ISSN: 1300-0012 | E-ISSN: 2458-9446
Volume : 26 Issue : 2 Year : 2025
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Agri - Ağrı: 26 (2)
Volume: 26  Issue: 2 - 2014
1. Front Matter

Pages I - V

REVIEW
2. Case Management Based Multidisciplinary Care Protocol In The Palliative Care Of Cancer Patients
Hanife Özçelik, Çiçek Fadıloğlu, Bülent Karabulut, Meltem Uyar, Hayriye Elbi, Sibel Eyigör, Özen Önen Sertöz, Can Eyigör, Derya Hophancı Bıçaklı, Zehra Çalışkan, Gül Özaydemir, Yasemin Güzel, Yasemin Kuzeyli Yıldırım
PMID: 24943853  doi: 10.5505/agri.2014.93585  Pages 47 - 56
Today, multifaceted approach is needed for the palliative care of advanced stage cancer patients. The main objective for these patients, elimination of pain and other symptoms, psychosocial and spiritual needs are met and to increase the quality of life. We are also faced with the challenge of meeting the physical and psychosocial needs of family members. The purpose of a holistic approach to patient and family who provide effective and quality care, care coordination and case management of a multidisciplinary team approach is based on cooperation. Care protocols specified patient care activities to be carried by the related disciplines to achieve results on a timeline that shows a certain, a multidisciplinary clinical management tool. A lot of care guidelines and protocols developed by a team of experts to contribute to the palliative care activities, and this is thought to be a guiding team members, working with patients.

EXPERIMENTAL AND CLINICAL STUDIES
3. Pain Management of Elderly in Nursing Homes
Filiz Özel, Yasemin Yıldırım, Çiçek Fadıloğlu
PMID: 24943854  doi: 10.5505/agri.2014.41103  Pages 57 - 64
Objectives: The aim of this study was to determine pain management status of the elderly in nursing homes.
Methods: The descriptive study sample included 82 elderly who presented to two nursing homes in İzmir between February-July 2012. In this study, Elderly Identification Form, Mini-Mental Scale, McGill Pain Scale (MAS) and Pain Management Inventory were used as the data collection tool.
Results: It was determined that the highest rates of complaints the elderly individuals had were knee pain (64.6%) and headache (58.5%) in this study. Of the elderly people participating in the study, 96.3% took pain relievers for pain management and according to their statements, of the pain management methods they used, resting and directing attention to something else (X = 5.76 ± 0.87) and taking prescribed pain relievers (X = 5.69 ± 0.87) were very beneficial.
Conclusion: In elderly individuals, it is important to use pharmacological and non-pharmacological methods for pain management. Therefore, it is recommended to determine the most frequently used methods for pain management by the elderly and to integrate them into the care plan.

4. Comparison the Effects of Prilocaine and the Addition of Dexketoprofen and Dexamethasone to Prilocaine for Intravenous Regional Anesthesia
Hale Borazan, Osman Şahin, Mehmet Selçuk Uluer, Ahmet Keçecioğlu, Tuba Berra Sarıtaş, Şeref Otelcioğlu
PMID: 24943855  doi: 10.5505/agri.2014.93064  Pages 65 - 72
Objective: The aim of this study was to compare the anesthetic and analgesic effects of prilocaine alone, prilocaine added dexketoprofen and dexamethasone during intravenous regional anesthesia (IVRA).
Methods: Forty five patients undergoing forearm or hand surgery were randomly assigned to one of three groups to receive (Group P) 3 mg/kg 0.5% prilocaine; (Group PDK) 3 mg/kg 0.5% prilocaine plus 50 mg dexketoprofen; (Group PDM) 3 mg/kg 0.5% prilocaine plus 8 mg dexamethasone in total 40 ml volume for IVRA. The onset and duration of sensory and motor blocks, hemodynamic datas, duration of analgesia and tourniquet, time to first analgesic requirement, visual analog scale (VAS), total analgesic consumption in 24 hours and patient satisfaction score were assessed and recorded.
Results: Time to onset of sensory block was found to be longer in Group P (p<0.05), though no significance was found according to sensory block recovery times amoung groups. Time to onset of motor block was found to be longer and recovery time of motor block was found to be shorter in Group P (p<0.05). Time to first analgesic requirement was found to be longer in Group PDK,and was found to be high in Group PDM than Group PDK(p<0.05). The VAS scores was found to be high and patient satisfaction scale was found to be low in Group P (p<0.05).
Conclusion: The addition of dexketoprofen and dexamethasone to prilocaine during IVRA improves the quality of both anesthesia and analgesia moreover dexketoprofen provides beter postoperative analgesia during the first 24 hour after surgery.

5. Preemptive Analgesic Efficacy of Gabapentin and Nimesulide in the Functional Endoscopic Sinus Surgery
Ertuğrul Kilic, Ayşe Mızrak, Sıtkı Göksu, Mehmet Cesur
PMID: 24943856  doi: 10.5505/agri.2014.25582  Pages 73 - 81
Preemptive analgesia is an important factor in controlling the postoperative pain and avoiding the stress response caused by the surgery. We aim to compare impact of Gabapentin and Nimesulide on postoperative analgesic consumption on the visual analog scale (VAS) as well as any potential side effects, to those of the placebo group.
Ninety patients aged 18–70 under ASA I-II risk, who were to undergo Functional Endoscopic Sinus Surgery (FESS), were included in the study. Patients were randomized into three groups. One hour before the surgery, oral placebo capsules were administered to Group I patients, Gabapentin 1200 mg to Group II patients and Nimesulide 100 mg to Group III patients. Perioperative hemodynamic parameters were measured for all patients. During the first 24 hours of the postoperative period, side effects such as nausea, vomiting, hypotension, hypertension, bradycardia, tachycardia were noted, and the time from end of the surgery to the first diclofenac need was recorded in addition to VAS scores.
In all of the follow-ups for 24 hours of the postoperative period, time from end of the surgery until the first diclofenac requirement; Group 2 > Group 3 > Group 1. Total diclofenac consumption of group 2 was found to be significantly lower than Group 1 and Group 3 on a statistical basis. Postoperative VAS score in Group 2 was lower than Group 1 and Group 3.

To conclude, we believe that Gabapentin or Nimesulide may be safely used preemptively for the purposes of postoperative analgesia after FESS procedures.

6. Effect of Intravenous Dexketoprofen Use on Postoperative Analgesic Consumption in Patients with Lumbar Disc Surgery
Ebru Kelsaka, Fuat Güldoğuş, Erhan Çetinoğlu
PMID: 24943857  doi: 10.5505/agri.2014.47550  Pages 82 - 86
Objective: The objective of this study was to evaluate the postoperative analgesic effect of a preemptive, single-dose intravenous dexketoprofen administration in patients undergoing lumbar microdiscectomy.
Material and Methods: A total of 50 ASA I-II patients candidate to laminectomy were included in this study. They were divided in two groups. Patients in Group A were given 50 mg (2 mL) dexketoprofen and those in Group K 2 mL normal saline intravenously by a blinded anesthesia physician, 10 minutes before the start of intervention. All cases underwent general anesthesia. All patients received postoperative patient-controlled analgesia with tramadol. The VAS scores 1, 4, 8, 16 and 24 hours following the operation, sedation and patient satisfaction scores and tramadol consumption were evaluated.
Results: VAS scores recorded during the first 8 postoperative hours and total tramadol amounts were lower, and the patient satisfaction scores higher, in patients given dexketoprofen than control group. Sedation scores and side effects were similar in both groups.
Conclusion: Single-dose preemptive intravenous dexketoprofen provides effective analgesia especially in the first 8 postoperative hours, reducing tramadol use.

CASE REPORTS
7. The Coexistence of Tolosa-Hunt Syndrome and Diabetic Cranial Mononeuropathy: A Case Report and a Review of Literature
Işıl Yazıcı, Alp Sarıteke, Yaşar Zorlu
PMID: 24943858  doi: 10.5505/agri.2014.89421  Pages 87 - 92
Tolosa-Hunt syndrome(THS) is described as painful ophtalmoplegia caused by nonspesific inflammation of cavernous sinus or superior orbital fissure, which is response to steroid theraphy. Cranial neuropathies in diabetic patients are extremely rare and occur in older patients with poorly controlled diabetes.
56 year old diabetic female patient who developed simultaneous right VI., left III., IV., VI., VII. and maxiller branch of trigeminal nerve palsies with acute periorbital pain applied to our outpatient clinic. Although the coexistence of THS and diabetic cranial neuropathy is an uncommon condition, this should be considered as a possible diagnosis on patients who are admitted with painful ophtalmoplegia and simultaneous multipl cranial neuropathies. We approved to present our diabetic patient with cranial magnetic imaging because of this interesting unity and fasial nerve palsy accompanying to THS.

8. Pain Management With Intrathecal Clonidine In Colon Cancer Patient With Opioid Hyperalgesia: Case Presentation
Lütfiye Pirbudak, Alper Sevinç, Göktürk Maralcan, Ertuğrul Kılıç
PMID: 24943859  doi: 10.5505/agri.2014.37233  Pages 93 - 96
Introduction: Hyperalgesia is normally an increase in the response to a painful stimulant. Opioid-induced hyperalgesia (OIH) is a situation frequently encountered in algology clinics. Its treatment is complicated and problematic and often requires alternative methods.
Case: A 45-kilogram, 40-year-old male patient had been diagnosed with stage IV colon cancer 2.5 years ago. He had used non-steroid antiinflammatory drugs (NSAIDs), opioid analgesics and steroid preparations casually for his increased pain without any monitoring for one year. He was admitted five times for pain control. In the last visit, he complained of severe abdominal, pubic and rectal pain (visual analogue scale [VAS] 8), which was unresponsive to epidural analgesic, and later presented to the algology clinic; he was sleep-deprived, restless and in a panic state. Intrathecal morphine (1 mg) was applied considering his opioid tolerance. Because of increased pain (VAS 8-9) one hour after surgery for abscess in the liver and peritonea, the patient was given intravenous dexketoprofen trometamol and diazem considering his OIH. Then, bolus dexmedetomidine (1 µg/kg) followed by dexmedetomidine infusion (0.2 µg/kg/h) was started. Three days later, diagnostic intrathecal clonidine (30 µg) was applied, and the patient’s complaints regressed. With the patient reporting relaxed pain (VAS 1-2) after 30 minutes, an intrathecal port was placed. Both cancer pain and OIH were controlled with clonidine 90 µg/day. He was more relaxed, and his pain was tolerable until his death.
Discussion-Conclusion: Intrathecal clonidine administration may be an effective method for the treatment of OIH.

9. Complication belong to Stellate ganglion blockade after cervical trauma
Sinem Sarı, Osman Nuri Aydın
PMID: 24943860  doi: 10.5505/agri.2014.41961  Pages 97 - 100
Aim: Stellate ganglion block (SGB) is one of the most often used sympathetic blockade procedure. Despite performed by experienced physicians some complications may occur.
Case: The right brachial plexus injury was diagnosed in the patient who admitted to orthopedia clinic, with weakness in the right arm, and pain after motor vehicle accident. There was no response to medical treatment of fortyfour-years-old female patient and there was loosing of sensation from dis the right elbow joint to fingers on the radial and median nerve tracing. In the electromyelography; C5-T1 root avulsion, and MRI; Patient was evaluated as CPRS I (Complex regional pain syndrome) phase 1. In spite of medical treatment, SGB was performed. Respiratory arrest occurred 4-5 minutes after injection. Patient was breated with mechanical ventilator during 2 hours, and discharged 24 hours later with normal vital functions. One year later, the patient admitted the algology polyclinic with strong pain in the same area. Stellate ganglion Radyofreguency (RF) was planned. The first RF cannula was placed under fluoroscopy. Cerebrospinal fluid was seen in the second canula, and canula was withdrawn. Third cannula was placed in another region, and conventional RF was performed through two canuls. For anatomical structure defect, we planned cervical MR myelography. In the cervical MR myelography, traumatic pseudomeningocele was observed at the level of C6-T1 on the brachial plexus. Intraspinal block was thought to develop during blockade of stellate ganglion due to this.