Objectives: The sudden and rapidly increasing severity of pain in sickle cell anemia painful crises frequently requires the use of strong opioids. Patients require continuous administrations of various doses (increased/decreased) within the following hours. This study aims to retrospectively evaluate the effects of a structured protocol based on standardized Visual Analogue Scale (VAS) and Patient-controlled analgesia (PCA) patient demand count on morphine consumption in painful crises.
Methods: A total of 177 painful crises of 93 patients who were administered morphine using the PCA method according to appropriate analgesia protocol between 2004–2018 were evaluated in this study. The demographic data, hemoglobin chromatography and genotypes, painful episode follow-up time, VAS scores before and after treatment, and daily morphine consumption of the patients were recorded. Morphine consumption during the crisis according to age groups and sex were compared.
Results: Of the patients, 57% were homozygous hemoglobin type SS (HbSS). Mean morphine consumption with PCA method was 56.9±35.4 mg (min-max: 10–232 mg) and mean follow-up time was 3.4±2.1 days (min.–max.: 1–11). VAS scores were significantly lower after treatment (6.8±2.3 pre-treatment; 0.8±0.6 post-treatment) (p<0.05).
Conclusion: To our knowledge, our study is the first structured protocol based on VAS and PCA demand data. We believe lower morphine dosage using PCA protocol according to the rapidly changing pain levels of the patients will provide effective analgesia. Prospective studies with fewer limitations will more effectively demonstrate the effectiveness of this protocol.

Objectives: Musculoskeletal disorders are the most common work-related health problems. The risk of musculoskeletal disorders is increased by working in a cold environment. The present study aims to investigate the effects of working years on the body.
Methods: We examined the effects of the working years on the musculoskeletal system and carpal tunnel syndrome symptoms of the individuals who were engaged in cutting, shredding, packaging, bagging and transportation operations at 9 degrees and lower ambient temperatures in a poultry factory in Turkey. Nordic Musculoskeletal Questionnaire (NMQ) was used to evaluate musculoskeletal symptoms of the individuals. Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) was used to investigate the carpal tunnel symptoms. Individuals grouped according to their total working years in a cold factory setting. Groups were formed as less than two years, between two and five years, between six and nine years, and ten years or more.
Results: This study showed that the increase in working years in a cold factory setting might lead to a feeling of pain and discomfort in various regions of the body, disrupt ordinary works due to the pain felt (p<0.05). This study also showed that the severity of the symptoms felt because carpal tunnel syndrome worsened, especially when an individual has been working for more than ten years in cold.
Conclusion: Working in the cold for a long time may result in long-term health effects on the human body.

Objectives: Psychodynamically, chronic pain problems with no organic cause have been conceptualized as a punishment through physical pain for guilt feelings. This study aimed to investigate the effects of conscious guilt feelings on nocebo pain responses and whether the resultant nocebo pain would affect conscious guilt feelings in the form of expiation through the pain.
Methods: An experiment was conducted with 100 participants. There were two independent variables, which were guilt induction (guilt-no guilt) and nocebo manipulation (nocebo-no nocebo). Nocebo manipulation was done by telling the participants that they would receive electricity from an EEG cap. In addition, they watched a video in which a confederate imitates having pain during the procedure. There were two dependent variables, guilt feelings, and experienced pain. Guilt feelings were measured using Positive and Negative Affect Scale twice, once after guilt induction and once after nocebo pain manipulation. Subjective pain scores were measured by using a basic 0 to 10 visual pain scale, on which the participants reported how much pain they experienced.
Results: The findings revealed that only the main effect of nocebo was significant.
Conclusion: The participants reported mild headaches in the absence of any physical stimulation after nocebo manipulations. The effect was observed in a standard laboratory environment. Non-physical nocebo pain induction could create pain, but conscious guilt induction did not increase the amount of reported nocebo pain, and resultant pain did not function as a punishment. Limitations and implications of the study were discussed.

Objectives: Pain management is an important issue following lumbar spinal surgery. Wound infiltration is a technique that a local anesthetic solution is infiltrated into the tissues around the surgical area. Previous studies reported that US-guided modified thoracolumbar interfacial plane (mTLIP) block after lumbar spinal surgery provided effective analgesia. In this study, we aimed to compare the analgesic efficacy of the US-guided mTLIP block and wound infiltration following lumbar disc surgery.
Methods: 60 patients aged 18–65 years, ASA classification I–II, and scheduled for lumbar disc surgery under general anesthesia were included in the study. US-guided mTLIP block was performed via the lateral approach in group T (n=30), and wound infiltration was performed in group W (n=30). Opioid consumption, postoperative pain scores and adverse effects of opioids, such as allergic reactions, nausea, and vomiting, were recorded.
Results: Opioid consumption and the use of rescue analgesia were significantly lower in group T in all the postoperative periods (1, 2, 4, 8, 16, and 24 h) (p<0.05). The VAS scores for pain during mobility and while at rest were significantly lower in group T than those in group W 8 h after the surgery (p<0.05). The incidences of nausea, vomiting, and itching in group W were higher than the incidences in group T.
Conclusion: The mTLIP block provides effective analgesia for the first 24 h following lumbar disc surgery, and it may be an alternative to wound infiltration for pain management.

Objectives: Comparison of self-rating method and telephone interview method on outcome measures’ results.
Methods: This cross-sectional study included 100 patients aged 18–40 years who applied to Physical Medicine and Rehabilitation outpatient clinics with mechanical low back pain. Outcome measures [Oswestry Disability Index (ODI), Roland Morris Disability Questionnaire (RMDI), Numeric Pain Rating Scale (NPRS), Istanbul Low Back Pain Disability Index (ILBPD] were administered, and the duration of administration was recorded by two different methods. The self-assessment method and scales were administered by patients in the outpatient clinic and the telephone interview method; scales were administered by the researcher via telephone-calls 24 hours after the out-patient visit.
Results: There were no significant differences observed in the results of outcome measures by the method of administration except the Istanbul Low-Back-Pain Disability Index (p=0.030). Outcome measures’ results were highly correlated with one another when administered by different methods and orders of administration. Duration of administration was significantly shorter when outcome measures were administered by telephone interview (p<0.001).
Conclusion: Different methods of administration usually do not have an impact on outcome measure results. However, in some scales like ILBPDI, it may emerge as a factor affecting outcome measures’ results. Therefore, adherence to an initially preferred administration method throughout the follow-up period is important regarding the reliability of the results.

Objectives: It is possible to observe the in-vivo movements of nerves using real-time ultrasound. In this study, we aimed to visualize the movements of the sciatic nerve as a guide to identify the sciatic nerve to distinguish from surrounding tissue.
Methods: This trial was a prospective, cross-over comparative study. We included 25 healthy volunteers in this study. The movements of the sciatic nerve were visualized in the transverse view at popliteal and midthigh levels using ultrasonography. Anterior-posterior movements were assessed by measuring skin-to-nerve distance. The distances were measured during maximum ankle dorsiflexion, maximum plantar flexion and neutral position and compared with each other. We also evaluated the quality of dynamic (real-time) rotation/lateral movements of the sciatic nerve by assigning a subjective observer score.
Results: The movement of sciatic nerve was significant at popliteal region with active and passive ankle dorsiflexion which was 0.32 cm and 0.23 cm respectively (p=0.003). The movement of sciatic nerve was significant at midthigh region with active and passive ankle plantar flexion which was 0.11 cm and 0.01 cm respectively (p<0.001). Excellent rotation/lateral movement was observed in subjects at popliteal region and good rotation/lateral movement was observed at midthigh level.
Conclusion: Sciatic nerve movement can be observed with ankle dorsiflexion and plantar flexion in the transverse plane at popliteal and midthigh locations under real time ultrasound. This preliminary study suggest that observing the movements of sciatic nerve is potentially valuable in clinical sciatic nerve blocks for facilitating the localization of the sciatic nerve.

Frontal sinus osteomas are benign and well-defined masses that may cause various symptoms when they press on the surrounding tissues. Paranasal sinus osteoma is seen as a well-defined mass showing high opacity in Computed tomography. In this case study, we presented here a 53-year-old frontal recess osteoma with severe headache filling the left frontal recess in the context of the literature

Ultrasound-Guided Dorsal Penile Nerve (DPNB) Block was performed to provide surgical anesthesia for a 22 years old ASA II patient who had hemophilia A and was undergoing circumcision surgery. 20 ml of 0.25% bupivacaine was used for the DPNB. Surgery was completed under block without complication. Twenty-four hours of the analgesia was provided following surgery.

Ankylosing spondylitis (AS) is a chronic, progressive, autoimmune collagen tissue disease characterized by inflammation and lower back pain. General anesthesia may pose a high risk in the AS due to intubation difficulty, as well as affected respiratory and cardiovascular organs. In cases of involvement of the vertebrae, neuraxial anesthesia may be difficult or even impossible. In this article, we discuss a case of AS that received a successful an epidural catheter was placed using a transforaminal route under C-arm fluoroscopy guidance for total hip replacement surgery, which was difficult due to intubation and an interlaminar neuraxial anesthesia.

Bezold-Jarisch reflex is a reflex that may occur during regional anesthesia, upper-extremity blocks and sometimes in general anesthesia, resulting in hypotension, bradycardia, apnea or cardiac arrest elicited by chemical or mechanical receptor stimulations. This reflex mostly occurs in the sitting position during upper-extremity nerve blocks can be forgotten in other complications. The complications that occurred after this reflex can be overcome by taking necessary precautions and providing sufficient cardiac monitorization. In our cases to be presented, we want to remind you of Bezold-Jarisch reflex, which may cause severe complications when forgotten.

Tolosa-Hunt Syndrome (THS) is an idiopathic condition characterized by periorbital and hemicranial pain, ipsilateral oculomotor and sixth cranial nerve involvement, good response to steroids, granulomatous inflammation of the cavernous sinus or the top of the orbita. A 25 year- old- male patient presented with severe burning burn pain near the left eye with double vision. The left eye exhibited semiptosis, limited outward gaze, and difficulty in the downward outward gaze. No history of trauma or drug use was reported. Cranial Magnetic Resonance Imaging (MRI) showed thickening cavernous sinus walls to the left, while contrasted MRI sections suggested inflammation as indicated by intense staining. Cerebral arterial and venous angiography were normal. Parenteral treatment with 1mg/kg methylprednisolon commenced. The pain passed on the third day of treatment. Ophthalmoplegia began improving in the third week. The clinical symptoms were completely over after the third month of the clinic. The pain did not recur after corticotheraphy started. The cranial MRI of the patient was reviewed in a comparative perspective in the first and third months of the clinic. Inflammation was observed to get better. THS should always be considered in painful ophthalmoplegia cases. Cranial MRI towards the cavernous sinus, in particular, would suffice for diagnosis, provided that the vertex of orbita is not affected.

Piriformis syndrome is a painful entrapment neuropathy caused by compression of the sciatic nerve under piriformis muscle for structural or acquired reasons. Myofascial pain syndrome is the most common cause. There are physical therapy modalities, stretching exercises, injection therapies and medical treatment approaches.In this case, we planned to demonstrate a different perspective to the treatment of piriformis syndrome with the ultrasound-guided dry needling treatment.