Objectives: 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.
Methods: 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 0.1ml 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.
Results: 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 30mg/kg Tramadol+300mg/kg Gabapentin combination caused statistically significant increase in both tests (p<0.05).
Conclusion: 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.

Amaç: Tek baþýna veya birlikte sistemik olarak verilen tramadol ve gabapentinin farelerde akut aðrýda muhtemel antinosiseptif etklerini araþtýrmaktýr.
Gereç ve Yöntem: Hayvan Etik Komitesinin onayý sonrasý; 96 BALB/c albino diþi fare 12 gruba ayrýldý: (I) enjeksiyon yapýlmaksýzýn kontrol grubu, (II) salin uygulanan kontrol grubu, (III)-(IV) tramadol 10 mg/kg veya 30 mg/kg uygulanan gruplar, (V)-(VIII) gabapentinin sýrasýyla 30, 100, 200, 300 mg/kg uygulandýðý gruplar idi. Tramadol ve gabapentinin olasý etkileþimlerinin araþtýrýldýðý gruplarda farelere tramadol+gabapentinin dört farklý dozlarý uygulandý; (30+30, 30+100, 30+200 ve 30+300 mg/kg) (sýrasýyla, Grup IX-XII). Farelerin her 10 gram aðýrlýðý için intraperitoneal olarak 0.1 mL ilaç uygulandý. Enjeksiyondan 30 dakika sonra tail-flick ve hot plate testleri gerçekleþtirildi.
Bulgular: On ve 30 mg/kg tramadol tail-flick ve hot plate testlerinde doz baðýmlý antinosiseptif etki oluþturdu. Gabapentin 300 mg/kg dýþýndaki dozlarda tail-flick testinde antinosiseptif etki oluþturmazken, hot plate testinde doz baðýmlý antinosiseptif etki oluþturdu.
Her iki testte de tramadol ve gabapentin birlikte kullanýldýklarýnda, tek baþlarýna kullanýlmalarýna oranla daha fazla antinosiseptif etki oluþturdu, fakat sadece 30mg/kg tramadol+300mg/kg gabapentin birlikte kullanýldýðýnda her iki testte de anlamlý antinosiseptif etki saptandý (p<0.05).
Sonuç: Gabapentin ve tramadol birlikte kullanýldýklarýnda, tail-flick ve hot-plate testlerinde gabapentin 300 mg/kg dozu dýþýnda additif antinosiseptif etki oluþturmadý. Tail-flick testi sonuçlarýna göre tramadol, gabapentinden daha iyi antinosiseptif etki oluþturdu.

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Amaç: Laparoskopik cerrahi sonrasý postoperatif aðrý laparatomiye göre daha hafiftir ve hastalar intraperitoneal lokal anestezik ve opioid uygulamalarýndan fayda görebilir. Çalýþmamýzda jinekolojik laparoskopik cerrahi uygulanacak hastalarda intraperitoneal uygulanan %0.75 ropivakain ve meperidinle kombinasyonun postoperatif analjezi üzerine etkilerini karþýlaþtýrmayý amaçladýk.
Gereç ve Yöntem: Jinekolojik laparoskopi sonunda, randomize çift-kör çalýþma protokolüne göre intraperitoneal enjeksiyon uygulandý. Hastalar üç gruba ayrýldý: R Grubuna (n=18) % 0.75 ropivakain 3 mg/kg 200 ml salin içinde; RM Grubuna (n= 17) % 0.75 ropivakain 3 mg/kg ve meperidin 50 mg 200 ml salin içinde; K Grubuna (n= 18) 200 ml salin trokarla uygulandý. Hastalara aðrýsý olduðunda (VAS ³ 3) diklofenak sodyum ve eðer aðrýsý geçmezse 1 mg/kg meperidin i.v. uygulandý.
Bulgular: Aðrý skorlarý ve analjezik gereksinimi postoperatif ilk bir saat için RM grubunda daha düþük bulundu. Daha sonraki dönemde aðrý skorlarý tüm gruplar için benzerdi ve 24 saatlik total analjezik tüketimi açýsýndan fark saptanmadý. Her üç grup arasýnda omuz aðrýsý ve yan etkiler yönünden fark saptanmadý.
Sonuç: Jinekolojik laparoskopik cerrahi sonrasý intraperitoneal %0.75 ropivakain ile meperidin kombinasyonu ropivakain yada saline göre postoperatif ilk bir saatte daha düþük aðrý skorlarý ve analjezik tüketimi saðlamaktadýr.

Objective: Postoperative pain after laparoscopic surgery is less intense than after laparotomy and patients may benefit from an intraperitoneal injection of local anesthetic and opioids. We aimed to compare intraperitoneal 0.75% ropivacaine with 0.75% ropivacaine plus meperidine for postoperative analgesia in patients undergoing gynecologic laparoscopy.
Material and Methods: At the end of gynecologic laparoscopy, in a double–blind, randomized manner, one of the following injections was given intraperitoneally. Patients were allocated into three groups: patients in R Group (n= 18) were given 0.75% ropivacaine 3 mg/kg in 200 mL saline; patients in RM Group (n= 17) were given meperidine 50 mg plus 0.75% ropivacaine 3 mg/kg in 200 mL saline; patients in C Group (n= 18) were given 200 mL saline through the trocars. All patients were given diclofenac sodium when they had pain (VAS ³ 3) and 1 mg/kg meperidine i.v. was also given when pain persisted.
Results: The pain scores and analgesic requirements during the first postoperative hour were significantly lower in the RM Group than those in the R and C Groups. Beyond that time, the pain scores were similar in all groups and there were no differences in total analgesic requirement in 24 h between groups. The three groups were comparable for shoulder pain and side effects.
Conclusion: The intraperitoneal infiltration of 0.75% ropivacaine plus meperidine reduced pain scores and analgesic requirement during the first one hour after gynecologic laparoscopy compared with the intraperitoneal infiltration of ropivacaine or saline.

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Amaç: Giderek artan sayýda yapýlan günübirlik bir cerrahi giriþim olan laparoskopik kolesistektomide aðrý tedavisi önemli bir sorundur. Her ne kadar laparoskopik cerrahi günübirlik bir giriþim olarak kabul edilse de, hastalar sýklýkla aðrý nedeniyle hospitalize edilmekte ve bu da opioid tüketimini ve opioidlerin sebep olduðu yan etkileri arttýrmaktadýr. Bu çalýþmanýn amacý laparoskopik kolesistektomi sonrasýnda aðrý tedavisi için hasta kontrollü analjezi yönteminde tramadole deksketoprofen trometamol eklenmesinin etkinliðini araþtýrmaktýr.
Metod: Çalýþmaya 18-65 yaþlarý arasýnda ASA I-II risk grubundan 40 hasta alýndý ve kapalý zarf yöntemi ile randomize edildi. Grup TD'de 600 mg tramadol ve 100 mg deksketoprofen, Grup T'de ise 600 mg tramadol 100 ml %0.9 normal saline eklenerek PCA hazýrlandý. Postoperatif dönemde VAS>40 olmasý durumunda 8 mg lornoksikam iv verildi.
Sonuçlar: Yan etki profili açýsýndan (hipotansiyon, bradikardi, sedasyon) iki grup arasýnda istatistiksel olarak anlamlý bir fark yoktu fakat Grup T'de 4 hasta bulantýdan, 3 hasta ise kusmadan yakýndý. Grup TD'de opioid tüketimi daha düþük ve hasta memnuniyeti daha yüksekti.
Tartýþma: Bu çalýþma laparoskopik kolesistektomi sonrasýnda tramadole deksketoprofen trometamol eklenmesinin hasta kontrollü analjezi yönteminde VAS skorlarýný düþürdüðünü, hasta memnuniyetini arttýrdýðýný ve opioid tüketimini azalttýðýný göstermiþtir.

Purpose: 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 in post-laparoscopic cholecystectomy pain treatment.
Method: 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.
Results: 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.
Conclusion: 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.

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Araþtýrma kadýnlarýn karýn, diþ ve kulak aðrýsýnda çocuklarýna yaptýklarý uygulamalarý belirlemek amacýyla tanýmlayýcý olarak yapýldý. Mart-Mayýs 2004 tarihleri arasýnda Antalya’da bulunan 6 no’lu saðlýk ocaðý bölgesinde oturan kadýnlar örnekleme alýndý. Veri toplama aracý olarak araþtýrmacýlar tarafýndan hazýrlanan anket formu kullanýldý. Kadýnlarýn % 29.2’sinin karný aðrýdýðý zaman evde hazýrladýklarý karýþýmlarý çocuklarýnýn karnýna ve ayak tabanýna sürdükleri; % 30.3’ünün çocuklarýn aðrýyan kulaðýna anne sütü damlattýklarý; % 38.9’unun çocuklarýn aðrýyan diþlerine aspirin koyduðu, tuz, limon tuzu vb. uygulamalarý yaptýklarý belirlendi. Çalýþmamýzda, kadýnlarýn çoðunluðunun karýn, diþ ve kulak aðrýsý durumunda çocuklarýna hatalý uygulamalar yaptýklarý görülmektedir. Kadýnlarýn eðitim durumu ve yaþlarýnýn geleneksel uygulama yapma sýklýðýný etkilediði belirlenmiþtir. Çalýþma sonucunda, kadýnlara çocuk bakýmý, sýk görülen saðlýk sorunlarý ve yanlýþ uygulamalar konularýnda hemþireler tarafýndan eðitimler yapýlmasý önerilebilir.

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.

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Amaç: Bu çalýþmada lumbar disk hernisine baðlý radikülopatisi olan hastalara uygulanan transforaminal lumbar epidural steroid enjeksiyonun (TLESE) etkinliði ve güvenliði araþtýrýlmýþtýr.
Gereç ve Yöntem: Çalýþma TLESE uygulanan hastalarýn dosyalarýnýn retrospektif olarak taranmasý ile hazýrlandý. En az bir aydýr devam eden, konservatif tedaviye yanýt vermeyen, görüntüleme yöntemlerinde bulging ya da protrüzyon’u olan lumbar disk herni’li hastalar çalýþmaya dahil edildi. Bütün uygulamalar C-kollu floroskopi eþliðinde, lokal anestezi altýnda ve ayaktan metotla uygulandý. Tüm olgularda 80 mg triamsinolon ve %0.25’lik bupivakain karýþýmý, disk hernisinin olduðu düzeyden, transforaminal olarak, anterior epidural bölgeye enjekte edildi. Baþlangýç VAS aðrý skorlarý deðerleri, uygulama sonrasý 1, 3 ve 6. ay deðerleri ile karþýlaþtýrýldý. Uygulamaya yönelik hasta memnuniyeti, puanlanarak tespit edildi. Ayrýca erken ve geç dönem komplikasyonlarý deðerlendirme için toplandý.
Bulgular: Toplam 222 hastaya 460 kez TLESE uygulanmýþtýr (ortalama: 2.1, tekrarlanma aralýðý: 1-6 kez). Uygulamalar en sýk L4-L5 ve L5-S1 düzeylerinden gerçekleþtirilmiþtir. Baþlangýç VAS skorlarý ortalamasý 8.2±0.7 iken, TLESE sonrasý 1, 3 ve 6. ayda sýrasýyla 5.0±1.6, 4.8±1.5 ve 5.1±1.5 olarak bulunmuþtur. Hastalarýn %63,9’u (n=142) memnuniyetlerini ‘iyi ve mükemmel’ olarak belirtmiþlerdir. Majör komplikasyonun yaþanmadýðý bu çalýþmada toplam minör komplikasyon oraný %11.1’dir.
Sonuç: TLESE’nin kýsa ve orta dönemde etkin ve güvenli bir yöntem olduðu görülmüþtür.

Objective: This study looks into the efficacy and safety of the transforaminal lumbar epidural steroid injection (TLESI) applied to patients with radiculopathy due to lumbar disk herniation.
Methods: The patients’ files which were applied TLESI, were retrospectively scanned. Patients who did not respond to one-month conservative treatment and who were detected to have bulging or protruding lumbar disk herniation as a result of imaging methods were included in the study. All applications were performed with C-arm fluoroscopy under local anesthesia by outpatient method. In all cases, a mix of 80 mg triamsinolone and 0.25% bupivacaine, was transforaminally injected to the anterior epidural area. Initial VAS pain scores were compared with the values of the 1, 3 and 6th months after the application. Patient satisfaction was determined through scoring. Furthermore, early and late term complications were collected for evaluation.
Results: A total of 222 patients were administered TLESI 460 times (average: 2.1, repeat interval: 1-6 times). The applications were carried out most frequently at the levels of L4-L5 and L5-S1. While the initial VAS score average was 8.2±0.7, after TLESI, it was 5.0±1.6, 4.8±1.5 and 5.1±1.5 in the 1, 3 and 6th months, respectively. 63.9% of the patients (n=142) defined the treatment as ‘good and excellent’. No major complications were experienced and the overall minor complication rate was 11.1%.
Conclusion: It was seen that TLESI was an efficient and safe method in the short and medium term.

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The aim of this study was to compare the sharp and blunt needles in order to determine the incidence of complications during transforaminal anterior epidural steroid injections.
In this retrospective study, 185 cases that undergo transforaminal epidural steroid injection with sharp or blunt needles were evaluated between June 2004 and December 2008. Patients age, sex, diagnosis, needle type (sharp or blunt), volume of local anesthetic and steroid injected, complications (paresthesia, dural puncture, bleeding, paralysis, intravascular penetration, headache, local back pain, temporary motor loss in lower extremities) was recorded.
3 cases in blunt needle group and 8 cases in sharp needle group showed paresthesia during the procedure. The difference was not found to be significant among the groups. Vascular penetration was observed in 2 cases in blunt and 13 cases in sharp needle group and the difference between groups was statistically significant (p<0.001). Dural punction and headache incidence were not significant when the two groups are compared. The local back pain at the injection site had a higher incidence in the blunt needle group.
When using the blunt needles, vascular penetration and paresthesia were less during transforaminal epidural steroid injections. Therefore blunt needles seem to be more advantageous.

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Çalýþmamýzda yüksek riskli bir hastada US rehberliðinde düþük LA dozlarýnda cerrahi anestezi planlanmýþtýr. ASA III olarak deðerlendirilen hastaya ultrason rehberliðinde sað femoral blok ve her iki bacaða popliteal blok uygulanarak cerrahi anestezisi saðlanmýþtýr. Blok uygulamalarý sýrasýnda 80 mm uzunluðunda iðne ile 10 ml %0,5 levobupivakain ve 10 ml %2 lidokain uygulanarak blok gerçekleþtirilmiþtir. Femoral sinir ultrason eþliðinde görüntülenip, nörostimülator yardýmý ile quadriceps kasý motor yanýtý doðrulandýktan sonra 10 ml %0,5 levobupivakain negatif aspirasyon yapýlarak uygulanmýþtýr. Ultrason rehberliði ile sinirlerin direkt olarak görüntülenebilmesi blok baþarý oranýný arttýrýrken lokal anestezik ihtiyacýnýn da azalmasýna katkýda bulunur. Ultrason rehberliðinde yapýlan bloklarda düþük miktarda lokal anestezik kullanýlmasý birden fazla bloðun uygulanabilmesine imkan tanýmaktadýr.

U.S. high-risk patients in our study under the guidance of a low dose of LA in the surgical anesthesia was planned. ASA III patients as assessed by ultrasound guidance into the right femoral popliteal block by block, and both legs were provided surgical anesthesia. During the practice blocks with 80 mm-long needle and 10 ml of levobupivacaine 0.5% 10 ml of 2% lidocaine was performed by applying the block. Ultrasound guided femoral nerve be displayed, with the help nörostimülator right quadriceps muscle and motor responses after negative aspiration of 10 ml levobupivacaine 0.5% was applied. With ultrasound guided nerve blocks can be directly displayed as the success rate while improving the local anesthetic will also contribute to decreased. In the block under the guidance of ultrasound, a small amount of local anesthetic is allowing more than one block application

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Postoperatif muskulokutanöz sinir hasarý nadir bir sorun ve komplikasyondur. Bildirilen vakalarda bu sinirin hasarý sonucunda, nöropatik aðrý olmaksýzýn bisesps ve brakialis kaslarýnda güç kaybý olduðu yazýlmýþtýr (1,2,3). Brakiyal pleksusun, lateral kutanöz siniri gibi terminal dallarýndan birinde hasar oluþtuðu zaman majör belirti aðrý olup; bu aðrý ön kolun radial yüzüne doðru yayýlýr (1,4). Literatürde izole muskulokutanöz sinir hasarýlarýnýn, tekrarlayan mikrotravmalar ve sinirin indirekt veya direkt travmaya maruz kalmasý nedeniyle oluþtuðu bildirilmiþtir (5). Ýzole muskulokutanöz sinir hasarý ayrýca, ön kolun uzun süre boyunca ekstansiyonda kalmasýna baðlý da oluþabilir.

Postoperative isolated injury of the musculocutaneous nerve is a rare disorder and complication. Reported cases are claimed to present with loss of biceps and brachialis power without neuropathic pain (1,2,3). When injury occurs to one of the terminal branches of the brachial plexus, the lateral cutaneous nerve of the forearm, pain is the major symptom and it typically radiates along the radial aspect of the forearm (1,4). In the literature, isolated lesions of the musculocutaneous nerve have been attributed to repeated microtrauma, indirect trauma or direct trauma to the nerve (5). It may also occur due to strenuous extension of the forearm for prolonged periods.

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