ISSN: 1300-0012 | E-ISSN: 2458-9446
Volume : 25 Issue : 2 Year : 2025
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Agri - Ağrı: 25 (2)
Volume: 25  Issue: 2 - 2013
EXPERIMENTAL AND CLINICAL STUDIES
1. the comparision of effects intraoperative tramadol and ketamine usage for postoperative pain relief in patient with tonsillectomy
Çiğdem Sizer, İnci Kara, Ahmet Topal, Jale Bengi Çelik
PMID: 23720078  doi: 10.5505/agri.2013.82612  Pages 47 - 54
We aimed to compare effects of ketamine and tramadol administered intraoperatively on postoperative pain and analgesic demand in children undergoing tonsillectomy operations.
Ninety children undergoing tonsillectomy, aging 5-15 years old, ASA I - II admitted in this study. Cases were arranged in three groups and they were given stadardized general anaesthesia. After coagulation, ketamine 0,5 mg.kg-1 intravenously (iv) in ketamine group, 2 mg.kg-1 tramadol iv in tramadol group and serume physiologic iv in control group were given. Duration of anaesthesia, operation and stay in PACU were recorded. NRS and CHEOPS scales were used to assess postoperative pain. Paracetamol, 15 mg.kg-1, was given rectally in the first 6 hours (hrs) and orally over 6 hrs, if NRS greater than 3 and CHEOPS greater than 8 were assessed. All data were recorded concerning with the first, total dosage of analgesic and complications. within 24 hrs.
Demographic data, duration of anaesthesia, operation and stay in PACU were similar between groups (p>0.05). Number of patients required additive analgesic were higher in control group. No differences were found between tramadol and ketamine groups (p>0.05). The time additive analgesic given was earlier in control group (p<0.05), but similar in tramadol and ketamine groups (p>0.05). Paracetamol dosage was significantly higher in control group (p<0.05), but similar between tramadol and ketamine groups (p>0.05). Frequency of nausea and vomiting was found significantly higher in tramadol and ketamine groups (p<0.05).
Postoperative pain was effectively managed using 2 mg.kg-1 tramadol and 0,5 mg.kg-1 ketamine in pediatric tonsillectomies.

2. Spinal anesthesia for elective cesarean section is associated with shorter hospital stay compared to general anesthesia
Fadıl Havas, Mukadder Orhan-sungur, Yılmaz Yenigün, Meltem Karadeniz, Miray Kılıç, Tülay Özkan Seyhan
PMID: 23720079  doi: 10.5505/agri.2013.42204  Pages 55 - 63
Objectives: This prospective study aims to compare the maternal and neonatal effects of spinal and general anesthesia for elective cesarean section.
Methods: Term parturients receiving routine spinal (Group SA, n=95) or general (Group GA, n=93) anesthesia and standard postoperative analgesia for elective cesarean section are included in the study. Operation time, incision-hysterotomy (TS-H) and hysterotomy-umbilical cord clamping (TH-U) intervals, oxytocine requirement, intraoperative fluids, ephedrine requirement, incidence of hypotension, time to first analgesic requirement (Tanalg), pethidine consumption, adverse events, time to first breastfeeding, oral food intake (TOI), flatulence (TF), defecation (TD), mobilization and postoperative hospital stay were compared between the groups. Newborn Apgar scores, umbilical venous blood gas analysis, incidence of hypoglycemia, nutritional support, phototherapy and ventilatory support were also analyzed.
Results: Spinal anesthesia was associated with longer TS-H and TH-U durations, lower oxytocine requirements, higher incidence of hypotension, increased ephedrine and fluid consumption and delayed Tanalg. Furthermore, TOI, TF, TD and postoperative hospital stay was shorter in spinal anesthesia when compared with general anesthesia (48h vs. 52 h respectively, p<0.01). No difference in postoperative analgesic consumption and neonatal outcomes except 1st min Apgar scores and umbilical blood gas analysis was detected.
Conclusion: Spinal anesthesia when compared to general anesthesia shortens postoperative hospital stay with early return of gastrointestinal functions in elective cesarean section.

3. The Effect of Gender and Working Conditions on Pain Threshold in Healty Volunteers
Prof. Dr. Fuat Güldoğuş, Doç. Dr. Ebru Kelsaka, Hemşire Birsen Öztürk
PMID: 23720080  doi: 10.5505/agri.2013.97769  Pages 64 - 68
Aim: The aim of this study was to evaluate the sensorial/affective dimension pain levels of patients with electrostimulation method and investigate the effects of gender/working conditions on pain thresholds.
Material and methods: The sensorial dimension of pain and pain threshold levels of 262 healthy volunteers, ages between 20 and 40 years were assessed by using the Painmatcher machine. Patients were divided into four groups during the assessment period; Group I female medical staff (KS) (woman doctors/nurses), Group II male medical staff (ES) (male doctors), Group III female sanitation workers (KT) and Group IV male sanitation workers (ET).
Results: Sensorial dimension of pain was significantly higher in male and female sanitation workers than female medical staff (p<0.05). Sensorial dimension of pain were similar between male medical staff and female sanitation workers (p>0.05). Pain threshold levels were significantly higher in male sanitation workers than male medical staff (p<0.05). Female sanitation workers and female medical staff had similar pain threshold levels (p>0.05). Correlation between pain threshold levels and sensorial dimension of pain were not significant in Groups KS and ET, however it was significant between groups ES and KT (p<0.05).
Conclusion: Sensorial dimension of pain and pain threshold levels are affected by working conditions rather than gender. Threshold level of pain was high in physically working people.
Key words: Painmatcher, pain threshold, gender.

4. Intracranial Hypotension: A Rare Cause of Orthostatic Headache: A Review of the Etiology, Treatment and Prognosis of 13 Cases
Sibel Güler, Bekir Çağlı, Ufuk Utku, Ercüment Ünlü, Yahya Çelik
PMID: 23720081  doi: 10.5505/agri.2013.97720  Pages 69 - 77
To view the causes, clinical picture, treatment and prognosis of spontaneous intracranial hypotension, a rare cause of orthostatic headache, along with the cases followed in our clinic.
Method: Thirteen cases (6 males and 8 females), diagnosed with spontaneous intracranial hypotension in our clinic between January 1st, 2009 and October 30th, 2011, were included in the study. The presenting symptoms, treatment, findings on cranial magnetic resonance imaging, the pressure of cerebrospinal fluid taken at lumbar puncture (in available patients), and healing period of the patients were recorded.
Results: Five patients with orthostatic headache and accompanying symptoms, treated with bed rest, increase in oral fluid intake, intravenous hydration and caffeine, had a complete recovery. Complete recovery was observed in two patients (15.3%) within 10 days, in another two (15.3%) within 15 days and in one patient (7.6%) within 21 days. Headache and other clinical symptoms significantly regressed within 30 days in four patients (37.6%) who received similar treatment, but a mild headache persisted intermittently during follow-up. As the headache had not resolved after 30 days, epidural blood patch was applied in these four cases (37.6%) and the clinical picture completely improved within 10 to 15 days.
Spontaneous intracranial hypotension should primarily be suspected and contrast-enhanced cranial imaging should be performed in cases complaining about postural headache. It should be kept in mind that there might be cranial nerve paralysis and pyramidal tract signs. At first, conservative treatments should be considered, however if conservative treatments fail, epidural blood patches must be applied.

5. Comparing Efficincies of Diclofenac Sodium and Paracetamol in Patients with Primer Dysmenorrhea Pain by Using Visual Analog Scale (VAS)
Murat Ayan, Ufuk Taş, Erkan Söğüt, Semih Arıcı, Serkan Karaman, Mehmet Esen, Fazlı Demirtürk
PMID: 23720082  doi: 10.5505/agri.2013.42103  Pages 78 - 82
Purpose: In this study, the aim was to compare the efficiencies of diclofenac sodium and paracetamol cure using visual analog scale in the patients applying to emergency room with primer dysmenorrhea.
Tools and method: Group I (n=40) patients diagnosed with primer dysmenorrhea and treated with paracetamol (75 mg intramuscular) and Group II (n=40) patients diagnosed with primer dysmenorrhea and treated with diclofenac sodium (1 g intravenous) were included in this study. In both groups, patients were between 19-30 years old. In all groups, the intensity of the pain was ranked between 0 (no pain) and 10 (intolerable) by using VAS. VAS score of the groups were compared.
Findings: Between two groups, there was not a significant difference statistically in terms of age, mean arterial pressure and pulse values. The VAS values of the first group were higher than that of 2nd group in the beginning. But after the treatment, in the 10th and 30th minutes, the VAS values were lower than that of 2nd group. (p=0.00). The VAS values of the each group in the beginning, on the 10th and 30th minutes were significantly different from each other. VAS values on the 10th and 30th minutes were lower compared to the values in the beginning and the values in the 30th minute was lower according to the 10th minute. (p=0.00).
Result: We can suggest that paracetamol is more efficient than diclofenac sodium in primer dysmenorrhea pain treatment.

CASE REPORTS
6. Episacral Lipoma: A Treatable Cause of Low Back Pain (Case Report)
Hatice Rana Erdem, Barış Nacır, Zuhal Özeri, Aynur Karagöz
PMID: 23720083  doi: 10.5505/agri.2013.63626  Pages 83 - 86
Episacral lipoma is a small, tender subcutaneous nodule occuring mainly over posterior iliac crest. It has been shown to be a significant and treatable cause of acute and chronic low back pain. Episacral lipoma occurs as a result of a tear in the thoracodorsal fascia and the subsequent herniation of a portion of the underlying dorsal fat pad through the tear. This clinical entity is common, and its recognition is simple. The presence of a painful nodule, with disappearance of pain after injection with anaesthetic solution, is diagnostic. Medications and physical therapy may not be helpful. Injection of the nodule with local anaesthetic and steroid solution is effective in treating the episacral lipoma.
Here we describe 2 patients with painful nodules over the posterior iliac crest. One patient complained of severe low back pain radiating to the left lower extremity and subsequently underwent disc operation. The other had been treated for greater trochanteric pain syndrome. In both patients,symptoms appeared to be relieved by local anaesthetic and steroid injection.
The episacral lipoma should be considered more often in the workup and in differential diagnosis of acute and chronic low back pain

7. Eagle Syndrome: Case Report
İrem Fatma Uludağ, Levent Öcek, Yaşar Zorlu, Burhanettin Uludağ
PMID: 23720084  doi: 10.5505/agri.2013.26779  Pages 87 - 89
Eagle syndrome is an aggregate of symptoms caused by an elongated styloid process, most frequently resulting in headache, facial pain, dysphagia and sensation of foreign body in throat. The proper diagnosis is not difficult with clinical history, physical examination and radiographic assessment if there is a sufficient degree of suspicion. The treatment is very effective.
We report here a typical case of Eagle syndrome which was misdiagnosed as trigeminal neuralgia for many years and was treated with carbamazepine. We aim to point the place of Eagle syndrome in the differential diagnosis of facial pain. We also re-emphasize the usefulness of the three-dimensional computed tomography in the diagnosis of Eagle syndrome.
Even though Eagle syndrome is a rare condition, in cases of facial pain refractory to treatment or unexplained complaints of the head and neck region, it should be considered in the differential diagnosis as it has therapeutic consequences.

8. A case of recurrent complex regional pain syndrome accompanying Raynaud’s disease: a prospective coincidence?
Serdar Kesikburun, Zafer Günendi, Koray Aydemir, Ahmet Özgül, Arif Kenan Tan
PMID: 23720085  doi: 10.5505/agri.2013.31932  Pages 90 - 92
Complex regional pain syndrome (CPRS) and Raynaud’s disease are disorders characterized by vasomotor disturbances associating with abnormal autonomic nervous system. We present a case of CRPS I which had a history of recurrence and no initiating event. Raynaud’s disease accompanying with CRPS I was also diagnosed clinically in the patient. It is considered that a sympathetic dysfunction which underlies the pathophysiologies of both disorders may be responsible for coexistence of these two distinct entities. Recurrence and unknown etiology of CRPS I might be accounted for temporary alterations in the sympathetic dysfunction.