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.

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 Group AS received intraperitoneal levobupivacaine before trocars were withdrawn and incisional levobupivacaine at the end of surgery.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.

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.

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.

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.

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.

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.

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.

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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