Baþ aðrýsý tüm yaþ gruplarýnda sýk görülen yaygýn bir halk saðlýðý problemi olmakla birlikte, yaþa, cinsiyete ve toplum özelliklerine göre farklýlýk göstermektedir. Bu hastane bazlý çalýþmada, Türkiye’nin kýrsal bir bölümünde baþ aðrýsýnýn özellikleri ve alt tipleri cinsiyete ve yaþa göre incelenmiþtir. Toplam 11549 hasta deðerlendirilmiþ ve 4951 hastada (%42.8) baþ aðrýsý saptanmýþtýr. Bir yýllýk baþ aðrýsý prevalansý çocuklarda %38.6, eriþkinlerde %47.0 ve yaþlý nüfusta ise %23.3 olarak izlenmiþtir (p<0.001). Eriþkinlerde ve ileri yaþlý hastalarda kadýn erkek oraný yüksek olarak saptanmýþ (p<0.001), çocuklarda ise kadýn erkek oraný arasýnda farklýlýk izlenmemiþtir (p=0.654). Tüm yaþ gruplarýnda en sýk taný sýk epizodik gerilimi tipi baþ aðrýsý olarak izlenmiþtir. epileptik nöbetlere ve rinosinüzite baðlý baþ aðrýlarý çocuk yaþ grubunda üç kat daha sýk olarak görülürken, kronik gerilim tipi baþaðrýsý eriþkinlerde ve ileri yaþ grubunda üç kat daha sýk olarak saptandý. Çocuk yaþ grubunda migren hastalarýnýn %60’ý erkek iken, eriþkin migren hastalarýnýn %80’i kadýn idi. Baþ aðrýsýnýn ve alt tiplerinin epidemiyolojisinin bilinmesi, tüm yaþ gruplarýnda yüksek bir prevalansa sahip olmasý ve büyük bir halk saðlýðý sorunu oluþturmasý nedeniyle önemlidir.

Headache is a frequent and widespread symptom constituting a major health problem at all age groups, though vast differences are present according to the age and gender, as well as population characteristics. In this hospital-based study, we investigated the characteristics and subtypes of headache with relation to age and gender in a rural community in eastern part of Turkey. A total of 11549 subjects were evaluated, and 4951 patients (42.8%) had headache. The 1-year headache prevalence was 38.6% in children, 47.0% in adults, and 23.3% in elderly (p<0.001). The female to male ratio was higher in adults (p<0.001) and elderly headache patients (p<0.001), but not in children (p=0.654). The most common diagnosis was frequent episodic tension-type headache in all. The headache attributed to epileptic seizure and rhinosinusitis were about three times more common in children, while chronic tension-type headache was about three times more common in adults and elderly. While 60% of patients with migraine were male in children, about 80% of patients were females in adults. The understanding of the epidemiology of headache and subtypes is important as it constitutes one of the major health problems due to its high prevalence at all age groups.

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Giriþ: Gerilim Tipi Baþ Aðrýsý (GTBA) ’nýn geliþiminden periferal ve santral nosiseptif mekanizmalar sorumlu tutulmaktadýr. GTBA’nýn akut tedavisinde sýklýkla analjezikler, koruyucu tedavisinde ise antidepresanlar kullanýlmaktadýr. Bu çalýþmada Epizodik Gerilim Tipi Baþ Aðrýlý (EGTBA) ’lý hastalarda lokal lidokain uygulamasýnýn tedavi edici etkinliði araþtýrýldý.
Materyal Metod: Çalýþmamýza perikranial hassasiyeti bulunan 20 EGTBA’lý hasta (Grup 1) ile perikranial hassasiyeti bulunmayan 20 EGTBA’lý hasta (Grup 2) dahil edildi. Her iki gruptaki hastalara üç seans lokal %1’lik lidokain enjeksiyonu uygulandý. Hastalarýn her birine iki taraflý olmak üzere frontal kaslara, temporal kaslara, masseter kaslarýna, sternokloidomastoid kaslara, semispinalis capitis kaslarýna, splenius capitis kaslarýna ve trapezius kaslarýna 1’er ml enjeksiyon uygulandý. Hastalarýn tedavi öncesi ve tedavi sonrasý 1. 2. ve 3. aylarda deðerlendirmeleri yapýlarak, bir ay içerisindeki aðrýlý gün sayýlarý ve aðrý þiddetleri Vizüel Analog Skala (VAS) olarak kaydedildi.
Bulgular: Çalýþmaya 11 erkek 29 bayan hasta alýndý. Grup 1’in yaþ ortalamasý 35,95±9,85 (18-53) yýl, Grup 2’nin yaþ ortalamasý 34,85±10,04 (20-54) yýl idi. Gruplar arasýnda yaþ ve cinsiyet ve tedavi öncesi aðrý sýklýðý ve aðrý þiddeti açýsýndan farklýlýk saptanmadý (p>0,05). Lokal lidokain uygulanan perikranial hassasiyeti bulunan EGTBA’lý hastalarýn hem aðrý sýklýðý hem de aðrý þiddeti 1., 2. ve 3. ay kontrollerinde lokal lidokain uygulanan perikranial hassasiyeti bulunmayan EGTBA’lý hastalarýn ayný dönemdeki aðrý sýklýðýndan ve aðrý þiddetinden istatistiksel olarak anlamlý derecede daha düþük olduðu saptandý (p<0,05).
Sonuçlar: Lokal lidokain uygulamasý, perikranial hassasiyeti olan EGTBA’lý hastalarýn tedavisinde etkin bir yöntem olarak kullanýlabilir.

Objective: Peripheral and central nociceptive mechanisms are responsible in the development of Tension Type Headache (TTH). Analgesics are frequently used in the treatment of acute TTH. Antidepressants are used in the prevention. In this study, therapeutic efficacy of local application of lidocaine was investigated in Episodic Tension Type Headache (ETTH) patients.
Materials and methods: ETTH patients with pericranial tenderness (n=20, Group 1) and without pericranial tenderness (n=20, Group 2) were included into our study. Three sessions of local injection of 1% lidocaine were performed in both groups. Two-sided intramuscular injections of 1 mL were applied for each patient. The muscles were frontal, temporal, masseter, sternokloidomastoid, semispinalis capitis, splenius capitis and trapezius muscles. Patients were evaluated in 1st, 2nd. and 3th months. The number of painful days per month and pain intensities were recorded according to Visual Analog Scale (VAS) before and after the treatment
Results: Of the patients; 11 were males and 29 were females. The mean ages of Group 1 and Group 2 were 35.95 ± 9.85 (18-53) and 34.85 ± 10.04 (20-54) years respectively. There was no difference between the groups in terms of age, gender, pain frequency and pain intensity (p> 0.05). The frequency and severity of pain was significantly lower in pericranial sensitive ETTH patients at 1st, 2nd. and 3th months after local lidocaine injections compared with ETTH patients having pericranial tenderness (p <0.05).
Conclusions: Local lidocaine application can be used as an effective method in the treatment of ETTH patients with pericranial tenderness.

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Giriþ: Ultrason rehberliðinde yapýlan supraklavikuler ve infraklavikuler bloklar üst ekstremite cerrahisinde sýklýkla uygulanmaktadýr. Bu çalýþmanýn birinci amacý ultrason rehberliðinde yapýlan supraklavikuler ve infraklavikuler bloklarýn, blok baþarýsý, blok baþlama zamaný ve blok uygulama zamanýnýn, ikinci amacý ise iðne yönlendirme sayýsýnýn ve istenmeyen yan etkilerin görülme sýklýðýnýn karþýlaþtýrýlmasýydý.
Gereç ve yöntem: 110 hasta supraklavikuler (Grup S) ve infraklavikuler (Grup Ý) olmak üzere iki gruba ayrýldý. Lokal anestezik olarak tüm hastalara 20 ml % 5 lik levobupivakain ve 10 ml % 2 lik lidokain karýþýmý uygulandý. Duyu skoru yedi terminal sinirde 30 dk boyunca her 10 dk da bir olarak deðerlendirildi.
Bulgular: Gruplar arasýnda blok oluþma süresi (Grup Ý: 12.5±5; Grup S: 11.6±4 dk) ve blok baþarýsý (Grup Ý: % 92.7; Grup S: % 83.6) benzerdi. Blok uygulama süresi Grup Ý’de Grup S’ den anlamlý derecede kýsaydý (194.4±65; 226.3±59 sn) (P<0.05) Ýðne yönlendirme sayýsý Grup Ý’de Grup S’den anlamlý derecede azdý (p<0.05). Grup Ý’de ki hastalarda ulnar ve median sinirlerin blokajý Grup S’deki hastalardan, Grup S’ deki hastalarda ise medial kutanöz sinirin blokajý Grup Ý’ dekilerden anlamlý derecede baþarýlý idi (p<0.05). Grup S’de 9 hastada (%16.3) Horner sendromu, bir hastada (% 1.8) parestezi görüldü.
Sonuç: Ýnfraklavikuler ve supraklavikuler yaklaþýmla blok özellikleri benzer bulunmuþtur ancak infraklavikuler yaklaþým geçici yan etkilerinin daha az olmasý nedeniyle supraklavikuler bloða tercih edilebilir.

Ultrasound-guided supraclavicular and infraclavicular blocks are commonly used for upper extremity surgery. The primary aims of our study were to compare block success, block onset times and performance times, secondary aims were to compare the number of needle advancement, and incidence of adverse events of ultrasound-guided supraclavicular or infraclavicular blocks.
Methods: 110 patients were randomized into two groups: supraclavicular (Group S) and infraclavicular (Group I). All the patients were administered 20 ml 0.5% levobupivacaine and 10 ml 2% lidocaine as mixture of local anesthetics. The sensory score of the seven terminal nerves was assessed every 10 min for 30 min.
Results: Block success (Group I: % 92.7; Gorup S: % 83.6) and block onset time (Group I: 12.5±4.8; Group S: 11.6±3.9 min) were similar between the groups. Block performance time was shorter in Group I, than Group S (194.4±65; 226.3±59 sec, (P<0.05). The numbers of needle advancement were lower in Group I than Group S, (p<0.05). The Group I patients had a significantly better block of the median and ulnar nerves than Group S and Group S patients had a better block of the medial cutaneous nerve, than Group I (p<0.05). Horner syndrome was observed in 9 patients (16.3%) and paresthesia in one patient (1.8%) in Group S.
Conclusions: Similar block features was observed with infraclavicular and supraclavicular approaches but infraclavicular block may preferable to supraclavicular block due to the lower incidences of transient adverse events.

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Amaç: Algoloji polikliniðine bel aðrýsý þikâyetiyle baþvuran hastalarýn yaþ, cins, medeni durum, meslek, eðitim düzeyleri, sigara ve alkol kullanýmý gibi özelliklerini inceleyerek bel aðrýsýný tetikleyen risk faktörlerini araþtýrmaktý.
Gereç ve yöntem: Hastalarýn yaþ, cinsiyet, meslek, medeni hal, öðrenim ve ekonomik durumu, sigara ve alkol kullanýmý bilgileri soruldu ve ”Aðrý Deðerlendirme Formu”na kaydedildi. Hastalarýn öðrenim durumlarý sorgulanýrken, en son okuduklarý öðrenim düzeyleri, ekonomik durum herhangi bir gelir düzeyi ile sýnýrlanmaksýzýn, hastalarýn kendi ifade ettikleri yanýtlar göz önüne alýndý.
Bulgular: Polikliniðimize baþvuran 772 hastanýn 200’ünde mekanik bel aðrýsý saptandý. Hastalarýn %23.5’inde disk hernisi, %20’inde faset eklem dejenerasyonu, %18.5’inde dar spinal kanal, %7.5’inde sakroiliyak eklem dejenerasyonu, %20.1’inde birden fazla patoloji, %10.5’inde diðer patolojiler tespit edildi. Bel aðrýsý yaþa ve cinsiyete göre farklýlýk göstermedi. Ýþçilerde bel aðrýsý belirgin olarak yüksek, öðrencilerde düþük saptandý (p=0,005) Bel aðrýlý hastalarýn 170’i evli, 30’u dul veya bekârdý (p=0,059). Yüksek eðitim ile aðrýnýn azaldýðý tespit edildi (p=0,001). Düþük ekonomik durumdakilerde daha fazla aðrý saptandý (p=0,042). Sigara içme bel aðrýsý ile iliþkili bulunurken (p=0,030), alkol alýmý ile bel aðrýsý arasýndaki iliþki saptanmadý (p=0,638)
Sonuç: Düþük eðitim, düþük ekonomik düzey, aðýr iþlerde çalýþma ve sigara kullanýmý ile bel aðrýsý arasýnda anlamlý iliþki bulundu. Risk faktörlerini azaltmaya yönelik önlemlerin alýnmasý ile maddi kayba neden olan, günlük yaþam aktivitelerini engelleyen bel aðrýsý sýklýðýnýn bir ölçüde azaltýlabileceði kanýsýna varýldý.

Purpose: To study the risk factors that triggered the low back pain such as age, gender, marital status, occupation, education level, smoking and alcohol consumption of patients who applied to Algology Polyclinic.
Material and Method: The patients’ age, gender, occupation, marital status, education, economic level, smoking and alcohol consumption are asked and entered in to “Pain Assessment Form”. When the education levels were questioned, their last education level is asked; when their economic level was questioned, the answers of patients were considered without restricting them between limits.
Results: Out of 772 patients, 200 of them had mechanical low back pain. 23,5% had hernia nucleous pulposus, 20% had facet joint degeneration, 18,5% had narrow spinal channel, 7,5% had sakroiliac joint degeneration, 20,1% had more than one pathology, 10,5% had other pathologies. Low back pain did not differ according to age and gender. Students had significantly low, whereas workers had significantly high low back pain (p=0,005). Of the patients with low back pain, 170 of them were married, 30 widow or single (p=0,059). With higher education the pain significantly decreased (p=0,001). With low economic levels, more pain was examined (p=0,042). There was a correlation between low back pain and smoking (p=0,030, but there was not any correlation between low back pain and alcohol consumption (p=0,638).
Conclusion: Lower education, lower economic level, to work in heavy jobs and smoking were correlated with low back pain. It was concluded that by taking precautions that lower risk factors, low back pain can be decreased.

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Aile merkezli bakým pediatri hemþireliðinin en temel ilkelerinden biridir ve çocuklarýn aðrýlý iþlemler sýrasýnda ebeveynlerinden destek almalarýna olanak tanýr. Fakat saðlýk profesyonelleri aðrýlý iþlemler sýrasýnda ebeveynlerin bulunmasýna iliþkin bazý tereddütler yaþamaktadýrlar. Bu tanýmlayýcý çalýþmanýn amacý çocuklara yapýlan aðrýlý iþlemler sýrasýnda ebeveynlerin bulunmasý hakkýnda hemþirelerin görüþlerini belirlemektir. Çalýþma 15 Mart-15 Haziran 2009 tarihleri arasýnda bir üniversite hastanesinin ebeveynlerin çocuklarýyla birlikte kalabildikleri servislerinde yapýlmýþtýr. Araþtýrmaya katýlmayý kabul eden toplam hemþire 43’tür (%57). Çalýþmada demografik veri formu, açýk ve kapalý uçlu sorulardan oluþan görüþme formu kullanýlmýþtýr. Hemþirelerin %62.8’i ebeveynlerin aðrýlý iþlemler sýrasýnda ebeveynlerin çocuklarýn yanýnda olmamasý gerektiðini ifade etmiþlerdir. Hemþireler tarafýndan ebeveynlerin aðrýlý iþlemler sýrasýnda çocuklarýn yanýnda olmasýnýn dezavantajlarý çocuðun anksiyetesini artýrmasý (%77.1), saðlýk personelinin anksiyetesini artýrmasý (%60.0) ve iþlemin baþarýsýný etkileme olarak ifade edilmiþtir. Hemþirelerin aðrýlý iþlemlerin çocuk ve ebeveynleri için daha az travmatik olmasý için yaptýklarý önerileri ise sýrasýyla; çocuk ve ebeveynlere iþlemin açýklanmasý (%83.7), iþlemden önce sedasyon veya lokal anestezi yapýlmasý (%37.2) ve aðrýlý iþlemlerin uzman ekipler tarafýndan yapýlmasýdýr (%20.9).

Family- centered care is one of the basic principles of pediatric nursing and allows pediatric patients having parental support during invasive procedures. But, health care professionals hesitate about parental presence during pediatric invasive procedure. The aim of this descriptive study is determining the views of nurses about parental presence during children’s invasive procedures. This study was conducted between the dates 15th March and 15th July 2009 in a university hospital in whose clinics allowed to parental stay in Ankara. The total number of the nurses accepted to participate in the research is 43 (57%). Demographic data form, open and close ended interview questionnaires were used in the study. The majority of nurses reported that the parents should have not be present with the child during the painful procedure. The disadvantages of parental presence during a painful procedure commonly expressed by the nurses respectively; increased level of children’s anxiety (77.1%), increased level of health professional’s anxiety (60.0%) and detrimental effect of parental presence on the success of the procedure (60.0%). The nurses’ recommendations due to make less traumatic of the painful procedures for both site of children and their parents are respectively; explaining the procedure to the children and parents (83.7%), doing local anesthesia or sedation before procedure (37.2%) and performing the painful procedures by specialized teams (20.9%).

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Purpose: In this study, we evaluated the analgesic efficacy and adverse effect profile of levobupivacaine in caudal and DPNB in postcircumcision pediatric patients.
Methods: Sixty boys between 2-10 age undergoing circumcision were enrolled. The patients were divided into two groups; Group C (n=30) and Group P (n=30) were applied caudal block and dorsal penile nerve block (DPNB), respectively. Blocks were performed before surgery as a supplement to general anesthesia with 1 mL kg-1 0.25% levobupivacaine. Postoperative pain and sedation scores were assessed on the 10th, 30th minutes, 1th, 2 th, 3 th, 4 th, 5 th and 6th hours. The number of pain free patients for the first 6 hours, duration of analgesia, time to first analgesic administration, walking, micturition, and total paracetamol demands, and length of stay were recorded.
Results: Demographic data were similar between groups. The number of children who spent the first 6 hours pain free was larger in Group C than Group P (p=0.0001). The time to first analgesic (p=0.000033) and walking (p=0,004) were longer in Group C. There were 14 patients with motor block in Group C (p=0.00007). In view of AUC; FPRS, OPS and MPOPS were significantly better in Group C on the first postoperative 6 hours.
Conclusion: Caudal block done by using levobupivacaine for postoperative pain management in circumcision is more successful than penile block; however there is a significant delay in time to first walking and as might be expected there is a risk for motor block.

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Meperidin pediatride çeþitli durumlarda kullanýlan opoid analjeziktir. Meperidinin aktif metaboliti olan normeperidin merkezi sinir sistemi üzerine uyarýcý etkilidir. Meperidinin irritabilite, hiperrefleksi,tremor, miyoklonus ve nadiren konvülsif nöbete yol açabildiði literatürde yer almaktadýr. Bu risk özellikle yüksek meperidin dozunda, hepatik enzimleri indükleyen ilaç kullanýmýnda, böbrek yetersizliðinde ve nöbet eþiðini düþüren fenotiazinlerin kullanýmý durumunda artmaktadýr. Böbrek iþlevi normal hastalarda meperidin kullanýmýna baðlý konvülsif nöbet literatürde nadir olarak bildirilmektedir. Femur kýrýðýna baðlý þiddetli postoperatif aðrýlarý olan ve bu amaçla tedavide düþük doz meperidine kullanýlan ve meperidine baðlý tonik-klonik konvülsif nöbet geçiren böbrek fonksiyonlarý normal 10 yaþýndaki erkek hastayý sunmayý uygun bulduk.

Meperidine is an opiod analgesic used in a variety of clinical situations. The active metabolite, normeperidine, is a central nervous system excitatory agent and has the ability to cause irritability, hyperreflexia, tremor, myoclonus and seizures. Previously identified risk factors fort he development of meperidine–related seizures include renal failure, high meperidine dosages and co-adminestration of hepatic enzyme inducing medications or phenothiazines which decreases seizure treshold. Patients with normal renal function rarely manifest seizure activity when given meperidine. Here we report a 10 years old boy with femur fraction whom had normal renal function and we used low dose meperidine due to post operative pains.

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Transversus abdominis bloðu (TAB), L1-3 sinir köklerinin kutanöz dallarýnýn, T7-12 interkostal snirlerin, ilioinguinal ve iliohipogastrik sinirlerin internal oblik ve transersus abdominis kaslarý arasýnda bloke edildliði görece olarak yeni bir rejyonel anestezi tekniðidir. Bu teknik daha çok abdominal cerrahi sonrasý akut postoperatif aðrýnýn tedavisi için kullanýlmaktadýr. Bu vaka sunumunda üst abdominal cerrahi sonrasý transversus abdominis bloðunun kullanýlmasý anlatýlmaktadýr.

Transversus abdominis plane (TAP) block is a relatively new regional anesthesia technique in which T7-12 intercostal nerves, ilioinguinal and iliohypogastric nerves, cutaneous branches of L1-3 nerves are blocked between the internal oblique and transversus abdominis muscles. This technique is mostly used for the treatment of acute postoperative pain following abdominal surgery. In this case report, we evaluate the usage of TAP block in prolonged pain following upper abdominal surgery.

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Ultrasound rehberliðinde interskalen blok uygulamasý sýrasýnda saptadýðýmýz brakial pleksus varyasyonu olgusunu sunuyoruz.

We report a brachial plexus variation identifýed during performance of an ultrasound-guided interscalene Block.

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