ISSN: 1300-0012 | E-ISSN: 2458-9446
Volume : 21 Issue : 2 Year : 2025
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Agri - Ağrı: 21 (2)
Volume: 21  Issue: 2 - 2009
REVIEW
1. An integrated psychosocial-spiritual model for cancer pain management
Özden Dedeli, Gülten Karadeniz
PMID: 19562532  Pages 45 - 53
Cancer pain is known to be a multidimensional and complex experience that can cause severe suffering and can lessen the quality of life. The psychosocial and spiritual aspects of cancer pain play an important role in this phenomenon. This article describes a multidisciplinary model for cancer pain management that focuses on the psychosocial and spiritual aspects of cancer pain and the needs of patients.

EXPERIMENTAL AND CLINICAL STUDIES
2. Preemptive analgesic effects of intravenous paracetamol in total abdominal hysterectomy
Semih Arıcı, Alp Gurbet, Gürkan Türker, Belgin Yavaşcaoğlu, Şükran Şahin
PMID: 19562533  Pages 54 - 61
Objectives: Paracetamol is primarily thought to be a cyclooxygenase inhibitor acting through the central nervous system. Indirect effects of paracetamol are through the serotoninergic system as a non-opioid analgesic. In this study, total abdominal hysterectomy patients were given intravenous (iv) paracetamol 1 g preoperatively or intraoperatively to assess its postoperative analgesic effects. Methods: 90 patients undergoing total abdominal hysterectomy were enrolled into the study. Patients were randomized into three groups: in Group I, iv paracetamol 1 g was given 30 minutes prior to induction. In Group II, iv paracetamol 1 g was given prior to skin closure. Group III served as the control group and received saline as placebo. Postoperatively, all patients received morphine via patient-controlled analgesia pump. Postoperatively, rest and activity pain scores, sedation scores, hemodynamic parameters, postoperative morphine consumption, side effects, patient satisfaction, and total hospital stay were recorded.
Results: In the control group, at rest and movement pain scores and total morphine consumption via patient-controlled analgesia were higher than in Groups I and II. When Groups I and II were compared, total morphine consumption was much greater in Group II. Intravenous paracetamol intraoperatively and postoperatively did not result in any hemodynamic effects. Conclusion: In total abdominal hysterectomy, preemptive iv paracetamol 1 g provided good quality postoperative analgesia, with decreased consumption of morphine and minimal side effects.

3. The effects of lumbar plexus block and epidural block on total blood loss and postoperative analgesia in total hip arthroplasty
Taylan Akkaya, Gülten Ütebey, Alp Alptekin, Murat Sayın, Haluk Gümüş, Yalım Ateş
PMID: 19562534  Pages 62 - 68
Objectives: In this study, the effects of lumbar plexus block and epidural block on total blood loss and postoperative analgesia in patients undergoing total hip arthroplasty (THA) under general anesthesia was documented. Methods: The study included 45 patients undergoing THA under general anesthesia. Group GA (n=15) received general anesthesia, Group GA+E (n=15) received general anesthesia + epidural catheter and Group GA+LPB (n=15) received general anesthesia + lumbar plexus catheterization. Intraoperative blood transfusion (IOBT) requirements and intraoperative bleeding (IOB) were documented. Postoperative hemoglobin, hematocrit and total blood loss through the drains were also documented. All patients received patient-controlled analgesia through the IV route. Time to first analgesic requirement (TFAR), total IV morphine consumption (MORPH 24) and 24-hour visual analogue scale (VAS) values were evaluated.
Results: TFAR was the lowest (8.7±4.0 min.) in the GA group and highest (42.7±14.4 min) in the GA+LPB group, and the GA+E group had lower values than the GA+LPB (32.3±16.0 min) group (p<0.05). IOBT, IOB, and MORPH 24 average values were the lowest in the GA+LPB group and highest in the GA group, with GA+E in between (p<0.05). Postoperative first VAS values were significantly different between the GA group and the others (p<0.001). There was also a significant difference between the GA group and the others regarding postoperative average Hb values (p<0.02).
Conclusion: THA using either regional technique provides less blood loss and better analgesia. We will consider LPB in our future cases in view of the lower intraoperative blood loss and better analgesia.

4. The effects of two different multimodal analgesic regimens in total hip replacement surgery
Nurten İnan, Suna Akın Takmaz, Serkan İltar, Işın Yazıcı, Hülya Başar
PMID: 19562535  Pages 69 - 74
Objectives: This study evaluated the effectiveness of two different multimodal analgesia protocols in terms of postoperative pain relief, tramadol consumption during patient-controlled analgesia (PCA) and side effects after total hip replacement surgery.
Methods: Group F (n=18) received general anesthesia after a 3-in-1 femoral nerve block (FNB) was applied using 40 ml of bupivacaine 0.25%. Group FD (n=18) received general anesthesia after the same block and dexketoprofen p.o. was given. All patients received intravenous tramadol at the end of surgery via a PCA device. Group FD was given dexketoprofen 75 mg/day for 48 hours postoperatively. Pain scores were evaluated at 0, 1/2, 1, 4, 8, 12, 24 and 48h at rest and on movement of the hip. Side effects and global satisfaction scores in both groups were also evaluated in this setting. Results: Total tramadol consumption was lower in Group FD (377.7±137.4) than in Group F (593.9±132.3) (p<0.05). Visual analogue scale (VAS) scores were ≤3 in all follow-up periods in both groups. While in Group FD, 6 patients had nausea, 3 vomiting and 1 sedation, in Group F, 5 patients had nausea, 3 vomiting and 2 sedation. Patient global satisfaction scores in Group F were very good in 14 patients and good in 4 patients, and in Group FD were very good in 13 patients and good in 5 patients. Conclusion: Both analgesia protocols were effective in pain relief in total hip replacement patients, with similar side effects. The effect of additional dexketoprofen was to reduce postoperative tramadol consumption.

CASE REPORTS
5. Reflex sympathetic dystrophy secondary to piriformis syndrome: a case report
Didem Akçalı, Ayça Taş, Pelin Çizmeci, Suna Oktar, Murat Zinnuroğlu, Emre Arslan, Hüseyin Köseoğlu, Avni Babacan
PMID: 19562536  Pages 75 - 79
Piriformis syndrome is a rare cause of hip and foot pain which may be due to sciatic nerve irritation because of anatomic abnormalities of sciatic nerve and piriformis muscle or herniated disc, facet syndrome, trochanteric bursit, sacroiliac joint dysfunction, endometriosis and other conditions where sciatic nerve is irritated. There has been no reflex sympathetic dystrophy (RSD) case presented due to piriformis syndrome before. A sixty-two-year-old female patient had right foot and hip pain (VNS: 8), redness and swelling in the foot since 15 days. Her history revealed long walks and travelling 3 weeks ago and sitting on the foot for a long time for a couple of days. Physical examination revealed painful hip movement, positive straight leg rise. Erythema and hyperalgesia was present in dorsum of the right foot. Right foot dorsiflexion was weak and hyperesthesia was found in right L4-5 dermatome. Medical treatment and ultrasound treatment to piriformis muscle was not effective. The patient was injected 40 mg triamcinolon and local anesthetic in right piriformis muscle under floroscopy by diagnosis of piriformis syndrome, neuropathic pain and RSD. Pain and hyperalgesia resolved and motor weakness was better. During follow-up right foot redness resolved and pain decreased (VNS: 1). In this case report, there was vascular, muscle and skeletal signs supporting RSD, which shows us the therapoetic effect of diagnostic piriformis injection. The patient history, physical examination and diagnostic tests were evaluated by a multidisciplinary team which contributed to the treatment.

6. Migraine type childhood headache aggravated by sexual abuse: case report
Hakan Kaleağası, Aynur Özge, Fevziye Toros, Hakan Kar
PMID: 19562537  Pages 80 - 82
Although the vast majority of chronic headache is idiopathic in origin, child abuse can be a very rare cause of paroxysmal headaches in children. The aim of this report was to present a case of migraine headache aggravated after sexual abuse, which did not respond to treatment. An 11-year-old girl admitted to the outpatient department of the Neurology Clinic with headache complaint for the past two years. Neurological examination, neuroimaging and laboratory tests were normal. According to the International Classification of Headache Disorders (ICHD)-II criteria, the headache was diagnosed as migraine without aura and treatment as prophylaxis was planned. Her headache did not respond to treatment, so she was consulted with the Department of Child and Adolescent Psychiatry and diagnosed as major depressive disorder. During one of the psychological interviews, she confessed that she had been sexually abused by her mother’s boyfriend for two years. After this confession and punishment of the abuser, her headache improved dramatically. The prevalence of physical, sexual, and emotional abuse during childhood has been estimated between 13% and 27%, and these children may suffer chronic pain, headache or depression. Sexual abuse has been strongly associated with the migraine-depression phenotype when abuse first occurred before the age of 12 years. Despite the high prevalence of abuse, many physicians do not routinely ask about abuse history. In conclusion, child abuse must be kept in mind in intractable childhood headache. A multidisciplinary approach with the Departments of Forensic Sciences and Child and Adolescent Psychiatry and detailed psychiatric evaluation should be useful in these cases.

LETTER TO THE EDITOR
7. Greater occipital nerve block in migraine headache: Letter to editor
Mehmet Baykal
PMID: 19562538  Page 83
this manuscript is a letter to the editor. there is no abstract section.