The modern approach to the management of pain involves optimizing all aspects of the process. This includes utilization of pharmacologic and non-pharmacologic modalities, consideration of patient characteristics, proper matching of the physiology of the pain with the analgesic’s mechanism of action (pharmacodynamics, PD), and the onset and duration of action (pharmacokinetics, PK). No single agent or formulation satisfies all of the requirements for all patients. Aspirin and other non-steroidal anti-inflammatory drugs (NDAIDs) are effective options for inflammatory pain and, as is acetaminophen, for mild pain. Specialized agents are helpful for particular pains, such as for migraine headache. Opioids remain the standard option for severe pain. Although they are generally a safe and effective option, opioids can produce dose-limiting adverse effects and have abuse potential. The goal of pain therapy is thus to achieve the maximum pain relief with the least amount of opioid exposure. Against this background of measured approach to the use of analgesics, an immediate release (IR) oral formulation of the established opioid oxycodone has been developed to provide rapid onset of action and rate of titration, both of which could maximize temporal matching of dose with pain level and reduce total exposure to drug. This article considers the option of an immediate release (IR) oral formulation for the management of pain.

The modern approach to the management of pain involves optimizing all aspects of the process. This includes utilization of pharmacologic and non-pharmacologic modalities, consideration of patient characteristics, proper matching of the physiology of the pain with the analgesic’s mechanism of action (pharmacodynamics, PD), and the onset and duration of action (pharmacokinetics, PK). No single agent or formulation satisfies all of the requirements for all patients. Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) are effective options for inflammatory pain and, as is acetaminophen, for mild pain. Specialized agents are helpful for particular pains, such as for migraine headache. Opioids remain the standard option for severe pain. Although they are generally a safe and effective option, opioids can produce dose-limiting adverse effects and have abuse potential. The goal of pain therapy is thus to achieve the maximum pain relief with the least amount of opioid exposure. Against this background of measured approach to the use of analgesics, an immediate release (IR) oral formulation of the established opioid oxycodone has been developed to provide rapid onset of action and rate of titration, both of which could maximize temporal matching of dose with pain level and reduce total exposure to drug. This article considers the option of an immediate release (IR) oral formulation for the management of pain.

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AMAÇ: Palyatif bakým dünyada hýzla geliþmektedir. Palyatif bakým hastalarýnýn büyük çoðunluðunu ileri evre kanser hastalarý oluþturmaktadýr. Son dönem kanser hastalarýnda bir semptomdan ziyade semptom kümesi adý verilen birden fazla semptom bulunmaktadýr. Çalýþmamýzda, son dönem kanser hastalarýnýn semptomlarýný irdelemeyi ve bu hastalardaki semptom kümelerini sunmayý amaçladýk.
GEREÇ VE YÖNTEM: Bu çalýþma, etik kurul onayý alýndýktan sonra, 01.01.2011 ile 01.02.2012 yýllarý arasýnda, Üniversitemiz, Anesteziyoloji ve Reanimasyon Kliniði kapsamýnda, muayene edilmiþ toplam 113 (74 kadýn, 39 erkek) son dönem kanser hastalarý retrospektif olarak deðerlendirildi. Hastalarýn rutin hikaye ve fizik muayene bulgularý, tedavi öyküsü, þikayetleri, kiminle beraber yaþadýðý, primer tümörü, tümörün metastazlarý ve Edmonton Semptom Deðerlendirme Sistem skalasýna göre halsizlik, aðrý, bulantý, kusma, iþtahsýzlýk, uyku bozukluðu, kabýzlýk, öksürük, dispne semptomlarýnýn skoru doldurulmuþ muayene kartlarýndan elde edilmiþtir (0: Hiç yok, 10: En þiddetli). Hasta verilerinin deðerlendirilmesinin yanýnda hiyerarþik semptom kümesi analizi kullanýlarak semptom kümeleri oluþturuldu.
BULGULAR: Çalýþmaya dahil edilen 113 hastanýn (74 kadýn ve 39 erkek) yaþ ortalamasý: 64.51±11.38 idi. Hastalar en çok genel cerrahi kliniði olmak üzere sýrasýyla acil týp, üroloji, onkoloji, kulak-burun-boðaz, göðüs cerrahisi, iç hastalýklarý ve beyin cerrahi klinikleri tarafýndan polikliniðimize yönlendirilmiþti. Halsizlik en sýk görülen semptomdu (%98.3). Ýlk semptom kümesini, bulantý-kusma-iþtah kaybý-kabýzlýk; ikinci semptom kümesini, nefes darlýðý-öksürük; üçüncü semptom kümesini ise, halsizlik-aðrý-uyku bozukluðu oluþturduðu görüldü.
SONUÇ: Kanser hastalarý en çok aðrý þikayeti nedeniyle hekime baþvursalar da, aðrýya eþlik eden birçok semptom olduðu bir gerçektir. Ýleri evre kanser hastalarýnýn tedavisi planlanýrken, bir semptoma odaklanmak yerine hastada bulunan semptomlar kümesine odaklanýlmalýdýr.

Objectives: Palliative care has been developing rapidly throughout the world. A substantial number of palliative care patients are advanced cancer patients. Terminal cancer patients suffer from groups of symptoms called symptom clusters, rather than from individual independent symptoms. The aim of this study is to evaluate the symptoms of terminal cancer patients retrospectively and to present the symptom clusters of these patients.
Methods: After ethical approval was obtained, a total of 113 (74 female, 39 male) patients with the diagnosis of the terminal stage cancer were retrospectively evaluated in Gaziosmanpasa University, Department of Anesthesiology and Reanimation between January 2011 and January 2013. Patient records were used to obtain medical history, physical examination findings, patient complaints, accompanying persons, primary cancer site, and metastasis sites. Symptoms such as fatigue, pain, vomiting, loss of appetite,insomnia, constipation, cough and dyspnea were assessed with the Edmonton Symptom Assessment System scale (0: None, 10: Worst possible). The symptom clusters were constructed using hierarchical symptom cluster analysis.
Results: The mean age was 64.51±11.38 years. Patients were referred to our outpatient clinic from Departments of General Surgery, Emergency Medicine, Urology, Oncology, Ear-Nose-Throat, Thoracic Surgery, Internal Medicine and Neurosurgery. Fatigue was the most-detected symptom (98.2%). Three symptom clusters were identified: nausea-vomiting-loss of appetite-constipation, dyspnea-cough, and fatigue-pain-insomnia.
Conclusion: Although palliative cancer patients were referred mainly with the symptom of pain, at least three symptom clusters were detected. The management of terminal stage cancer patients should focus on symptom clusters rather than individual symptoms.

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Migren; sadece bir baþ aðrýsý olmayýp çeþitli sistemlerde deðiþikliklerin bir arada olmasýyla karakterizedir ve atak dýþý dönemde de birçok psikiyatrik bozuklukla özelikle majör depresyon ve anksiyete bozukluklarý ile iliþkili olduðu bilinmektedir. Obsesif kompulsif bozukluk (OKB) ise, migrenlilerde görece az araþtýrýlmýþtýr.
Bu çalýþmada migren tanýsý almýþ ardýþýk hastalarda görülen obsesif-kompulsif belirtiler araþtýrýlarak saðlýklý kiþilerden oluþan kontrol grubu ile karþýlaþtýrýlmýþ ve bu belirtilerin migrenin tanýmlanan klinik özellikleriyle iliþkisi incelenmiþtir.
Çalýþmaya Ýstanbul Üniversitesi Ýstanbul Týp Fakültesi Nöroloji Anabilim Dalý Baþ Aðrýsý Polikliniðine, Aralýk 2010- Mart 2012 tarihleri arasýnda baþ aðrýsý þikayeti ile baþvuran hastalar arasýndan, Nöroloji uzmaný tarafýndan, Uluslararasý Baþ Aðrýsý Topluluðu ölçütlerine göre taný konmuþ 74 migren hastasý ve 36 saðlýklý kontrol alýnmýþtýr. Katýlýmcýlarýn tamamýna Yale Brown Obsesyon ve Kompulsiyon Derecelendirme Ölçeði (Y-BOCS)’nin tarama formu uygulanmýþ ve ölçeðin toplam puaný hesaplanmýþtýr.
Migren ve kontrol gruplarý Y-BOCS toplam puanlarý açýsýndan karþýlaþtýrýldýðýnda aralarýnda istatistiksel açýdan anlamlý bir farklýlýk bulunmuþtur (z(109)= -3.100, p<0.05). Ayrýca iki grup Y-BOCS obsesyon ve kompulsiyon alt test puanlarý açýsýndan da anlamlý farklýlýk göstermekteydi. Migren süresi, tarafý ve atak sýklýðý ile bulgular arasýnda anlamlý bir baðlantý gösterilemedi.
Bu çalýþma migren hastalarýnýn daha yüksek oranda OKB eðilimi olduðunu göstermektedir. Bu bulgularýn genetik kökenli deðiþikliklere ve/veya beyindeki fonksiyonel farklýlýklara baðlý olduðu düþünülebilir.

Objectives: A migraine is not just a headache. Migraines are characterized by the co-occurrence of various systemic changes and known to be associated with many psychiatric disorders in the interictal period, especially major depression and anxiety disorders. Obsessive-compulsive disorder (OCD) in patients with migraines is relatively less studied.
Methods: Obsessive-compulsive symptoms were investigated in consecutive patients with a diagnosis of migraine and compared with that of a control group of healthy individuals. The relationship of these symptoms with the defined clinical features of migraine was analyzed. 74 patients and 36 controls were included in this study. Patients were chosen from those admitted with headache complaints to the Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Headache Outpatient Clinics between December 2010-March 2012. A headache specialist diagnosed all patients with migraine using the International Headache Society criteria.. The Yale Brown Obsessive and Compulsive Scale (Y-BOCS) was used to score OCD symptoms in all participants.
Results: In comparing Y-BOCS total scores between the migraine patients and the control group, we found a statistically significant difference (z(109)= -3.100, p<0.05). Furthermore, both the Y-BOCS obsession and compulsion sub-scores were significantly different between the groups. The duration, frequency and side of migraine did not have any correlation with our findings.
Conclusion: In conclusion, our study suggested that migraine sufferers tend to have higher obsessive and compulsive symptoms. These findings could be based on genetic changes and/or functional differences in the brain.

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Amaç: Bu çalýþmada, kliniðimize baþvuran 1736 hasta, özellikleri, analjezik basamak tedavileri ve tedavi yöntemleri retrospektif olarak deðerlendirildi.
Bulgular: Ocak 1997 – Aralýk 2010 tarihleri arasýnda Fýrat Üniversitesi Týp Fakültesi Anesteziyoloji ve Reanimasyon Anabilim Dalý Algoloji Bilim Dalý’na maligniteye baðlý aðrý nedeniyle baþvuran 1736 hastanýn 269’u çalýþma dýþý býrakýlarak toplam 1467 hasta deðerlendirilmeye alýndý. Çalýþmamýzda hastalarýn %85.5’i analjezik basamak tedavisine göre tedavi edilmiþtir. Basamak tedavisiyle yeterli aðrý kontrolü saðlanamayan %14.5 oranýndaki olguya minimal invaziv analjezik giriþim yöntemleri uygulanmýþtýr. Adjuvan ilaç olarak antidepresan, kortikosteroid, antikonvülzan, nöroleptik, benzodiazepin, lokal anestezik, bifosfanat ve kalsitonin kullaným oranlarý sýrasýyla; %61.0, %7.1, %4.0, %4.0, %1.6, %12.3, %1.2 ve %2.8 olarak bulunmuþtur.
Sonuç: Sonuç olarak aðrýlý kanser hastalarýnýn aðrýsýnýn þiddetli olmasý; hastada aðrý tedavisini zorlaþtýrmaktadýr. Analjezik basamak tedavisiyle tedavi edilemeyen hastalar, minimal invaziv analjezik giriþim yöntemleriyle tedavi edilmektedir. Aðrý tedavisinde baþarýya ulaþmak, olgularýn multidisipliner týbbi uzman kadrosu ile deðerlendirilmeleri ve bu ekibin hazýrlayacaðý tedavi planlamasý ile olasýdýr. Böylece hiçbir kanser hastasýnýn kontrol altýna alýnamayan aðrý ile yaþamayacaðý kanýsýndayýz.
Aðrý tedavisinde baþarýya ulaþmak için adjuvan ilaçlara eriþmek kolay olmalýdýr. Adjuvan ilaçlarýn, aðrý tedavisi yapan Algoloji hekimleri tarafýndan rahatça reçete edilmesi gerektiði kanýsýndayýz.

Objectives: In this study, we retrospectively evaluated the characteristics of 1736 patients presenting to our clinic, including analgesic step treatments and method of treatments.
Methods: A total of 1467 patients, excluding 269 out of 1736, with pain due to malignancy were included in this study. Patients presented to the Algology Division of the Department of Anesthesiology and Reanimation of Firat University School of Medicine. Among the patients included in the study, 85.5% were treated according to the analgesic step ladder protocol of the WHO. Minimally invasive analgesic interventions were applied in 14.5% of the cases in which adequate pain control could not be achieved with step ladder treatment.
Results: The adjuvant pain medications used were antidepressants, corticosteroids, anticonvulsants, neuroleptics, benzodiazepines, local anesthetics, bisphosphonates, and calcitonin and their rate of usage were 61.0%, 7.1%, 4.0%, 4.0%, 1.6%,12.3%,1.2%, and 2.8%, respectively.
Conclusion: Because pain in the cancer patients is mostly severe, pain management can be difficult in these patients. The patients who cannot be treated with the analgesic step ladder method have been treated with minimally invasive analgesic intervention methods. A multidisciplinary medical expert group evaluation of the cases and a treatment planned by this team are cornerstones of achieving success in pain management. We believe in this way, no patient with cancer will live with uncontrolled pain.
Access to adjuvant drugs should be easy in order to achieve success in pain management. We believe that expert algology physicians who treat pain should easily prescribe adjuvant drugs.

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Amaç: Bu çalýþmadaki amacýmýz huzurevinde yaþayan geriatriklerin aðrý, depresyon günlük yaþam aktivitelerindeki baðýmsýzlýðýný araþtýrmak ve bunun yaný sýra bu parametreler arasýndaki iliþkiyi incelemekti.
Gereç ve Yöntem: Çalýþmaya 65-90 yaþ arasý, huzurevinde yaþayan 186 gönüllü dahil edildi. Geriatriklerin sosyo-demografik özellikleri, depresyon seviyeleri, aðrý düzeyleri ve günlük yaþam aktivitelerinde baðýmsýzlýklarý sýrasýyla sosyo-demografik deðerlendirme formu, Geriatrik Depresyon Ölçeði (GDS), Görsel Analog Skala (VAS) ve Nottingham Extended Activities of Daily Living Index (NEADL), kullanýlarak deðerlendirildi. Ýstatistiksel analizler için, katýlýmcýlar aðrýsý olanlar ve olamayanlar olarak ayrýldý.
Bulgular: Bu çalýþmanýn ana bulgusu, katýlýmcýlarýn% 55,9 'unun kronik aðrý bildirmesiydi ve bu hastalarýn anlamlý olarak daha yüksek GDS (p = 0.001) ve kronik aðrýsý olmayanlara göre anlamlý düzeyde düþük NEADL puanlarý (p = 0.01) vardý. Biz VAS ve GDS (r = 0.47, p = 0.001), VAS ve NEADL (r = -0.30, p = 0.001), GDS ve NEADL puanlarý arasýnda (r = -0.50, p = 0.001) önemli derecede korelasyon bulduk. Çok deðiþkenli modelde kadýn cinsiyet (p = 0.001), çocuk sayýsý (p = 0.005), kronik hastalýk sayýsý (p = 0.009), ve GDS skorunun (p = 0.001) kronik aðrýyý etkilediði bulundu.
Sonuç: Geriatrik populasyonda aðrý, depresyon varlýðý ve günlük yaþam aktivitelerindeki baðýmsýzlýk düzeylerinin incelenmesi, saðlýðýn geliþtirilmesinde ve yaþlý nüfusun refahý için alýnacak önlemlerin belirlenmesinde önemlidir.

Objectives: The aim of this study was to investigate pain, depression and independence in activities of daily living in geriatric residents of nursing homes, as well as to evaluate the relationship between these parameters.
Methods: 186 nursing home residents, aged 65 to 90 years, were enrolled in the study. Their socio-demographic features, depression levels, pain levels and independence in activities of daily living were evaluated using a socio-demographic assessment form, the Geriatric Depression Scale (GDS), the Visual Analogue Scale (VAS) and the Nottingham Extended Activities of Daily Living Index (NEADL), respectively. For statistical analyses, participants were divided into groups with and without chronic pain.
Results: The main finding of this study was that 55.9% of the participants reported chronic pain, and these participants had significantly higher GDS (p=0.001) and lower NEADL scores (p=0.01) than those who reported no chronic pain. We found a significant correlation between VAS and GDS (r=0.47, p=0.001), VAS and NEADL (r=-0.30, p=0.001), and GDS and NEADL scores (r=-0.50, p=0.001). Female gender (p=0.001), number of children (p=0.005), number of chronic diseases (p=0.009), and GDS score (p=0.001) were found to affect chronic pain in multivariate model.
Conclusion: Investigation of pain, presence of depression, and independence in activities of daily living is important in determining the necessary measures to be adopted for promoting the health and well-being of the geriatric population.

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Amaç: Endoskopik torasik sempatektomi palmar hiperhidrozu olan hastalar için yaygýn kabul gören bir tedavi yöntemi olmasýna raðmen, gövde kompansatuvar hiperhidrozu bu prosedürün çözümsüz bir yan etkisi olarak görülebilmektedir. Bu problem için tatmin edici bir tedavi yöntemi bugüne kadar tanýmlanmamýþtýr. Bu çalýþmada, gövde kompansatuvar hiperhidrozu tedavisinde yeni minimal invaziv bir tedavi yöntemi tanýmlamasýnýn yapýlmasý amaçlanmýþtýr.
Gereç ve Yöntem: Palmar hiperhidroz nedeniyle endoskopik torasik sempatektomi uygulanan ve gövde kompansatuvar hiperhidrozu geliþen 10 hastaya (2 kadýn, 8 erkek) ileriye yönelik olarak Kasým 2010 ve Ocak 2012 tarihleri arasýnda sempatik radyofrekans termokoagülasyon tekniði ile T6 seviyesinden ablasyon uygulandý. Tedavinin sonuçlarý telefon görüþmeleri ile deðerlendirildi.
Bulgular: Yaþ ortalamasý 29.2 yýl idi ve semptom ortalama süresi 10.5 ay idi. Ortalama takip süresi 14 ay idi. Altý hasta (%60) baþarýlý bir þekilde tedavi edildi. Tanýmlanan yönteme baðlý yeni bir komplikasyon görülmedi.
Sonuç: Gövde kompansatuvar hiperhidroz hastalarýnda T6 seviyesinden uygulanan radyofrekans ablasyon tedavisi ile ümit verici bu sonuca ulaþýlmýþtýr. Bu amaçla daha fazla çalýþma yapýlmasý gerektiði düþüncesindeyiz.

Objectives: Although Endoscopic Thoracic Sympathectomy is a widely accepted treatment method for patients with palmar hyperhidrosis, compensatory hyperhidrosis of the trunk remains a challenging side effect of the procedure. No satisfactory treatment options for this side effect were available until now. In this study, we aimed to define a new procedure for the treatment of compensatory hyperhidrosis of the trunk.
Methods: A total of 10 patients admitted our institution for the treatment of compensatory hyperhidrosis of the trunk were enrolled in the study between November 2010 and January 2012 in a prospective manner. Sympathetic blockage was achieved via radiofrequency thermo-ablation technique. The results of treatment were evaluated via telephone calls.
Results: Ten patients (2 females, 8 males) underwent radiofrequency thermo-ablation of T6 sympathetic ganglion for compensatory hyperhidrosis of the trunk. The mean age was 29.2 years and the median duration of symptom was 10.5 months. The median follow-up period was 14 months. Six of ten patients (60%) were treated successfully. There was no procedure related complication.
Conclusion: The radiofrequency treatment for patients with compensatory hyperhidrosis of the trunk is an alternative option with promising results.

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Amaç: Opioidler, akut ameliyat sonrasý aðrý tedavisinin temel komponentini oluþturmaktadýrlar. Etkin ameliyat sonrasý analjezi saðlamak için gereken opioid gereksiniminin artmasýyla, peroperatif opioid infüzyonu, akut opioid toleransý geliþimiyle suçlanmýþtýr. Akut opioid tolerans geliþiminin yanýsýra opioid ajanlar arasýnda tolerans geliþimi konusunda farklýlýk olup olmadýðý da halen tartýþmalýdýr. Bu çalýþmanýn amacý peroperatif dönemde intravenöz infüzyon þeklinde uygulanan morfin, remifentanil ve alfentanilin etkilerinin karþýlaþtýrýlmasýdýr.
Gereç ve Yöntem: Elektif majör abdominal cerrahi geçirecek, 60 hasta randomize olarak dört gruba ayrýldý. Grup C’ye (kontrol) indüksiyonda iv 5 cc, idamede 10 cc/s salin infüzyonu, Grup R’ye (remifentanil) indüksiyonda iv 1µg/kg bolus, idamede 0.25 μg/kg/dk remifentanil infüzyonu, Grup A’ya (alfentanil) indüksiyonda iv 10 µg/kg bolus, idamede 0.50 µg/kg/dk alfentanil infüzyonu, Grup M’ye (morfin) indüksiyonda iv 0.1 mg/kg bolus, idamede 0.02 mg/kg/s morfin infüzyonu uygulandý. Ameliyat sonrasý analjezi için iv meperidinli hasta kontrollü analjezi (HKA) uygulandý ve toplam meperidin tüketimleri kaydedildi. Ameliyat sonrasý 48 saat boyunca VAS skorlarý ve yan etkiler kaydedildi.
Bulgular: Grup M’ye ait VAS skorlarý ameliyat sonrasý birinci saatte Grup C’den anlamlý olarak daha düþük bulundu. Grup R ve Grup M’nin 24 saatlik toplam meperidin tüketimi Grup C’den anlamlý olarak daha düþüktü. Bulantý kusma insidansý bakýmýndan gruplar arasýnda anlamlý bir fark yoktu.
Sonuç: Sonuç olarak; majör abdominal cerrahi geçiren hastalarda peroperatif dönemde üç saat süre ile uygulanan morfin, alfentanil ve remifentanil infüzyonunun ameliyat sonrasý akut toleransa yol açmadýðý, aksine morfin ve remifentanil infüzyonunun ameliyat sonrasý opioid gereksinimini azalttýðý kanýsýna varýlmýþtýr.

Objectives: Opioids are the cornerstone therapy for the optimal pain management. Perioperative opioid infusion is accused of causing acute opioid tolerance, especially as the postoperative opioid requirement increases in time to provide efficient analgesia. It is debatable whether there is a difference between opioid agents regarding tolerance development. We aim to compare the effects of morphine, remifentanil and alfentanil when infused intravenously during the perioperative period.
Methods: Sixty patients undergoing elective major abdominal surgery were randomized into four groups. The four groups obtained the following treatments: saline 5 cc iv bolus and 10 cc/h infusion for induction and maintenance in Group C, remifentanil infusion 0.25 μg/kg/min following 1µg/kg iv bolus in Group R, alfentanil infusion 0.50 µg/kg/min following 10 µg/kg iv bolus in Group A, and morphine infusion 0.02 mg/kg/h after 0.1 mg/kg iv bolus in Group M. Meperidine 10 mg/cc iv patient-controlled analgesia was used postoperatively, and total meperidine consumptions were recorded. VAS scores and side effects were recorded during postoperative 48 hours.
Results: VAS scores in Group M were found to be significantly lower than in Group C at the 1st postoperative hour. Twenty-four hour total meperidine consumption in Group R and Group M were significantly lower than in Group C. No statistical difference was found between groups regarding the incidence of nausea and vomiting.
Conclusion: Our study indicated that infusions of morphine, alfentanil and remifentanil administered to patients undergoing major abdominal surgery did not cause acute opioid tolerance. In contrast, infusion of morphine and remifentanil reduced postoperative opioid requirement.

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Altmýþ yedi yaþýnda omuz rotator kaf yýrtýðý nedeniyle artroskopik omuz cerrahisi planlanan hastada interskalen blok uygulamasý sýrasýnda geliþen konvülziyon nedeniyle lokal anestezik sistemik toksisitesi (LAST) derlenmiþtir.

We aim to review local anesthetic systemic toxicity (LAST) due to suddenly developing convulsion during interscalene block in a 67-year-old patient undergoing shoulder surgery.

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Bölgesel anestezi sonrasýnda spinal miyoklonus son derece nadirdir. Bu olgu ile epidural levobupivakain infüzyonuna baðlý geliþen spinal miyoklonusu sunmayý amaçladýk.

Spinal myoclonus following regional anaesthesia is extremely rare. We report a patient who developed spinal myoclonus after an epidural infusion of levobupivacaine.

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Santral bloklardan olan epidural kateter uygulamalarýnýn morbid obezlerde baþarýsýzlýk oraný yüksektir. Son yýllarda ultrasonografinin kullaným pratiðine dahil olmasý ile kateter uygulamalarýnda baþarý oraný yükselmiþtir. Kateterin baþarýlý yerleþtirilmesiyle birlikte korunmasý da blok kalitesi için gereklidir. Morbid obezlerde cilt altý yumuþak doku kitlesinin artmasý kateterin yer deðiþtirmesine neden olmaktadýr. Morbid obezlerin çok hýzlý kilo vermesi sonrasýnda, ideal kiloda olsalar dahi cilt altý dokularýn aþýrý mobil olmasýna baðlý olarak kateterin yer deðiþtirmesi sorununun hala devam ettiðini bu olgu sunumu ile vurgulamak istedik.

Epidural catheter applications as a central blocks have a high failure rate in the morbidly obese patients. Success rate has increased in recent years with the use of ultrasonography in practice for catheter applications. Successful placement and secure of the catheter is required to protect the quality of the blocks. Subcutaneous soft tissue mass in the morbidly obese patients is caused to the displacement of the catheter. After morbidly obese patients lose weight fast, catheter displacement still continued depending on excess mobile subcutaneous tissue. With the presentation of these cases, we focused on this problem.

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