Amaç: Bu çalýþmada, kalça kýrýðý sonucu kalça protezi ameliyatý geçirecek hastalarda ultrason rehberliðinde fasiya iliyaka kompartman bloðu ve 3-1 bloðun ameliyat sonrasý analjezik etkinliðini karþýlaþtýrmayý amaçladýk.
Gereç ve Yöntem: Elektif þartlarda kalça protezi ameliyatý olacak, 20 ve 80 yaþ arasý 70 hasta, yerel etik komite onayýný aldýktan sonra bu randomize, ileriye yönelik, kontrollü çalýþmaya dahil edildi. PCA ve vizüel analog skala (VAS) hakkýnda bilgi verildi. Tüm hastalar rastgele üç gruba ayrýldý. Anestezi indüksiyonu tüm gruplar için standardize edildi. Ultrason rehberliðinde fasiya iliyaka kompartman bloðu (FICB) ilk gruba ve 3-1 blok ise ikinci gruba anestezi indüksiyonu öncesi uygulandý. Kontrol grubu için bir blokaj uygulanmadý. Tüm hastalara cerrahi kesi sonrasý 20 mg tenoksikam ve 1 mg/kg tramadol intravenöz yoldan enjekte edildi. Ameliyat sonrasýnda IV tramadol hasta kontrollü analjezi (PCA) rutin olarak tüm hastalara baþlandý. Çalýþmamýzda Kortizol ve ACTH düzeyleri, hemodinamik parametreler, bulantý ve sedasyon varlýðý araþtýrýldý.
Bulgular: Çalýþmamýzda ultrason rehberliðinde uygulanan FICB ve 3-1 bloðun kontrol grubuna göre, VAS deðerleri ve opioid tüketimini azalttýðýný, bulantý ve sedasyon üzerine hiçbir yan etkisinin olmadýðýný ve stres hormonlarýný baskýladýðýný tespit ettik.
Sonuç: Kalça protez operasyonlarýnda ultrason eþliðinde uygulanan 3-1 blok ve FICB’nin ameliyat sonrasý analjezi saðlamak amacýyla multimodal analjezik tedavinin bir parçasý olmasý ve bu yöntemlerin güvenli bir yol olarak belirtilmesi gerektiðine inanmaktayýz.

Objectives: In this study, we aimed to compare the postoperative analgesic efficiency of an ultrasound-guided fascia iliaca compartment block and a 3 in 1 block in patients who underwent hip prosthesis surgery as a result of hip fracture.
Methods: With approval from the local ethics committee, 70 patients, aged 20 to 80, undergoing hip prosthesis surgery under elective conditions were included in this randomized, prospective, controlled study. They were informed of the patient-controlled analgesia (PCA) device and visual analog scale (VAS). All patients were separated randomly into three groups. Anaesthesia induction was standardized for all groups. An ultrasound guidance fascia iliaca compartment block (FICB) was applied to the first group before anaesthesia induction. For the second group, a 3 in 1 block was applied, while for the control group no block was applied. After incision on all patients, 20 mg tenoxicam and 1 mg/kg tramadol were injected intravenously. Following surgery, IV tramadol PCA was begun on all patients routinely. In our study, the presence of cortisol and ACTH levels, hemodinamical parameters, nausea and sedation were determined.
Results: We observed a decrease in VAS values and opioid consumption, no adverse effects on nausea and sedation, and a suppression of stress hormones in both the ultrasound-guided FICB and 3 in 1 block groups.
Conclusion: We believe that the safe and efficient application of the ultrasound-guided 3 in 1 block and the FICB is necessary in multimodal analgesic treatment in order to enable postoperative analgesia in hip prosthesis surgery.

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Amaç: Bu çalýþmada günübirlik diz artroskopisi uygulanan hastalarda düþük doz hiperbarik bupivakaine sufentanil eklenmesinin tek taraflý spinal anesteziye etkilerinin incelenmesi amaçlanmaktadýr.
Gereç ve Yöntem: 20-50 yaþ arasýnda ASA fiziksel durumu I-II olan ve diz artroskopisi yapýlmasý planlanmýþ 62 hasta çalýþmaya dahil edildi. Hastalar iki gruba randomize edildi. 1 ml %0.5 hiperbarik bupivakain ile unilateral spinal anestezi Grup B’ye (n=33) ve 0.5ml (2.5µg) sufentanilin 1 ml hiperbarik bupivakaine eklenmesi ile yapýlan unilateral spinal anestezi Grup BS’ye (n=29) uygulandý.
Bulgular: Ýki grup arasýnda sosyodemografik deðiþkenler, hemodinamik parametreler, maksimum duysal, sempatik ve motor blok seviyeleri, motor blok çözünme zamaný ve taburculuða kadar geçen süre açýsýndan istatistiksel anlamlý farklýlýk gözlenmedi (p>0.05). Ýki grup arasýnda iki segment gerileme zamaný (Grup B: 52 dk, Grup BS: 59dk), ambulasyon zamaný (Grup B: 147 dk, Grup BS: 157 dk) ve ürinasyon zamaný (Grup B: 136 dk, Grup BS: 149 dk) açýsýndan istatistiksel anlamlý farklýlýklar vardý (p<0.05). Bu çalýþmada Grup B’de kaþýntý gözlenmezken, Grup BS’de yedi hastada ameliyat sonrasý kaþýntý gözlendi (p<0.05).
Sonuç: Günübirlik artroskopi uygulanan tüm hastalara taburculuk süresini uzatmaksýzýn düþük doz hiperbarik bupivakaine sufentanil eklenmesi ile tek taraflý spinal anestezi baþarýyla uygulanmýþtýr. Ancak, artroskopi gibi günübirlik giriþimlerde, tek baþýna düþük doz hiperbarik bupivakain uygulamasýnýn da yeterli olduðu sonucuna varýlmýþtýr.

Objectives: The aim of this study is to examine the effects of sufentanil added to low-dose hyperbaric bupivacaine in unilateral spinal anaesthesia for outpatients undergoing knee arthroscopy.
Methods: Sixty two patients (ASA I-II) aged 20 to 50 who were planning on undergoing a knee arthroscopy were enrolled in this study. Patients were randomly divided into two groups. Unilateral spinal anaesthesia with 1ml 0.5% hyperbaric bupivacaine was administered to Group B (n=33); and unilateral spinal anaesthesia with 0.5ml (2.5μg) sufentanil added to 1ml hyperbaric bupivacaine was administered to Group BS (n=29).
Results: There were no statistically significant differences observed between the groups in terms of demographic data, hemodynamic parameters, maximum sensorial, sympathetic and motor block levels, time to motor block resolution, and time of discharge (p>0.05). There were statistically significant differences between the groups in terms of two segments regression time (Group B=52 min., Group BS=59 min.), ambulation time (Group B=147 min., Group BS=157 min.) and urination time (Group B=136 min., Group BS=149 min.) (p<0.05). In this study, no itching was observed in Group B, whereas seven patients in Group BS were observed as having postoperative itching (p<0.05).
Conclusion: All patients were successfully given unilateral spinal anaesthesia with sufentanil added to low-dose hyperbaric bupivacaine for an outpatient knee arthroscopy, without affecting the time of discharge. However, for one-day interventions such as arthroscopy, it was concluded that administration of only low-dose hyperbaric bupivacaine was sufficient.

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Amaç: Bu çalýþmanýn amacý, kronik omuz aðrýsý olan hastalarda floroskopi eþliðinde yapýlan üçlü omuz enjeksiyonunun kýsa, orta ve uzun dönemde VAS deðerleri üzerine etkinliðini belirlemektir.
Gereç ve Yöntem: Çalýþma, 01 Ocak 2011-31 Aðustos 2012 tarihleri arasýnda floroskopi eþliðinde 40 mg metiprednizolon ve 25 mg bupivakainle üçlü omuz enjeksiyonu uygulamasý yapýlan kronik omuz aðrýlý 92 hastanýn dosyalarýnýn geriye dönük olarak incelenmesiyle yapýldý. Üçlü omuz enjeksiyonu uygulanan hastalarýn birinci hafta, bir-altýncý ay ve birinci yýl VAS deðerleri bazal VAS deðerleriyle karþýlaþtýrýldý.
Bulgular: Hastalarýn birinci hafta, bir-altýncý ay ve birinci yýl VAS deðerleri bazal VAS deðerlerine göre istatistiksel olarak anlamlý düþüktü (p<0.001). Ancak altýncý ay ve birinci yýl VAS deðerleri birinci hafta ve birinci ay VAS deðerlerine göre istatistiksel olarak anlamlý yüksekti (p<0.001).
Sonuç: Floroskopi eþliðinde yapýlan üçlü omuz enjeksiyonu kronik omuz aðrýsý olan hastalarda kýsa, orta ve uzun dönemde etkindir ancak orta ve uzun dönemdeki etkinliði kýsa dönemdeki etkinliðine göre daha düþüktür.

Objectives: This study aimed at determining the short-, mid- and long-term effects of a triple shoulder injection accompanied by fluoroscopy on Visual Analogue Scale (VAS) values in patients with chronic shoulder pain.
Methods: The study was conducted by retrospective investigation of the files of 92 patients experiencing chronic shoulder pain, and on whom a triple shoulder injection with 40 mg methylprednisolone and 25 mg bupivacaine accompanied by fluoroscopy was applied between January 01, 2011 and August 31, 2012.
Results: 1st week, 1st - 6th month, and 1st year VAS values were significantly lower when compared to the basal VAS values from a statistical point of view (p<0.001). However, VAS values corresponding to the 6th month and 1st year were significantly higher than the VAS values corresponding to the 1st week and 1st month when considered statistically (p<0.001).
Conclusion: Triple shoulder injection accompanied by fluoroscopy applied on patients with chronic shoulder pain is effective in short-, mid- and long-term, but its mid- and long-term effectiveness is less than its short-term effectiveness.

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Amaç: Bu randomize, kontrollü, tek kör çalýþmada; diz artroskopilerinde levobupivakain ile yapýlan kombine siyatik-femoral sinir bloðu; etkinlik, derlenme özellikleri, hasta ve cerrah memnuniyeti ile erken dönem ameliyat sonrasý aðrý üzerine etkileri açýsýndan tek taraflý spinal anestezi ile karþýlaþtýrýlmýþtýr.
Gereç ve Yöntem: Çalýþmaya alýnan olgular iki gruba ayrýldý. Grup I’deki olgulara (n=20)toplam %0.5’lik 40 cc levobupivakain ile kombine siyatik-femoral sinir bloðu uygulandý. Grup II’deki olgulara (n=20) lateral dekübit pozisyonda 7.5 mg levobupivakain ile tek taraflý spinal anestezi (ULSA) uygulandý. Olgular anestezi düzeyi T12 olana kadar (maksimum 10 dk.) bu pozisyonda bekletildi. Cerrahi anestezi düzeyine ulaþmak için geçen zaman, iki taraflý duyusal ve motor blok düzeyleri kaydedildi. Postanestezik derlenme skoru ≥12 olmasý için geçen süre kaydedildi. Ameliyat sonrasý dönemde, ameliyat sonrasý analjezi (VAS) deðerleri, motor blok seviyeleri, yan etkiler, hastanýn ve cerrahýn memnuniyeti 1., 3., 6. ve 12. saatlerde kaydedildi.
Bulgular: Cerrahiye hazýr olma süresi Grup II’de istatistiksel olarak anlamlý düzeyde kýsa bulundu. Hasta ve cerrah memnuniyetleri arasýnda iki grup arasýnda istatistiksel açýdan fark bulunamadý: Ýlk altý saatteki VAS deðerleri grup I’de grup II’ye göre belirgin olarak düþüktü (p<0.05).
Sonuç: Kombine siyatik-femoral sinir bloðu, düþük doz uygulanan tek taraflý spinal anesteziyle ayný klinik profille beraber yeterli anestezik etkiyi gösterirken, ameliyat sonrasý ilk altý saatlik dönemde VAS deðerleri açýsýndan daha baþarýlý bir analjezi saðlamýþtýr.

Objectives: In this randomized, controlled, blind study, a combined sciatic-femoral nerve block with levobupivacaine was compared with a unilateral spinal anaesthesia with respect to effectiveness, patient and surgeon satisfaction, and the effect on postoperative pain in arthroscopic knee surgery.
Methods: Patients were randomly divided into two groups. Group I (n=20) received a combined sciatic-femoral nerve block with levobupivacaine 0.5% totalling 40 ml. In group II (n=20), a spinal anaesthesia in the lateral decubitus position (ULSA) with 7.5mg levobupivacaine 0.5% was performed, and patients were kept in the same position to achieve an anaesthesia level of T12 (maximum 10 minutes). The development of motor and sensorial block on both sides and onset time to surgical anaesthesia were recorded. The time required for the postoperative recovery score to be ≥12 was recorded. In the postoperative period, postoperative analgesia (VAS), motor block, side effects, and patient and surgeon satisfaction were recorded at the 1st, 3rd, 6th and 12th hours.
Results: Time of readiness for surgery was significantly shorter in Group II (p<0.05). All patients were satisfied with both techniques. There were no differences in judgement between the groups. VAS scores at the 6th hour were significantly lower in group I than in group II (p<0.05).
Conclusion: Combined sciatic-femoral nerve block for outpatient arthroscopic knee surgery offers satisfactory anaesthesia, with a clinical profile similar to that of low-dose spinal anesthesia. Sciatic-femoral nerve blocks are associated with significantly lower pain scores during the first 6 postoperative hours.

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Amaç: Meme cerrahisinden sonra hastalarýn %50’sinde kronik ameliyat sonrasý aðrý geliþtiði gösterilmiþtir. Çalýþmalarda paravertebral bloðun meme cerrahisi için hem etkili bir anestezi hem de analjezi yöntemi olduðu gösterilmiþtir. Bu çalýþmadaki amacýmýz 150 mg levobupivakain ile tek doz torakal paravertebral blok uygulanan mastektomi hastalarýnda ameliyat sonrasý analjezi ve opioid kullanýmýný araþtýrmaktýr.
Gereç ve Yöntem: Meme kanseri tanýsý olan ve modifiye radikal mastektomi ve aksiller disseksiyon uygulanan 20-65 yaþ arasý 40 hasta çalýþmaya alýndý. Hastalar kontrol grubu (Grup K, n=20) ve torakal paravertebral grup (Grup T, n=20) olarak iki ayrý gruba ayrýldý. Hastalar ameliyat sonrasý 0, 1, 6, 12 ve 24. saatlerde istirahat sýrasýnda aðrý için 0-10 mm’lik Vizüel Analog Skala (VAS) ile sorgulandý. Ameliyat sonrasý kullanýlan ek tramadol miktarlarý (1.5 mg/kg iv infüzyon) kaydedildi.
Bulgular: Kontrol grubundaki hastalarýn postoperatif 0, 1, 6, 12 ve 24. saat VAS skorlarý torakal paravertebral blok uygulanan gruptan anlamlý olarak yüksek bulunmuþtur (p<0.01). Gruplarýn ameliyat sonrasý 0. saat VAS skorlarýna göre 1, 6, 12 ve 24. saat VAS skorlarýnda istatistiksel olarak anlamlý düþüþ gözlendi (p<0.01). Grup T’de ek tramadol kullanýmý anlamlý olarak daha düþük bulunmuþtur (p<0.01).
Sonuç: Genel anestezi öncesinde tek doz 150 mg levobupivakain ile yapýlan paravertebral blok modifiye radikal mastektomi ve aksiler lenf disseksiyonu uygulanan hastalarda ameliyat sonrasý 24 saat boyunca düþük aðrý skorlarý saðlamýþ ve ek analjezik ihtiyacýný azaltmaktadýr.

Objectives: Following mastectomy, 50% of patients have chronic postoperative pain. Studies have shown that a paravertebral block is an effective method of analgesia as well as anaesthesia. The aim of this study is to compare postoperative pain values and opioid consumption after a single dose of 150 mg levobupivacaine with a thoracic paravertebral block in patients undergoing mastectomy.
Methods: Enrolled in the study were forty patients, aged 20 to 65, diagnosed with breast cancer, and undergoing modified radical mastectomy and axillary dissection. Patients were randomized into two groups, as control group (group K, n=20) and thoracic paravertebral group (Group T, n=20). Postoperative pain values were recorded at 0, 1st, 6th, 12th and 24th hour at rest, using a 0-10 mm Visual Analogue Scale (VAS). Additional quantities of postoperative tramadol (1.5 mg/kg, iv infusion) were recorded.
Results: Postoperatively, at 0, 1st, 6th, 12th and 24th hour, patients in the control group had significantly higher VAS values than the group treated with a thoracic paravertebral block (p<0.01). Compared to VAS scores at postoperative 0 h, there was a statistically significant decrease in VAS scores at 1st, 6th, 12th and 24th hour in both groups (p<0.01). Additional use of tramadol was significantly lower in group T (p<0.01).
Conclusion: A paravertebral block with a single dose of 150 mg levobupivacaine before general anaesthesia in patients undergoing modified radical mastectomy and axillary lymph node dissection decreases postoperative pain values and the need for analgesics during the postoperative 24 hours.

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Ultrasonun (US) büyük avantajlarýndan birisi baþarýlý blok için gereken lokal anestetik (LA) miktarýndaki azalmadýr. Azalmýþ LA gereksinimi, birden fazla ekstremitesinden ameliyat olacak hastaya çoklu blok yapýlýrken LA toksisitesi riskini azaltýr. Otuz sekiz yaþýnda kadýn hasta, sað ayaðýnda polidaktili, sað elinde sindaktili için elektif ameliyatý planlanmýþ. Siyatik sinir bloðu ve infraklavikular blok, hastaya, US rehberliðinde yapýldý. Siyatik blok, pron, “figure of four” pozisyonunda, popliteal seviyede uygulandý. Ýnfraklavikular blok için lateral sagital teknik kullanýldý. Ýki blok da baþarýlý oldu ve hasta blok uygulamalarýndan 30 dakika sonra operasyona hazýrdý. Operasyon süresince hastanýn herhangi bir ek anestetik ve analjezik ihtiyacý olmadý. Operasyon her iki ekstremitede sorunsuz olarak gerçekleþtirildi. Bu, literatürdeki, kol ve bacak olarak, iki farklý ekstremitede çoklu blok uygulanan ilk olgu sunumudur. Sonuç olarak bizim olgu sunumumuz, farklý ekstremitelerde çoklu bloklarýn, US rehberliðinde düþük doz LA kullanýlarak, baþarýlý ve güvenli bir þekilde uygulanabildiðini gösteren güzel bir örnektir.

A major advantage of ultrasound (US) has been reduction in the amount of local anaesthetic (LA) needed for successful blocks. Reduced LA requirement reduces the risk of LA toxicity when multiple blocks are to be done for surgery of more than one extremity in the same patient. The 38-year-old female was scheduled for elective surgery of polydactilia in her right foot and syndactili in her right hand. A sciatic nerve block and an infraclavicular block were applied to the patient, with ultrasound guidance. The sciatic block was performed at the popliteal level in figure of four position in prone position. The lateral sagital technique was used for the infraclavicular block. Both blocks were successful, and the patient was ready for surgery 30 minutes after block performances. The patient didn’t need any additional anaesthetic or analgesic during the operation. Surgery was performed uneventfully on both extremities. This is the first case report in the literature in which multiple blocks were applied to two different extremities, the leg and arm. In conclusion, our case report is a good example of multiple blocks in different extremities being performed successfully and safely according to US guidance and using low doses of local anaesthetics.

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Kompleks bölgesel aðrý sendromu (KBAS), genellikle ekstremitelerde aðrý, þiþlik, kýsýtlý eklem hareket açýklýðý, vazomotor instabilite ve yamalý kemik demineralizasyonu ile karekterize bir hastalýktýr. Bu olgu sunumunda sol el dördüncü parmak distal falanks kýrýðýndan iki ay sonra sol elinde þiþlik, aðrý, hareket kýsýtlýlýðý þikayetleri baþlayan, yapýlan deðerlendirmeler sonucunda KBAS tip 1 tanýsý alan 46 yaþýndaki kadýn hasta sunulmuþtur. Hastanýn tedavisinde kalsitonin, gabapentin, kalsiyum ve D3 vitamini, retrograd ödem masajý, kontrast banyo, konvansiyonel TENS, kesikli ultrason, desensitizasyon ve eklem hareket açýklýðý egzersizi ile þikayetlerinde azalma kaydedilmiþtir. Üst ekstremite aðrýlarýnýn ayrýcý tanýsýnda distal falanks kýrýðýndan sonra geliþen KBAS tip 1 akýlda tutulmalýdýr.

Complex Regional Pain Syndrome (CRPS) is a disease characterized especially by pain, swelling, limited range of motion, vasomotor instability and patchy bone demineralization in the extremities. In this case, we report a 46-year-old woman diagnosed with CRPS type 1, whose complaints, such as swelling in the left hand, pain, and limitation of movement, started 2 months after a fracture of the distal phalanx in the left 4th finger. Her complaints were reduced with treatment of calcitonin, gabapentin, calcium and vitamin D3, retrograde edema massage, contrast baths, conventional TENS, pulsed ultrasound, desensitization and exercise with range of joint motion. CRPS type 1 should be considered in the differential diagnosis of upper limb pains which start after a fracture of the distal phalanx.

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Duchenne musküler distrofisi, (DMD) nöromusküler hastalýklar arasýnda en sýk görülen rahatsýzlýktýr. Ciddi kardiyak rahatsýzlýklar, yüksek rabdomyoliz geliþme ihtimali ve genel anestezinin hayati risk olasýlýðý yüksek komplikasyonlarýyla, DMD, anestezistler için genellikle sýkýntý oluþturmaktadýr. Genel anesteziyle ilþkili muhtemel morbiditeden kaçýnmak için hastamýzda supraklaviküler blok uyguladýk. Bu raporda, masif rabdomyosarkomu olan ve amputasyon endikasyonu mecut olan, 17 yaþýndaki Duchenne’li bir hastayý sunmayý amaçladýk. Ameliyat sonrasý dönemde, kýsa süre içinde geçen, malign hipertermi benzeri bir reaksiyon geliþimini tespit ettik. Biz ortopedik cerrahi geçirecek DMD’li hastalarda genel anesteziye güvenli bir alternatif olarak rejyonel anestezi uygulamalarýný önermekteyiz.

Duchenne muscular dystrophy (DMD) is the most common of the neuromuscular disorders. DMD is usually a challenge for the anaesthesiologist, with poor cardiac function, a high risk of developing rhabdomyolysis, and the probable life-threatening complications of general anaesthesia. To avoid possible morbidity associated with general anaesthesia, we applied a supraclavicular blockade. In this report, we present a 17-year-old DMD patient with a massive rhabdomyosarcoma, for whom a left arm amputation was indicated. In the post-operative period, a malignant hyperthermia-like reaction occurred, which resolved in a short time. We suggest a regional blockade as a safer alternative to general anaesthesia for the management of high risk DMD patients during orthopedic procedures.

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Patients with ankylosing spondylitis (AS) present challenges for anesthesiologists particularly about airway management because of the limited or no cervical spine mobility, fixed flexion deformity of thoracolomber spine and possible temporomandibular joint disease.[1,2] We describe an alternative method to prepare these patients for ventral hernia repair.

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