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Volume: 35  Issue: 1   Year: 2023
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  Ağrı: 16 (1)
Volume: 16  Issue: 1 - 2004
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Serdar Edirne, Ayşen Yücel
Page 6

2.Visceral pain
P P Raj
PMID: 15152583  Pages 7 - 20
Visceral pain, which originates from organ tissues of the thorax, abdomen or pelvis, is generally percieved as a deep, dull and vague sensation; in most cases it cannot even be clearly described, being a sense of discomfort, malaise or oppression rather than real pain. Crushing, cutting and burning generally have no algogenic effect in the viscera whereas mechanical stimulation, ischemia and chemical stimulation, seperately or in combinations, may cause pain. With these characteristics, visceral pain differs from somatic pain. The characteristics of visceral pain, perception and transmission of painful visceral stimuli are explained, some common visceral pain syndromes are presented and sympathetic neurodestructive approaches as a treatment option are described in this review.

3.Methods for assessment of pain in children
M Uyar
PMID: 15152584  Pages 21 - 28
In children, assessment and measurement of pain is challenging. The difficulties of pain assessment in children can be explained by their constantly changing state of perception, interpretation and expression of pain related to age, developmental stage, previous pain experiences, and other modifying environmental factors. Unlike most adults, children (especially younger ones) lack the cognitive and behavioral competency both to understand questions concerning their pain and to describe their pain. Especially very young children don’t have pain experience and cooperation with adults is limited. Age, general health status and ability of self report are the factors that must be considered when selecting appropriate method of pain measurement and pain assessment must be repeated regularly. Although many different tools are used to measure and assess pain, no single one supplies enough information about pain and its different components to be used as the standard measure of pain in children.

4.Regional anesthesia and analgesia applications in children and infants - II
N S Özyalçın, F Menda
PMID: 15152585  Pages 29 - 42
For years pediatric pain management has been practiced without clear rational use of analgesic therapy. The recent improved understanding of anatomical and physiological pathways of pain perceptions, and opioid and local anesthetic pharmacology in infants and children has led to the development of formal analgesic regimens for the management of pain. Also modifying the anatomical approach for children, studying new agents and combinations of agents, technological developments have made regional anesthetics techniques more accessible to children. For these reasons, in the last two decades, there has been an explosion of interest and research related to the use of regional anesthetic techniques in children. Regional anesthetic techniques have a significant but limited place in the practice of pain management in infants and children. However regional anesthetic techniques presumably afford many of the same advantages for the pediatric patients as it does in the adult patients. In this review, we discuss regional and topical anesthetic techniques available to clinicians who care for this population.

5.Radiofrequency lesioning of the sympathetic chain at different levels
R Ruiz Lopez
PMID: 15152586  Pages 43 - 48
The interruption of sympathetic pathways is a commonly used modality for the treatment of many painful conditions and some other problems like vascular disorders. Radiofrequency (RF) techniques have gained popularity in this field in the recent years. The major advantages of RF techniques over other neurodestructive methods are; the formation of controlled lesion, low complication rates and low perioperative discomfort. In this paper, RF applications of the different sympathetic regions are described, together with the indications, risks and comments of the author.

6.Thalamic pain syndrome
E. Özyuvacı, A. Altan, A. Yücel
Pages 49 - 52
Central pain is a chronic pain due to various causes, with accompanying neurological symptoms and often unresponsive to medical therapy. Pain management and results in a 31 years old female patient with a diagnosis of thalamic pain syndrome, which is one of the causes of central pain is analysed in this article.

7.Pott disease in the differential diagnosis of low back pain
S A Önal, B Özer
Pages 55 - 57
Tuberculosis of skeletal system is frequently located in spine and is called as “Pott disease”. Pott disease is frequently located in lumbar vertebrates and it can be interfered with the other diseases which cause low back pain. Our patient which was operated because of breast cancer nearly 10 years ago, has had waist and leg pain for 6 weeks. The story of breast cancer reminded us the possibility of a metastasis. But there were no findings in favour of metastasis except the high scores of sedimentation rate. There was a disc herniation according to the MR imaging of lumbar region. Therefore we performed epidural steroid injection but 10 days later the patient was unalde to walk. We present this case to understand the importance of the differential diagnosis of Pott disease.

8.Is epidural preemptive analgesia effective in lower abdominal surgery?
Ş Özcan, M Tabuk, B Baltacı, N Ünal
Pages 58 - 63
In this study, we aimed to investigate the pre-emptive analgesic efficacy of epidural application of fentanly-bupivacaine combination. A total of 60 patients admitted for total abdominal hysterectomy were included in this study after the approval of the ethic committee, and the patients were randomly classified into three groups. An epidural catheter was inserted to all patients through L2-3 or L3-4 space before general anesthesia induction. 2 µg/kg fentanyl in 0.25 % bupivacaine in 10 ml serum saline was applied to the preemptive analgesia group (Group P) 20 minutes before the incision, and to the post-incisional analgesia group (Group E) 20 minutes after the incision, whereas control group received 10 ml serum saline 20 minutes before the incision through the epidural catheter. Pain scores were assessed with 100 mm Visual Analogue Scale (VAS) and four point Verbal Rating Scale (VRS) at 1., 2., 4., 6., 12., 24., 48. hours postoperatively. First analgesic requirement time and total analgesic consumption for 48 hours were also recorded. The VAS and VRS values in the postoperative 48 hours were significantly lower in Group P compared with the other groups (p<0.05). First analgesic requirement time was also significantly prolonged in Group P (p<0.001). Total analgesic consumption in Group P was significantly lower than the other two groups (p<0.05). As a result we observed that preemptive administration of epidural fentanyl-bupivacaine combination reduces the postoperative pain and analgesic consumption in lower abdominal surgery.

9.Evaluation of the knowledge and attitude of obstetric patients on epidural analgesia
L. Pirbudak, Ö. Balat, S. Tuncer, Ü. Öner
Pages 64 - 68
Epidural analgesia (EA) is one of the most commonly used techniques in obstetric analgesia. Our objective was to evaluate patients who experienced EA during labour as well as to find out their knowledge, attitude and behaviour in this matter, prospectively. Between 1997 and 2002, a questionnaire, “patient evaluation form for EA”, was delivered to 190 obstetric patients. The patients were divided into two groups. In Group I there were 100 patients who were evaluated between 1997 and 1999, and Group II was comprised of 90 patients who were evaluated between 2000 and 2002. Demographic data of the patients were similar in both groups. The question “How have you been informed about EA?” was replied as “TV or newspaper” by 50 % of the patients in Group I while the answer was “from someone who experienced it before” by 60 % of the patients in Group II (p<0.01). With these information about EA, 30 % and 40 % of the patients in Group I were found out to be worried about neural paralysis and some possible disorders related to their babies, respectively. However, 40 % of the patients in Grup II worried about back pain and headache (p<0.01). As a result, considering the mother candidates’ high information rate from someone who experienced EA before (60 %), interest to the labour analgesia will increase as the mothers are satisfied with the results of EA.

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