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Volume: 36  Issue: 1   Year: 2023
  Ağrı: 25 (4)
Volume: 25  Issue: 4 - 2013
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EXPERIMENTAL AND CLINICAL STUDIES
1.Is Physical Inactivity Associated With Musculoskeletal Disorders?
Selin Uz Tunçay, İpek Yeldan
PMID: 24264549  doi: 10.5505/agri.2013.09825  Pages 147 - 155
Amaç
Çalışmamızın amacı, kişilerde kas iskelet sistemi rahatsızlıklarıyla fiziksel aktivite düzeyleri arasındaki ilişkiyi belirlemekti.
Gereç ve yöntem
Çalışmaya 20-65 yaş arası 125 (74 kadın, 51 erkek) birey katıldı. Kas iskelet sistemi rahatsızlıklarını sorgulamak amacıyla “Genişletilmiş Nordic Kas İskelet Sistemi Anketi”, fiziksel aktivite düzeyini belirlemek amacıyla, Uluslararası Fiziksel Aktivite Anketi Kısa Formu kullanıldı.
Bulgular
Olguların yaş ortalamaları 31,56 ± 7,09 yıldı. Olguların % 33.6’sının yeterli düzeyde, %39.2’sinin düşük düzeyde aktivite yaptığı, % 27.2’sinin ise inaktif olduğu bulundu. En sık ağrı yaşanan bölgeler yaşamları boyunca herhangi bir dönemde bel (%51.2), sırt (%51.2), boyun (%48.8), son 12 ay içinde boyun (% 38.4), sırt (% 35.2) ve bel (% 35.2), son 1 ay içinde sırt (% 29.6), boyun (% 28.8) ve bel (% 23.2), değerlendirmenin yapıldığı gün sırt (%16.8), omuzlar (%12.8), boyun ve bel (%11.2) idi. Fiziksel aktivite düzeyine göre son 12 ay, son 1 ay ve değerlendirmenin yapıldığı gün görülen kas iskelet sistemi rahatsızlıklarının varlığı karşılaştırıldığında sadece diz ağrısı ile fiziksel aktivite düzeyi arasında istatistiksel anlamlı ilişki bulundu (sırasıyla p=0.002, p=0.001, p=0.023).
Sonuç
Sonuçlarımız kas iskelet sistemi ağrılarının en sık omurgada (bel, sırt, boyun) görüldüğünü göstermiştir. Fiziksel aktivite düzeyine göre kas iskelet sistemi rahatsızlıklarının varlığı karşılaştırıldığında, sadece diz ağrısı ile fiziksel aktivite düzeyi arasında ilişki bulunmuştur. Çalışmamızda diz ağrısı olanlarda fiziksel aktivite düzeyinin yüksek olması, fiziksel olarak aktif olanların inaktif olanlara göre spora bağlı yaralanmaya daha eğilimli olmaları ve diz ekleminin anatomik özelliği ile açıklanabilir.
Objective
The aim of our study was to determine the relationship between musculoskeletal disorders (MD) and physical activity levels (PAL) in individuals.
Material and Method
125 individuals (74 female, 51 male) aged between 20-65 participated in the study. Extended Nordic Musculoskeletal Questionnaire was used to examine MD, International Physical Activity Questionnaire was used to determine PAL.
Results
The mean age of the cases was 31,56 ± 7,09 years. It was found that individuals were 33.6% sufficiently active, 39.2% minimally active, 27.2% inactive. Body regions which were most commonly reported for experiencing pain, low back (51.2%), upper back (51.2%), neck (48.8%) at some point in their lifetime, neck (38.4%), upper back (35.2%), low back (35.2%) during the past 12 months, upper back (29.6%), neck (28.8%), low back (23.2%) in the past month, upper back (16.8%), shoulders (12.8%),neck and low back (11.2%) on the day of study. When MD during the past 12 months, in the past month, on the day of study were compared with PAL, statistically significant relation was found between knee pain and PAL (p=0.002, p=0.001, p=0.023, respectively).
Conclusion
The results showed that musculoskeletal pain was more frequent in spine (low back, upper back, neck). When the presence of MD compared with PAL, statistically significant relation was found between knee pain and PAL. In our study, patients with knee pain had high PAL, this can be explained by, those who are physically active tend to experience sport related injuries than inactive individuals and anatomic feature of knee joint.

2.Placebo Effect of Saline in Pain Management: Compared Study with Hemodialysis and Non-hemodialysis Nurses' Experiences
Seher Ünver, Meltem Yıldırım, Emine Ünal
PMID: 24264550  doi: 10.5505/agri.2013.82621  Pages 156 - 162
Objectives: To identify and compare hemodialysis and non-hemodialysis nurses' experiences about the placebo effect of intravenous saline injection in pain management.
Methods: This descriptive study design was carried out between January 22nd - February 4th, 2012 with 202 voluntary nurses who work in hemodialysis and medical-surgical clinics. An online survey system was used for data collecting. Cookie and IP logging prevented multiple voting. The survey contained 21 questions. Data were evaluated by descriptive statistics and Chi-Square test.
Results: The mean age of the nurses was 31.13±6.03 years. Fifty-two point five percent (n=106) of the nurses were working in a hemodialysis unit while the others (45.5%) were from other clinics such as medical and surgical units. While 68.4% of the hemodialysis nurses stated that they “sometimes” use placebo, 62.7% of the non-hemodialysis nurses stated that they “rarely” use placebo. In hemodialysis nurses, “always” believing the patient's pain was significantly lower than expected count. This ratio was found more than expected in non-hemodialysis nurses (p=0.006). Hemodialysis nurses stated that “the use of placebo is not necessary to be recorded”. However, non-hemodialysis nurses stated more than expected that “the placebo usage should be recorded” (p=0.006).
Conclusion: Hemodialysis nurses are more likely to use saline injection as a placebo in pain management rather than non-hemodialysis nurses. However, non-hemodialysis nurses believe the patient's pain more than hemodialysis nurses do. This makes placebo usage for the first step choice among hemodialysis nurses.

3.Gabapentin premedication for postoperative analgesia and emergence agitation after sevoflurane anesthesiain peadiatric patients.
Akgün Ebru Salman, Aynur Camkıran, Sabiha Oğuz, Aslı Dönmez
PMID: 24264551  doi: 10.5505/agri.2013.98852  Pages 163 - 168
The aim of this study was to investigate the effect of gabapentin premedication on postoperative 24th hour total analgesic consumption and the incidence of emergence agitation after sevoflurane based anesthesia in peadiatric patients undergoing tonsillectomy and adenoidectomy.
Material Methods: 46 healthy children ASA class I or II, aged 3-12 year old children were included into the study. The patients were randomly assigned to one of the control (Group C) or gabapentin group (Group G) consisting of 23 patients each. Group C received 10 ml of saline, Group G received gabapentin 15 mg.kg-1 dissolved in 10 ml of saline orally30 min. before the induction of anesthesia. After anesthesia induction with 8% sevoflurane in 50% O2 –N2O. General anesthesia was maintained with 1 MAC sevoflurane in 50% O2 –N2O. Emergence agitation was assessed with a 5 point scale and recorded every 10 min. of first 30 min. of the postoperative period. Parents were contacted 24 hours after the surgery to evaluate pain, total analgesic consumption, parent satisfaction and any side effect.
Results: Agitation scores were significantly lower in group G compared to group C in the postoperative 20th and 30th minutes (p<0.01,0.05 respectively). (Table 3) Total analgesic requirement in postoperative 24 hour was significantly lower in group G.(0.01)(Table 4) Satisfaction scores of parents was also higher in group G.(0.05)(Table 5 )
Conclusion: Gabapentin premedication decreases postoperative 24th hour analgesic consumption and attenuates emergence agitation after sevoflurane anesthesia.

4.The Effects of Pregabaline on Postoperative Pain and Opioid Consumption Used Perioperatively in Patients Undergoing Modified Radical Mastectomy
Tolga Koyuncu, Gonca Oğuz, Seda Akben, Sevinç Nas, Süheyla Ünver
PMID: 24264552  doi: 10.5505/agri.2013.19970  Pages 169 - 178
Amaç: Bu çalışmada, modifiye radikal mastektomi (MRM) operasyonu uygulanan hastalarda perioperatif kullanılan pregabalinin postoperatif ağrı ve opioid tüketimi üzerine etkileri araştırıldı.
Gereç ve Yöntem: Çalışmaya MRM opererasyonu planlanan ASA 1-2 60 kadın hasta dahil edildi. Hastalar rastgele ikiye ayrılarak her gruba 30’ar hasta alındı. Pregabalin grubuna operasyondan bir saat önce 150 mg oral pregabalin, plasebo grubuna içi boş kapsül verildi. Anestezi indüksiyonu her iki grupta da pentotal, fentanil ve roküronyum, idame ise sevofluran, N2O ve O2 ile sağlandı. Operasyondan 12 saat sonra pregabalin grubundaki hastalara 75 mg pregabalin verilirken, plasebo grubuna tekrar boş kapsül verildi. Tüm hastalara cerrahi bitiminden bir saat önce 8 mg iv lornoksikam, 30 dk önce 4 mg ondansetron yapıldı. Her iki gruba da postoperatif analjezi için morfinle hazırlanmış hasta kontrollü analjezi cihazı bağlandı. Postoperatif VAS ağrı skorları, hemodinamik parametreler, morfin tüketimi, bulantı, kusma, sedasyon ve baş dönmesi gibi yan etkiler takip edilerek kaydedildi.
Bulgular: Demografik parametreler benzerdi. VAS ağrı skorları pregabalin grubunda 1.dk, 30.dk, 1, 4, 8 ve 12 saatlerde anlamlı olarak düşüktü (p<0.05). Postoperatif morfin tüketimi ve ek doz gereksinimi plasebo grubunda daha fazla olmakla beraber iki grup arasında anlamlı farklılık yoktu. Placebo grubundaki hastalar daha yüksek yan etkilerden rahatsızlık skorlarına sahip bulundu. Hemodinamik parametreler ve diğer yan etkiler benzerdi.
Tartışma: Çalışmamızda perioperatif uygulanan pregabalinin, MRM operasyonlarında belirgin yan etki yapmadan postoperatif analjezinin etkinliğini artırdığını, fakat opioid tüketimini değiştirmediğini gördük. Bu konuda farklı doz ve hasta gruplarıyla daha ileri çalışmalar yapılması gerektiğini düşünüyoruz.
AIM: In this study, effects of pregabaline on postoperative pain and opioid consumption used perioperatively in patients undergoing modified radical mastectomy(MRM) were investigated.
MATERIALS AND METHODS: Sixty ASA1-2 patients scheduled for MRM were included. Patients were randomly divided into two and 30 patients were allocated into each group. Group Pregabaline was given pregabaline 150mg 1hr before operation and Group Placebo empty capsule. In both groups, anesthesia induction was obtained by penthotal, fentanyl and rocuronium and maintainence by sevoflurane, N2O and O2. Twelve hr after operation, Group Pregabaline was administered pregabaline 75mg while Placebo group received empty capsule again. All patients received lornoxicam 8mg iv 1hr before end of surgery and ondansetrone 4mg 30min before. Patient-controlled analgesia device prepared with morphine was connected to both groups for postoperative analgesia. Postoperative VAS pain scores, hemodynamic parameters, morphine consumption, side-effects like nausea-vomiting, sedation and dizziness were followed and recorded.
RESULTS: Demographic parameters were similar. VAS scores were significantly lower in Group Pregabaline at 1, 30min, 1,4,8 and 12hr (p<0.05). There was no significant difference in postoperative morphine consumption and need for additional dose, although they were higher in Placebo group. The patients in Placebo group had higher bothersome scores for side-effects. Hemodynamic parameters and other side-effects were similar.
CONCLUSION: In our study, we showed that pregabalin administered perioperatively increased postoperative analgesic efficacy in MRM operations without making significant side effect,but did not change opioid consumption. We think that further studies about this topic must be held with different dose and patient groups.

CASE REPORTS
5.Neuropathic pain due to herpes zoster infection with atypical localization
Özlem Sağır, Sabri Özaslan, Yücel Meriç, İsmail Arslan, Ahmet Köroğlu
PMID: 24264553  doi: 10.5505/agri.2013.47568  Pages 179 - 182
Akut herpes zoster infeksiyonu; suçiçeği hastalığına neden olan varisella zoster virüsünün immun direncin baskılanması durumunda yeniden aktive olması sonucu ortaya çıkar. Klinik belirtilere, ağrı ve ciltte makülopapüler lezyonlar eşlik eder. Tedavisinde çeşitli farmakolojik ve girişimsel yöntemler uygulanmaktadır. Etkin tedavi, akut ağrı ve cilt lezyonlarının iyileşmesinde ve postherpetik nevralji gelişmesinin önlenmesinde önemlidir.
Elli beş yaşında, 160 cm boyunda, 65 kg ağırlığında bayan hasta, sağ ön kol ve elde şiddetli ağrı, yanma, karıncalanma ve kızarıklık şikayetleri ile polikliniğimize başvurdu. Başka bir merkezde servikal disk hernisi tanısıyla tedavi başlanan hastanın servikal muayenesi olağandı. Hastada öykü ve fizik muayene bulguları ile akut herpes zoster enfeksiyonu düşünüldü. Lezyonlarının gerilemiş ve atipik yerleşimli olması ve vizüel analog skala (VAS) değerinin 10 olması nedeniyle hem tanı, hem de tedavi amacıyla sağ stellat gangliyon bloğu uygulandı. Hastanın blok sonrası 9. dakikada VAS değeri %50 azaldı, bloktan 2 saat sonra VAS skoru 2 olarak değerlendirildi. Stellat ganglion bloğu sonrası antiviral, gabapentin ve trisiklik antidepresan ile tedaviye başlanarak evine taburcu edildi. Tedavinin 3. ayında herhangi bir şikayeti olmayan hastanın ilaç dozları azaltılarak kesildi.
Sonuç olarak, atipik yerleşimli herpes zosterin akut döneminde uyguladığımız stellat ganglion bloğunun hem ayırıcı tanı ve akut ağrı tedavisi, hem de hasta konforunu artırarak daha sonra uygulanacak ilaç tedavisine hasta uyumu ve etkinliğini artırmada faydalı olduğu kanaatindeyiz.
Acute herpes zoster infection appears in the situation of depression of immune system and reactivation of varicella zoster virus which causes small pox. Pain and maculopapular lesion accompany clinical symptoms. Various pharmacological and invasive methods can be used for treatment. Efficient therapy is important for prevention of postherpetic neuralgia and cure of acute pain and dermatological lesions.
A 55 years old, 160 cm height and 65 kg weight female patient with complaints of severe pain, sensation of burning, tingling at the right hand and forearm was admitted to our pain department. The patient who was diagnosed as cervical hernia at an other medical center had a normal physical servical spine examination. Patient history and physical examination findings with acute herpes zoster infection was considered. Right stellate ganglion blockade for diagnosis and treatment was performed because of regressed and atypically located lesions and a visual analog scale score of 10. VAS score decreased 50 % at 9th min after block, VAS score at 2nd hour was 2. Antiviral, gabapentin, and tricyclic antidepressant treatment was started after stellat ganglion blockade and patient was discharged. After 3 months complaints dissapeared and drug doses were discreased and stopped.
In conclusion we think that stellate ganglion blockade can be useful in diagnosis, acute pain control, improving patient comfort and compatibility to drug therapy in atypically located herpes zoster

6.Monoplegia after Combined Spinal Epidural Anesthesia
Onur Balaban, Yavuz Gürkan, Alparslan Kuş, Kamil Toker, Mine Solak
PMID: 24264554  doi: 10.5505/agri.2013.48568  Pages 183 - 186
Serious neurological complications like permanent neurological injury after neuraxial blocks are rare in contemporary anesthetic practice. We report a case of 36 years old female undergoing venous stripping operation under combined spinal epidural anesthesia (CSE). CSE procedure was completed after second attempt at L4-L5 level and surgery was completed uneventfully. After full recovery of motor block in the recovery room patient was discharged to surgical ward. Epidural patient controlled analgesia with levobupivacine 0.125% and fentanyl 2µg/ml was started. 10 hours after surgery right lower limb sensory loss and monoplegia occurred. Epidural catheter was removed and normal MRI findings were noted. After one month physical therapy treatment and two months follow up the patient was able to walk with the aid of a walking stick. We discuss the factors that might have contributed to radiculopathy and neurotoxicity as a cause of neurologic deficit.

7.A New Anagesic Drug: PREGABALIN; And The First Intoxications
Enver Belli, Kerem Erkalp, Zehra Yangın, Sibel Fadıllıoğlu, Ayşin Alagöl
PMID: 24264555  doi: 10.5505/agri.2013.22448  Pages 187 - 189
Pregabalin gabapentinle aynı yapı ve etkiye sahip, GABA analogu, antiepileptik, analjezik ve anksiyolitik bir ilaçtır. Literatürde pregabalin zehirlenmesine ait çok az sayıda bildiri vardır. Bu yazıda, 3 gram pregabalin içen 24 yaşındaki erkek hastayı sunduk. Hasta ilacın uzaklaştırılması, intravenöz sıvı tedavisi, oksijenizasyon, mide yıkama, aktif kömür uygulaması gibi Genel Destek Tedavisi ve Semptomatik Yaklaşım (GDTSY) ile tedavi edildi. Ancak ya hastaların böbreklerinin iyi çalışır durumda olması ya da hemodiyaliz imkanının çok yakınlarda bulunması gerekliliği unutulmamalıdır.
Pregabalin is an antiepileptic, analgesic and anxiolytic drug that GABA analogue with similar structure and actions to gabapentin. There are very few reports about pregabalin intoxication in the literature. A 24-year-old male presented following ingestion of 3 g of pregabalin in this report. He was managed with General Supportive Care and Symptomatic Approach (GSCSA) such as discontinuation of the drug, hydration with IV fluids, oxygenation, gastric lavage and activated charcoal administration and enhanced elimination techniques. But, it is to be noted that either the kidneys of the patients are in good functioning state or there is a hemodialysis facility in the immediate vicinity.



   
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