Amaç: Bu çalýþmanýn amacý periodontal hastalýklarda profilaktik bileþen olarak eklenen Anadolu propolisinin analjezik etkisinin deðerlendirilmesidir.
Gereç ve Yöntem: Su, etanol ve asetondan ekstre edilmiþ Anadolu propolisi hazýrlandý. Ekstrelerin analjezik etkisi fare tail-flick testi ile deðerlendirildi (n=6 her bir ekstre için). Gruplar arasý karþýlaþtýrmalar için tek yönlü ANOVA, sonrasýnda ise data gruplarý ortalamalarýnýn arasýndaki belirgin farklarýn saptanmasý amacýyla post-hoc Scheffe's testi uygulandý. P<0.05 anlamlýlýk sýnýrý olarak kabul edildi.
Bulgular: Sudan ekstre edilmiþ Anadolu propolisi tail-flick testi ile farelerde latens sürenin belirgin þekilde 1.61 kat artýþýna neden oldu (p<0.001). Ancak, aseton ve etanol den ekstre edilmiþ propolisin belirgin bir etkisi ortaya konamadý.
Sonuç: Anadolu propolisinin analjezik etkisi kanýtlandý. Propolisin diþ macunlarýnda kullanýlmasý diðer olumlu etkileri ile beraber analjezik açýdan da faydalý olabilir.

Objective: The aim of the present study was to assess the analgesic effect of Anatolian Propolis, which is added to toothpastes as a prophylactic component for periodontal diseases.
Methods: Water, ethanol and acetone extracted Anatolian Propolis were prepared. Analgesic effect of the extracts was assessed using the tail-flick test in mice (n=6 per each extract). Comparison among groups were made by using one-way ANOVA, followed by post-hoc Scheffe's test to determine significant differences among the means of the data groups. P<0.05 was accepted as significant difference.
Results: We found that water extracted Anatolian Propolis caused a significant increase, 1.61 fold increase (p<0.001 versus control), of the latency time using tail-flick test in mice. However, acetone extracted and ethanol extracted propolis led no significant effect.
Conclusion: We proved the analgesic effect of water extracted Anatolian Propolis. Thus, propolis used in the composition of toothpastes may be beneficial in terms of its analgesic action in addition to its other favorable effects.

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Amaç: Çalýþmanýn amacý saðlýklý gönüllülerde sural sinire perinöral olarak uygulanan tramadolün sinir iletimi üzerine doz baðýmlý bloke edici etkinliðinin olup olmadýðýnýn araþtýrýlmasýdýr.
Gereç ve Yöntem: 24 bilgilendirilmiþ saðlýklý denek eþit olarak 4 gruba [Salin (plasebo), % 0.5 tramadol, %1 tramadol and %1.5 tramadol] ayrýldý. Çalýþma çift kör olarak tasarlandý. Duyusal sinir aksiyon potansiyelleri elektronörografik olarak kaydedildi. 2 ml’lik çalýþma solüsyonu sinir stimülatörü yardýmý ile ayak bileði düzeyinde sural sinire perinöral olarak enjekte edildi. Ýzleyen kayýtlamalarda duyu yanýtý amplitüdünün bazal deðerin % 80’inin altýna inmesi durumunda duyusal blok oluþtuðu kabul edildi.
Bulgular: Elektronörografik kayýtlara göre salin grubundaki hiçbir denekte blok geliþmedi. Bununla birlikte, % 0.5, % 1 ve % 1.5 tramadol ile blok geliþim oranlarý sýrasýyla 1/6, 4/6 ve 6/6’ydý. Baþlangýç düzeylerine göre duysal aksiyon potansiyeli amplitüdlerinin ortanca deðerlerindeki maksimum azalma salin grubunda %7.8, %0.5 tramadol ile %12.5, %1 tramadol ile %38.5 ve %1.5 tramadol ile %77.5’di (p<0.05). %0.5 tramadol ile duysal blok süresi 5 dakika iken, %1 tramadol ile 15 dakika ve % 1.5 tramadol ile 35 dakikaydý.
Sonuç: Perinöral olarak sural sinire uygulanan tramadol doz baðýmlý olarak duyu sinir iletimini bloke etmektedir.

Objectives: The aim of this study was to investigate whether tramadol had a dose dependent blocking effect on nerve conduction when administered perineurally to the sural nerve of healthy volunteers.
Methods: 24 informed healthy subjects were randomized into four equal groups [Saline (placebo), 0.5% tramadol, 1% tramadol and 1.5% tramadol]. The study was designed to be double-blinded. Sensory nerve action potentials were recorded electroneurographically. Two mililiters of study solution was administered to sural nerve perineurally at the level of ankle by the guidance of a nerve stimulator. A sensory block was assumed to have developed when the amplitude of the averaged sensory nerve action potentials diminished below 80% of the baseline value in the subsequent recordings.
Results: According to electroneurographical recordings, none of the volunteers in saline group had block. However, the block rates with 0.5%, 1% and 1.5% tramadol were 1/6, 4/6 and 6/6 respectively (p<0.05). The maximum decrement in the sensory action potential amplitudes with respect to baseline amplitudes given as median values were as follows: 7.8% with saline; 12.5% with 0.5% tramadol; 38.5% with 1% tramadol and 77.5% with 1.5% tramadol (p<0.05). While the median duration of sensory block with 0.5% tramadol was 5 minutes, it was 15 minutes with 1% tramadol and 35 minutes with 1.5% tramadol.
Conclusion: Perineurally administered tramadol blocks sensory nerve conduction of sural nerve in a dose dependent manner.

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Amaç: Elektif sezaryenlerde, spinal anestezide intratekal morfin, fentanil yada kombinasyonlarýnýn randomize, çift kör kontrollü olarak karþýlaþtýrýlmasý amaçlandý.
Gereç ve Yöntem: Elektif sezaryenlerde 0.5% hiperbarik bupivakain ile spinal anestezi uygulanan 60 gebeye randomize olarak intratekal morphine 0.2 mg, fentanyl 25 μg, yada fentanyl 12.5 μg ile beraber morphine 0.1 mg uygulandý. Spinal bloðun baþlangýcý, T10 seviyesine ulaþma zamaný, duyusal ve motor bloðun en üst seviyelerduyusal bloðun T10’a gerilemesi, motor bloðun gerilemesi, cerrahi özellikler, maternal yan etkiler, Apgar ve NAKS skorlarý, umblikal kan gaz analizlari, ilk analjezik gereksinim zamaný kaydedildi.
Bulgular: Ýntraoperatif dönemde hiçbir hastada aðrý görülmedi. Sensoriyal ve motor bloðun derecesi ve süresi her üç grup arasýnda benzer olup T10’a gerileme ve motor bloðun kalkma zamanlarý arasýnda fark bulunmadý. Postoperatif ilk analjezik gereksinim zamaný fentanilin tek baþýna kullanýldýðý grupta diðer gruplara göre çok kýsa olup aralarýndaki fark istatistiksel olarak anlamlý idi. Postoperatif yan etkiler ve hemodinamik etkiler açýsýndan her iki grup arasýnda fark yoktu. Neonatal bulgular açýsýndan APGAR ve umblikal kan gazý deðerlerinde fark bulunmadý.
Sonuç: Postoperatif analjezide morfinin fentanile göre üstün olduðu; bupivakain/morfin kombinasyonuna fentanil eklenmesinin de ek klinik yarar saðlamadýðý kanaatine varýldý.

Objectives: This randomised double-blind controlled trial examines the effects of fentanyl and morphine, alone and in combination, as adjuncts to spinal anesthesia for elective Cesarean section.
Methods: Sixty women undergoing elective Cesarean section, with spinal anesthesia using 0.5% hyperbaric bupivacaine were randomly allocated to receive morphine 0.2 mg, fentanyl 25 μg, or fentanyl 12.5 μg plus morphine 0.1 mg, intrathecally. The start of spinal block, the time to T10 level, the highest sensorial and motor block level, time to regresion of sensory block to T10, the time to resolution of motor block, surgical characteristics, maternal side-effects, Apar and NACS scores, umbilical blood gas evaluations, time to first analgesic requirement were recorded.
Results: There was no patient having pain during the intraoperative period. The degree and time of sensorial and motor block was similar in both groups and there was no difference in the time to T10 level and the time to reversal of motor block. The difference in time to first postoperative analgesic requirement was statistically significant. There was no difference between groups in postoperative side effects. There was no neonatal difference in Apgar, NACS and umbilical blood gas evaluations.
Conclusions: The quality of postoperative analgesia with morphine, when used alone, was found to be superior to that with fentanyl. The combination of opioids offered no advantages over morphine alone.

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Amaç: Yaygýn bir sorun olan aðrýnýn kontrol altýna alýnmasýnda aðrý ve aðrý inançlarýný etkileyen faktörlerin bilinmesi önemlidir. Bu çalýþmanýn amacý yetiþkin nüfusta aðrý ve aðrý inançlarýnýn sosyo-demografik ve ekonomik özelliklerle iliþkinin deðerlendirilmesidir.
Yöntem: Tanýmlayýcý-kesitsel türdeki bu çalýþma 18-65 yaþ arasý 131 birey ile yapýlmýþtýr. Verilerin toplanmasýnda sosyo-demografik ve ekonomik durum ile aðrýya iliþkin özellikleri deðerlendiren anket formu ve Aðrý Ýnançlarý ölçeði kullanýlmýþtýr.
Bulgular: Araþtýrma grubunun % 78.6’sý son bir yýl içinde aðrý yaþarken, % 38.8’i kronik aðrý yakýnmasý vardýr. Lojistik regresyon analiz sonuçlarýna göre yaþam boyunca sýklýkla aðrý yaþama için 30-65 yaþ grubunda yer almak (OR: 0.215 p=0.008 ) ve eðitim düzeyinin ilkokul ve daha düþük düzeyde olmasý (OR: 3.427 p=0.021); son bir yýl içinde aðrý yaþama için cinsiyetin kadýn olmasý (OR= 3.003 p=0.016 ) ve evli olma (OR: 4.550 p=0.005); kronik aðrý yaþama içinse 30-65 yaþ grubunda yer almak (OR=3.027 p=0.027) ve düþük gelir (OR=4.932 p=0.001) risk faktörleri olarak belirlenmiþtir. Organik ve psikolojik aðrý inançlarý puaný benzer olmakla birlikte sosyo-demografik ve ekonomik belirleyicilerin ölçeðin organik boyutu için anlamlý olmadýðý (p>0.05); düþük gelirin psikolojik inançlarý %11 oranýnda belirlediði görülmektedir (R2=0.115, p<0.05).
Sonuç: Araþtýrmada sosyo-demografik ve ekonomik durumun aðrý yaþama için risk faktörü olduðu ve aðrý inançlarýna yönelik kültürel faktörlerin deðerlendirilmesi gerektiði sonucuna ulaþýlmýþtýr.

SUMMARY
Objective: In order to control pain which is a prevalent problem, to get knowledge regarding pain and pain beliefs is crucial. The aim of this study was to evaluate the correlation between pain, pain beliefs and the socio-demographic, economic characteristics at the adult population.
Methods: This descriptive, cross-sectional study was completed with 131 individuals between 18-65 ages. A questionnaire form, evaluating socio-demographic and economical status, pain traits as well, and Pain Beliefs Scale were used for data collection.
Results: 78.6% of the research group experienced pain within last one year; of 38.8% suffered from chronic pain. According to the results of logistic regression analysis, the risk factors were determined as being between 30-65 age groups (OR: 0.215 p=0.008 ) and had graduated from elementary school and lower education level (OR: 3.427 p=0.021) for experiencing life long frequent pain; being female (OR= 3.003 p=0.016 ) and married (OR: 4.550 p=0.005) for experiencing pain within last one year; being between 30-65 age groups (OR=3.027 p=0.027) and had a lower income (OR=4.932 p=0.001) for chronic pain. However the organic and psychological pain beliefs scores were similar, socio-demographic and economic determinants were not significant for organic subscale (p>0.05); lower income determined 11% of psychological subscale (R2=0.115, p<0.05).
Conclusions: The conclusions obtained from the research was that socio-demographic and economic status were risk factors for experiencing pain, and cultural factors related to pain beliefs warrant investigation.

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Tanýmlayýcý tipte yapýlan bu çalýþmada hastalarýn ameliyat sonrasý yaþadýklarý aðrýya hemþirelerin yaklaþýmlarýna iliþkin görüþleri ile bu yaklaþýmlardan memnuniyet düzeylerini belirlemek amaçlandý. Araþtýrmada veriler araþtýrmacýlar tarafýndan hazýrlanmýþ iki anket formu ile toplandý. Elde edilen veriler SPSS paket programýnda sayý, yüzdelik ve ki-kare testi ile deðerlendirildi. Çalýþmaya katýlan 360 hastanýn %61.4’ü kadýn, %83’ü 40 yaþ üstü; %88’i düþük eðitimliydi. %60.4’ünün ameliyat deneyimi yoktu. Hastalarýn %30.6’sýna kalp-akciðer (KVC), %25.5’ine GÝS ameliyatý yapýldýðý belirlendi. Hastalarýn %96.4’ünün öksürürken, %81.9’unun yataktan kalkarken aðrý yaþadýklarý, yaþadýklarý aðrý nedeniyle %96.4’ünün öksürme, %78.3’ünün hareket etme ve %46.7’sinin soluk alma sýrasýnda zorlandýklarý bulundu. KVC, TAH+BSO, GÝS ameliyatý olan hastalarýn, öksürürken ve yataktan kalkarken, diskektomi yapýlan hastalarýn yürürken daha çok aðrý yaþadýklarý ve ameliyat türü ile yaþanýlan aðrý (p< 0.05 ), hastalarýn ameliyat sonrasý yapmakta zorlandýðý aktiviteler ve ameliyat türü arasýnda (p< 0.05 ) anlamlý iliþki olduðu bulundu. Çalýþmada hastalar hemþirelerin aðrý ölçeði kullanmadýðýný, aðrýyý nasýl rahatlatacaðý hakkýnda bilgi vermediðini, aðrýya neden olan aktiviteler sýrasýnda ne yapýlmasý gerektiðini göstermediðini, aðrýyý azaltacak pozisyon almasýna yardým etmediðini, non-farmakolojik yöntemleri kullanmadýðýný söyledi. Ancak hastalarýn tamamý hemþirelerin aðrýyý hafifletmek üzere yaptýðý analjezik uygulamasýndan memnundu.

In the study that was carried out as defining, it was aimed to determine options related to nursing practices about postoperative pain experiencing by patients and satisfaction of patients about these practices. Data were collected by two questionnaires that was prepared by researchers. Collected data were evaluated with Chi-square and number, frequency tests. 360 patient participating in this study of them 61.4% were women, 83% over 40 years old and 88% had low education. 60.4% had not surgery experience. It was determined that 30.6% of patients had undergone heart-lung (CVS) and 25.5% gastrointestinal system operation. It was found that 96.4 % of patients had experienced pain while were coughing and 81.9% getting up from the bed and difficulty 96.4%, to coughing 78.3%, mobilization and 46.7% breathing because of postoperative pain.
In the study it was found that patients undergoned CVS, TAH+BSO, GÝS operation had experienced more pain while they were coughing and getting up from the bed, patients undergoned dischectomy while they were walking, There were significant difference between types of operation and pain (p<0.05) and activities that patients had difficulty to do and types of operation (p<0.05). The patients said that nurses didn’t use a pain scala, give information about how pain was relieved, show what was needed to do during the activities that cause pain, help the patients to position for relieving the pain, use non-pharmacological interventions. But all of the patients were satisfied with analgesic that was administered by nurses to relieve the pain.

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Pregabalin ve gabapentin, göreceli güvenilirlikleri ve kolay tolere edilebilmeleri nedeniyle kullaným alaný giderek geniþleyen antikonvülzan, analjezik ve anksiyolitik ajanlardýr. Buna karþý; baþ dönmesi, somnolans, doz baðýmlý periferik ödem ve kilo artýþý gibi yan etkileri ilaç kesilmesine neden olabilmektedir. Ayrýca, literatürde ciddi kronik hastalýk öyküsü ve kardiyak öyküsü olan yaþlý hastalarda kalp yetmezliði geliþtiðine dair az sayýda olguya rastlanmýþtýr. Bu olguda, kardiyak öyküsü olmayan ve nöropatik aðrý nedeniyle 300mg/gün pregabalin sonrasý öncelikle periferik ödem ve sonrasýnda ileri tetkiklerde tespit edilen santral ödem tablosu geliþen bir hasta sunulmaktadýr. Pregabalin kesilmesi sonrasý tablonun gerilediði gözlenmekle birlikte önerilen dozlarda baþlanan gabapentinle de periferik ödem geliþmiþtir. New York Kalp Cemiyeti sýnýf III-IV kalp yetmezliði olan hastalarda pregabalin reçete edilirken dikkatli olunmasý konusunda uyarmýþtýr. Etki mekanizmalarý henüz netlik kazanmamýþ olmakla birlikte kalsiyum kanallarý üzerindeki etkileri bu yan etkilerle iliþkili olabilir. Sonuç olarak, giderek artan hýzda kullanýlan bu ilaçlarýn yan etkiler açýsýndan ileri kardiyak hastalar dýþýnda da yakýndan takip edilmesi gerektiði kanaatindeyiz.

Pregabalin and gabapentin are widely used analgesic, anticonvulsant and anxiolytic agents as they are relatively reliable and easily tolerable. However, use of them may cause some side effects such as dizziness, somnolance, dose dependent peripheral edema and weight gain which may cause to give up the use of them. Besides, there are few reports in literature addressing old aged patients with serious chronic disease and cardiac history, develope heart failure during pregabaline application. In this case, we present a patient, without a cardiac history, treated with 300 mg/kg pregabalin due to neuropatic pain, developed peripheral and then central edema which were determined after advanced investigations. After quitting pregabalin the situation regressed. Then, peripheral edema has developed associated with recommended dose of gabapentin use instead of pregabalin. Despite the presence of any published evidence, New York Heart Association issued a warning about being careful when prescribing pregabalin to type III-IV heart failure patients. Though the effect mechanisms of pregabalin and gabapentin are not well known, calcium channel relationship may led to these side effects. In summary, we believe that pregabalin and gabapentin, which is mostly used nowadays, should be administered with care not only in patients with advanced cardiac pathology but also in all patients due to its potential side effects.

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Akut herpes zostere (AHZ) baðlý postherpetik nevralji (PHN) geliþme insidansý % 48–75 arasýndadýr. Herpes zosterin akut fazýnda uygulanan sinir bloklarý ile hem aðrýnýn kontrolü saðlanmakta hem de PHN geliþimi önlenebilmektedir. Burada göz çevresinden baþlayýp saçlý deriye doðru supraorbital ve supratroklear sinir hatlarý boyunca uzanan veziküllerle birlikte görülen akut herpes zostere baðlý nevralji tedavisinde modifiye van-Lint blokajýnýn uygulandýðý iki hasta aktarýlmaktadýr. Sað göz çevresinden baþlayýp alýndan saçlý deriye uzanan aðrýlý veziküllerle seyreden akut herpes zoster tanýlarýyla takip edilen 72 ve 66 yaþýnda iki kadýn hasta kliniðimize aðrý tedavilerinin düzenlenmesi için kabul edildi. Klinik þikâyetleri uyuþukluk, hipoestezi, yanma, zonklama ve þiddetli aðrý olan hastalarýn ilk vizüel analog skala (VAS) deðerleri 9 ve 10’du. Medikal tedavileri asiklovir ve asetaminofen ile düzenlenen, klasik sinir blokajý uygulanacak bölgelerde aktif vezikülleri bulunan hastalara 5 mL %1 lidokain ile modifiye van-Lint sinir blokajý uygulanmasý planlandý. Enjeksiyonunun ardýndan VAS skorlarý 1’e gerileyen hastalara 1 hafta sonra ayný yöntemle iþlem tekrarlandý. 2. enjeksiyondan önce hastalarýn veziküllerinde sönme ve kurutlanma tesbit edildi, hipoestezi, yanma ve zonklamanýn geçtiði, uyuþukluðun ise azalarak devam ettiði hastalarda VAS skorlarý 4 ve 5 olarak kaydedildi. 2. enjeksiyondan sonra uyuþukluk þikâyetleri geçen, VAS skorlarý 1 ve 2’ye gerileyen hastalarýn 3 aylýk takiplerinde ek analjezik ihtiyaçlarýnýn da kalmadýðý tespit edildi. Göz çevresinden saçlý deriye uzanan aktif veziküllerle seyreden supraorbital ve supratrochlear sinir hattýnda akut herpes zostere baðlý nevralji tedavisinde modifiye van-Lint tekniði 5 mL %1 lidokain ile güvenle ve etkin olarak uygulanabilir.

Acute herpes zoster (AHZ) causes postherpetic neuralgia (PHN) in 48-75 % of patients. Nerve blocks performed in the acute phase of herpes zoster may treat the pain and prevent PHN development. Here, we present pain relief with modified van-Lint block in two cases with acute herpes zoster involving vesicules on the traces of supraorbital and supratrochlear nerves. Two female patients, 72 and 66 years old respectively, with acute herpes zoster involving vesicules on the traces of supraorbital and supratrochlear nerves starting from right periocular region to scalp presented with symptoms such as hypoaestesia, dizziness, burning, throbbing and severe pain and their initial visual analogue scale (VAS) scores for pain were 9 and 10, respectively. Supraorbital and supratrochlear nerve blockade with modified van-Lint technique was planned as the classical nerve block sites were covered with active vesicules. Following the nerve blocks, VAS scores of both patients were decreased to 1 immediately. Vesicules were faded and scabbed and symptoms such as hypoaestesia, burning and throbbing were recovered, dizziness was relieved and VAS scores were 4 and 5, respectively after one week. VAS scores were 1 and 2, respectively after 2nd injection, and all sypmtoms were resolved and no additional analgesic was required during 3 month follow-up. Modified van-Lint block with 5 mL %1 lidocaine may provide successful pain relief in acute herpes zoster involving vesicules on the traces of supraorbital and supratrochlear nerves.

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Nöropatik aðrý, sinir sisteminin bir kýsmýnýn zedelenmesi, fonksiyonun bozulmasý veya uyarýlabilirliðinin deðiþmesi ile ilgili bir aðrýdýr. Kýrk dokuz yaþýndaki bayan hastanýn sað ön kol kist operasyonu sonrasý sað ön koldan baþlayan aðrýsý vardý. Vizüel Analog Skala (VAS) skoru 10 olarak deðerlendirildi. Medikal tedavide tramadol, gabapentin ve amitriptilin baþlandý. Olgunun þikayetlerinin devam etmesi üzerine Pasha-Cath ile epidural pulse radyo frekans tedavisi uygulanmasýna karar verildi. Olgu þu an iþlem sonrasý 2. yýlda olup VAS 1-2 olarak devam etmektedir. Sonuç olarak, nöropatik aðrýda medikal tedavinin yetersiz kaldýðý durumlarda Pasha-Cath ile epidural pulse radyo frekans uygulamasýyla da etkin bir tedavi saðlanabileceði kanýsýndayýz.

Neuropathic pain, the nerve fibers themselves may be damaged, dysfunctional or injured. A 49-year old female patient experienced right anterior arm pain radiating after the right arm operation. Visual analogue scale (VAS) score was 10. Tramadol, gabapentin and amitriptyline were started as medical treatment. In view of the persisting complaints, epidural pulse radio frequency with Pasha –Cath was scheduled. After 2 years,VAS remained at 1-2. As a result, we concleded that epidural pulse radio frequency with Pasha-Cath is an alternative and effective choice of treatment in neuropathic pain when the medical treatment alone is not sufficient.

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