Interventional techniques are divided into two categories: neuroablative and neuromodulatory procedures. Neuroablation is the physical interruption of pain pathways either surgically, chemically or thermally. Neuromodulation is the dynamic and functional inhibition of pain pathways either by administration of opioids and other drugs intraspinally or intraventricularly or by stimulation. Neuroablative techniques for cancer pain treatment have been used for more than a century. With the development of imaging facilities such as fluoroscopy, neuroablative techniques can be performed more precisely and efficiently.

Objectives: We aimed to determine the effects of intraperitoneal administration of levobupivacaine on pain after laparoscopic cholecystectomy in a prospective, randomized, double-blinded, placebo-controlled trial.
Methods: In all patients, infiltration of levobupivacaine 0.25% (15 mL) was used prior to skin incisions for trocar insertion. After pneumoperitoneum was achieved, patients were allocated randomly to receive intraperitoneally either 40 mL of 0.25% levobupivacaine (LB group, n=20) or normal saline (NS group, n=20) under direct vision into the hepatodiaphragmatic lodge and above the gallbladder. Data of intraoperative variables, postoperative pain relief, rescue analgesic consumption, side effects, and patient satisfaction were followed in both groups.
Results: The postoperative pain scores were significantly lower in the first half-hour period in the LB group than in the NS group (p<0.05). However, the incidence of right shoulder pain was not significantly different between the LB group (10%) and NS group (15%). The mean dose of meperidine consumption and the number of patients needing rescue meperidine were significantly lower in the LB group than in the NS group (p<0.05). Significantly lower vomiting incidence and increased patient satisfaction were determined in the LB group compared to the NS group (p<0.05).
Conclusion: Intraperitoneal administration of 40 mL levobupivacaine 0.25% given immediately after pneumoperitoneum into the hepatodiaphragmatic lodge and above the gallbladder demonstrated useful effects on postoperative pain relief after laparoscopic cholecystectomy, especially in the early postoperative period, and reduced postoperative rescue analgesic requirement, with excellent patient satisfaction. There were no LB-related complications or side effects.

Objectives: We undertook this study to examine the relationships between clinical symptoms as evaluated by Washington Neuropathic Pain Scale (NPS) and electrodiagnostic classification in patients with carpal tunnel syndrome (CTS).
Methods: Eighty patients with unilateral CTS were included in this study. After diagnosis of CTS by electromyography, all patients completed a 10-item questionnaire (NPS).
Results: A statistically significant correlation between total NPS score and severity of CTS was found (p=0.013, r=0.276).
Conclusion: The present study indicates that using NPS might be useful in evaluating the clinical outcome of patients with CTS.

Objectives: We studied the influence of patient positioning on the visibility of the sciatic nerve during ultrasound (US) examination in the popliteal region.
Methods: Using a linear broad band 7-12 MHz frequency probe, US examination of 24 sciatic nerves was performed by a blinded operator to obtain the best possible image at the level of the popliteal crease (PC) and at 4 and 8 cm above the PC in the prone position. Examinations were performed in neutral prone (Group N), with a silicone roller under the foot (Group R) and in “figure of four” (Group FOF) positions. “Figure of four” position was described as: the leg to be examined is flexed and abducted to allow the foot to rest on the ankle of the contralateral leg. A visibility score for the sciatic nerve was established as follows: Score I: Nerve is identified, but borders are not clear. Score II: Nerve is identified. Borders of the nerve are clearly distinguished from the surrounding structures. Three or less fascicles are visible. Score III: Nerve is identified. Borders of the nerve are clearly distinguished from the surrounding structures. Four or more fascicles are visible.
Results: The distance of nerve division from the PC was 6.9±1.6 cm. A higher visibility score was obtained in Group FOF (2.6±0.6 vs 1.7±0.8) at the PC and at 4 cm (2.3±0.5 vs 1.6±0.8) and 8 cm (2.3±0.7 vs 1.4±0.7) above the PC, compared to Group N (p<0.001).
Conclusion: “Figure of four” position improves the visibility of the sciatic nerve and may have clinical impact.

Objectives: Postoperative analgesia technique varies depending on the operation, patient, anesthetist, and circumstances. PCA (patient controlled analgesia) is an effective way of supporting postoperative analgesia. In this study, we aimed to present the efficacy and safety of our postoperative PCA treatment and the patient profile along with the requirements, preferences and decision-making process.
Methods: We discuss herein the PCA protocols of our clinic, the overall distribution of operations for which PCA was applied and the principles by which a pain team works.
Results: The operations for which PCA was applied included knee prosthesis, cesarean section, hip prosthesis, lower extremity trauma surgery, painless delivery, gastrointestinal surgery, multiple trauma surgery, thoracotomy, hysterectomy, laminectomy, and urogenital surgery. Postoperative PCA alone was successful in 89% of the patients, and with the supplemental analgesic agent, it was successful in an additional 6% of the patients, thus achieving a total success rate of 95%.
Conclusion: We believe the epidural and intravenous PCA protocols applied in our clinic for postoperative analgesia are effective and safe.

Objectives: Intraoperative remifentanil administration results in acute opioid tolerance that is manifested by increased postoperative pain, opioid requirement and specifically peri-incisional hyperalgesia. The aim of this study was to investigate the effect of lornoxicam in preventing remifentanil-induced hyperalgesia.
Methods: Patients were randomly divided into two groups. Fifteen minutes before surgery, saline solution was given to the patients in group I and 16 mg i.v. lornoxicam in group II. Anesthesia was induced with 1 µg/kg remifentanil combined with 1.5-2 mg/kg propofol and maintained with 0.5 MAC desflurane and 0.4 µg/kg/dk remifentanil in both groups. Desflurane concentration was titrated according to autonomic responses. All patients were given i.v. 0.15 mg/kg morphine 30 min before the end of surgery. At the end of surgery, patients received morphine i.v. via a PCA (Patient Controlled Analgesia) device. Pain score, morphine demand and delivery were assessed at 2, 4, 6, 12 and 24 h after surgery. Total morphine consumption was recorded for 24-48 h. Peri-incisional hyperalgesia was assessed by measuring pain threshold to pressure using an algometer before operation and at 24-48 h postoperatively.
Results: The pain scores and cumulative morphine consumption were significantly lower in the lornoxicam group when compared with the control group (p<0.05). Pain thresholds were significantly less at 24-48 h postoperatively in the control group than in the lornoxicam group. No significant difference was observed in side effects (p>0.05).
Conclusion: Lornoxicam administered preemptively prevented remifentanil-induced hyperalgesia.

Objectives: Migraine is characterized by headache attacks, and symptoms belong to various organ systems. Temporal characteristics of headache must be known to prescribe the appropriate drug for the treatment of migraine attacks. In this study, we aimed to reveal the temporal characteristics of headache and to search whether or not these characteristics differ in patient subgroups in migraineurs admitted to a tertiary health center.
Methods: Consecutive adult migraineurs who admitted to the Headache Section of Kocaeli University Faculty of Medicine Research Hospital involved the study. Their demographical data, medical history and temporal caharacteristics of headaches were questioned.
Results: Thirty (19.6%) patients among the 153 migraineurs involved had chronic daily headache. Headaches were detected to reach the maximum pain intensity within 2 hours in 34 patients (22.2%) and to continue over 24 hours in 87 (56.9%) patients. Patients with headaches lasting over 24 hours had a greater mean age than of those with headaches ending within 24 hours (40.8±12.4 and 36.2±11.4, respectively; p=0.019). The mean disease age of the patients with headaches lasting over 24 hours was also greater than of the group with headaches ending within 24 hours.
Conclusion: Our study revealed that temporal characteristics of headache may differ in patient subgroups in adult migraineurs. Further studies with large populations are warranted to verify these results and determine which temporal characteristics are common in which patient subgroups.

Herpes zoster primarily affects the posterior root ganglions and sensorial nerve fibers, and causes vesicular skin eruptions, radicular pain and loss of sensorial function along the distribution of the affected ganglion. Motor involvement can also be observed. When classical cutaneous lesions are present, the motor paresis consequent to herpes zoster is easily diagnosed. However, diagnosis becomes complicated when the motor weakness is the earlier sign and precedes the cutaneous lesions and sensory symptoms. We present a case in whom the major clinical symptom and sign was the motor weakness in cervical radiculopathy consequent to herpes zoster.