The concept of quality control in the health field has been theorized and rationalized in the studies of Donabedian who in the 60’s laid down the basis of “Quality Assurance” defining it as “all those actions that tend to monitor the quality of a service”. During the years in which quality assurance first became an issue, no mention was made of chronic pain treatment in an organic and organized manner as it is today, neither was the health service interested in the “quality of life” and the problems of patients in the terminal stage. Lots of things have changed since that times but also lots of things have to be changed, especially in the developing countries. In this article, the evolution of quality concept in the pain service is reviewed while discussing the goals of the quality assurance in pain management

As doctors, we all have seen cases with complaints about headaches after jogging, swimming, weight lifting or after playing tennis, especially theese are cases who has been newly began exercising. Headache is one of the ten most common reasons for contacting a doctor. The first and most important factor in handling headache is the anemnesia of the patient. Headache can only be diagnosed by the patients’ anemnesia. All other diagnosing methods applied, can only be useful in specifying the headache. The connectin between exercising and headache is to be examined by determining the location, distribution, duration, frequency, progress, characteristic and intensity of the headache. This kind of headache which is frequently seen by sportsmen has a negative effect on their performance and life quality. Furthermore, this sort of headache problems can be seen by normal people who have started exercising for a healthier life, if necessary controls are not made and exercising programmes suitable for the person are not prepared. We should remember not to loose anything from our existing health when aiming a healthier life. For this reason, we should go through the necessary check-up, take the condition tests and follow a suitable exercising programme. We should bear in mind that regular and continious exercising plays an improtant role in increasing the quality and standarts of our lives.

This study is a cross-sectional survey held between February 1999 and October 1999, in order to define the pain prevalance among adults in Turkey. The survey was carried out in nine months in 15 cities selected from five demographic regions of the country and a questionnaire consisting of 28 questions was applied to 3001 participants in face to face fashion. The pain prevalance among adults in Turkey is 63.7 %. The prevalance increases with age and is higher in females, urban society and western region (p<0.001). Nearly half of the pain suffering (44.6 %) is occuring almost everyday, nearly a quarter (24.6 %) is lasting for 4-12 hours and 26.0 is irresistible pain (p<0.001). 76.6 % of pain is chronicle and chronic pain is more frequent in Western and Middle Anatolian Regions, urban areas, 35-44 years and females (p<0.001). First mentioned painful region by the participants are head (34.4 %), low-back (14.1 %), lower-extremity (12.0 %) and abdomen (10.9 %). Headache is more frequent in females, urban society, and Western and Middle Anatolian Regions whereas lower-extremity pain is more frequent in males and rural society. 48.9 % of the participants couldn’t define the reason (factor) initiating their pain or mentioned spontaneous beginning. Of the participants having pain as a complaint (n=1906), 12.3 % has the history of visiting an emergency clinic because of pain, in the last three months and 4.1 % has the history of hospitalization because of pain, in the last three months

The aim of this study was to compare the efficacy of preemptive analgesia with fentanyl or ketamine in women undergoing mastectomy for breast cancer. ASA I-II, 47 women scheduled for mastectomy were included in the study. For all patients, anesthesia was induced with thiopentale, vecuronium and maintained with O2: N2O (30: 70) + isoflurane. Heart rate (HR), mean arterial pressure (MAP), peripheral O2 saturation (SpO2) were monitored. After the induction of anesthesia, the patients were randomly divided in three groups: Group K (n=16) received 1 mg/kg ketamine, while group F (n=16) received 1 µg/kg fentanyl before the skin incisions and after excision of the specimens. Group P received isotonic saline at sametimes. No other analgesic drugs were used intraoperatively. HR, MAP, extubation times, emergency times, respiration rate, SpO2, side effects were recorded and postoperative pain was evaluated by visual analogue scale (VAS; 0-10) and verbal rating scale (VRS) in the recovery room at full emergence (0), 1st, 2nd, 4th, 12th and 24th hours. Postoperative analgesic requirements (meperidine) were recorded. The comments of anaesthesiologist and patients about postoperative period were also evaluated. There were no differences in weight, age, emergence times, extubation times. Hemodynamic and respiratory parameters, VAS and VRS scores and meperidine requirements were similar at all times between the group K and F. The increase of postoperative nausea and vomiting in group F was significantly higher than group P but was similar between group K and P and group K and F (p<0.05). As a conclusion, both ketamine and fentanyl have premptive effects in patients undergoing mastectomy but we think that analgesic effects are probably due to administirating ketamine and fentanyl both before surgical incision and before wound closure.

The effectiveness of the combination of unilateral spinal anesthesia (USA) and combined spinal epidural anesthesia (CSEA) was examined in a prospective clinical study. 25 ASA I-II patients, who underwent operations in which USA can be applied, were positioned in a lateral decubitus position with the operative side downwards. After the Tuohy needle of a CSEA-set was inserted through L3-L4 interspace into the epidural space, the spinal needle of the same set was inserted. 1.5 ml of hyperbaric bupivacaine % 0.5 was injected into the subarachnoid space. Afterwards, an epidural catheter was inserted through the Tuohy needle. Following the procedure, patients were observed regarding the sensory and motor blocks in both sides and the hemodynamic parameters, without any position change. In one patient bradicardia and in another one hypotension was observed. In 2 patients (8 %), spinal anesthesia was insufficient, so it had been necessary to use the epidural component to obtain the anesthesia for the operation. In all the other patients, epidural catheter was used for postoperative analgesia. Unilateral sensory and motor blocks exclusively on the operative side were observed in 40 % and 88 % of the patients respectively. Sensory block on the operative side reached T9 (T5-T12) level, as motor block was 3 (2-3) on Bromage scale. It was concluded that the combination of USA and CSEA can be an easy, reliable and comfortable method, where further studies comparing different doses are necessary.

The efficacy of preemptive analgesia is accepted and it is widely used in numerous surgical procedure except arthroscopy. In this study we compared preoperative and postoperative intraarticular tenoxicam for analgesia after knee arthroscopy. 30 patients were allocated randomly into three groups. Group 1 (n=10) recieved 20 mg intraarticular tenoxicam after the induction of anesthesia, 20 minutes before the surgical procedure. Group 2 (n=10) recieved 20 mg tenoxicam and Group 3 (n=10) recieved only intraarticular serum physiologic solution after the arthroscopy. Pain was assessed at postoperative 1., 2., 3., 4., 6., 12., 24. and 48. hours by the Visual Analog Scale. Supplemental analgesia was required by 8 patients in Group 3, 6 patients in Group 2 and only 1 patient in Group 1. Mean analgesic requirement time was 108.3 (± 50.7) minutes in Group 3, 350 (± 125.3) minutes in Group 2 and 280 minutes in Group 1. We conclude that preemptive intraarticular tenoxicam produces more effective analgesia than other groups.

In this study 35 male, Albino type, New Zelland rabbits were used. The rabbits were divided in to 5 groups. A, B, C and D groups were administrated to intrathecally single dose 1, 2, 4 and 8 mg/kg tramadol hydrochloride respectively and also single dose of saline was given intrathecally to the control group. Pain treshold, whether the seizures improved or not, respiratory depression, motor disfunction and sedation grade were evaluated at the intervals of 5, 15, 30, 60 and 120 th min. Additionally neurotoxicity was examined histopathologically. It has been detected that tramadol has moderate analgesic potential which starts rapidly, lasts for a short time and depends on the doses. Motor dysfunction and seizures were not observed. Light sedation and respiratory depression were observed at high doses. Neurotoxicity found in all groups except the control group. We conclude that intrathecal tramadol hydrochloride has moderate analgesic effects which lasts for a short time and low incidence of side effects, but it may have toxic effects on the spinal cord.

Magnesium is a NMDA receptor antagonist. NMDA receptor antagonists potentiate the analgesic effects of opioids. The aim of this preliminary, randomised, double blind, placebo controlled study was to evaluate the effect of a preoperative single dose magnesium sulphate on the postoperative morphine consumption. At the preoperative period either 40 mg/kg magnesium sulphate (GI) or % 0.9 NaCl (GII) were given to 30 patients who underwent gynecological surgery. Serum magnesium levels were measured preoperatively, after induction and after extubation. After standardized anaesthesia method postoperative analgesia was provided by the patient controlled analgesia (PCA) method using morphine. The groups were compared for the total morphine consumption, PCA demand and delivery rates, satisfaction of the patient and side effects. Magnesium levels were higher in GI than GII after induction and extubation. The total morphine consumption in 24 hours and patient demand rates were statistically significantly lower in GI than in GII (24.5±5.5 / 28.1±3 mg/day and 68.8±17.8 / 84.7±20.7 respectively; p=0.04). Patient satisfaction was better in GI. No differences between the two groups were detected in terms of side effects. We conclude that 40 mg/kg magnesium sulphate as a single preoperative dose reduces postoperative morphine requirement without side effects and increases the postoperative patient comfort.

Epidural analgesia is a safe anesthetic technique in the elderly and high risk patients. We report an eighty year old patient who developed a transient hoarseness during a transurethral prostate resection under epidural anesthesia. Although the complication was transient and without long term effects, the quality of anesthesia for the patient was not satisfactory