Objectives: This study aims to investigate the effects of suprascapular nerve and axillary nerve block on postoperative pain, tramadol consumption, sevoflurane consumption and visual clarity of the surgical field in arthroscopic shoulder surgery.
Methods: Forty-six patients undergoing arthroscopic shoulder surgery were randomized to receive either both suprascapular and axillary nerve block with ultrasound guidance (20 ml 0.25% bupivacaine) before general anesthesia (group SSAXB, n=23) or a subacromial local infiltration (20 ml 0.25% bupivacaine) after the procedure (group control, n=23). End-tidal sevoflurane consumption, visualization of the arthroscopic field scores of the patients were recorded during the procedure. The patient’s postoperative pain scores (at PACU, 4, 8, 12, 24 hours after the surgery) and tramadol consumption were also recorded.
Results: End-tidal sevoflurane concentration values were similar in both groups (p>0.05). Group SSAXB had a better mean static pain score in the PACU (Group SSAXB 4.27±1.48 vs Group C 6.24±1.09 p<0.05). Tramadol consumption was lower in group SSAXB than in group C (253.1±85.3 mg vs 324.2±72 mg, p=0.005). Visual clarity scores of the arthroscopic field were higher in group SSAXB than in group C along the intraoperative period (p<0.05).
Conclusion: SSAXB are effective in postoperative analgesia, reduce tramadol consumption and provide a clean image in the arthroscopic area of arthroscopic shoulder surgery, but these blocks do not reduce sevoflurane consumption.

Objectives: In our study, patient controlled epidural analgesia (PCEA) and patient controlled intravenous remifentanil analgesia (PCIVA) were compared for VAS, and also their side effects on mother and newborn.
Methods: In this study, 37 pregnant women with a single fetus, who had labor analgesia, were divided into groups of PCIVA (Group 2) and PCEA (Group 1). Bupivacaine 1.25 mg/ml and fentanyl 2 mcg/ml in 100 ml epidural solution were prepared for Group 1. The infusion dose was 15 ml, 5 ml divided doses. We set 5 ml/h basal infusion, 5 ml patient-controlled bolus and 20 min lock time. We prepared 2 mg remifentanil in 100 ml intravenous solution for Group 2. We set 20 mcg/h infusion, 0.05mcg/kg patient-controlled bolus and five min lock time. VAS, maternal-fetal heart rate, blood pressure, oxygen saturation, nausea-vomiting and sedation were recorded during labor. We recorded Apgar scores and maternal satisfaction at the end of labor.
Results: The findings showed that both groups could provide adequate analgesia. However, VAS scores were higher in Group PCIVA. The mother satisfaction and newborn’s Apgar scores were similar. In both groups, desaturation, which is requiring oxygen support, was not determined. The oxygen saturations were lower in Group 2. The side effects and patient satisfaction were similar in both groups.
Conclusion: Although PCIVA was found to be satisfactory concerning maternal satisfaction, VAS after 2nd hour were higher compared to PCEA. PCEA is the gold standard in labor analgesia. However, we believe that PCIVA is a good alternative to epidural analgesia in cases where epidural analgesia is contraindicated or where the patient does not want an epidural.

Objectives: To investigate the anatomical differences of sacral hiatus, pain levels and success rates during caudal epidural steroid injection (CESE) using ultrasonography.
Methods: In the study, 255 patients (148 male and 107 female) with lower lumbar back pain and sciatica were included. These patients were applied caudal epidural steroid injection by ultrasonography. Sonograms were obtained by ultrasonography (USG) guideline. Patients’ pain levels were assessed by the Visual Analogue Scale (VAS) during the CESE procedure performed on USG guided, and success rates were saved. The intercornual distance, sacral distance and sacrococcygeal ligament thickness were measured.
Results: There was no statistically significant difference between the demographic data of the patients (p>0.05). There was a significant difference between male and female patients concerning intercornual distance (15.8 versus 16.6 mm; p=0.004) and sacrococcygeal ligament thickness (4.1 mm vs. 3.7 mm; p=0.018). There was no significant difference between patients about KESE success rate, VAS values and sacral distance (p>0.05).
Conclusion: We found that sacral hiatus has anatomical differences between male and female patients. According to current evidence, the success rate of caudal epidural steroid injection increased when the anatomical structures of sacral hiatus are shown correctly in USG guided.

Objectives: In this study, it is planned to observe the effects of vibration tourniquet application on the pain felt in school-aged pediatric patients. This is a randomised study.
Methods: The research population consisted of patients who were between ages 6 and 12 in the Pediatric Blood Drawing Unit at the Mersin University Research and Application Centers for diagnosis or treatment between dates of May 2017 and November 2017. The sample group consisted of 90 pediatric patients who were eligible for case taking criteria; 45 of them were control and other 45 of them were intervention group (vibrating tourniquet applied). All 90 patients agreed to participate in this study. The children information form was used to assess descriptive properties of children and Wong-Baker FACES- Pain Rating Scale was used for assessment of pain levels. In intervention group patients, blood was drawn with using vibrating tourniquet. Heart beat, respiration rate, blood pressure, fever and saturation level before and after blood drawn were measured for intervention and control group patients and they were asked to mark their level of pain on the Wong-Baker FACES Pain Rating Scale.
Results: There was a statistically significant difference when vibrating-tourniquet-applied case and vibrating-tourniquet-not-applied control groups’ mean pain points were compared (p<0.05).
Conclusion: In conclusion, the findings suggest that using vibrating tourniquet for drawing blood is effective in decreasing the pain level of children.

Objectives: Lumbar facet (zygapophysial) arthropathy is a common cause of chronic lower back pain, and percutaneous radiofrequency denervation of the facet joints appears to be an effective treatment that yields long-term improvement. A technique utilising a distal approach to place the needle parallel to the medial branch has recently come into common use. In the present study, a technique incorporating a distal approach and an A-P fluoroscopic view was investigated.
Methods: In this study, clinical charts of 164 patients with lumbar facet syndrome who had undergone RFTC (radiofrequency thermocoagulation) of facet-joint medial branches were retrospectively evaluated. The success rate of percutaneous radiofrequency thermocoagulation of facet-joint medial branches performed utilising a distal approach with an A-P view was evaluated. NRS (numeric rank score) pain scores and subjective patient-reported global responses were measured.
Results: Of the patients, responses were rated as excellent by 46 (28.0%), good by 67 (40.8%), fair by 21 (12.8%) and poor by 30 (18.2%). The median duration of pain relief was 7.3 months. In the 113 patients who reported excellent or good responses, the median duration of pain relief was 10.2 months.
Conclusion: Radiofrequency thermocoagulation for facet arthropathy is a safe and effective treatment option that is well-tolerated. We suggest that a distal approach with an A-P view for facet radiofrequency thermocoagulation is a viable alternative to other approaches.

Objectives: The primary objective of this study was to investigate the effects of Pulsed RF application in the genicular nerve on pain and function in patients with osteoarthritis (OA) and its side effects.
Methods: This study was conducted between February 2018 and June 2018. Patients who were previously administered diagnostic blocks were evaluated a day later; a drop of at least 50% in numeric pain scores was considered a positive response, and these patients were included in the Pulsed RF neurotomy procedures. Radiofrequency (RF) cannula was advanced towards targeted nerves under the guidance of fluoroscopy. RF lesions were created by applying Pulsed RF treatment to the three genicular nerves three times with five minutes intervals at 42 °C using NT1000 RF Generator. Following the Pulsed RF application, 2 mL 0.5% bupivacaine was injected into each genicular nerve as an anesthetic agent. VAS, pain DETECT scores, WOMAC scores were evaluated preoperative baseline and postprocedure weeks 1, 4, and 12. Patient Global Impression of Change (PGIC) score was evaluated postprocedure weeks 12.
Results: This study included 20 patients who were administered genicular nerve Pulsed RF. The mean age was 55.2±3.24 years, and F/M ratio was 12/8. Compared to the pre-procedure period, patients’ pain and function evaluation, WOMAC and VAS values decreased by approximately 50% at the end of the 12th week. No side effect was observed in any patients.
Conclusion: Our findings suggest that Pulsed RF neurotomy of the genicular nerves is an efficient and safe treatment method for patients with chronic knee osteoarthritis.

Extracorporeal shockwave lithotripsy (ESWL) is widely used for the treatment of urinary tract calculi; however, the vast majority of the patients does not tolerate the procedure without analgesia and sedation. Pain control in ESWL has been crucial for process success and patient comfort. Systemic drugs, such as non-steroid anti-inflammatory drugs, opioids, alfa-2 agonist and various local and regional anesthesia methods (transversus abdominis plane block, paravertebral block, infiltration) have been applied to control ESWL pain. Quadratus lumborum block (QLB) is performed as one of the regional anesthetic techniques for abdominal surgery. This block provides anesthesia and analgesia on the anterior and lateral wall of the abdomen. In this report, we presented the analgesic efficacy of QLB in 15 patients, which included nine renal and six ureter stones for ESWL. The mean of the VAS scores ranged from 0.20±0.41 to 2.73±1.22, and mean fentanyl consumption was 15.00±15.08 mcg during the procedure. No opioid-related side effects were observed in any of the patients. Full fragmentation was obtained in nine of the 15 patients, and partial fragmentation was obtained in five patients.

Spontaneous epidural hemorrhage is one of the rare neuropathic pain etiologies. In this case, a 68-year-old patient, who had atrial fibrillation and cardioversion history, is evaluated for neuropathic pain due to spontaneous epidural hemorrhage that arose from oral anticoagulant therapy. As well as being unique in etiologic terms, we thought it is an uncommon occasion for management worth sharing.

The rhinolith is massed in a mineral nugget in the nasal cavity, which is the result of the accumulation of salts around the nidus. The nidus may be endogenous or exogenous. Long-term and unilateral nasal obstruction, nasal discharge, pain and malodor are major complaints. However, sometimes, they may not show any signs for years and maybe detected incidentally during a routine examination. In this study, we present a case of giant rhinolith with headache and nasal obstruction complaints.

Cervical artery dissection is an acute arterial disease. Although it is not a common disease, 40-60% cerebral infarction and 20-30% transient ischemic attack could be seen. Thus, cervical artery dissection is important to recognize. Fifty-three years old female patient consulted with head, neck and face endaural pain that started after than spread directly left face half, effect of sometimes orbita and sometimes submaxillary area, occasionally accompanied by redness in the eye, extending from a few minutes to a few hours, it has been sharp and pulsatil characteristics and she never experienced before similar. Although not typical, with the initial diagnosis was trigeminal neuralgia and cluster headache (CH), carbamazepine and tramadol treatment were started. The patient who had neck pain was severe during USG, and with atypical features was BT angioed to the brain and neck concerning differential diagnosis of the patient. It was detected profile compatible with dissection at left ICA proximal. In the literature, there are rare cases of ICA dissection mimicking CH and other trigeminal autonomic cephalalgias. A common recommendation in CH case reports is the need for neurovascular imaging in cases with atypical features.