Chronic postsurgical pain (CPSP) has lately become a neglected phenomenon. However, in recent years, investigations of the possible risk factors (type of surgery, preoperative pain, acute postoperative pain, and psychological and genetic factors) have also gained as much importance as the clinical problem. CPSP is not only observed following major surgery, but also following minor surgical procedures, such as hernia and vasectomy. Definitive data regarding the incidence of CPSP have not been obtained yet, since it is difficult to develop standard methods to resolve this difficult and complicated clinical picture. Many different medications, such as gabapentin, ketamine, venlafaxine, lidocaine, tramadol, and steroids have been tested in addition to multimodal analgesic techniques for the management of CPSP. Hence, preventive analgesia is a broader application of preemptive analgesia that includes any preoperative analgesic regimen able to control the sensitivity induced by pain.

OBJECTIVES: The aim of this study was to investigate whether sympathetic skin response (SSR) was affected in cases with failed back surgery syndrome (FBSS). METHODS: Twenty-nine cases admitted to our department and diagnosed as FBSS were recruited for the study. All the cases had back, leg or back and leg pain in the months or in one year following spinal surgery. The control group consisted of 13 healthy hospital personnel. Electrophysiologic nerve conduction studies and SSR recordings were applied on the symptomatic side (29 legs) in study cases and both sides (26 legs) in the control group. SSRs of the study group were compared with those of the sex-, body mass index- and age-matched control group of 13 people. Patients having peripheral nerve entrapment syndromes, peripheral vascular disease, neurologic or psychiatric disease, alcoholism, or drug abuse were excluded from the study. Pain intensity was recorded by visual analog scale (VAS) and depression was recorded by Beck Depression Inventory (BDI). RESULTS: Latency duration in SSR in the study group was significantly higher (p=0.006) when compared with the healthy controls. There was no SSR in 4 patients and there was a positive correlation between BDI and SSR (r=0.46). CONCLUSION: It was concluded that the sympathetic nervous system is affected in FBSS patients with changes in SSR, and that the dysfunction of the sympathetic nervous system may contribute to the intensity and chronicity of pain states in this group of patients.

OBJECTIVES: Suprascapular nerve block has been shown to be effective in acute, postoperative and chronic shoulder pain. The understanding of providing analgesia without destruction of neural tissue makes pulsed radiofrequency (PRF) lesioning attractive as a non-destructive method. In this study, the effectiveness of suprascapular PRF in chronic shoulder pain in both the short- and long-term was assessed. METHODS: Forty patients suffering from shoulder pain of at least two months’ duration, diagnosed with rotator cuff rupture by MRI scanning and with no response to systemic or physical therapy, were enrolled. After a favorable response to a diagnostic suprascapular nerve block, PRF application was done. Pain assessment was done using a standardized 7-point Likert scale and shoulder joint function assessment by Oxford Shoulder Score (OSS). The outcome measures were assessed in the third week as short-term and in six months as long-term. RESULTS: Thirty-two patients completed the study. Eight patients were excluded from the study because of vagotony due to sitting position (20%). In comparison with baseline, Likert score of chronic shoulder pain was good (6.73±0.78; 6.50±1.07) (for both, p=0.000) and mean OSS was 16.28±3.15; 13.81±2.23 (for both, p<0.001) in the two assessment periods. CONCLUSION: Suprascapular nerve PRF lesioning was effective in chronic shoulder pain of rotator cuff lesion, and this effect was maintained in the long-term period. The improvement in shoulder joint function in parallel with decreased chronic shoulder pain was also notable.

OBJECTIVES: The aim of this study was to compare the effects of lidocaine alone and those of morphine or tramadol when added to lidocaine for intravenous regional anesthesia (IVRA) on tourniquet pain, the onset and regression time of motor and sensory block, the level and duration of analgesia, and analgesic consumption. METHODS: After institutional approval and informed consent, 90 patients scheduled for forearm or hand surgery were enrolled and randomly assigned to one of three groups for administration of either 0.5% lidocaine (Group L), 0.5% lidocaine with 1.5 mg.kg-1 tramadol (Group LT), or 0.5% lidocaine with 0.1 mg.kg-1 morphine (Group LM) in a volume of 40 ml. The onset and duration of sensory and motor blocks, duration of analgesia and proximal and distal tourniquet, time to first pain medication, visual analog scale (VAS) scores, analgesic requirements in 24 hours, vital signs, and side effects were recorded. RESULTS: Sensory block onset time was significantly shorter in Group LM compared with the other groups and also in Group LT compared to Group L. In addition, sensory block regression time was significantly shorter in Group L than in Group LM (p<0.05). There was a significant increase in VAS scores at the postoperative 4th and 5th hr in Group L (p<0.05). Mean arterial blood pressure was significantly reduced in Group LM at the time of tourniquet deflation (p<0.05). CONCLUSION: IVRA with lidocaine and morphine or tramadol improves postoperative analgesia and sensory block. However, these combinations provide no advantage on tourniquet pain, motor block quality, analgesia duration or analgesic consumption.

The main purpose of this study was to investigate pain perception of the professional volleyball players at rest and maximal cardiovascular stresses during different phases of menstruation. Thirteen volleyball players from Celal Bayar University were used as the participants of the study. At rest, anthropometric measurements, systolic and diastolic blood pressures were determined. Then, pain tolerance and pain threshold were measured by sphygmomanometer that placed upper part of the arm. Visual Analog Scales (VAS) was used to grade the pain. At the 2nd (menstrual phase) and 14th (ovulation phase) days of menstruation, oxygen consumption (VO2), heart rate (KA), blood lactate (KL) pain perception and rate of perceived exertion (RPE) were taken during two incremental maximal exercises testing. Statistical analysis of this study indicated that at rest pain tolerance and threshold values of the volleyball players were significantly higher during menstruation phase compare to ovulation phase. Also, VO2 and KL measurements taken at the high intensities during 2nd day of mensturation were statistically higher than that of measurements were done at 14th day of mensturation. Moreover, pain perception of the participants that was measured during 2nd day of menstruation was significantly lower than that of measurements during the 14th days of menstruation (p<0.05). According to results of regression analysis, RPE and KL were two dependent variables that were statistically related to pain perception during two different phases of menstruation. As a conclusion due to the decrease in pain perception, the intensity of the training could be increase during menstruation period.

Foreign bodies in the external auditory canal may cause otalgia, and live insects have been reported among the causes. A number of methods have been used to immobilize the live insects. In our manuscript, we describe immobilization of an insect and provision of analgesia using EMLA cream.

Ultrasound may provide effective guidance during nerve blocks in cases where nerve stimulation is not feasible for various reasons. We describe a 28-year-old, ASA physical status I, male patient who was operated for pectoral flap release under lateral sagittal infraclavicular block. Using ultrasound guidance alone, total volume of 30 ml of local anesthetic mixture (15 ml of levobupivacaine 5 mg/ml and 15 ml of lidocaine 20 mg/ml with 5 µg/ml epinephrine) was injected dorsal to the axillary artery. There was no vascular puncture or any other complication. The block was successful and the patient was ready for surgery 20 minutes after block performance. This case report is one of the examples that ultrasound guidance may be the only way to perform safe regional anesthesia; ultrasound guidance alone is an effective way of performing infraclavicular block.