Objective: Complementary and alternative medicine (CAM) is increasingly being used as adjunctive treatment in primary headache syndromes in many countries. In the Turkish population, no epidemiologic data have been reported about awareness and usage of these treatments in patients with headache.
Methods: One hundred and ten primary headache patients attending three headache clinics completed a questionnaire regarding their headaches, the known modalities and the use and effect of CAM procedures for their headaches.
Results: The mean age of the patients was 34.7±9.6 years (32.8-36.5). Almost two-thirds of patients had completed high school and university, and one-third of patients were housewives. Migraine without aura (45.5%) was the most frequently diagnosed type of headache followed by migraine with aura (19.1%) and tension-type headache (18.2%). In 43.6% of the patients, headache frequency was 5-10 per month. The most frequently known CAM modalities were massage (74.5%), acupuncture (44.5%), yoga (31.8%), exercise (28.2%), psychotherapy (25.5%), and rosemary (23.6%). The most frequently used CAM treatments were massage (51%) and exercise (11%). Only massage was reported to be beneficial in one-third of the primary headache patients; the other modalities were not.
Conclusion: Our findings suggest that the subgroup of primary headache patients in Turkey seek and use alternative treatments, frequently in combination with standard treatments. Neurologists should become more knowledgeable regarding CAM therapies; further randomized and controlled clinical researches with large sample sizes are needed.

Objective: We aimed to evaluate the effectiveness of subcutaneously implanted epidural ports (SIEP) in the management of patients with advanced-stage gynecologic cancer-related severe chronic pain who do not respond to intravenous tramadol infusion, transdermal fentanyl, and oral morphine administration or who cannot tolerate the unacceptable and unmanageable side effects of these drugs.
Methods: In this prospectively designed study, SIEP to permit the administration of morphine were implanted for relief of severe chronic pain in 21 cases with stage IV gynecological cancer (ovarian [n=6], endometrium [n=3], cervix [n=10], vaginal [n=1], and vulvar [n=1]). In order to define the level of pain, visual analogue scale (VAS) and patient satisfaction score (PSS) were used before and on the 5th, 15th, and 30th days after epidural port application.
Results: The mean overall survival period of the cases undergoing epidural port application was 80 days (range: 31-560). In terms of pain parameters, values at the end of the 5th, 15th and 30th days (VAS2, VAS3 and VAS4) were significantly lower than the value before morphine application via SIEP (VAS1) (p<0.01). PSSs at the 5th, 15th and 30th days were significantly higher than the PSS before port implantation (p<0.05). Pain management was started with 2 mg morphine with a maximum of 4 mg morphine administered into the epidural space per day. No clinically detected infectious condition or morphine-related side effects that required treatment occurred during the follow-up.
Conclusion: Morphine administration via SIEP provided excellent pain relief without creating side effects, increased patient quality of life, and contributed to the patient’s ability to enjoy life.

Objective: Adequate pain management following day-case surgery allows early ambulation of patients. In this study, we aimed to compare postoperative analgesic efficacy of intravenous (iv) dexketoprofen vs. iv paracetamol following day-case operative hysteroscopy.
Methods: One hundred and fourteen American Society of Anesthesiologists (ASA) I-II patients scheduled for day-case operative hysteroscopy were recruited and randomized to three groups in the study. Group D received 50 mg iv dexketoprofen trometamol, Group P 1000 mg iv paracetamol and Group C normal saline solution. Visual Analogue Scale (VAS) pain intensity, pain relief, sedation, nausea-vomiting, other side effects, and additional opioid analgesic requirement were noted at postoperative 15 minutes (min), 30 min, 1 hour (h), 2 h, and 3 h. Patients with VAS ≥40 mm received meperidine 0.25 mg/kg as rescue analgesic medication.
Results: VAS scores at 15 min, 30 min, 1 h, and 2 h were significantly lower in Group D compared to Group C. VAS scores at 15 min and 30 min were significantly lower in Group D compared to Group P. The percentages of patients who required opioid treatment were 34%, 60%, and 63% in Groups D, P and C, respectively (p<0.05). Total delivered opioid dose was 0.10±0.16 mg/kg, 027±0.33 mg/kg and 0.28±0.25 mg/kg in Groups D, P and C, respectively (p<0.05). Pain relief score was significantly better in Group D at postoperative 15 min when compared with Group C (p<0.05).
Conclusion: Our study demonstrated that iv dexketoprofen has superior efficacy for postoperative pain management following day-case operative hysteroscopy when compared with paracetamol and placebo.

Objective: Non-steroidal anti-inflammatory drugs (NSAIDs) are recommended for multimodal postoperative pain management. The purpose of this study was to evaluate the postoperative pain relief and opioid-sparing effects of dexketoprofen and lornoxicam after major orthopedic surgery.
Methods: After obtaining ethical committee approval and informed consent, 120 patients undergoing elective hip or knee replacement under general anesthesia were randomized to receive two intravenous injections of 50 mg dexketoprofen (GD), 8 mg lornoxicam (GL) or saline as placebo (GP) intravenously. Postoperatively, patient-controlled analgesia (PCA) morphine was started as a 0.01 mg.kg-1 bolus dose, with lockout time of 10 minutes without continuous infusion. Pain assessment was made using the Visual Analogue Scale (VAS) at rest or during movement at postoperative 1, 2, 4, 6, 8, 12, and 24 hours.
Results: The three groups were similar in terms of age, gender, American Society of Anesthesiologists (ASA) class, number of patients who underwent hip or knee surgery, weight, height, and operation duration. Patients in GD and GL demonstrated significantly reduced pain scores at rest and active motion compared to GP, with lower scores in the dexketoprofen group. Patients in GD and GL used significantly less morphine in the postoperative period compared to GP. The total morphine consumption of patients in GD was lower than in GL.
Conclusion: Intravenous application of 50 mg dexketoprofen twice a day and 8 mg lornoxicam twice a day improved analgesia and decreased morphine consumption following major orthopedic surgery. When the two active drugs were compared, it was found that dexketoprofen was superior to lornoxicam in terms of analgesic efficacy and opioid consumption.

Objective: The aim of this study was to compare the pre-emptive analgesic efficacy of intravenous (IV) dexketoprofen trometamol (DT) and placebo, following impacted mandibular third molar surgery.
Methods: Twenty patients over 18 year old who needed bilateral lower third molar extractions were included in this prospective, randomized and placebo-controlled clinical trial. Patients whom had taken DT 50 mg of before their one extraction, took placebo before their other extraction which had been performed on the opposite side. A total of 40 observations were made. Pain scores were evaluated with a Verbal Rating Scale (VRS) after surgery. Moreover; the time to first analgesic requirement use, additional analgesic need of patients, patient and doctor satisfaction, side effects were also determined.
Results: During the first 12 hours, the VRS values in DT group were significantly lower than those of placebo group patients (p<0.05). In placebo group, the time to first analgesic requirement use was significantly earlier than that of patients in DT group (p<0.05). Additional analgesic need of placebo group were significantly greater, when compared with the analgesic need of DT group patients (p<0.05). Among the DT group patients, patient and physician satisfaction was greater, which was statistically significant (p<0.05).
Conclusion: Preemptive use of IV DT is more effective than placebo for using as preemptive analgesia for acute postoperative pain control in patients underwent removal of an impacted mandibular third molar surgery.

Anesthetizing the lumbar plexus at its origin facilitates a more “complete” psoas compartment block compared to peripheral approaches. It is usually performed using surface anatomical landmarks, and the site for local anesthetic injection is confirmed by observing quadriceps muscle contraction to peripheral nerve stimulation. Ultrasound may provide guidance alone or together with the aid of nerve stimulation during nerve blocks. We present a 48-year-old male patient, American Society of Anesthesiologists (ASA) physical status II, who refused spinal anesthesia, and underwent knee arthroscopy with ultrasound-guided psoas compartment block and general anesthesia. Following the standard monitoring and lateral decubitus positioning, the vertebral body, psoas, erector spinae, and quadratus lumborum muscles and hyperechoic nerve roots of the patient were visualized at the level of L4-5 with curvilinear ultrasound probe. The needle was inserted with ultrasound guidance, and correct tip position was confirmed with quadriceps contraction. Then, the mixture of 30 mL local anesthetic (10 mL 2% lidocaine and 20 ml 5% levobupivacaine) was injected at the estimated position of the lumbar plexus (junction of the posterior third and anterior two-thirds of the psoas muscle). He also received general anesthesia for the surgery. Anesthesia and surgical procedures were completed successfully without any additional anesthetic/analgesic requirement or complication. The postoperative period was pain-free both at rest and during mobilization for 24 hours. This case report shows that ultrasound-guided psoas compartment block is feasible and efficient for peri- and postoperative analgesia during knee arthroscopy.

Recent advances in surgical and anesthetic techniques have facilitated general anesthesia and surgical possibilities in the higher-risk patient group. Although general anesthesia is the only preferred approach for breast surgery, there have been many clinical trials about breast surgery that has been achieved with regional anesthesia techniques. It is known that regional anesthesia application decreases the preoperative stress, postoperative morbidity and mortality. Additionally, this application positively affects the early start of feeding and mobilization. Regional anesthesia techniques like high thoracic epidural anesthesia, cervical epidural anesthesia and paravertebral block have been applied successfully in mastectomy operations. Combined thoracic epidural anesthesia-interscalene block technique may also be a good alternative to general or cervical, high thoracic epidural anesthesia. We aimed herein to present a case who underwent successful mastectomy and axillary dissection under combined thoracic epidural anesthesia-interscalene block.

A circumcision was planned for a four-month-old infant under local anesthesia. After the application of lidocaine, the infant stopped crying, and then generalized tonic-clonic convulsions and a diffuse erythematous rash developed. The patient was immediately monitored, ventilation was provided, and 1 mg midazolam was given intramuscularly. After insertion of a cannula, sodium thiopental 50 mg was given intravenously, the patient’s convulsions were controlled, and endotracheal intubation was performed. The patient was extubated 30 minutes later. However, the patient was re-intubated due to his noisy breathing, and 10 mg prednisolone was given intravenously due to mild edema seen in the larynx during endotracheal intubation. Two hours after the second intubation, the patient started to breath spontaneously and opened his eyes; he was extubated and transferred to the intensive care unit. Two days later the patient was discharged. Systemic toxicity to the local anesthesia was considered in this patient. All precautions need to be considered during the application of local anesthesia in pediatric patients, including proper indication, monitoring of the patient in the preoperative period, establishment of venous access, and readiness to apply cardiopulmonary resuscitation in the event of local anesthetic toxicity. The maximum dose of local anesthesia should be considered and it should be diluted during application.