EXPERIMENTAL AND CLINICAL STUDIES | |
1. | What is the impact of having a family history of migraine on migraine characteristics? Arife Çimen Atalar, Osman Özgür Yalın, Hüsniye Aslan, Betül Baykan PMID: 31736021 doi: 10.14744/agri.2019.26042 Pages 113 - 121 Objectives: There are only a handful of studies examining the clinical differences between patients with and without a family history of migraine. Our aim is to compare the descriptive and clinical properties of patients with and without a family history, and to investigate the association between the migraine burden and disease characteristics and disability of migraine. Methods: A total of 530 consecutive patients diagnosed with migraine according to the International Headache Society criteria were enrolled into the study. Detailed systemic and neurological examinations, and blood pressure, weight, height, and body mass index measurements, clinical and demographical data, the visual analog scale, allodynia symptom checklist, and the Migraine Disability Assessment Scale (MIDAS) scores were recorded. The groups with and without a family history of migraine were compared statistically. Results: Patients with a positive family history had a higher educational status (high school and higher) (p<0.05) and an increased triggering of pain with physical activity (p=0.013). The age at onset was earlier (p=0.049); disease duration was longer (p=0.030), and MIDAS scores were significantly higher (p=0.028) in patients with a family history of migraine. Conclusion: Having a family history of migraine is associated with an earlier age at onset and a longer disease duration, in addition to an increased disability in these patients. The family history may be assumed as a marker of the genetic load in migraineurs; therefore, an early diagnosis and an appropriate management are essential in these patients to avoid migraine-related disability. |
2. | Views of algology inpatients about ethical issues related to pain Gülay Yıldırım, Şükran Ertekin Pınar, Sinan Gürsoy, Iclal Özdemir Kol PMID: 31736028 doi: 10.14744/agri.2019.80378 Pages 122 - 131 Objectives: To determine the views of patients hospitalized in the algology clinic about ethical issues related to pain. Methods: A total of 135 patients admitted to the algology clinic comprised the population of this descriptive study. Data were collected using the visual analogue scale (VAS) and the questionnaire on ethical issues related to pain. To evaluate the data, percentage distribution and the Tukey test of variance were used. Results: Of the patients, 92.6% believed that they had the right to pain relief, and 94.8% believed that they should be consulted when decisions about them were made. It was determined that 43.0% of the patients disagreed with Proposition 1, “When a terminal-stage cancer patient with unrelievable pain requests an overdose of pain medication, possibly to cause death, the physician must prescribe it,” while 51.9% of the participants disagreed with Proposition 2, “When a terminal-stage cancer patient with unrelievable pain and his or her family request an overdose of pain medication, possibly to cause death, the physician must prescribe it,” and 44.4% of them disagreed with Proposition 3, “When a terminal-stage cancer patient with unrelievable pain requests an overdose of pain medication, possibly to cause death even though his or her family refuses, the physician must prescribe it.” A statistically significant relationship (p<0.05) was found between the mean VAS scores and Propositions 1 and 3. Conclusion: The patients were willing to be informed and to be asked about their views regarding the issue, but they did not want to be prescribed a high dose of pain medication, possibly to cause overdose and death. |
3. | Analgesic effect of the bi-level injection erector spinae plane block after breast surgery: A randomized controlled trial Can Aksu, Alparslan Kuş, Hadi Ufuk Yörükoğlu, Cennet Tor Kılıç, Yavuz Gürkan PMID: 31736025 doi: 10.14744/agri.2019.61687 Pages 132 - 137 Objectives: Due to the complex breast innervation, postoperative analgesia after breast surgery is a challenge for the anesthesiologists. The erector spinae plane block (ESPB) is a newly defined promising technique for this purpose. The main purpose of this study was to evaluate the analgesic efficacy of the ultrasound-guided ESPB in breast surgery, monitoring its effect on the postoperative opioid consumption. Methods: Fifty female patients, who were scheduled to undergo elective breast surgery, with the American Society of Anesthesiology physical score I–II, and aged between 25 and 70 years, were included into the study. Patients were randomized into two groups, as the ESPB and the control group. All patients in the ESPB group received a bi-level (T2–T4) ultrasound-guided ESPB with 20 ml 0.25 % bupivacaine (10 ml for each level) preoperatively. An intravenous patient-controlled analgesia device for the postoperative analgesia was given to all patients. The numeric rating scale (NRS) scores for pain and postoperative morphine consumptions were recorded at the 1st, 6th, 12th, and 24th hour postoperatively. Results: Postoperative morphine consumption was significantly lower in the ESPB group compared to the control group at the postoperative 6th, 12th, and 24th hour (p<0.001 for each time interval). The morphine consumption at the 24-hour was reduced by 75%. There was no significant difference in the NRS scores (median NRS values were 2, 1, 0, 0, and 2, 2, 1, 1, respectively). Conclusion: Our study has shown that a significant opioid-sparing analgesic effect in patients undergoing breast surgery could be achieved with a US-guided bi-level ESP block. |
4. | Analgesic efficacy of intraperitoneal, incisional, and intraperitoneal + incisional levobupivacaine in laparoscopic gynecological surgery Aslı Dikici, Nurten Kayacan, Bilge Karslı PMID: 31736022 doi: 10.14744/agri.2019.46034 Pages 138 - 144 Objectives: We aimed to investigate the analgesic efficacy of intraperitoneal, incisional, and intraperitoneal + incisional levobupivacaine in laparoscopic gynecological surgery. Methods: Group 1 received levobupivacaine 20 mL intraperitoneally, Group 2 received levobupivacaine 20 mL to the trocar wounds, Group 3 received levobupivacaine 20 mL intraperitoneally and levobupivacaine 20 mL to the trocar wounds. Postoperative abdominal pain at rest and during mobilization and shoulder pain were assessed at the 2nd, 4th,12th, and 24th postoperatively by VAS. If VAS was >3, the analgesia was assessed as inadequate, and diclofenac sodium was injected. In addition, time the first analgesic requirement, total analgesic consumption, analgesic effectiveness, and the satisfaction of patients about the analgesic method were recorded during the postoperative period. Results: No significant difference was found between groups with respect to VAS (p>0.05). Patients in Group 2 had a higher postoperative analgesic consumption and lower timing of the first analgesic requirement than Groups 1 and 3, but these differences were not significant (p>0.05). The satisfaction of the patients about the analgesic technique was similar between the groups. Conclusion: The use of levobupivacaine intraperitoneally is an alternative method to reducing of postoperative shoulder and abdominal pain in gynecological laparoscopic surgery. Also, we observed a lower total analgesic consumption and more analgesic effectiveness in intraperitoneal groups than the other. Further studies are needed with different intraperitoneal local anesthetics. |
5. | Effective pain therapy can improve the survival of patients with pancreatic cancer Sibel Ozcan, Sevim Akın, Aysun Yıldız Altun, Esef Bolat, Selami Ateş Önal PMID: 31736024 doi: 10.14744/agri.2019.61224 Pages 145 - 149 Objectives: In this study, characteristics and analgesic treatment of patients with pancreatic cancer who applied to the algology clinic were evaluated. Methods: Demographic characteristics, pathologic diagnosis, metastasis, cancer treatment, and analgesic interventions in 60 patients with pancreatic cancer, referred to the algology clinic, were examined. Results: The application time of the patients to the clinic was 3.9±0.92 months after the diagnosis, and the visual analog scale (VAS) was 6.96±0.11 at the initial assessment. According to the analgesic step ladder protocol, a nonopiod + weak opioid + strong opioid (transdermal) were applied in 58.33%, a nonopioid + weak opioid + strong opiod (oral) in 5%, and nonopiod + weak opioid in 36.66% of the patients. Adjuvant pain medications were used in 68.33% of the patients (benzodiazepine, 80.48%; antidepressant, 19.51%), while no adjuvant was used in 31.66% of the patients. While the mean survival time for patients with pancreatic cancer changed from 3 to 6 months, it was 8.48±7.46 months for patients who applied to the pain clinic. Conclusion: Abdominal pain in pancreatic cancer is the most common symptom that negatively affects the quality of life. A good analgesia improves the survival, while pain decreases the survival. The results of the present study demonstrated that the survival of the patients with metastatic pancreatic cancer who received effective pain therapy in the algology clinic may be longer. |
CASE REPORTS | |
6. | Acute rhabdomyolysis following epidural steroid injection: An unusual complication in a patient with low back pain Damla Yürük, Ahmet Yılmaz, Güngör Enver Özgencil, İbrahim Aşık PMID: 31736023 doi: 10.5505/agri.2017.54366 Pages 150 - 152 Epidural steroid injection is a very common intervention in the treatment of low back pain and sciatic symptoms. The most common complication for epidural steroid injection is transient headache with or without identifiable dural puncture. Other complications have also been reported, including intravascular entry, local hematoma, bleeding, increased back pain, facial flushing, vasovagal reactions, nausea, and fever. We report a case of rhabdomyolysis following epidural steroid injection for lumbar radiculopathy. |
7. | Quadratus lumborum block for both cholecystectomy and right-sided nephrectomy Yavuz Gürkan, Hadi Ufuk Yörükoğlu, Halim Ulugöl, Alparslan Kuş PMID: 31736019 doi: 10.5505/agri.2017.24392 Pages 153 - 154 The quadratus lumborum block (QLB) is a unilateral facial plane block, which extends from T4 to L1 at the paravertebral space. Injecting local anesthetic between the facial plane of the quadratus lumborum muscle and the psoas major muscle provides the block of the referred dermatomes. However, the number of published studies for QLB used in various surgical procedures is limited. In this case report, we share the results of a 46-years-old ASA I female patient, who underwent open surgery for cholecystectomy and right-sided nephrectomy in the same session. After general anesthesia was induced, QLB was performed in the left lateral decubitus position. A convex probe was placed in transversely between the iliac crest and the costal margin at the midclavicular line. 20cc of 0.25% bupivacaine was injected to the facial plane between the quadratus lumborum and psoas major muscles. The surgery lasted 4 hours and completed uneventfully. In the postoperative period, the patient was provided with morphine PCA. After 24 hours, the VAS score was 0, and the total demanded morphine dose was 13 mg. This case report recommends that QLB may be an adequate choice in the postoperative pain management for patients undergoing cholecystectomy and nephrectomy. |
8. | Ultrasound-guided quadratus lumborum block for postoperative analgesia in a pediatric patient Gözen Öksüz, Yavuz Gürkan, Aykut Urfalıoglu, Mahmut Arslan PMID: 31736020 doi: 10.5505/agri.2017.05935 Pages 155 - 157 The quadratus lumborum block (QLB) is a newly described block providing successful, safe, and long-lasting analgesia with the guidance of ultrasound. The QLB allows local anesthetic to spread posterior to the quadratus lumborum muscle and expand beyond the middle layer of the thoracolumbar fascia and paravertebral space. We present our experience with the use of an unilateral QLB to provide postoperative analgesia in a 3-year-old pediatric patient weighing 14 kg who underwent a unilateral inguinal hernia repair. His family was satisfied with the general status and pain cessation in the patient. |
LETTER TO THE EDITOR | |
9. | Ultrasound-guided erector spinae plane catheter placement for long-term continuous analgesia in pulmonary malignancy Onur Balaban, Tayfun Aydın, Merve Yaman PMID: 31736026 doi: 10.5505/agri.2018.74240 Pages 158 - 160 Abstract | |
10. | Tremor on the same extremity after axillary brachial plexus block Hüseyin Ulaş Pınar PMID: 31736027 doi: 10.14744/agri.2019.76983 Page 161 Abstract | |