Henceforth, ultrasonography (US) is an indispensible imaging technique in regional anesthesia practice. With the guidance of US, various invasive interventions in chronic pain pathologies of the musculoskeletal system, peripheral and neuroaxial pathologies has become possible. The management includes diagnostic blocks as weel as radiofrequency ablation and institution of neurolythic agents. During these algologic interventions we are able to see the target tissue, the dispersion of the drug and all nearby vascular structures. Besides these the US also protects the team from ionic radiation that one encounters when using flouroscopy of computed tomography. Latest publication in this field show that applicability of US in chronic pain syndromes is rapidly expanding with a good future. The additional equipment (echogenic needles, 3-D US etc.) will also expands its applications in algology practice.
This review highlights different applications of US in chronic pain conditions.

We aimed to compare the preventive effect of the skin antiseptics as %10 povidon iodine and 2-propanol+benzalkonium chlorideon the contamination of the tip of epidural catheter.
We included 160 patients, administered antibiotic prophylaxis, aged 18-65 years, ASA physical status I–II. Patients were randomized. Group P(n=80) were given povidon iyot as a skin antiseptic before inserting the catheter: Group B 2-propanol and benzalkoniumchloride were used. The swab was taken before and after the usage of antiseptics and sent for culture. The catheter was pulled after cleaning the skin in the catheter area with anthiseptics used before after 48 hours inserting the catheter. Two-three cm pieces of tip of catheter was cut in the sterile conditions and sent to laboratory. Preoperative and postoperative complete blood count, body temperature and the signs of postoperative local skin infection in the catheter area were recorded.
Leukocyte, neutrophil and lymphocyte counts of all patients were in normal ranges. The skin swab culture taken after the usage of antiseptics was positive in 6 patients in group P; coagulase-negative staphylococc in 5 patients, E. Coli in 1 patients. The difference between both groups was found statistically significant (p=0.013). Cultures were negative for all the epidural catheter.
The results showed that the combination of benzalkonium chloride+2-propanol was found to be more effective in reducing the skin flora around the epidural catheter insertion site.

Aim
The aim of the current study was to determine musculoskeletal system diseases and the related factors in mothers who have children with cerebral palsy.
Method
Eighty-five females who had children with cerebral palsy were included in the study as the treatment group, and 42 females who had healthy children were included in the study as the control group. The sociodemographic characteristics of all mothers were recorded. The pains in musculoskeletal system were evaluated according to the Standardized Scandinavian Musculoskeletal System Questionnaire and the level of depression was evaluated according to Beck’s Depression Scale.
Results
Musculoskeletal system pain and depression scores in mothers who had children with cerebral palsy were significantly higher than the control group. The most frequent pain in mothers who had children with cerebral palsy was low back pain (44.7%). In multiple regression analysis, the number of children, the age of the child with cerebral palsy, the functional level of the child and the depression level of the mothers were found as independent risk factors for musculoskeletal system pain in mothers who had children with cerebral palsy.
Discussion
The mothers who have children with cerebral palsy are at higher risk for musculoskeletal system pain and depression findings, compared to the mothers who have healthy children. It should be kept in mind that musculoskeletal system pain is more frequently seen in mothers who have children with cerebral palsy, especially children at older ages and those that have poor functional status.

Objectives: This study was conducted to determine levels of pain and self-efficacy of individuals with osteoarthritis.
Methods: The research was carried out on 83 patients who had been admitted to the physical therapy and rehabilitation outpatient clinic and hospitalized department with the primary diagnosis of osteoarthritis. The research data were collected using patient information form, visual analog scale (VAS), Osteoarthritis Index (Western Ontario and McMaster Universities Osteoarthritis Index-WOMAC) and arthritis self-efficacy scale. In the assessment of data; pearson correlation analysis, t test and one-way analysis of variance were used. p value less than 0.05 was considered statistically significant.
Results: It was determined that %78.5 of study group is the most experienced complaint of pain and limitation of movement, that %69.9 of those experienced pain affects a lot of activities of daily living. Osteoarthritis İndividuals’s average VAS score was 5.7±2.3, WOMAC score 56.3±14.8 and self-efficacy score 103.7±29.5. Men, higher level of education, non housewife, those activities of daily living independently and none of additional chronic disease levels of self-efficacy were significantly higher than the other groups (p<0.05). The study found that VAS and self-efficacy, and self-efficacy scores of the WOMAC negative, between VAS and WOMAC scores a significant positive correlation.(p <0.05).
Conclusion: The mean score of self-efficacy of individuals with osteoarthritis found moderately and, who the level of self-efficacy was affected by gender, education, level of independence, pain, and functional status.

Objectives: In this randomized, controlled, blinded study, the effects of thoracic
paravertebral analgesia were compared with those of epidural analgesia on postoperative pain, hemodynamics and respiration rate after thoracotomy.
Methods: The patients, scheduled for elective open-lung surgery, were included in the study. Before the surgery eighteen patients had thoracic epidural cathether (ED group) and 17 patients had an ultrasound-guided paravertebral cathether (PV group) inserted. Standard general anesthesia was administered to all of the patients. At the end of the anaesthesia, all patients received levobupivacaine 0.1% with morphine 0.1 mg ml-1 via catheters for postoperative analgesia. Patient controled analgesia(PCA) regime with tramadol was applied. The amount of local anaesthetics and tramadol used within the first 24 hours (delivery+demand) were recorded. The VAS pain score, sedation score, side effects and vital signs(blood pressure, heart rate and respiratory rate) were assessed by a blinded observer at 1, 2, 3, 4, 6, 12 and 24 hours postoperatively.
Results: The numbers of PCA boluses delivered and attempts were not statistically significant in Group PV (26.8 ± 1.3 and 33.1 ± 4.5) those Group ED (25.1 ± 3.5 and 32.5 ± 4.3. VAS scores were not statistically different between the PV group and ED groups (p=0.3).
Sedation in PV group was lower than those in ED group at 1. hours (p=0.001). Five patients in ED group experienced hypotension(p=0.02).
Conclusion: Paravertebral block with levobupivacaine 0.1% and morphine 0.1 mg ml-1 may be an altenative for the pain relief after thoracotomy.

Objectives:
Obturator nerve block has been described and performed to prevent the obturator reflex during transurethral resection. Different techniques were found since then. We are using the interadductor approach in our clinic. We aimed to find out the outcomes of our practice in this study.

Material Methods:
After obtaining the ethical approval of the committee, files of patients, who had transurethral resection surgery between October 2013-October 2014, were scanned retrospectively.

Results:
A total of 137 patients were found to have transurethral resection. Number of patients who had combination of spinal anesthesia with obturator nerve block for the operation was 69. All of the obturator nerve blocks were done under the ultrasound guidance with interradductor approach. It was found that the obturator nerve block was unsuccessful in two patients due to observation of the obturator reflex. All the operations were done without any complication in all patients.

Conclusions:
Obturator nerve block is an effective method for preventing the obturator reflex. Combination of obturator nerve block and spinal anesthesia seems to be a safe method for surgical anesthesia in transurethral surgeries. Ultrasound guidance in obturator nerve block helps to increase the block success rates and gives additional advantages for patient’s safety.

We present the case of a 77 year old patient with severe coronary heart disease, undergoing radical mastectomy with axillary lymph node dissection by ultrasound-guided continuous paravertebral block (CPVB).Radical mastectomy with axillary dissection is a surgical procedure that usually performed under general anesthesia and necessitates endotracheal intubation. Patients with coronary heart disease (CHD) and sleep apnea syndrome (SAS) have higher risk for general anesthesia. Ultrasound guided CPVB is a simple and safe alternative technique that offers anesthesia as well as postoperative analgesia with minimal side-effects.

Intramuscular injections are probably the most common causes of sciatic nerve injury in developing countries. Piriformis syndrome, primary tumors of sciatic nerve, metastatic tumors invading or compressing the nerve, endometriosis, vascular malformations, prolonged immobilization or specific positions are rarer causes of sciatic neuropathy. Although the most reliable methods are nerve conduction studies and electromyography for diagnosis, and prognosis, magnetic resonance imaging is also suggested to be an alternative investigation method to determine the type of lesion, to establish its site and the level of nerve involvement.
Here, we present a case with sciatic neuropathy which developed after intramuscular injection during a prolonged lithotomy position under sedation.

Background and objective: Spinal cord stimulation has been performed frequently in the last years as a neuromodulation technique for the treatment of chronic low back pain. Dorsal column is stimulated with the electrode replaced at epidural region. We applied subcutaneous lead as an adjunct in failed back syndrome patient receiving spinal cord stimulation for limb pain but had inadequate response to back and gluteal pain.

Case report: 65 year old male patient had an operation because of lumbar disc herniation. After the operation he had recieved physical therapy and multiple steroid injections due to his unrelieved pain. He was admitted to our pain clinic with a radiating pain to right gluteal and limb. He was performed spinal cord stimulation. Later on subcutaneous lead was placed on the right cluneal nevre distrubition because of the unrelieved pain. He has a VAS of 1-2 and pain was reduced over 80 %.

Technique: Octad electrode was placed between T8-T10 after the tuohy needle was introduced between L1-L2 intervertebral area. Paresthesia was obtained at right extremity. The boundries of the right gluteal region side has been determined which the paresthesia did not obtaiıned. Octad electrode was placed subcutaneously after the vertical line drawn from the center point. Paresthesia was obtained at all region (pw 390-450 msec, f 10-30 hz).

Conclusion: Subcutaneous electrode replacement can be used as an alternative technique after spinal cord stimulation due to unrelieved pain.

Palmoplantar dysesthesia is a dermatological toxic reaction caused by chemotherapeutics. It is also known as hand-foot syndrome syndrome. It is not a life threatening condition but it decreases life quality of patients. Clinically, dysesthesia, erythema, edema and desquamation on palmoplantar region are seen in patients. Cytarabine, doxorubicine, capecitabine, epirubicine, docetaxel, vinorelbine and 5-FU are chemotherapeutics that may cause palmoplantar dysesthesia syndrome. Our case was 62 years old woman presented with diffused erythema on palmoplantar area after usage of capecitabine for metastatic meme carcinoma. We reported this case because palmoplantar dysesthesia syndrome caused by capecitabine may affect treatment compliance of patients.

BACKGROUND: Anaphylaxis during general anesthesia (GA) is rare; but increases morbidity and mortality. The investigation of suspected anaphylaxis is challenging since the patient is often exposed to a number of drugs within a few minutes.
CASE: Fortytwo years-old female, ASA II patient had multiple drug allergy (propofol, meperidine, bupivacaine, cefazolin, amoxiciline-clavulanate, metronidazole, flurbiprophen, levofloxacin, diclophenac). She previously had 9 operations under GA and experienced anaphylaxis culminating in internal care unit administration in two of them. She was scheduled for reconstruction of deep flexor tendon injury with plantar tendon graft of the left foot. However; GA or the combination of axillary brachial plexus and sciatic nerve block options were not seemed appropriate when the block failure, local anesthetic toxicity and anaphylaxis risks were taken into account. Therefore, the surgical plan was switched to the transfer of palmaris longus tendon of the left hand and the anesthesia decision was made to perform only axillary brachial plexus block with non-allergic agents.
After sedation; axillary artery, vein, median, ulnar, radial and musculocutanous nerves were visualized with the high frequency linear probe in the axillary region. Twentyone mL (10mL 2% lidocaine(200 mg), 10mL 2% prilocaine(200 mg) and 1mL adrenaline(100 mcg)) was administered by using in-plane technique. After the adequate block, operation was completed uneventfully. The patient had only 500mg of IV paracetamol twice during the first 24hours postoperatively(NRS≤5).
CONCLUSION: This case is presented to emphasize that anesthesia and surgical team communication and the use of alternative anesthesia techniques improve patient safety.