches such as music to control pain and anxiety. Research has found music therapy to be an effective method of reducing pain intensity and anxiety levels in intensive care patients. Therefore, the use of music therapy is important for intensive care patients. This article will deal with the effects of music therapy on pain and anxiety management in intensive care patients.

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Giriþ: Semptomatik lumbar disk herniasyonlu hastalarda, kanal darlýk oraný ile epidural steroid enjeksiyonunun baþarý oraný arasýndaki iliþkinin belirlenmesidir.

Materyal Metot: Lumbar disk hernisi nedeniyle bacak aðrýsý þikayetiyle baþvuran ve epidural steroid enjeksiyonu uygulanan hastalar çalýþmaya dahil edildi. Aksiyel MR görüntülerinde kanal darlýðýnýn en fazla olduðu kesit ölçümler için seçildi. Kanal alaný ve disk herniasyon alaný; herbir kesit alanýndaki toplam piksel sayýsý, tarama düzeltme faktörü ile çarpýlarak mm2/piksel cinsinden hesaplandý. Kanal darlýk oraný; disk herniasyon alanýnýn, kanal kesit alanýna bölünüp 100 ile çarpýlmasý ile hesaplandý. Aðrý deðerlendirilmesi; enjeksiyon öncesi ve enjeksiyondan 1 ay sonra gerçekleþtirilen görsel analog skala (GAS) skoru kullanýlarak yapýldý. Ayrýca demografik bilgiler, semptom süresi, herniasyonun lokalizasyonu ve tipi not edildi.

Bulgular: 14 erkek ve 25 bayan olmak üzere toplam 39 hasta çalýþmaya dahil edildi. Ortalama yaþ 50,2±11,6 idi (27-76). 21 hastada (%51) ek olarak bel aðrýsý mevcuttu. Ortalama kanal darlýk oraný %36,1±2,4 idi. Ortalama semptom süresi 19,4±6,6 ay idi. Enjeksiyon sonrasý GAS skorunun, enjeksiyon öncesine göre istatistiksel olarak belirgin azalma gösterdiði saptandý (p<0,0001). GAS skorundaki bu azalma, semptom süresi 3 aydan daha kýsa süreli olan vakalarda daha belirgindi (p=0,021). Kanal darlýk oraný ile enjeksiyon sonrasý GAS skoru arasýnda belirgin negatif korelasyon mevcuttu (p=0,042). Bununla birlikte enjeksiyon sonrasý GAS skoru ile yaþ, cinsiyet, herniasyonun lokalizasyon ve tipi arasýnda anlamlý bir iliþki saptanmadý (p>0.05).

Tartýþma: Kýsa semptom süresi ve yüksek oranda kanal darlýðý olan hastalarýn, epidural steroid enjeksiyonundan daha fazla oranda fayda gördüðü gözlenmiþtir.

Introduction: The aim of this study is to determine the relation between the percent of canal compromise and success rate of epidural steroid injection (ESI) in patients with lumbar herniated intervertebral discs.

Material and Methods: Patients with lumbar herniated intervertebral disc suffered from leg pain and treated with ESI were selected. The axial MRI showing the largest canal compromise by the herniated disc was selected for measurements. The canal and herniation area measurement were calculated from the number of pixels per cross-sectional area, multiplied by a scan correction factor, mm2 /pixel. The percent canal compromise was obtained by disc herniation area divided by canal cross-section area and multiplied by 100. For pain assessment, VAS was used before (pre-injection VAS) and a month after ESI (post-injection VAS). Demographic data, duration of symptoms, location and type of herniation were noted.

Results: 39 patients were included in this study. Mean age was 50. 21 of cases also had back pain. Mean percent canal compromise ratio was 36,1%. Mean duration of symptoms was 19,4 months. The post-injection VAS was significantly decreased when compared with pre-injection VAS (p<0,0001) and this significance was related with if duration of symptoms shorter than 3 months (p=0,021). There was a significant negative correlation between percent canal compromise and post-injection VAS (p=0,042). There was no correlation between post-injection VAS and age, sex, location and type of herniation (p>0.05).

Conclusion: The patient had shorter duration of symptoms and high percent of canal compromise could have more benefit from ESI.

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Amaç: Ameliyat öncesi uygulanan tek doz deksketoprofen trometamol ile parasetamolün laminektomi sonrasý 24 saatlik dönemde postoperatif aðrý ve opioid tüketimi üzerine etkisinin randomize, çift kör, plasebo-kontrollü çalýþma olarak araþtýrýlmasý amaçlandý.
Gereç ve Yöntem: Elektif tek seviye lomber disk cerrahisi geçirecek ASA I-II grubundan 75 hasta çalýþmaya dahil edildi. Hastalar rastgele 3 gruba ayrýldý. Grup D: anestezi indüksiyonundan 30 dk önce oral 25 mg deksketoprofen, Grup P: anestezi indüksiyonundan 30 dk önce oral 500 mg parasetamol ve Grup C: anestezi indüksiyonundan 30 dk önce oral plasebo tablet uygulamasý sonrasýnda standard genel anestezi verilen tüm hastalara ameliyat sonrasýnda HKA ile iv morfin baþlandý. Üç grubun hemodinamik verileri, postoperatif aðrý durumu (VAS), sedasyon düzeyi, morfin tüketimi ve yan etkileri ilk 1 saatte her 15 dakikada bir, sonrasýnda 2., 6. ve 24. saatlerde karþýlaþtýrýldý.
Bulgular: Gruplar arasýnda ortalama VAS skorlarý arasýnda anlamlý fark gözlenmedi(p>0.05). 24 saatlik toplam morfin tüketimi Grup D, P ve C'de sýrasýyla 28.1 mg, 40.6 mg ve 43.6 mg idi. Grup D'de tüketilen morfin miktarý 2., 6. ve 24. saatlerde anlamlý olarak düþük bulundu (p<0,006). Hemodinamik bulgular, sedasyon skorlarý ve yan etkiler gruplar arasýnda benzer bulundu (p>0.05).
Sonuç: Çalýþmamýzýn sonucunda, elektif lomber disk ameliyatlarýnda preemptif 25 mg deksketoprofen trometamol uygulamasýnýn plaseboya kýyasla postoperatif morfin tüketiminde % 35'lere varan azalma saðladýðý, ancak parasetamolün bu açýdan beklenen etkinliði göstermediði kanaatine varýldý.

Objectives: The aim of this prospective randomized, double-blind study was to evaluate the analgesic efficacy and opioid-sparing effects of preemptive single dose of dexketoprofen trometamol, in comparison with that of paracetamol or placebo, for elective lumbar disc surgery, over a 24 h investigation period.
Methods: After institutional approval and informed consent had been obtained, 75 patients scheduled for single level lumbar disc surgery were randomly allocated into three equal groups. Patients received oral dexketoprofen 25 mg (group D), 500 mg paracetamol (group P) or placebo tablets (group C) 30 min before induction of standard anesthesia. Patient-controlled analgesia was supplied postoperatively using morphine. Hemodynamics, visual analog scale (VAS), sedation score, morphine consumption and side effects were recorded at every 15 min in the first hour, and 2, 6 and 24 h after surgery.
Results: The mean pain scores were similar among groups (p>0.05). The cumulative (SD) 24-hour morphine consumption was 28.1 mg, 40.6 mg, and 43.6 mg for groups D, P and C, respectively. The amount of morphine use at 2, 6 and 24 h was significantly lower in Group D (p<0,006). Hemodynamic parameters, sedation scores and side-effects did not differ among the groups (p>0.05).
Conclusion: The study demonstrates preemptive dexketoprofen trometamol 25 mg is associated with a decrease of up to 35% in morphine consumption compared with placebo over 24 hours following lumbar disc surgery, however, paracetamol 500 mg does not show an expected opioid sparing effect comparatively.

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GÝRÝÞ: Bu çalýþmanýn amacý iv parasetamol ve lornoksikamýn postoperatif aðrýda ne derece etkili olduðunu ve tramadol kullanýmýný ne oranda azalttýðýný ortaya koymaktýr.
GEREÇ-YÖNTEM: Çalýþmaya elektif tiroidektomi ameliyatý yapýlan ASA I-II grubundan, 18-72 yaþ arasýnda, 60 hasta, randomize olarak kabul edildi. GrupL’deki hastalara operasyon bitiminde iv lornoksikam 8mg, Grup P’deki hastalara iv parasetamol 1g ve GrupK’daki hastalara iv 100cc SF uygulandý. Tüm hastalara standart genel anestezi uygulandý
Ek analjezi ihtiyacý olup olmamasý 0-6, 6-12, 12-24 saatlik periyotlarda takip edildi. Aðrý skoru Visual Analog Skala(VAS) ile postoperatif 15.dk, 1, 2, 4, 6, 8, 12, 18 ve 24.saatlerde kaydedildi.
BULGULAR: Ýlk analjezik gereksinim zamaný GrupL’de ortalama 127.5 dakika, GrupP’de 162.3 dakika ve Grup K’da 35.5 dakika bulundu, süre her iki grupta anlamlý þekilde artmýþtý(p<0.001). VAS GrupP ve L’de 15.dakika, 1. 8. 12. ve 18. saatlerde anlamlý olarak düþük bulundu. Gruplarýn postoperatif 24 saat boyunca tüketilen toplam tramadol miktarý GrupK ile karþýlaþtýrýldýðýnda GrupP ve GrupL’de anlamlý olarak düþük bulundu(p<0.05). GrupK’da hastalarýn %100’ü ek analjezik kullandý, GrupL’de ise hastalarýn %50’si, GrupP’de hastalarýn %55’i ek analjezik kullandý(p<0.001). Grup L ve Grup P’de hastalarýn %90’ý, Grup K’da ise %30’u aðrý kontrolü için kullanýlan yöntemi mükemmel buldu(p<0.0001).
SONUÇ: Troid ameliyatlarýnda iv parasetamol veya lornoksikam kullanýmý; opioid ihtiyacýný ve bulantý kusma oranýný azaltmýþ, ilk analjezik gereksinim zamanýný uzatmýþ ve postoperatif aðrý skorlarýnda belirgin azalma saðlamýþtýr.

BACKGROUND: The purpose of the present study was to determine the efficacy of lornoxicam and IV paracetamol on postoperative analgesia and the reduction in tramadol consumption.
METHODS: Sixty patients following thyroidectomy were enrolled in to the study who were ASA class 1-2, and aged between 18-72 years, and were randomized into three groups: GroupL receiving 8mg of iv lornoxicam, GroupP receiving iv 1g paracetamol and, GroupC receiving 100cc of iv saline solution. All patients received standard general anesthesia.
The postoperative salvage analgesic consumption was recorded at 0-6, 6-12 and 12-24 hour intervals. Pain scores were evaluated with a visual analogue scale at 15min, and 1, 2,4,6,8,12,18, and 24h postoperatively.
RESULTS: The time to first analgesic requirement was approximately 127.5min in GroupL, 162.3 in GroupP and 35.5min in GroupC, and found to be significantly prolonged in GroupL and GroupP. Pain scores were significantly lower in GroupP and GroupL at 15 min, 1, 8, 12, and 18hours. Twenty four hour analgesic consumption was significantly lower in GroupP and GroupL compared to GroupC. Supplemental analgesics requirement was as follows: 100% in GroupC, 50% in GroupL and 55% in GroupP. The degree of satisfaction of postoperative pain management was exellent 90% in both GroupsL and P, and 30% in GroupC.
CONCLUSION: Administration of lornoxicam and iv paracetamol following thyroid surgery decreased the postoperative pain scores and opioid requirement, as well as the incidence of nausea and vomiting; while prolonging the time to the first analgesic supplement.

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Amaç: Sezaryen operasyonlarýnda spinal bloðun güvenirliliði ve epidural bloðun kullaným esnekliklerini içeren kombine spinal-epidural bloðun kullanýmý giderek artmaktadýr (KSEB). Biz çalýþmamýzda KSEB ile spinal bloðun maternal ve fetal etkilerini karþýlaþtýrmayý amaçladýk.
Gereç ve Yöntem: Miyadýnda 40 gebe randomize olarak iki gruba ayrýldý. KSEB grubuna intratekal 1.5 ml, spinal blok (SB) grubuna 2.5 ml %0.5 hiperbarik bupivakain uygulandý. KSEB grubunda bloðun uygulanmasýndan itibaren 10 dakika geçmesine raðmen duyusal blok T4’e ulaþmamýþ ise epidural kateterden her bloke olmayan segment için 2 mL %0.5 bupivakain ilave edildi. Maternal hemodinamik etkiler, intraoperatif anestezi kalitesi ve yan etkiler, Apgar ve NAKS skorlarý ve postoperatif analjezi yönünden iki grup karþýlaþtýrýldý.
Bulgular: Duyusal bloðun T4’e ulaþma zamaný ve tam blok oluþma süresi SB grubunda KSEB’a göre istatistiksel olarak kýsa saptandý (p<0.05). Ortalama arter basýncý ve kalp atým hýzý SB grubunda düþük saptandý (p<0.05). Umblikal kord kan gazý deðerleri, Apgar skoru, NAKS ve bulantý, kusma gibi yan etkiler açýsýndan farklýlýk görülmedi.
Sonuç: Hem spinal hem KSEB iyi bir cerrahi analjezi saðlamýþtýr. Maternal hipotansiyon her iki teknik için de risk olmakla birlikte, spinal blok ile daha erken ve derin olmaktadýr. Maternal kan basýncýnýn dikkatli monitörizasyonundan ve hipotansiyonun hemen tedavi edilmesinden dolayý neonatal açýdan fark saptanmamýþtýr.
Anahtar Kelimeler: Kombine spinal–epidural blok, spinal blok, sezaryen.

Objectives: Combined spinal-epidural block (CSEB) has gained increasing interest as it combines the reliability of a spinal block (SB) and the flexibility of an epidural block in cesarean section. We have investigated maternal and fetal effect of CSEB against SB in cesarean operation.
Material and Methods: Forty healty, term pregnant women were randomized into two groups. Patients in the CSEB and SB groups were given 1.5 mL and 2.5 mL of 0.5% hyperbaric bupivacaine intrathecally, respectively. If sensorial block did not reach T4 within 10 min, supplemental bupivacaine was injected epidurally 2 mL per unblocked segment in CSEB group. The quality and side effects of surgical anesthesia, hemodynamic parameters, Apgar scores, NACS and postoperative duration of pain were compared between the two groups.
Results: The time for the block to rich T4 level was significantly lower in SB group (p<0.05). More patients in the SB group achieved complete motor blockade sooner than in the CSEB group (p<0.05). Mean arterial pressure was lower in SB group (p<0.05). There were no significant differences between the groups in the incidences of apgar scores, cord blood gases, and NACS and adverse effects such as nausea and vomiting.
Conclusion: Both spinal and CSE block provide good surgical analgesia for cesarean section. Maternal hypotension is a risk with both technigues, but it occurs earlier and more higher with spinal block. There is no difference in neonatal outcome, provided that maternal blood pressure is cautiously monitored and hypotension promptly treated.

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Giriþ ve amaç: Migren tipi baþaðrýsý çok sýk karþýlaþýlan bir baþ aðrýsý tipidir. Migren ile alerjik hastalýklarýn yaygýn olarak beraber görülmesi migren patofizyolojisinde alerjik mekanizmalarýn rol oynayabileceðini düþündürmüþtür. Bu çalýþmada çocukluk çaðýnda besin alerjilerinin önemli bir kýsmýndan sorumlu olan süt ve yumurta aký alerjilerinin migren ile iliþkisini araþtýrmayý amaçladýk.
Materyal-Metod: Daha önce yapýlan okul çalýþmasýnda migren tipi baþaðrýsý tespit edilen 39 öðrenci ile baþaðrýsý tariflemeyen 167 çocuk çalýþmaya alýndý. Çocuklarýn serum örneklerinden süt ve yumurta aký-spesifik IgE düzeyleri ölçüldü.
Bulgular: Toplam 4 çocukta süt spesifik IgE pozitif bulunurken 2 çocukta yumurta aký-spesifik IgE pozitif bulundu. Her iki besin spesifisik IgE pozitifliði ile migren arasýnda bir iliþki saptanmadý. Ancak yumurta aký-spesifik IgE düzeyleri migren tipi baþaðrýsý olan çocuklarda anlamlý olarak daha yüksek bulundu (p=0.008).
Sonuç: Çocukluk çaðý migreninde süt ve yumurta allerjilerinin rolü gösterilememiþtir. Ancak migren tipi baþaðrýsý olan çocuklarda yumurta aký-spesifik IgE deðerlerinin yüksekliði migren ile besin alerjilerinin patogenezinde ortak mekanizmalarýn rol oynadýðýna iþaret edebilir.

Background and aim: Migraine is a very common headache disorder. Due to the co-occurrence of migraine and allergic disorders allergic mechanisms have been thought to play role in migraine pathophysiology. This study aimed to investigate the association between cow's milk allergy and egg-white allergy with migraine type headache of childhood.
Materials and methods: We included 39 children with migraine type headaches and 167 children with no headaches who had been previously evaluated in a school screening study program. Egg-white and cow's milk specific IgE levels were measured for all involved subjects.
Results: Specific IgE levels were positive for cow's milk in 4 children and for egg-white in 2 children, respectively. There was not detected meaningful relationship between food allergies and migraine. However, specific IgE levels for egg-white were significantly higher in migraineurs (p=0.008).
Conclusion: Childhood migraine does not appear to be associated with cow's milk or egg-white allergy. However, the elevation of egg-white specific IgE levels in migraine type headache may signify the possible presence of shared pathogenetic pathways in the development of migraine and food allergies.

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Oksipital nevralji büyük oksipital sinir ve küçük oksipital sinirin dermatomlarýnda paroksismal batýcý ve çakýcý tarzda þiddetli aðrý olarak tarif edilmiþtir. Nevralji bu sinirlerin inflamasyonundan, hasarýndan veya irritasyonundan kaynaklanmaktadýr. Bu yazýda torasik herpes lezyonunu takiben ortaya çýkan oksipital nevraljili bir hastayý sunuyoruz.

Paroxysmal shooting or stabbing pain in the dermatomes of the nervus occipitalis major or nervus occipitalis minor is defined as occipital neuralgia. Initial cause of the neuralgia appears to be from inflammation, damage or irritation of these nerves. In this article we present a patient with occipital neuralgia followed by thoracic herpes lesion.

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