Volume: 36 Issue: 1 Year: 2023
Ağrı: 16 (3)
|Volume: 16 Issue: 3 - 2004
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|Cyclooxygenase-2 inhibitors in postoperative pain management
Yasemin Güneş, Geylan Işık
Pages 7 - 16
Management of acute postoperative pain remains suboptimal; nearly 80 % of the patients report moderate to extreme pain following surgery. Nonselective nonsteroidal antiinflammatory drugs (NSAIDs) have a role in postoperative pain management, but conventional NSAIDs can cause gastrointestinal ulceration, renal injury, and disruption of platelet function and hemostasis. Recently, cyclooxygenase-2 (COX-2) specific inhibitors such as rofecoxib and celecoxib were devoleped to provide the increased efficacy of non-specific NSAIDs while limiting associated side effects. These drugs have demonstrated analgesic efficacy and opioid sparing effect after variety of surgical procedures. This article will review the role and outcome of COX-2 inhibitors for postoperative pain management.
Işın Ünal Çevik
Pages 17 - 24
Following chicken pox infection, varicella-zoster virus stays as a latent infection in sensory root ganglia. After many years, the reactivation of this latent virus in sensory ganglia causes herpes zoster. Herpes zoster (shingles) is an unilateral, dermatomal, localised, painful, vesicular, and contagious skin infection. In elderly and immunocompromised patients, shingles can cause complications such as postherpetic neuralgia (PHN) and direct central nervous system invasion. Early intervention with antiviral treatment, analgesic therapy and antidepressant therapy may reduce the risk of these complications. The treatment of PHN is same as for other neuropathic pain syndromes. The clinical importance of PHN is due to the severity and chronicity of pain which is usually not responsive to many treatments, and quality of life may be adversely affected by PHN.
|Evolution of interventional techniques
P Prithvi Raj
Pages 25 - 34
Regional anesthesia techniques are used in pain treatment for more than a century. Although its use for acute pain conditions, such as intraoperative, postoperative and traumatic pain, is very well accepted, its use for the chronic pain syndromes is still lacking a consensus among the practitioners. The interventional techniques, which are mostly originated from the regional anesthetic techniques, have gained an increasing interest for the treatment of chronic pain syndromes during the last few decades. In this review, the development and clinical aspects of epidural injections, epiduroscopy, facet denervaion, intradiscal applications, vertebroplasty, sympathetic neurolysis, and central and peripheral continuous infusion techniques are discussed.
|Sacral nerve stimulation in fecal incontinence; efficacy and safety
Nuri Süleyman Özyalçın, Gül Köknel Talu, Emre Balık, Türker Bulut
Pages 35 - 44
Fecal incontinence is common due to various reasons. Conservative therapy of fecal incontinence may sometimes be effective in improving function, but usually many patients require surgery. Sacral nerve stimulation is another treatment modality which gained interest, and appears to be an alternative method that is successful with low morbidity. With the approval of the local ethical committee a total of 14 patients with rectal incontinence had undergone trial stimulation of sacral neuromodulation after failure of conservative treatment modalities. The implantations were performed under surgical sterile conditions with fluoroscopic guidance through the S3 foramen. After correct placement 0.5-2 V, 15 /min, pulse width 210 µs stimulus was given. The patients had trial period longer than 6 weeks; 9 of 14 patients responded positively to the trial period. Of these 1 had permanent implantation, 3 were booked for permanent implantation, and 2 of the patients had complete incontinence relief from the trial period. Evaluating the data and the results of our study we may conclude that sacral nerve stimulation is an emerging surgical technique to produce a clinically beneficial physiological effect on the lower bowel, pelvic floor and anal canal.
|Myofascial pain syndrome in the differential diagnosis of chronic abdominal pain
Ali Çimen, Mehmet Çelik, Serdar Erdine
Pages 45 - 47
Myofascial pain syndrome is a painful musculoskeletal condition, and a quite common cause of chronic pain. It is characterized by the development of trigger points that are locally tender when active, and refer pain through specific patterns to other areas of the body. Its etiological factors are various; trauma, vertebral column diseases, systemic disorders, psychological distress, lack of motion, and chilling of the body parts. Myofascial pain syndrome may be misdiagnosed as arising from a visceral source especially if its probability is not kept in mind and a proper patient examination is lacking. Although there are many therapeutic approaches, trigger point injections can be diagnostic and therapeutic.
|Impact of surgery and trauma in developing chronic pain
Emine Özyuvacı, Aysel Altan, Ali Karahan
Pages 48 - 50
Surgery and trauma are recognized as important causes of chronic pain. In this manusript, we analyzed the patients who visited our clinic with posttraumatic or delayed surgical pain complaints between January 2001 and January 2004. Identification and evaluation of pain were done as defined in the taxonomy of IASP. Duration and severity of pain as well as diagnosis and etiology were evaluated as suggested in the taxonomy. Our results showed that 107 out of 2866 patients (4 %) were diagnosed of having chronic pain related to the history of trauma or surgery. The age range of the patients was from 32 to 66 years with an average of 48 years. Male/female ratio was 35/72. The duration of pain varied. 15 % of the patients complained of pain lasting for 1 to 6 months, 67 % complained of pain lasting for 6 to 24 months, and 18 % complained of pain lasting more than 24 months. A significant amount of patients (72 %) complained of very severe pain, 21 % complained of moderate pain, and finally only 7 % complained of mild pain. The diagnosis of pain were as follows: radiculopathy and postlaminectomy pain in 48 %, neuropathic pain in 33 %, phantom pain in 12 %, carpal syndrome in 6 %, and thalamic syndrome in 1 %. Pathogenesis of pain was evaluated to be originating from peripheral nervous system in 56 %, muscle and skeletal system in 43 %, and central nervous system in 1 % of the cases. Additionally, fifty-nine percent of the cases complained of back pain. Long-term (?1 year) and continuous follow up of postoperative and posttraumatic pain during acute course may prevent a significant amount of chronic pain complaints.
|The analgesic and anti-inflammatory effects of subcutaneous bupivacaine, morphine and tramadol in rats
Arzu Gerçek, Zeynep Eti, F. Yılmaz Göğüş, Aydın Sav
Pages 53 - 58
The analgesic and anti-inflammatory effects of subcutaneously administered bupivacaine, morphine and tramadol on formalin-induced inflammation were compared. 0.25 % bupivacaine in Group B, 20 mg/kg tramadol in Group T, 1 mg/kg morphine in Group M and 0.9 % NaCl in Group S in a volume of 200 µl were injected into the right hind paw of the rats (n: 40) 15 minutes before injection of 50 µl 5 % formalin. Sedation and pain behaviour scores, number of flinches and licking-time were recorded. The degree of dermal edema, intraneural edema, vasodilation, erythrodiapedesis, infiltration of polymorphonuclear leukocyte/lymphocyte and mast cell counts were analyzed histopathologically. In Group T and B, circumferential changes were lower than in Group M and S. The pain behaviour scores were significantly lower in Group T and B. The number of flinches in Group T was lower than Group B and S. The vasodilation was significant only in Group M. The dermal edema was limited to deep dermis only in Group T. Preinflammational subcutaneous tramadol infiltration can provide effective analgesia and may have anti-inflammatory effects.
|Patient-controlled epidural analgesia in labour: the addition of fentanyl or clonidine to bupivacaine
Nurten Kayacan, Gülbin Arıcı, Bilge Karslı, Zekiye Bigat, Münire Akar
Pages 59 - 66
In this study, we studied 45 healthy parturients with singleton vertex presentation. Patients were allocated randomly to receive either 0,125 % bupivacaine with 2 µg/ml fentanyl or 0,125 % bupivacaine with 1,5 µg/ml clonidine for epidural labour analgesia. A patient controlled epidural analgesia (PCEA) pump was programmed as follows: basale infusion rate: 6 ml/h, demand bolus: 5 ml, lockout interval: 10 min. Efficacy of analgesia was evaluated using visual analogue scale. Maternal and fetal cardiovascular variables, Apgar scores of the newborn at 1-5 min and umbilical arterial blood gas measurements were recorded. The duration of stages of labour and total analgesic consumption were also noted. Systolic blood pressure decreased significantly at 3rd h in bupivacaine plus fentanyl group. Although all patients experienced a good analgesia, pain scores in bupivacaine plus clonidine group were lower than bupivacaine plus fentanyl group. The analgesic requirement in bupivacaine plus clonidine group was less than the other group. There were no significant differences in fetal heart rate, Apgar scores or umbilical blood gases. In conclusion, the addition of clonidine to epidural bupivacaine for PCEA was superior to bupivacaine plus fentanyl for analgesia and analgesic requirement during labour.