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Volume: 34  Issue: 4   Year: 2022
  Ağrı: 17 (2)
Volume: 17  Issue: 2 - 2005
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1.Thoracic outlet syndrome
Gül Köknel Talu
PMID: 15977087  Pages 5 - 9
Diagnosis and treatment of thoracic outlet syndrome (TOS) involves neurologists, physiatrists, family physicians, orthopedic surgeons, vascular surgeons, thoracic surgeons, neurosurgeons and sometimes psychiatrists. It is generally accepted that TOS is caused by compression of brachial plexus elements or subclavian vessels in their passage from the cervical area toward the axilla and proximal arm either at the interscalene triangle, the costoclavicular triangle, or the subcoracoid space. Cervical ribs, anomalous muscles, and fibrous bands may further constrict these areas. Patients with thoracic outlet syndrome usually have aching type pain radiating from their scapula down the upper extremity. It is more common in women, and between 20 and 50 years of age. In order to diagnose accurately, clinical presentation may be evaluated as neurogenic TOS, those with compression of the brachial plexus, or vascular TOS, those with compression of the subclavian vessels and nonspecific-type TOS. The diagnosis of TOS can be made by history, physical examination, provocative tests, ultrasound, radiological evaluation and electrodiagnostic evaluation. For most patients with TOS, conservative treatment is offered. Definitive treatment involves surgical decompression of the related structures.

2.Chronic pain and rehabilitation
Ender Berker, Nilay Dinçer
PMID: 15977088  Pages 10 - 16
The perception and interpretation of pain is the end point of an interaction of cognitive, cultural, and envioremental factors and this complex interaction effects the pain response and quality of life of each person which shows that pain perception and the verbal and behavioral response shows variations and is specific for each patient. Chronic pain can be due to Fibromyalgia Syndrome (FMS) and Neuropathic Pain (NP) where the underlying pathophysiologic mechanisms are being revealed or it can be chronic low back pain (CLBP) where pain persists in spite of healing of tissue and no underlying pathologic mechanism can be defected. Central sensitization, inhibition of descending pain inhibitory systems, functional changes in otonomic nervous system amd neurotransmitter as well as changes in stres response system are factors contributing to the initiation and maintenance of pain and cognitive, behavioral factors are also important contributors in chronic pain. Biopsychosocial and biomedical mechanisms should be assessed in the rehabilitation interventions. The aims of rehabilitation in chronic pain are to increase activity tolerance, functional capacity and to decrease socio-economic loads. The targets of activity should be physical, functional and social. Psychologic based programs as cognitive-behavioral techniques and operant conditioning are also valid procedures in rehabilitation of chronic pain patients. Rehabilitation should be multidisciplinary and of long-term targeted to valid out-come for success.

3.Percutaneous lumber nucleoplasty
Serdar Erdine, Nuri Süleyman Özyalçın, Ali Çimen
PMID: 15977089  Pages 17 - 22
Low-back pain is one of the most common causes for seeking professional medical assistance and the most frequent cause of absence from work. It is not rare that the intervertebral discs are the etiological factor. Degenerated discs with internal disruptions may cause axial back pain whereas protrusion or herniation of a disc may result in radicular pain. Open surgical procedures targeting the intervertebral discs are carried out frequently for years. But especially because of its lack of superiority over the conventional therapies in the long-term and the risk of development of failed back surgery syndrome, the investigators are forced to develop minimally invasive techniques of disc decompression. In the last two decades, better understanding of the spinal anatomy, function and pain generating mechanisms along with the technological achievements, has accelerated the development of many modalities for the treatment of low back pain. Chemonucleolysis, automated percutaneous lumbar discectomy (APLD), intradiscal laser discectomy, intradiscal electrothermal therapy (IDET) and most recently percutaneous nucleoplasty are the minimally invasive techniques developed for this aim. Percutaneous nucleoplasty is a minimally invasive technique which uses radiofrequency energy to ablate the nucleus pulposus in a controlled manner for disc decompression. The current data about this new technique is insufficient yet, but the preliminary reports indicate that the technique is relatively safe and the outcomes are encouraging.

4.Elongated styloid process (Eagle’s syndrome): literature review and a case report
Kadir Serkan Orhan, Yahya Güldiken, Halil İbrahim Ural, Ayşegül Çakmak
PMID: 15977090  Pages 23 - 25
Eagle's syndrome occurs when an elongated styloid process or calcified stylohyoid ligament causes recurrent throat pain or foreign body sensation, dysphagia, or facial pain. Additional symptoms may include neck or throat pain with radiation to the ipsilateral ear. The symptoms related to this condition can be confused with those attributed to a wide variety of facial neuralgias. Diagnosis can usually be made on physical examination by digital palpation of the styloid process in the tonsillar fossa. The treatment of Eagle's syndrome is primarily surgical. The styloid process can be shortened through an intraoral or external approach. We report a 51-year-old woman with the symptomatology of Eagle's syndrome and literature review.

5.The headache triggered with ingestion of hot and soft fizzy drinks: Similarity with ice cream headache
Hamit Macit Selekler, Sezer Şener Komşuoğlu
PMID: 15977091  Pages 26 - 28
Ice cream headache is more frequent in migraineurs. This is probably due to the specific interactions between neural and vascular systems in migraine patients. Two patients suffering from ice cream headache reported us that a similar headache occurred during migraine attacks with various stimuli such as ingesting hot and fizzy drinks. In addition to the pace of ingestion and temperature of the material, central sensitization may also have a role in the occurrence of this pain. We think that various factors play role in this neuro-vascular interaction. Accepting the ice cream headache as a prototype of this neuro-vascular interaction could provide path to new concepts.

6.Preemptive oral rofecoxib plus postoperative intraarticular bupivacaine for pain relief after arthroscopic knee surgery
Beyhan Karamanlıoğlu, Ayşin Alagöl, Fatma Nesrin Turan
PMID: 15977092  Pages 29 - 33
This study was designed to test the hypothesis whether preemptive administration of rofecoxib, a novel selective COX-2 inhibitor, can prolong intraarticular bupivacaine analgesia after arthroscopic knee surgery. Sixty-two patients were randomly assigned to one of the three groups. Group 1 (n=21) was administered oral rofecoxib 50 mg 1 h before surgery plus intraarticular 0.5 % bupivacaine 20 ml postoperatively. Group 2 (n=21) was administered the same dose of bupivacaine. Group 3 (n=20) was administered saline 20 ml intraarticularly after surgery. Pain scores (VAS) were assessed at 30 min, 1, 2, 4, 6, 12 and 24 h postoperatively. Analgesia duration, analgesic (tramadol and tenoxicam) requirements, and adverse effects were recorded postoperatively for 24 h. Pain scores were significantly lower in the Group 1 at all time points (p<0.05, p<0.001) and were significantly lower in the Group 2 at 30 min (p<0.001), 1 and 4 h (p<0.05) compared to the Group 3. Pain scores were significantly lower in the Group 1 compared to the Group 2 during the first 4 h after surgery (p<0.05, p<0.001). Analgesia duration was longer in Group 1 than Group 2 or 3 (743.0 ± 480.5 min versus 262.4 ± 292.2 min and 17.0 ± 12.1 min; p<0.05, p<0.001 respectively), and in Group 2 than Group 3 (p<0.05). Tramadol requirements were significantly less in Group 1 than Group 2 and 3 (4.8 ± 15.0 mg versus 40.5 ± 43.6 mg and 67.5 ± 24.5 mg; p<0.05, p<0.001 respectively), and in Group 2 than Group 3 (p<0.05). There were no significant differences among the groups regarding the tenoxicam requirements and adverse effects. In conclusion, the combination of oral rofecoxib administered preemptively and intraarticular bupivacaine administered postoperatively provided a significant analgesic benefit and decreased the opioid requirements after arthroscopic knee surgery, when compared to bupivacaine alone or saline.

7.The comparison of the effects and side effects of local anesthetic and opioid combinations in epidural patient controlled analgesia
Zeynep Eti, Tümay Umuroğlu, Arzu Takıl, Yılmaz Göğüş
PMID: 15977093  Pages 34 - 39
The aim of this study was to retrospectively evaluate the efficacy and side effects of local anesthetic and opioid combinations in 457 patients who have received epidural patient-controlled analgesia (EPCA). Hemodynamic parameters, numeric rating scale, sedation scores, the degree of motor and sensory blockage, the presence of side effects, the parameters of PCA device were recorded from the postoperative pain records. 253 patients received 0.1 % bupivacaine + 3 µg/ml fentanyl (Group B1F3), 80 patients received 0.125 % bupivacaine + 3 µg/ml fentanyl (Group B12F3), 43 patients received 0.125 % bupivacaine + 4 µg/ml fentanyl (Group B12F4), 46 patients received 0.1 % bupivacaine + 0.1 mg/ml morphine (Group B1M1) and 35 patients received 0.125 % bupivacaine + 0.1 mg/ml morphine (Group B12M1). Nausea was significantly higher in group B1M1 compared to B12F3, in group B12M1 compared to B1F3 and B12F3 (p<0.05), vomiting was significantly higher in group B1M1 and B12M1 (p<0.05) compared to B12F3, pruritus was significantly higher in group B12F4 compared to B12F3 and B1F3, in group B1M1 compared to B1F3 and B12F3 and in group B12M1 compared to B1F3 and B12F3 (p<0.05). As a result, in EPCA, the combination of bupivacaine and fentanyl provides as effective analgesia as the combination of bupivacaine and morphine and 3 mg/ml fentanyl admixture may be preferred with less side effects such as nausea, vomiting and pruritus.

8.Comparison of bupivacaine-fentanyl versus bupivacaine-morphine for patient controlled epidural analgesia
Yavuz Gürkan, Hakan Canatay, Nur Baykara, Mine Solak, Kamil Toker
PMID: 15977094  Pages 40 - 43
Analgesic efficacy and possible side effects of bupivacaine-fentanyl (BF) and bupivacaine-morphine (BM) combinations for patient controlled epidural analgesia (PCEA) have been compared. Sixty ASA I-II patients who had PCEA following lower abdominal surgery were admitted to the study. Epidural catheter was inserted at the level of L3-4 or L4-5 following induction of general anesthesia. In Group BF epidural drug solution was prepared as bupivacaine 0.1 % and fentanyl 2 µg/ml. In Group BM, solution was prepared as bupivacaine 0.1 % and morphine 0.2 µg/ml. In both groups PCEA was set as; bolus dose: 4 ml, lock - out period: 20 minutes, 4 hour limit: 30 ml. VAS was measured at postoperative 1, 2, 3, 6, 9, 12 and 24th hours. In both groups adequate postoperative analgesia was provided. VAS score was higher in Group BF than Group BM at postoperative 12th hour (p<0.05). One patient in Group BF had unilateral motor block, one patient in Group BM had respiratory depression responding to i.v. naloxan administration. The incidence of pruritis was higher in Group BM than Group BF (p<0.05). Both treatment modalities provided adequate postoperative analgesia, but the risk of respiratory depression with opioid use should be considered.

9.Reality about pain control: The knowledge and beliefs of nurses on the nature, assessment and management of pain
Fatma Eti Aslan, Aysel Badır
PMID: 15977095  Pages 44 - 51
The present research was conducted descriptively to define the approaches of nurses to the nature of pain, its assessment, and management. The research was carried out in October 2001 in Antalya with a scope of 227 nurses attending to the Second National Clinician Nurses’ Congress. Initial aim was to include all 286 nurses attending the congress, however, because 59 nurses refused to participate, the number of the participants finalized as 227. A data gathering form of 20 questions was used. Results were presented in percentages. At the end of the research, though the knowledge the nurses had on the nature of pain was satisfactory, their attitudes related with pain assessment and management were noted to be below expectations. These results point out a void in the nurses’ knowledge pertaining to pain management. As a result, we consider imperative that the nurses should acknowledge the significance of pain and should improve their professional attitudes and knowledge in order to gain control over pain through a multidisciplinary approach and to prove the crucial and inevitable role of nurses in such a team.

10.Comparison of ropivacaine, ropivacaine plus tramadol and ropivacaine plus morphine in patients undergoing minor hand surgery
Enis Şakirgil, Yasemin Güneş, Hayri Özbek, Dilek Özcengiz, Okan Balcıoğlu, Geylan Işık
PMID: 15977096  Pages 52 - 58
In our study we aimed to compare the effects of ropivacaine alone, ropivacaine plus tramadol HCl, and ropivacaine plus morphine HCl used as intravenous regional anesthesia (IVRA), on duration to the initiation of analgesia, total analgesia time, analgesic requirement, sedation levels and hemodynamic parameters. 53 patients undergoing minor hand surgery were included into the study. Patients were randomly divided into three groups to receive 40 ml of ropivacaine 0.2 % (Group R, n=18), ropivacaine 0.2 % plus 1 mg/kg tramadol HCl (Group RT, n=18), and ropivacaine 0.2 % plus 0.1 mg/kg morphine HCl (Group RM, n=17) as IVRA. Following the injection, the durations for the initiation of analgesia were recorded. Levels of sedation, analgesia (VAS) and hemodynamic parameters were recorded in 5 minute intervals throughout first 35 minutes intraoperatively and at 1, 5, 10, 15, 20, 30, 45 and 60th minutes postoperatively. Patients were asked about the initiation of pain and requirements of analgesic at the first postoperative day. The duration to the initiation of analgesia was similar between the groups. Total analgesia time was found to be 304.0 ± 317.6 min in Group R, 327.0 ± 316.5 min in Group RT, and 635.9 ± 492.3 min in Group RM. The difference between Group R and RM was statistically significant (p<0.05). Analgesic requirements were similar between the groups (p>0.05). Mild local anesthetic toxicity was observed in Group RM in two patients. We conclude that, when used as IVRA, ropivacaine alone or with tramadol or morphine produced similar analgesia and surgery conditions, and ropivacaine plus morphine had more adverse effects besides its longer duration of analgesia.

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