Amaç: Bu sistematik derlemede, hastalarýn ameliyat sonrasý aðrý yönetimine iliþkin hemþirelik uygulamalarýndan memnuniyet düzeylerini incelemek amaçlanmýþtýr.
Gereç ve Yöntem: Konuyla ilgili Science Direct, Türk Medline, Psychinfo, Ovid, Prequest, Google Scholar ve Ulakbim Türk Týp Dizini veritabanlarýndan 2005-2015 tarihleri arasýnda yayýnlanmýþ çalýþmalar incelenmiþ ve alýnma kriterlerine uyan 5 çalýþma inceleme kapsamýna alýnmýþtýr. Çalýþma kapsamýna alýnan makalelerin metodolojik kaliteleri Türkçe Joanna Briggs Enstitüsü MAStARI Kritik Deðerlendirme aracý ile yapýlmýþtýr. Veriler bu çalýþma için geliþtirilen standart bir veri özetleme formu kullanýlarak özetlenmiþ ve deðerlendirilmiþtir.
Bulgular: Sistematik derleme kapsamýna alýnmýþ çalýþmalarýn örneklem grubunu künt ve penetran travma geçirerek acil ünitesine alýnmýþ hastalar (n=418), total diz protezi takýlmýþ ortopedi ünitesinde yatan hastalar (n=120), batýn ve göðüs bölgelerinden çeþitli nedenlerle opere edilmiþ hastalar (n=559), kalp ameliyatý geçirmiþ hastalar (n=52)oluþturmaktadýr. Çalýþmalarda en yüksek aðrý puaný 7.20±1.95 (min-max: 0-10) olup, en yüksek memnuniyet düzeyi %100 olarak belirlenmiþtir. Tüm çalýþmalarda ameliyat sonrasý aðrý yönetiminde sýklýkla farmakolojik yöntemlerin kullanýldýðý ve hemþireler tarafýndan özellikle ilaç dýþý uygulamalarýn aðrý yönetiminde yeterince kullanýlmadýðý, buna raðmen; hastalarýn memnuniyet düzeyinin çoðunlukla yüksek olduðu belirlenmiþtir.
Sonuç: Bu sistematik derlemede, son on yýldýr ameliyat sonrasý aðrý yönetimi için yapýlan hemþirelik uygulamalarýndan hasta memnuniyetinin yüksek düzeyde olduðu ve aðrý yönetiminde önerilen ilaç dýþý hemþirelik uygulamalarýnýn yetersiz olduðunu gösteren bilimsel kanýtlara ulaþýlmýþtýr.

Objectives: The aim of this study was to investigate patient satisfaction with nursing practices regarding postoperative pain management.
Methods: A systematic review of the literature published between 2005 and 2015 was conducted, comprising a search of 7 databases: ScienceDirect, Turkish Medline, PsycINFO, Ovid, Prequest, Google Scholar, and the ULAKBIM Turkish Medical Database. Five articles were identified as eligible for review. The methodological quality of the studies was assessed using the Turkish version of the Joanna Briggs Institute-Meta Analysis of Statistics Assessment and Review Instrument (JBI -MAStARI) Critical Appraisal Checklist. The data were extracted using a standard data extraction form developed for this study, and subsequently evaluated.
Results: In the articles eligible for this review, the study samples comprised patients with blunt or penetrating trauma sent to the emergency room (n=418) and those who underwent total knee replacement (n=120); heart, lung, or gastrointestinal system surgery (n=559); or open heart surgery (n=52). The maximum pain score was 7.20±1.95 (min-max: 0-10) and the maximum satisfaction score was 100%. The findings revealed that pharmacological methods were most frequently used for postoperative pain management and non-pharmacological methods were not used sufficiently by nurses. Nevertheless, the patients were satisfied with the postoperative pain relief nursing care.
Conclusion: In this systematic review, scientific evidence indicated that patient satisfaction with nursing practices related to postoperative pain management was high; however, non-pharmacological methods were used insufficiently in the last decade.

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Amaç: Nitrogliserin (NTG) ile oluþan migren tipi baþ aðrýsý, nitrat tedavisinin en belirgin yan etkisidir. Bu nedenle, bu çalýþmanýn amacý, koroner yoðun bakým ünitesinde tedavi gören hastalarda refleksoloji masajýnýn, intravenöz nitrogliserine baðlý baþ aðrýsý üzerine etkisini araþtýrmaktýr.
Gereç ve Yöntem: Bu çalýþma randomize bir klinik araþtýrmadýr. Çalýþma örnekleri rastgele yöntemi ile üç gruba ayrýldý ve 75 hasta; kontrol grubunu, plasebo grubunu ve müdahale grubunu oluþturdu.Nitrogliserin alan hastalarda baþ aðrýsý yoðunluðu Aðrý için Sayýsal Deðerlendirme Ölçeði (NRS) ile ölçüldü. Müdahale grubundaki hastalara 20 dakika boyunca iki kez refleksoloji masajý yapýldý. (Ýkinci masaj, birinciden 3 saat sonra yapýldý.), ayak baþparmaðýnýn üst kýsmý baþýn refleksoloji noktasý olarak belirlenmiþ bunun için refleksoloji masaji grubunda hastalarýn her iki ayak baþ parmaklarýnýn ust kýsmýna masaj uygulandý. Plasebo grubunda baþ aðrýsý ile iliþkili olmayan bir noktaya (ayak topuðuna) masaj yapýldý. Kontrol grubundaki hastalara herhangi bir masaj yapýlmadý.
Bulgular: Çalýþma öncesi aðrý skalasý ortalamalarý açýsýndan üç grup arasýnda baþlangýç farký yoktu (p=0.66); ancak uygulama sonrasý gruplar arasýndaki fark istatistiksel olarak yüksekti (p=0.000).
Sonuç: Refleksoloji masajý, nitrogliserine baðlý baþ aðrýsýnýn yoðunluðunu azaltabilir.

Objectives: Nitroglycerin (NTG)-induced migraine-type headache is the most prominent side effect of nitrate therapy. Therefore, the aim of this study was to clarify the effectiveness of reflexology massage on intravenous NTG-induced headache in coronary care unit (CCU) inpatients.
Methods: This was a randomized clinical trial. The study sample included 75 patients that were randomly divided into three groups: control, intervention, and placebo groups. The intensity of baseline headache in patients who received NTG was measured by the numeric rating scale for pain (NRS Pain). Patients in the intervention group received reflexology massage two times for 20 min (at 3-h interval), wherein the upper part of patient’s both foot thumbs, which is the reflection point of the head, was massaged. In the placebo group, an unspecified point on the foot (heel), which was not related to the head, was massaged. Patients in the control group did not receive any massage.
Results: No baseline differences existed among the three groups for the mean pain scale score (p=0.66) before the study; but the difference between the groups after the application was statistically significant (p=0.000).
Conclusion: Reflexology massage can reduce the intensity of NTG-induced headache.

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Amaç: Subkostal transvers abdominis plan bloðunun (TAP) postoperatif aðrý üzerindeki etkisi halen araþtýrma konusudur. Bu çalýþmanýn amacý, inguinal herniorafi hastalarýnda postoperatif subakut aðrý üzerine subkostal TAP bloðunun etkisini deðerlendirmektir.
Gereç ve Yöntem: Genel Anestezi altýnda mesh ile elektif tek taraflý inguinal herniyorafi geçirecek olan 18-75 yaþ arasýndaki ASA skoru 1-3 olan hastalar çalýþmaya alýnmýþtýr. Elli hastaya postoperatif aðrý tedavisi için iv analjezik verildi (grup I), elli hastaya operasyondan sonra iv analjeziye ek olarak subkostal TAP blok uygulandý (grup II). Operasyondan 1 ay sonra gruplar arasý numerik aðrý skalasý Mann-Whitney U testi ile karþýlaþtýrdý. Hastalarýn operasyondan sonra 15. Dakika. 1, 6, 12, 24. saat, 15. gün NRS skorlarý ile 15 gün ve 1 ay sonraki yaþam kalitesi skorlarý (LQS) deðerlendirildi.
Bulgular: Postoperatif 15. dakika, 1, 6, 12, 24. saat, 15. gün (p=0.00) ve 1. aydaki NRS deðerleri grup II’de grup I’e göre anlamlý derecede düþük bulundu (p=0.02). Ameliyattan 15 gün sonra LQS açýsýndan gruplar arasýnda anlamlý fark yoktu (p=0.013). Gruplar arasý karþýlaþtýrmada LQS birinci ayda Grup I’deki postoperatif 15. güne kýyasla daha yüksekti (p=0.201).
Sonuç: Subkostal TAP bloðu akut dönemde ve inguinal herniorafi yapýlan hastalarda ameliyat sonrasý ilk ayda etkili bir postoperatif aðrý tedavisi saðlamaktadýr.

Objectives: The effect of subcostal transversus abdominis plane (TAP) block on postoperative pain is contradictive. The aim of this study was to evaluate the effect of subcostal TAP block on subacute pain in patients who have undergone inguinal herniography.
Methods: Patients aged between 18 and 75 years with American Society of Anesthesiologists 1–3 and who were to undergo elective unilateral inguinal herniography with mesh under general anesthesia were included. Fifty patients were under an intravenous analgesic regimen (group I) and 50 patients underwent subcostal TAP block postoperatively in addition to the intravenous analgesic regimen (group II). The primary outcome measure was pain scores 1 month postoperatively by comparing Numerical Rating Scale values with the Mann–Whitney U test between groups I and II. Secondary outcome measures were life qualification scores 1 month postoperatively and pain scores 24 h and 15 days postoperatively.
Results: Postoperative 15th-min; 1st-, 6th-, 12th-, and 24th-h; 15th-day (p=0.00); and 1st-month Numerical Rating Scale values were significantly lower in group II than in group I (p=0.02). No significant difference was observed between the groups in terms of LQS 15 days postoperatively (p=0.013). On group comparison, LQS was higher in the 1st month than at the 15th day postoperatively in group I (p=0.201).
Conclusion: Subcostal TAP block provides an effective postoperative pain treatment in the acute period and in the 1st postoperative month in patients undergoing inguinal herniography.

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Amaç: Bu randomize kontrollü araþtýrmanýn amacý kronik boyun aðrýsýna (KBA) sahip hastalarda proprioseptif eðitimin denge üzerine etkisini incelemektir.
Gereç ve Yöntem: Çalýþmaya katýlan 40 hasta randomize olarak çalýþma ve kontrol gruplarýna ayrýldý. Her iki gruba da Konvansiyonel Fizik Tedavi uygulanýrken, çalýþma grubu proprioseptif eðitim için ek olarak bakýþ yönü tanýma egzersizi (BYTE) ile tedavi edildi. Hastalara, tedavinin baþlangýcýnda, tedavi bitiminde ve son seanstan 3 hafta sonra aðrý þiddeti [Görsel Analog Skalasý (GAS)], boyun özür seviyesi [Boyun Özür Ýndeksi (BÖÝ)] ve denge [Dört Adým Kare Testi (DAKT), gözler açýk ve kapalý tek ayak denge testi (TADT)] deðerlendirmeleri yapýldý.
Bulgular: Tedavi öncesi deðerlendirmeler bakýmýndan gruplar arasýnda fark bulunmadý. Tedavi öncesi ile karþýlaþtýrýldýðýnda her iki grubun GAS skorlarýnda istatistiksel olarak anlamlý azalma vardý (p<0.05). Ek olarak çalýþma grubunun BÖÝ, DAKT ve gözler açýk ve kapalý TADT skorlarýnda istatistiksel olarak anlamlý geliþme olduðunu gözlemlenirken, kontrol grubunda tedavi öncesi ve sonrasý sonuçlar benzerdi.
Sonuç: Sonuçlarýmýza göre, KBA’ na sahip hastalarda dengeyi geliþtirmek ve özür seviyesini azaltmak için fizyoterapi programlarý proprioseptif eðitimi içermelidir.

Objectives: The aim of this randomized controlled study was to investigate the effect of proprioceptive training on balance in patients with chronic neck pain (CNP).
Methods: Forty patients participating in the study were randomly divided into study and control groups. Both of the groups underwent conventional physical therapy; additionally, the study group was rehabilitated with gaze direction recognition exercise (GDRE) for proprioceptive training. Exercises were performed during 3 weeks with five sessions per week. Pain intensity [visual analog scale (VAS)], neck disability [Neck Disability Index (NDI)], and balance [four step square test (FSST), single leg balance test (SLBT) with eyes opened and closed] assessments were conducted in the patients before and after the treatment and 3 weeks after the last session.
Results: No differences were observed between the groups in terms of pre-treatment measurements. There was a statistically significant decrease in VAS scores in both groups compared with pre-treatment conditions (p<0.05). In addition, whereas a statistically significant improvement in the study group’s NDI, FSST, and SLBT with eyes opened and closed scores was observed after the treatment, pre- and post-treatment results were similar in the control group (p>0.05).
Conclusion: Proprioceptive training should be included in physiotherapy programs to improve balance; it decreases the disability level in patients with CNP.

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Genel anestezi, özellikle batýn operasyonlarý için ilk tercih edilen anestezi yöntemidir. Ancak akciðer hastalýðý olan birinde, genel anestezi esnasýnda saðlanacak neuromusculer blokaj atelektaziyi artýracaðýndan, postoperatif ventilatör baðýmlýlýðýný artýracaktýr. Özellikle postoperatif komplikasyonlar için risk oluþturan kronik obstruktif akciðer hastalýðý (COPD) olgularýnda bu ihtiyaç daha belirgin olacaktýr. Thoracal epidural anaesthesia (TEA), üst abdominal operasyonlar için yeterli anestezi saðladýðýndan, ciddi akciðer hastalýðý ve evre 4 akciðer kanseri olan hastamýz için en iyi seçenektir.

General anesthesia is the first choice as an anesthesia method particularly for abdominal operations. However, because neuromuscular blockade induced during general anesthesia will increase atelectasis in a patient with pulmonary disease, it will also increase postoperative ventilator dependence, which will be even more apparent in cases of chronic obstructive pulmonary disease (COPD) that pose a risk, particularly for postoperative complications. Herein, thoracic epidural anesthesia (TEA) was found to be a better option for our patient with severe COPD and stage IV lung cancer, as it provided sufficient anesthesia and better postoperative care for laparoscopic gastrostomy.

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Bu yazýda baþaðrýsý olmaksýzýn, bulanýk görme ve diplopi ile presente olan, 23 yaþýnda erkek Ýdiopatik intrakranial hipertansiyon (ÝÝH) olgusu bildirilmiþtir. ÝHH’de baþaðrýsý en sýk görülen semptom olmasýna raðmen, bazen klinik olarak görülmeyebilir.Bu durum daha çok erkeklerde gençler özellikle çocuklarda ve zayýf hastalarda tanýmlanmýþtýr. Buradaki önemli nokta bu hastalar ciddi görsel bulgularla presente olmaktadýrlar, bu nedenle agresif tedavi edilmelidirler.

This study reports the case of a 23-year-old man with idiopathic intracranial hypertension (IIH) who presented with blurred vision and diplopia, without accompanying headache. Although headache is the most common symptom associated with IIH, occasionally, it may not be observed clinically. This situation is more frequently observed in males, young adults, children, and in patients with low body mass index. This case highlights a crucial aspect; patients who present with serious visual symptoms without headache must be treated aggressively because vision loss will develop rapidly.

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Hastalarýn yaþamlarýndaki en þiddetli baþaðrýsý olarak tarifledikleri, ani olarak geliþen baþaðrýsý oldukça dikkat edilmesi gereken bir durumdur. 32 yaþýndaki kadýn hasta, son bir haftadýr sýklýðý ve þiddeti gittikçe artan gökgürültüsü baþaðrýsý ataklarý nedeniyle baþvurdu. Son bir haftada birkaç kez acil baþvurduðunu ve çekilen beyin tomografisinin normal olarak raporlandýðýný ifade etti. Son baþvurusunda nörolojik muayenesinde, sol komplet okülomotor sinir felci saptandý. Beyin manyetik rezonans görüntüleme ve anjiografisinde solda posterior komunikan arter anevrizmasýnýn ipsilateral okülomotor sinire basý yaptýðý görüldü. Subaraknoid hemoraji izlenmedi. Anevrizma tedavisine yönelik endovasküler balon aracýlý koil embolizasyonu yapýldý. Giriþimsel iþlemden hemen sonra baþaðrýlarý düzeldi. Tedavinin üçüncü ayýnda ise komplet ptoz düzeldi. Gökgürültüsü baþaðrýsý, kanamamýþ anevrizmalarda çok sýk beklenen bir durum deðildir ancak geliþmekte olan bir rüptürün habercisi olabilir, bu sebeple erken taný ve tedavi oldukça önemlidir.

The abrupt onset of acute, high-intensity headache, unlike any experienced before, can be an urgent medical condition, which requires attention. A 32-year-old female patient developed thunderclap headache attacks had applied with increasing intensity and frequency since 1 week. She had visited the emergency department several times, and cranial computed tomography findings were normal. On the last presentation, neurological examination showed complete oculomotor nerve palsy on the left. Brain magnetic resonance imaging together with intracranial brain angiography revealed left posterior communicating aneurysm compressing the ipsilateral oculomotor nerve, with no evidence of subarachnoid hemorrhage. The patient was treated with endovascular balloon-assisted coil embolization of the aneurysm under digital subtraction angiography. As a result, the headache resolved soon after the intervention. Furthermore, complete ptosis recovered by the third month.
Although thunderclap headache has rarely been attributed to an enlarging unruptured cerebral aneurysm, early recognition and treatment are rather important as it may indicate a high risk of rupture.

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