ISSN: 1300-0012 | E-ISSN: 2458-9446
Volume : 32 Issue : 4 Year : 2024
Quick Search



CLOCKSS system has permission to ingest, preserve, and serve this Archival Unit

Agri - Ağrı: 32 (4)
Volume: 32  Issue: 4 - 2020
EXPERIMENTAL AND CLINICAL STUDIES
1. Reduction of pain during intravenous cannulation in children: Buzzy application
Remziye Semerci, Esra Nur Kocaaslan, Melahat Akgün Kostak, Nefise Akın
PMID: 33398861  doi: 10.14744/agri.2020.02223  Pages 177 - 185
Objectives: This study was a randomized, controlled examination of the effect of the Buzzy device (MMJ Labs, LLC, Atlanta, GA, USA) in reducing pain during peripheral intravenous cannulation in children. The device uses a combination of highfrequency vibration and cold to block pain.

Methods: The study was conducted with 56 children aged 7–12 years who presented at the pediatric emergency department of Trakya University Health Center for Medical Research and Practice. Data were gathered using a family and child data collection form and the Wong-Baker FACES Pain Rating Scale (Wong-Baker FACES Foundation, Oklahoma City, OK, USA). A vein visualization tool was used in both groups for peripheral intravenous cannulation, and the Buzzy device was also used in the experimental group. The pain of the children was assessed by a nurse and the children. Descriptive statistics, the Wilcoxon t-test, the Mann-Whitney U test, and correlation analysis were used to evaluate the data. The results were evaluated at a 95% confidence interval and p<0.05 was accepted as the level of significance.

Results: The mean age of the children was 8.37±1.96 years and 58.9% were male. The mean pain score provided by the children
in the experimental group was 3.40±3.56 and it was 3.76±3.06 in the control group. The mean pain score reported by the nurse for the experimental group was 4.53±3.44 and 3.76±2.73 for the control group. There was no significant difference between the pain scores reported by the children and the nurse according to group (p<0.05). However, there was a significant difference between the pain scores recorded by the nurse and the children (p=0.034).

Conclusion: The Buzzy device was not effective in reducing pain during intravenous cannulation. The level of pain reported by the nurse was higher than that described by the children. It is recommended that training on pain assessment and the use of distraction methods should be provided to nurses working in pediatric emergency departments.

2. A prospective and randomized trial comparing modified and classical techniques of ultrasound-guided thoracolumbar interfascial plane block
Bahadır Çiftçi, Mürsel Ekinci
PMID: 33398870  doi: 10.14744/agri.2020.72325  Pages 186 - 192
Objectives: A thoracolumbar interfascial plane (TLIP) block is a novel ultrasound (US)-guided technique that provides effective analgesia after lumbar spinal surgery. Two approaches for a TLIP block have been defined: a classical (cTLIP) technique and a modified (mTLIP) technique. A literature review revealed no published comparison of the 2 techniques. This study examined the practicality and analgesic efficacy of US-guided mTLIP and cTLIP blocks following lumbar disc surgery.

Methods: Sixty patients aged 18–65 years with an American Society of Anesthesiologists classification of I or II who were scheduled for lumbar disc surgery under general anesthesia were included. US-guided mTLIP (n=30) and cTLIP (n=30) blocks were performed. The performance time of the block procedures, the success of a one-time block, postoperative pain scores, opioid consumption, adverse effects, and block-related complications were recorded and analyzed.

Results: The performance time was significantly less in the mTLIP group (p<0.001). The success of a one-time block was significantly higher in the mTLIP group (p<0.001). The active/passive visual analog scale scores, intraoperative and postoperative opioid consumption, and rescue analgesic requirements were similar between the groups (p>0.05).

Conclusion: The results showed that a US-guided mTLIP block had a shorter performance time and a higher one-time block success rate compared with the cTLIP block. The quality of analgesia provided by the mTLIP and cTLIP blocks was similar.

3. Factors influencing sexual functions in Turkish female patients with migraine
Devrimsel Harika Ertem, Şevin Ayan Saatçioğlu, Ayhan Bingol, Özlem Mercan, Gokcen Erdogan, Serdar Kokar, Hanife Saglam, Derya Uluduz
PMID: 33398864  doi: 10.14744/agri.2020.47640  Pages 193 - 201
Objectives: Recent studies have shown a more frequent occurrence of sexual dysfunction in patients with headache. The aim of this study was to assess the effects of demographic and clinical characteristics and psychiatric symptoms on sexual dysfunction in Turkish female patients with migraine.

Methods: In all, 18 sexually active patients with episodic migraine (EM), 12 patients with chronic migraine (CM), and 22 healthy controls of similar age were enrolled in the study. A numeric rating scale was administered to assess pain intensity. The psychiatric symptoms and sexual function of all of the participants were evaluated using the Beck depression and anxiety scales and the Golombok-Rust Inventory of Sexual Satisfaction (GRISS).

Results: The mean GRISS subscale scores did not differ significantly between the migraine groups and the control group (all p values <0.05). A positive correlation was found between the duration of headache and GRISS subscales of noncommunication, dissatisfaction, vaginismus, and anorgasmia in EM patients. In addition, there was a negative correlation with the infrequency and avoidance subscales. No correlation was detected between the GRISS subscale scores and the demographic and clinical characteristics of the patients with CM, with the exception of the level of education. Higher pain intensity scores and the presence of anxiety or depression among the EM and CM patients significantly affected all of the subscale scores of the sexual function inventory.

Conclusion: Although there was no relationship between migraine chronicity and sexual dysfunction, our data indicated that patient demographic characteristics, greater pain severity, and comorbidities of depression or anxiety were associated with greater sexual dysfunction among patients with EM and CM.

4. Effects of paravertebral block and intravenous analgesic methods on postoperative pain management and opioid consumption in laparoscopic cholecystectomies
Levent Gündost, Kemalettin Koltka, Nükhet Sivrikoz, Özlem Turhan, Dilek Hündür, Hacer Ayşen Yavru, Emre Çamcı
PMID: 33398869  doi: 10.14744/agri.2020.60487  Pages 202 - 207
Objectives: The aim of this study was to evaluate the efficiency of a thoracic paravertebral block (TPVB) for postoperative analgesia in cases of a laparoscopic cholecystectomy performed under general anesthesia.

Methods: A total of 78 patients aged 18–70 years, with an American Society of Anesthesiologists classification of I-III who were to undergo an elective laparoscopic cholecystectomy were enrolled. The patients were randomly separated into 2 groups: Group 1 (38 patients) received a TPVB performed unilaterally at T6 before surgery and Group 2 (40 patients) received only general anesthesia. Postoperatively, both groups received patient-controlled analgesia with an infusion pump. Visual analog scale (VAS) scores at rest and with movement were recorded during the first 24 hours after surgery. Tramadol consumption during the first 24 hours, nausea and vomiting rate, time to first passage of bowel gas and defecation, nutrition, mobilization, and discharge were also noted.

Results: The patients who received an ultrasonography-guided TPVB had significantly lower postoperative VAS scores at rest and on movement at 4, 6, 12,18, and 24 hours and significantly lower levels of postoperative tramadol consumption. It was observed that 77.5% of the patients in Group 2 needed at least 1 dose of additional fentanyl intraoperatively. Group 2 had a significantly higher vomiting rate and it was observed that the time of first bowel gas and defecation, nutrition, and mobilization was later. There was no significant difference between groups in the discharge time.

Conclusion: Preoperatively performed TPVB provided efficient analgesia after a laparoscopic cholecystectomy. A TPVB can also reduce perioperative and postoperative opioid requirements.

INTERVENTIONAL TREATMENT
5. Evaluation of the efficacy of erector spinae plane block and intercostal nerve block in the postherpetic neuralgia
Gülçin Hacıbeyoğlu, Şule Arıcan, Sinan Oğuzhan Ulukaya, Resul Yılmaz, Ruhiye Reisli, Sema Tuncer Uzun
PMID: 33398871  doi: 10.14744/agri.2020.87523  Pages 208 - 218
Objectives: The aim of this study was to compare the efficacy of an intercostal nerve block, which has been used for many years in the treatment of postherpetic neuralgia, and the more recent alternative of an erector spinae plane (ESP) block.

Methods: The records of 39 patients who were treated in the algology department for postherpetic neuralgia between May 1, 2015 and May 1, 2018 were evaluated retrospectively. Patients who received an intercostal nerve block constituted Group 1 and those who received an ESP block were categorized as Group 2. The change in numeric rating scale (NRS) and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scores in the short term and in the long term were the primary results of the study.

Results: The NRS, LANSS, and sleep interference scale (SIS) scores of the patients in Group 1 and Group 2 were found to be significantly lower at the 24th hour, week 4, and week 12 compared with the values obtained before block application. In Group 1, the scores recorded at week 4 and week 12 were significantly higher than the 24th hour values, whereas no difference was observed between these results in Group 2. There was no significant difference between the groups in the week 4 and week 12 scores. Similarly, no significant difference was observed in the NRS, LANSS, or SIS scores before the block application or at the 24th hour. However, the scores at week 4 and week 12 were significantly lower in Group 2 compared with Group 1.

Conclusion: The results indicated that an ESP block significantly decreased neuropathic pain symptoms and the need for additional treatment in postherpetic neuralgia treatment in the long term.

CASE REPORTS
6. Maxillary sinus fungus ball as a cause for facial pain: Analysis of three cases
Ceyhun Aksakal
PMID: 33398866  doi: 10.5505/agri.2018.58826  Pages 219 - 222
The development of a sinus fungus ball (FB) is a form of non-invasive fungal sinusitis that generally affects immunocompetent individuals. In this report, 3 cases of maxillary sinus FB are described, including 1 bilateral maxillary sinus case. The fungal debris was cleared using endoscopic sinus surgery in each case. No recurrence was observed in follow-up at the 6th, 7th, or 26th month. The headache and facial pain symptoms of the patients improved. Efficient cleansing of the maxillary sinus, particularly the anterior wall, improves the recurrence ratio.

7. Ultrasound-guided bilateral greater occipital nerve block on headache seen after endovascular treatment of ruptured or unruptured intracranial aneurysms: A case report
Rafi Doğan, Hüseyin Ulaş Pınar, Ömer Karaca, Fatma Karakoç
PMID: 33398867  doi: 10.5505/agri.2018.59023  Pages 223 - 227
Headache is a common symptom in subarachnoid hemorrhage (SAH). Often, pain control is difficult and opioid use can have a complicated effect on the patient’s state of consciousness. In this study of 2 cases, opioid consumption was reduced while effective pain control of headache occurring after endovascular treatment of an intracranial aneurysm was achieved using an ultrasound-guided, bilateral greater occipital nerve (GON) block. Case 1 was a 59-year-old male patient with a Glasgow Coma Scale (GCS) of 13 who was diagnosed with Fisher scale grade 3 SAH. Coiling and stenting were performed for an anterior communicating artery aneurysm. Cerebrospinal fluid drainage was provided with a lumbar spinal catheter. Case 2 was a 55-yearold male patient with a GCS of 15 who underwent coiling of a fusiform aneurysm in the left basilar artery and stenting of the stenotic region due to a basilar artery aneurysm. After the procedure, the visual analog score (VAS) of the patients was 9 and 7, respectively, and a bilateral GON block was performed with ultrasound guidance. The VAS score of both patients decreased to 3 and did not exceed 3 during follow-up in the intensive care unit, eliminating the need for additional analgesics. A bilateral GON block provided effective analgesia and significantly reduced the need for other pain relief in both cases.

8. Avascular necrosis of the bilateral femoral head with pregnancy: A case report
Türkan Turgay, Ali Aydeniz
PMID: 33398868  doi: 10.5505/agri.2018.59480  Pages 228 - 231
Osteonecrosis or avascular necrosis of the femoral head is a pathologic process due to inadequate blood supply resulting the death of the cells in bone tissue and collaps of joint. Avascular necrosis is a progressive disease mainly affecting adults in middle age and leads substantial loss of joint function. Osteonecrosis of the femoral head during or just after pregnancy is a rare clinical entity. Therefore several causes of osteonecrosis schould be well-known, little is known about pregnancy as an etiological factor for femoral head. We present a case of a 30-year-old female with bilateral avascular necrosis of the femoral head that developed during the peripartum period.

9. Our performance of supraclavicular, intercostobrachial and lateral femoral cutaneous block in a patient with high risk undergoing malign melanoma surgery on the forearm
Serdar Yeşiltaş, Hayrettin Daşkaya, Kazım Karaaslan, Ayda Türköz
PMID: 33398865  doi: 10.5505/agri.2018.56767  Pages 232 - 235
The practice of anesthesia can include the need to accommodate surgical interventions on multiple extremities in a single procedure. General anesthesia is usually preferred in such cases in order to prevent an overdose of local anesthetics. One of the major benefits of using ultrasonography to provide regional anesthesia is that it facilitates reducing the local anesthetic drug dose required to obtain a successful block. The use of multiple, ultrasound-guided extremity blocks can be a reasonable alternative approach to general anesthesia, especially in high-risk patients. This report describes the case of a patient with malignant melanoma of the left lateral forearm. Surgical resection of the lesion, dissection of the axillary sentinel lymph node, and grafting from the lateral left thigh were planned. As the surgical procedure involved more than one extremity, a combination of anesthetic blocks was applied using ultrasound guidance. The use of supraclavicular, intercostobrachial, and lateral femoral cutaneous blocks is explained in the context of the literature.

LETTER TO THE EDITOR
10. Ultrasound guided erector spinae plane block provides effective opioid-sparing postoperative visceral pain relief after intussusception surgery: A pediatric case report
Tayfun Aydın, Onur Balaban, Lokman Demir
PMID: 33398862  doi: 10.14744/agri.2019.02350  Pages 236 - 237
Pediatric postoperative pain management may require a multimodal approach. Single injection erector spinae plane (ESP) block may provide prolonged opioid-sparing postoperative analgesiain pediatric patients. We present a pediatric case of ESP block for postoperative analgesia after intussusception surgery.Surgical reduction was planned for 9-month-old patient after a trial of hydrostatic enema reduction had failed.We performed ultrasound guided unilateral bi-level ESP block. ESP block provided effective postoperative visceral and somatic pain relief and opioid sparing analgesia in our case.

11. Kyphoplasty experience in an elderly
Mert Akbaş, Haitham Hamdy Salem, Bora Dinç, Bilge Karslı
PMID: 33398863  doi: 10.14744/agri.2019.36693  Pages 238 - 239
Objective: Vertebral compression fractures due to osteoporosis are seen frequently. Osteoporotic compression fractures can cause severe pain, limitation of physical activities and impairment of quality of life. Kyphoplasty, a minimally invasive procedure, could be effective in many cases and can provide fast pain relief.
Case: A patient with a history of falling from a height of 8 months duration visited our pain clinic. Opioids and anti-inflammatory analgesics were administered together with physical therapy and facet joint injections with no improvement. Radiological examination of the patient showed collapse fracture of L2 and L4 vertebrae on top of severe osteoporosis. Kyphoplasty was performed at the level of L2 vertebrae followed by 50% relieve in her pain (VAS score reduction from 8 to 3) and hence she was capable to resume her daily activities.
Conclusion: Percutaneous balloon kyphoplasty is a safe and effective procedure for the treatment of elder patient with osteoporotic vertebral compression fractures.