Giriþ: Dural ponksiyon sonrasý baþ aðrýsý (DPSB) olgularý, katkýda bulunan faktörler, epidural kan yamasý (EKY) tedavisi ve tedaviye yanýtlarý deðerlendirildi.Bu çalýþmada amacýmýz EKY uygulanan DPSB olgularýný incelemektir.
Metod: Bu retrospektif çalýþmada, EKY uygulanmak suretiyle tedavi edilen 77 DPSB olgusu dahil edildi. Olgular yaþ, cinsiyet, geçirilen operasyonun tipi, kullanýlan iðnenin tipi ve çapý, spinal giriþim sayýsý, EKY uygulamasý sýrasýnda radiküler aðrý, sonrasýnda analjezi kalitesi ve olgu memnuniyeti açýsýndan deðerlendirildi.
Bulgular: 77 olgunun (46 kadýn, 31 erkek) yaþ ortalamasý 31.5 ± 11.3 ve en yaygýn yapýlan cerrahi sezaryan idi. 48 olguda birden fazla giriþim yapýldýðý, 37 olguda 22G, 20 olguda 25 G spinal iðne kullanýlmýþtý. Baþ aðrýsý süresi kadýn hastalarda ortalama 3.1 ± 1.3 gün, erkek hastalarda 4.6 ± 1.3 gündü (p = 0.020). EKY uygulanan olgularda 10. dakikadan itibaren VAS anlamlý derecede azalýrken, olgu memnuniyeti anlamlý olarak arttý (p=0.001). Sadece bir (%1.29) olguda 2 defa EKY’na ihtiyaç duyuldu. Geçici radiküler aðrý EKY yönetiminde 17 olguda (%22.07) oldu, ancak 5-10 dk içinde geriledi. Tartýþma: DPSB’li olgularda EKY özellikle obstetrik olgularda etkin ve güvenilirdir. DPSB semptomlarýnýn bayan hastalarda daha erken görüldüðünü saptadýk. Spinal anestezi uygulamalarýnda 22 G’dan daha küçük çaplý iðneler tercih edilebilir ve birden çok denemeden özenle kaçýnýlabilir.

Purpose: We evaluated post dural puncture headache (PDPH) cases, contributing factors, their treatment with epidural blood patch (EBP) and responses to the therapy.
Methods: In this retrospective study, 77 PDPH cases treated with EBP were included. Patients were evaluated in terms of age, gender, type of surgery, type and diameter of the needle used for dural puncture, number(s) of dural puncture, onset of punctural headache, any conservative therapies for PDPH, number(s) of EBP application, analgesia quality at 10th minute and 2nd hour after EBP application and radicular pain during procedure.
Results: Mean age of 77 patients (46 female, 31 male) was 31.5 ± 11.3, and most common surgery performed was cesarean section. More than one attempt were applied in 48 patients. In 37 cases 22G spinal needle, in 20 cases 25 G spinal needle were used. The mean duration of the headache was 3.1 ± 1.3 days for female patients and 4.6 ± 2.3 days for male patients (p=0.020). VAS significantly decreased and patient satisfaction significantly increased after the 10th minute in patients who had EBP (p=0.001). In only one case (2%) second EBP was needed for pain relief. Transient radicular pain was observed in 17 cases (22.07%) at administration of EBP
Conclusion: . In PDPH cases EBP is an effective and relatively safe method especially in obstetric patients. we reported that the PDPH symptoms were presented earlier in female patients. Preference of small diameter needles less than 22 G and avoiding multiple attempts may be elaborated for spinal anesthesia.

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Amaç: Ýnsizyonel ve intraperitoneal %0.25 levobupivakain kombinasyonunun uygulama zamanýnýn laparoskopik kolesistektomi sonrasý aðrý üzerine etkisinin prospektif, randomize, kontrollü çalýþma olarak araþtýrýlmasý amaçlandý.
Gereç ve Yöntem: Altmýþ altý hasta üç gruptan birine dahil edildi. Grup BS’ye, trokar yerlerine insizyon yapýlmadan önce ve pnömoperitonyumdan hemen sonra levobupivakain uygulandý. Grup AS’ye trokarlar çekilmeden hemen önce intraperitoneal ve operasyon sonunda insizyonel levobupivakain uygulandý. Grup C kontrol grubu olarak kabul edildi. Ýntraoperatif deðiþkenler, postoperatif aðrý saðaltýmý, ek analjezik tüketimi ve hasta memnuniyetine iliþkin veriler karþýlaþtýrýldý.
Bulgular: Ýntraoperatif fentanil tüketimi Grup BS’de Grup AS ve Grup C’ye göre daha az bulundu (p<0.05). Operasyondan hemen sonra VAS skorlarý Grup BS ve Grup AS’de Grup C’ye göre daha düþük saptandý (p<0.05). VAS skorlarý ilk iki saat süresince Grup AS’de Grup C’ye göre anlamlý düþük bulundu. Ek meperidin gereksinimi olan hasta sayýsý ve ortalama meperidin dozu Grup AS’de Grup BS ve Grup C’ye göre daha az saptandý (p<0.05).
Sonuç: Ýnsizyonel ve intraperitoneal levobupivakain kombinasyonunun operasyon öncesi veya sonrasý uygulanmasý postoperatif aðrý, analjezik ve antiemetik gereksinimini azaltmakta ve hasta konforunu artýrmaktadýr. Ayrýca levobupivakainin cerrahi öncesi uygulanmasý intraoperatif fentanil tüketimini azaltýrken, cerrahi sonrasý uygulanmasý postoperatif ek analjezik gereksinimi azaltmasý açýsýndan avantajlýdýr.

Objectives: We aimed to investigate whether timing of administration of the combination of incisional and intraperitoneal 0.25% levobupivacaine has an effect on postoperative pain after laparoscopic cholecystectomy in a prospective, randomized, controlled study.
Methods: Sixty six patients were allocated to one of the three groups. Group BS received levobupivacaine before incisioning trocar sites and intraperitoneal levobupivacaine immediately after pneumoperitoneum. Group AS received intraperitoneal levobupivacaine before trocars were withdrawn and incisional levobupivacaine at the end of surgery. Group C received no treatment. Data of intraoperative variables, postoperative pain relief, rescue analgesic consumption and patient satisfaction were compared.
Results: The intraoperative fentanyl consumption was found lower in Group BS, compared to Groups AS and C (p<0.05). VAS scores were lower in both Groups BS and AS, compared to Group C immediately after the operation (p<0.05). VAS scores were significantly decreased during first two hours in Group AS, compared to Group C. The mean doses and number of patients needing rescue meperidine were lower in Group AS, compared to the Groups BS and C (p<0.05).
Conclusion: The combination of incisional and intraperitoneal levobupivacaine administered before or after surgery can reduce postoperative pain, analgesic and antiemetic consumption together with improved patient satisfaction. However, administering levobupivacaine before surgery might be advantageous for less intraoperative fentanyl consumption, while levobupivacaine after surgery is advantageous for less postoperative rescue analgesic requirement.

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Amaç: Bu çalýþmanýn amacý spinal anestezi ile total diz artroplastisi (TDA) yapýlan hastalarda postoperative 48 saatlik periyotta ultrason (US) kýlavuzluðunda tek doz femoral sinir bloðunun (FSB) aðrý kontrolü, morfin tüketimi, olumsuz etkiler ve hasta memnuniyeti üzerine etkilerini deðerlendirmek.
Metod: Dejeneratif eklem hastalýðý nedeniyle tek taraflý TDA uygulanacak, ASA fiziksel durumu I-III olan 104 hasta bu çalýþmaya dahil edildi. Hastalar rastgele iki guruba ayrýldý: Grup F (n: 51) hastalara US kýlavuzluðunda FSB’da 1: 200,000 epinefrin ilave edilmiþ 40 ml % 0.5 bupivakain, Grup P (n: 53) hastalara ayný metod ile koruyucu serbest salin enjeksiyonu yapýldý. Aðrý skorlarý, morfin tüketimi, olumsuz olaylar ve hasta memnuniyeti 48 saat boyunca deðerlendirildi.
Bulgular: Cerrahi sonrasý ilk 48 boyunca Grup F’ de Grup P ile kýyaslandýðýnda anlamlý olarak daha az morfin tüketilmiþtir (18.7 mg ile 39.6 mg, p< 0.001). Dört, 8, 12, 24 ve 48. saatlerde Grup P ile karþýlaþtýrýldýðýnda Grup F’de hem istirahette hem de hareketle VRS skorlarý anlamlý olarak daha düþüktür (tüm karþýlaþtýrmalar için p< 0.001). Ayrýca hasta memnuniyeti Grup F’de Grup P’den daha iyiydi.
Sonuç: Bu çalýþma US kýlavuzluðunda tek doz femoral sinir bloðunun TDA’ni takiben ilk 48 saatte hasta memnuniyetini artýrdýðý ve morfin tüketimini azalttýðýný göstermiþtir.

Purpose: The purpose of this study is to evaluate the effects of ultrasound (US) guided single-injection femoral nerve block (FNB) on pain control, morphine consumption, adverse effects, and patient satisfaction during the postoperative 48-hour period in total knee arthroplasty (TKA) patients with spinal anesthesia.
Methods: One hundred four ASA physical status I–III patients undergoing single TKA for degenerative joint disease were enrolled in this clinical study. Patients were randomly distributed into two groups: US-guided single-injection FNB with 40 ml of 0.5% bupivacaine and 1: 200,000 epinephrine was administered to Group F (n: 51) patients; preservative-free saline was injected in Group P (n: 53) patients using the same method as Group F. Pain scores, morphine consumption, incidences of adverse events, and patient satisfaction were assessed over the course of 48 hours.
Results: Group F used significantly less morphine compared with Group P (18.7 mg vs. 39.6 mg) during the first 48 hours after surgery (p< 0.001). When compared with group P, the VRS scores both at rest and during movement were significantly lower in Group F at 4, 8, 12, 24, and 48 hours after TKA (for all comparisons p< 0.001). In addition, patient satisfaction was better in Group F than Group P.
Conclusion: This study suggests that a US-guided single-injection femoral nerve block following TKA improves patient satisfaction and reduces consumption of morphine during the first 48 hours.

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AMAÇ: Boyun, omuz ve boyun-omuz aðrýlý olgularda, skapular diskinezi, aðrý ve esneklik arasýndaki iliþkilerin araþtýrýlmasý.
GEREÇ VE YÖNTEM: Çalýþmamýza Baþkent Üniversitesi Hastanesi Fiziksel Týp ve Rehabilitasyon ABD’na boyun ve omuz aðrýsý þikayeti ile baþvurmuþ, patolojik taný almýþ 160 olgu alýndý. Hastalar boyun (n=80, yaþ ort=48.78 ± 15.97, bmi ort= 27.14 ± 4.62 ), omuz (n=54, yaþ ort= 54.01± 14.64, bmi ort=26.28 ± 3.43) ve boyun+omuz (n=27 yaþ ort=51.48 ±15.25, bmi ort=26.13 ± 4.53) aðrýsý gruplarý olmak üzere 3 gruba ayrýldý. Boyun ve omuz aðrý þiddetinin deðerlendirilmesi amacýyla Görsel Analog Skalasý (GAS), eklem hareket açýklýklarýnýn ölçülmesi amacýyla gonyometre, omuz internal ve eksternal rotasyon hareketlerinin esnekliklerinin deðerlendirilmesi amacýyla mezura ile ölçüm yapýldý. Skapular diskineziyi deðerlendirmek amacýyla Lateral Scapular Slide Test (LSST), Scapular Retraction Test (SRT) ve Scapular Assistance Test (SAT) kullanýldý.
BULGULAR: Boyun patolojili olgularda dominant tarafta SRT ve SAT pozitifliði bulunan olgularda dominant olmayan tarafta da SRT (r=0,617, p=0,000) ve SAT (r=0,565, p=0,000) pozitif bulundu. Boyun ve omuz patolojili olgularda, aktivite sýrasýnda boyun+omuz aðrýsý istirahatte ve gece de aðrý devam etmektedir (r=0,572, p=0,002). Her 3 grupta da aðrý þiddeti ile skapular diskinezi arasýnda anlamlý iliþki bulunmadý. Tüm gruplarda LSST (LSST1: X±Sd=0,76±0,74; LSST2: X±Sd=0,68±0,81; LSST3: X±Sd=0,75±0,75) deðerleri 1,5 cm altýnda olduðundan dolayý skapular hareketlilik normal kabul edildi.
TARTIÞMA: Boyun, omuz, boyun ve omuz birlikte olan aðrýlý durumlarda eklem limitasyonlarý ile birlikte skapular diskinezinin de deðerlendirilmesinin aðrý ile iliþkili sorunlarýn çözümünde yol gösterici olacaðýný düþünmekteyiz. Ýleriki çalýþmalarda dahil edilecek gruplarýn patolojiye göre sýnýflandýrýlmasý, mevcut patolojinin skapular diskinezi üzerine etkisini anlamak açýsýndan önemli bir yol çizecektir.

PURPOSE: To investigate the relationship between scapular dyskinesia, pain and flexibility in patients with neck, shoulder and both pain problems.
MATERIAL AND METHOD: 160 patients with pathology and pain at neck and shoulder regions who came to Baskent University Hospital, Department of Physical Medicine and Rehabilitation were included to our study. Patients were divided into three groups; Neck group, shoulder group and neck+shoulder group. Visual Analog Scale (VAS) for pain intensity, goniometer for range of motion and tape measurement for evaluation of flexibility was used. Lateral Scapular Slide Test (LSST), Scapular Retraction Test (SRT) ve Skapular Assisstance Test (SAT) was used for evaluation of scapular dyskinesia.
RESULTS: SRT (r=0,617, p=0,000) and SAT (r=0,565, p=0,000) pozitivity was found correlated between dominant and nondominant sides in patients with neck pathology. Pain at night and during rest are found correlated with pain during activity in patients with neck+shoulder pathology (r=0,572, p=0,002). No significant correlation was found between pain intensity and scapular dyskinesia in all groups. LSST values were found under 1,5cm and therefore scapular mobilization was considered as normal (LSST1: X±Sd=0,76±0,74; LSST2: X±Sd=0,68±0,81; LSST3: X±Sd=0,75±0,75).
DISCUSSION: As well as joint limitations and flexibility, scapular dyskinesia should also be evaluated in order to solve problems related to pain in patients with neck, shoulder and neck+shoulder pathology. In future studies, the classification of groups according to pathology can lead an important way to understand the impact of scapular dyskinesia present on pathology.

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Amaç: Bu çalýþmada, kanser aðrýsýnda transdermal fentanil (TDF) kullanýmýnýn kognitif fonksiyonlar üzerine olan etkisinin incelenmesi amaçlandý.
Gereç ve Yöntem: Etik kurul ve hasta onamý alýnarak daha öncesinde opioid tedavisi almamýþ 50 kanser aðrýlý hasta çalýþma kapsamýna alýndý. Aðrý deðerlendirmesi Vizüel Analog Skala (Visual Analogue Scale-VAS), kognitif fonksiyon muayenesi Addenbrook Kognitif Muayenesi gözden geçirilmiþ versiyonu (Addenbrooke’s Cognitive Examination final revised version -ACE-R) ve günlük aktivite düzeyi Doðu Onkoloji Grubu Performans Ölçütü (Eastern Cooperative Oncology Group Performance Status -ECOG) ile deðerlendirildi, yan etkiler kaydedildi. Hastalarýn ilk baþvurularýnda algolojik deðerlendirmeleri yapýldý ve ACE-R uygulanarak normal kognitif fonksiyon düzeyleri tespit edildi. Olgularda 25 μg/saat TDF ile tedaviye baþlandý, VAS ≤ 2 olacak þekilde tedavilerinin belirli aþamalarýnda doz artýþý yapýldý. 30. günde yeterli analjezik etkinlik saðlandýktan sonra ACE-R yeniden uygulandý. Tüm hastalar kendi aralarýnda, TDF tedavisi öncesi ve sonrasý olmak üzere ACE-R toplam skoru ve alt gruplarý (dikkat-oryantasyon, bellek, akýcýlýk, dil, görsel-mekansal yetenekler) açýsýndan karþýlaþtýrýldý.
Bulgular: Çalýþma sonunda tedavi sonrasý, öncesi ile karþýlaþtýrýldýðýnda dikkat, oryantasyon, bellek, akýcýlýk, dil ve ACE-R toplam skorlarýnda istatistiksel olarak anlamlý artýþ saptandý. Görsel ve mekansal yeteneklerde ise anlamlý bir deðiþme görülemedi. Olgularýn günlük aktivite düzeyi baþlangýca göre deðiþmedi.
Sonuç: Kanser aðrýsýnda TDF kullanýmýnýn kognitif fonksiyonlarda bozulma yapmadýðý görüldü, hatta bazý kognitif test skorlarýnda anlamlý düzelme olduðu saptandý. Aðrýnýn olmamasý da hastalarýn yaþam kalitesini arttýrdý.

Objectives: In this study, we aimed to investigate of using transdermal fentanyl (TDF) effects to cognitive functions in cancer pain.
Methods: After approval informed consent of patients and Ethical Committee, fifty patients with cancer pain who had no opioid treatments before were included in the study. Pain was evaluated with Visual Analogue Scale (VAS), cognitive functions were assessed using by Addenbrooke’s Cognitive Examination final revised version (ACE-R), performance was evaluated with Eastern Cooperative Oncology Group Performance Status (ECOG), adverse reactions were noted.Patients’ algological evaluation had done in first application and the normal cognitive functions were established using by ACE-R. In cases the treatment was began with 25μg/h TDF and certain stages of the treatment dose was increased so that VAS ≤ 2. ACE-R was applied again on 30. day under enough analgesia. All patients were compared with ACE-R total scores and subgroups ( attention-orientation, memory, fluency, language, visuospatial abilities) at before and after TDF treatment in each other.
Results: At the end of the study, attention-orientation, memory, fluency, language, ACER total scores were statistically significant improvement after the treatment than compared to before. No significant change was obtained in visuospatial abilities. No difference was detected in performance status.
Conclusion: The use of transdermal fentanyl for the treatment of cancer pain are not associated with impairments in cognitive performance, even some cognitive test scores significantly improved. The absence of pain increased the quality of life.

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Giriþ: Ultrasonografinin rejyonal anestezi (RA) pratiðine girmesi RA’de önemli geliþme ve deðiþimlere neden olmuþtur. Bu geliþmeler RA uygulama yöntemleri ve blok seçimlerini de etkilemiþtir. Bu çalýþmanýn amacý ülkemizde RA’de kullanýlan araç ve uygulamalar hakkýnda bilgi sahibi olmaktýr.
Gereç ve yöntem: 2011 senesi Ulusal RA Kongresi sýrasýnda kongre katýlýmcýlarýna 10 sorudan oluþan bir anket formu daðýtýldý. Demografik verilerin yaný sýra RA tekniklerinden hangilerini uyguladýklarý ve periferik sinir bloðu uygulamalarýnda sinir lokalizasyonu için kullandýklarý yöntemler soruldu. Katýlýmcýlara RA konusunda aldýklarý eðitimlerini yeterli görüp görmedikleri ve bir RA kursuna katýlýp katýlmadýklarýný soruldu.
Bulgular: Formlar 95 kiþi tarafýndan doldurulmuþtur. En sýk uygulama spinal anestezidir. Periferik sinir bloklarý RA uygulamalarýnýn sadece %12’sini kapsamaktadýr. En sýk uygulanan periferik sinir bloðu ise aksiller bloktur. En yaygýn kullanýlan sinir lokalizasyon yöntemi öncelikle nörostimulasyon ve takiben ultrasonografidir. Katýlýmcýlarýn %58’inin aldýklarý RA eðitimi yeterli bulmadýklarý, % 50’sinin mesleki geliþim amacýyla bir kursa katýldýðý tespit edilmiþtir.
Sonuç: Sinir lokalizasyonunda en sýk nörostimulasyon kullanýldýðý ancak ultrasonografinin de hýzla yaygýnlaþtýðý gözlenmiþtir. En sýk uygulama nöroaksiyal bloklardýr. RA eðitimin hala geliþtirilmesi kanaatindeyiz.

Objectives: Introduction of ultrasound into regional anesthesia (RA) practice has resulted in important changes and developments in RA. These developments had influence on the way of practice and choice of blocks. The purpose of this study was to have an idea about the instruments used in RA and clinical applications in our country.
Methods: A questionnaire consisting of 10 questions were distributed to the participants of National RA Congress in 2011. Besides demographic data, RA techniques used and the method of nerve location was questioned. Participants were asked whether they were satisfied with their training in RA and if they participated a RA course.
Results: 95 participants filled the forms. Spinal anesthesia was the most commonly performed technique. Peripheral nerve blocks constitute only 12% of RA practice. Axillary block was the most commonly performed peripheral nerve block. The most commonly used nerve localization methods were nerve stimulation and ultrasound subsequently. 58% of the participants were not satisfied with their RA training and 50% participated a course for continuing medical education.
Conclusion: Nerve stimulation is the mostly performed method and US is increasingly used. The most commonly performed blocks are central neuroaxial blocks. There is still room for improvement in RA training.

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Hemicrania continua (HC) nadir primer baþaðrýsýdýr. Bazý otonomik bulgularla birliktedir (konjunktival yaþarma, pitoz, gözkapaðý ödemi, lakrimasyon, nazal konjesyon, rinore gibi). HC tanýsý için indometazin tedavisine yanýt zorunlu taný kriteridir. Bununla birlikte literatürde indometazine yanýt vermeyen olgular bildirilmiþtir. Biz bu olgu sunumunda indometazin yanýtý olmayan ancak pregabalin tedavisine yanýt veren bir olgudan bahsedeceðiz. Pregabalin indometazine dirençli HC baþaðrýsýnda bazý hastalar için etkili bir tedavi alternatifi olabilir.

Hemicrania continua (HC) is an uncommon primary headache disorder. It presents some autonomic features (conjunctival injection, ptosis, eyelid edema, lacrimation, nasal congestion, rhinorhea) including. Response to indomethacin treatment is the mandatory criteria for the diagnosis of HC. However, there are some reported cases who did not respond the indomethacin in the literature. In this case report we will present a patient who had a the indomethacin resistance but with pregabalin response. However, the patient had a response to pregabalin. Pregabalin may be effective treatment for hemicrania continua in some patients indomethacin resistance.

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Periferik sinir hasarýnýn patogenezinde; mekanik, basýnç, vasküler ve kimyasal nedenler rol oynar. Periferik sinir bloðu uygulamalarýnda kullanýlan iðneye ve intrafasiküler enjeksiyonlara baðlý mekanik hasar olabilir. Özellikle humerus kýrýklarýnda sinirlerin cerrahi alana komþuluðu ve cerrahi ekartasyonlar ile giriþimler sonucunda sinir hasarý meydana gelebilir. Ayrýca travma da posttravmatik sinir hasarýna yol açabilir.
Bu sunumda, humerus distal fraktürü nedeniyle opere olan olgumuzda postoperatif görülen sinir hasarýnýn nedenlerini tartýþtýk.

In the pathogenesis of peripheral nerve injury, mechanical,vascular, pressure and chemical reasons play a role. In the applications of peripheral nerve block, there can be mechanical injury due to the type of needle and intrafasicular injections. In humerus fractures, nerve injury can be seen due to the surgical retractions and close proximity of the nerves with the bone. And also trauma may be the reason for posttraumatic nerve injury.
In this presentation, we discussed the causes of postoperative nerve damage which is seen after the operation of the distal humerus fracture.

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The posterior femoral cutaneous nerve (PFCN) is a branch of the sacral plexus. It needs to be implemented as a complementary block for anesthesia or in the surgeries necessitating tourniquet in the suitable cases. We consider target oriented block concept within the PFCN block in the anesthesia implementations with the emergence of ultrasonic regional anesthesia in the practice and with the better understanding of sonoanatomy.

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Editöre Mektup olduðu için özeti yok.

Editöre Mektup olduðu için özeti yok.

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