Thoracic epidural anaesthesia is selected usually to provide adequate postoperative analgesia; however with administration of local anaesthetics to epidural space selective sympatolysis ensues. The effects of this transient sympathectomy on cardivascular, respiratory and other systems deserve certainly some interest as it may influence postoperative morbidity or mortality. Thoracic epidural anaesthesia has succesfully been used in cardiac, thoracic and major abdominal surgery. It provides dynamic analgesia, rapid mobilization, blunted stress response, early extubation with reduced pulmonary complications and also rapid recovery of bowel function. In cardiac surgery where thoracic sympathetic blockade is expected to be most useful, there is no difference in morbidity and mortality. Despite the superior quality of pain control, the beneficial aspect of thoracic epidural anaesthesia is not reflected on outcome in meta-analysis. Recent papers has still demonstrated positive effects on each system. So thoracic epidural anaesthesia is increasingly used and it seems that it will be discussed more in near future.

Chronic pain originating from the cervical spine, that may have diverse etiological factors, is a common condition in the clinical practice. Having distinct properties in the spine, cervical column has a wide range of motion and is commonly subject to traumatic injury. In this review, after the anatomical properties that has clinical significance and the evaluation of a patient with cervical pain are explained, the common cervical spinal pain conditions are discussed by emphasizing the therapeutic approaches in each condition.

The objectives of this study were to determine the age and sex dependent linear trend of recurrent headache prevalence in schoolchildren in Mersin. A stratified sample composed from 5562 children, detailed characteristics were previously published. In this study the prevalence distribution of headache by age and sex showed a peak in the female population at the age of 11 (27.2%) with a plateau in the following years. The great stratified random sample results suggested that, in addition to socio-demographic features, detailed linear trend analysis showed headache features of children with headache have some specific characteristics dependent by age, gender and headache type. This study results can be proposed the using in the future epidemiological based studies.

We investigated the effect of a new fixator made from a medication port of a intravenous fluid container on the migration of epidural catheter. Fifty patients were recruited to receive epidural analgesia and allocated to one of two groups. In the new fixator group (n=25) epidural catheter was advanced through a fixator then fixed with transparent adhesive dressing, in the standard dressing group (n=25), the catheter was fixed only with transparent adhesive dressing. Outward migration of the catheter over 2 cm, and inward migration over 1 cm was described as the failure of the fixation. At the end of the follow up time, outward migration or inward migration distance, and the reason for removing the catheter were recorded. In the standard dressing group, outward migration was detected in 7 patients compared to 2 patients in the new fixator group (p>0.05). Inward migration was determined in only 5 cases in the standard dressing group (p<0.05). There was no movement in 13 cases in the standard dressing group compared with 23 of the new fixator group (p<0.05). The main reason for removal in the standard dressing group was the migration of the catheter whereas the catheter was removed on a regular basis at the end of therapy in the new fixator group. We concluded that the newly described fixation method for epidural catheter is an effective method in reducing catheter migration for short term usage.

In total knee replacement operation, patients have a severe pain in postoperative period. Because of side effects of opioids, multiple postoperative pain treatment regimens are more suitable in these elderly patients. In this double-blind, randomized, placebo controlled study, the effect of lornoxicam administration (32 mg/48 hour) on morphine consumption and drug-related side effects were investigated in elderly patients undergoing total knee replacement. Group M (n=23) and Group L (n=23) received morphine with patient controlled analgesia (PCA) device postoperatively. Additionally Group L received lornoxicam 16 mg iv 15 minutes before surgery and 8 mg at postoperative 12th and 24th hours. Morphine consumption in Group L were significantly lower than in Group M at 2, 3, 6, 8, 24, 36 and 48 postoperative hours (p<0.05). At the end of 48th hour mean total morphine consumptions (mean ± sd) for Group M and Group L were 63,70 ± 15,70 mg and 34,60 ± 16,32 mg, respectively. AUC (Area under the curve) Morphine 0-48h in Group M was 59 ±13 and in Group L was 30±13 (p<0.001). Incidence of side effects in Group M were 60 % and 25 % in Group L (p<0.05). In Group M, 8 patients (40%) experienced nausea and 3 (15 %) patients experienced itching where as in Group L, 3 patients (15 %) experienced nausea, 1 patient (5 %) itching, 1 patient (5 %) dry mouth. Lornoxicam administration in total knee replacement is associated with decreased morphine consumption for postoperative analgesia and fewer side effects.

We have studied the plasma cortisol level between attacks in order to investigate the role of hypothalamic-pituitary-adrenal axis in migraine patients. We have not found any statistically significance between plasma cortisol levels of patients and control group, after taking the blood of 25 patients and 24 healthy controls between 8.30-9.30 am.

The purpose of the present study was to examine and compare the analgesic effects of breast feeding and sucrose solutions in reducing pain due to venipuncture in term neonates. 102 term infants requiring a venous blood sample for routine screening of phenylketonuria (n=26) and hyperbilirubinemia (n= 76) were included in the study. The participants were allocated into one of the sucrose, breast feeding, and control groups. Allocation of the infants into groups was performed due to mothers’ wishes whereas the control group included the infants on whom routine procedures of the hospital were performed. In order to assess the pain response of the neonates before, during and after venipuncture, Neonatal Infant Pain Scale (NIPS) was used and their heart rates, oxygen saturation levels and length of crying were noted. The crying time (seconds) was shorter both sucrose (9.56±12.96) and breast feeding (28.62±33.71) than the control group (103.50±63.69). No difference was found in the analgesic effect of breast feeding compared with sucrose, when assessed with the NIPS. The mean heart rate did not significantly differ among three groups before, during and after procedure. During procedure, the mean oxygen saturation levels of sucrose group were found significantly higher than the control group, but no difference was observed between sucrose and breast feeding groups. This study has confirmed some well known information that breast feeding and oral sucrose solution have pain reducing effects in infants undergoing venipuncture.