Amaç: Bu çalýþma, çocuklarda periferik damar yolu açma iþlemi sýrasýnda oluþan aðrýyý azaltmada Buzzy’nin etkisini incelemek amacýyla randomize kontrollü olarak yapýldý.

Gereç ve Yöntem: Çalýþma, Trakya Üniversitesi Saðlýk Araþtýrma ve Uygulama Merkezi, Çocuk Acil Servisine baþvuran 7–12 yaþ grubundaki 56 çocuk ile yürütüldü. Veriler ‘Aile ve Çocuk Veri Toplama Formu’, ‘Wong Baker Yüz Ýfadelerini Derecelendirme Ölçeði’ ile toplandý. Periferik damar yolu açma iþlemi sýrasýnda tüm gruplarda damar görüntüleme cihazý kullanýlýrken, deney grubuna aðrýyý azaltmak amacýyla ‘Buzzy’ kullanýldý. Çocuklarýn aðrýlarý hemþire ve çocuklarýn öz bildirimleriyle deðerlendirildi. Verilerin deðerlendirilmesinde; tanýmlayýcý istatistikler, Wilcoxon t testi, Mann Whitney U testi ve korelasyon analizi kullanýldý. Sonuçlar %95 güven aralýðýnda ve anlamlýlýk p<0.05 düzeyinde deðerlendirildi.

Bulgular: Çocuklarýn yaþ ortalamasý 8.37±1.96 yýl ve %58.9’u erkekti. Deney grubundaki çocuklarýn iþlem sýrasýndaki aðrý puaný 3.40±3.56, kontrol grubundakilerin ise 3.76±3.06 idi. Hemþirenin deney grubu için bildirdiði aðrý puaný 4.53±3.44, kontrol grubu için 3.76±2.73 idi. Gruplara göre çocuklarýn ve hemþirenin bildirdiði aðrý puanlarý arasýnda anlamlý bir fark yoktu (p<0.05). Ancak hemþirenin bildirdiði aðrý puanlarý ile çocuklarýn bildirdiði puanlar arasýnda anlamlý fark vardý (p=0.034).

Sonuç: Periferik damar yolu açma iþlemi sýrasýnda oluþan aðrýyý azaltmada Buzzy’nin etkili olmadýðý belirlendi. Hemþirenin bildirdiði aðrý düzeyi, çocuklarýn bildirdiklerinden fazlaydý. Çocuk acil servislerinde çalýþan hemþirelere aðrý deðerlendirmesi ve dikkati baþka yöne çekme yöntemlerinin kullanýlmasý ile ilgili eðitim verilmesi önerilmektedir.

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.

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Amaç: Torakolomber interfasiyal plan (TLIP) bloðu, lumbar spinal cerrahi sonrasý etkili analjezi saðlayan, ultrason (US) eþliðinde
yapýlan yeni bir rejyonal anestezi tekniðidir. Bu bloðun iki farklý tekniði tanýmlanmýþtýr: klasik (cTLIP) ve modifiye (mTLIP)
teknik. Literatürde henüz bu iki tekniði karþýlaþtýran bir çalýþma bulunmamaktadýr. Çalýþmamýzda lomber disk cerrahisi sonrasý
US eþliðinde mTLIP ve cTLIP bloklarýnýn iþlem uygulama kolaylýðýný ve analjezik etkinliðini karþýlaþtýrmayý amaçladýk.

Gereç ve Yöntem: Amerikan Anestezistler Derneði (American Society of Anesthesiologist/ASA) anestezi risk sýnýflamasýna göre sýnýf I-II, 18-65 yaþ arasý ve genel anestezi altýnda lomber disk cerrahisi planlanan 60 hasta çalýþmaya dahil edildi. Hastalara US eþliðinde mTLIP (n=30) ve cTLIP (n=30) blok uygulandý. Blok uygulama süresi, tek seferde blok baþarýsý, opioid tüketimi, postoperatif aðrý skorlarý, yan etkiler ve bloða baðlý komplikasyonlar kaydedildi.

Bulgular: Blok uygulama süresi mTLIP grubunda anlamlý derecede düþüktü (p<0.001). Tek seferde blok baþarýsý mTLIP grubunda anlamlý olarak yüksekti (p<0.001). Ýntraoperatif ve postoperatif dönemde opioid tüketimi, kurtarýcý analjezik kullanýmý ve aktif/pasif VAS skorlarý gruplar arasýnda benzerdi (p>0.05).

Sonuç: Çalýþmamýzýn sonuçlarýna göre US eþliðinde yapýlan mTLIP blok ve cTLIP blok lomber cerrahi geçiren hastalarda benzer etkinlikte analjezi saðlar. mTLIP blok daha kýsa uygulama süresine ve daha yüksek tek giriþimde blok baþarýsýna sahiptir.

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.

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Amaç: Cinsel iþlev bozukluðunun kronik aðrýlý olgularda sýk görülmesi, aðrýnýn cinsel iþlevler üzerindeki etkisine dikkat çekmektedir. Bu çalýþmada epizodik ve kronik migrenli kadýn olgularda baþ aðrýsýnýn cinsel iþlev bozukluklarýna etkilerinin araþtýrýlmasý amaçlanmýþtýr.

Gereç ve Yöntem: Çalýþmamýza 18 yaþ–50 yaþ (ortalama yaþ 32±4.24 yýl) arasýnda doðurganlýk döneminde 30 epizodik ve kronik migren baþ aðrýsý olgusu ve 22 saðlýklý kontrol dahil edildi. Olgularda demografik özellikler kaydedilerek, aðrý þiddetini belirlemek için sayýsal deðerlendirme ölçeði kullanýldý. Beck Depresyon ve Anksiyete Ölçekleri ve Golombok-Rust Cinsel Doyum Ölçeði (GRCDÖ) tüm migren olgularý ve kontrol grubunda uygulandý.

Bulgular: Migren gruplarý ve kontrol grubunun GRCDÖ alt ölçek puanlarý arasýnda anlamlý fark saptanmadý. Epizodik migren grubunda yaþ ve baþ aðrýsý süresi GRCDÖ alt ölçek puanlarý arasýnda pozitif korelasyon; öðrenim durumuyla negatif korelasyon göstermekteydi. Kronik migren grubunda öðrenim durumu ve aðrý þiddeti GRCDÖ alt ölçek puanlarý arasýnda negatif korelasyon saptandý. Aðrý þiddetinde artma, anksiyete ve depresyon varlýðý, her iki migren grubunda cinsel iþlevlerin tüm alt boyutlarýný anlamlý olarak etkilemekteydi.

Sonuç: Çalýþmamýzýn sonuçlarýna göre migren olgularýnda kronikleþme ile cinsel iþlev bozukluklarý arasýnda iliþki saptanmadý ancak depresyon ve anksiyetenin eþlik ettiði kronik ve epizodik migrenli olgular sýklýk, doyum, kaçýnma,dokunma, vajinismus ve anorgazmi gibi cinsel iþlev bozukluklarýnda saðlýklý bireylere göre anlamlý olarak daha fazla sorun yaþamaktalardýr.

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.

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Amaç: Primer olarak genel anestezi altýnda yapýlan elektif laparoskopik kolesistektomilerde (LK) preoperatif torakal paravertebral
blok (TPVB) uygulamasýnýn postoperatif analjezi üzerindeki etkisini görmektir.

Gereç ve Yöntem: Üniversite etik kurul onayý ve hasta onamlarý alýndýktan sonra, elektif laparoskopik kolesistektomi planlanan, 18–70 yaþ aralýðýnda ve ASA I-III olan 78 hasta çalýþmaya dahil edildi. Hastalar; preoperatif ultrasonografi(USG) eþliðinde TPVB uygulanan (Grup 1) 38 hasta ve uygulanmayan (Grup 2) 40 hasta olarak randomize edildi. Her iki gruba postoperatif dönemde HKA (CADD-Legacy®) uygulandý. Hastalara Grup 1’de USG eþliðinde preoperatif unilateral T6 seviyesinden TPVB uygulandý. Postoperatif ilk 24 saatte her iki grubun istirahat ve hareket visüel analog skala (VAS) skorlarý, postoperatif kullanýlan tramadol miktarý, bulantý kusma insidanslarý, gaz-gayta çýkýþý, mobilizasyon, beslenme ve taburculuk saatleri kaydedildi.

Bulgular: Postoperatif istirahat ve hareket sýrasýnda 4., 6., 12., 18. ve 24. saatte bakýlan VAS skorlarý ve postoperatif tramadol tüketimi Grup 1’de anlamlý derecede düþük saptandý. Grup 2’deki hastalarýn %77.5’inin intraoperatif en az bir doz ek fentanil ihtiyacý olduðu, bu grupta hastalarýn kusma oranýnýn anlamlý derecede daha fazla olduðu, gaz-gayta çýkýþý, beslenme ve mobilizasyon saatlerinin daha geç saatlerde olduðu gözlemlendi. Her iki grubun taburculuk saatleri arasýnda anlamlý fark olmadýðý saptandý.

Sonuç: Bu çalýþmada LK’lerde TPVB uygulamasýnýn, postoperatif analjezik etkinlik saðladýðý, intraoperatif ve postoperatif opioid ihtiyacýný azalttýðý gözlemlendi.

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.

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Amaç: Bu çalýþmada postherpetik nevralji tedavisinde uzun yýllardýr kullanýlan interkostal sinir bloðu ile yakýn zamanda tanýmlanan erektör spina düzlem bloðunun etkinliðinin kýyaslanmasý amaçlanmýþtýr.

Gereç ve Yöntem: 1 Mayýs 2015–1 Mayýs 2018 tarihleri arasýnda Necmettin Erbakan Üniversitesi Meram Týp Fakültesi Algoloji Kliniði’nde postherpetik nevralji nedeniyle tedavi görmüþ 39 hasta dosyasý retrospektif olarak deðerlendirildi. Ýnterkostal sinir bloðu yapýlanlar Grup 1, erektör spina düzlem bloðu yapýlanlar Grup 2 olarak kabul edildi. Kýsa dönem ve uzun dönemde NRS ve LANSS skorlarýndaki deðiþim çalýþmanýn birincil sonuçlarý olarak kabul edildi.

Bulgular: Grup 1 ve Grup 2’deki hastalarýn NRS, LANSS ve uyku interferans (SIS) skorlarýnýn 24. saat, 4. hafta ve 12. hafta deðerleri blok öncesine göre anlamlý derecede düþüktü. Grup 1’deki hastalarýn 4. hafta ve 12. hafta deðerleri 24. saat deðerlerine göre anlamlý derecede yüksekken Grup 2’deki hastalarda bu deðerler arasýnda fark yoktu. 4. ve 12. hafta deðerleri arasýnda da her iki grupta anlamlý fark yoktu. Benzer þekilde, gruplar arasýnda NRS, LANSS ve SIS skorlarý açýsýndan blok uygulamasýndan önce ve 24 saat sonra anlamlý bir fark gözlenmedi. Ancak 4. ve 12. haftalardaki puanlar Grup 2’de Grup 1’e göre anlamlý olarak düþüktü.

Sonuç: Bu çalýþma postherpetik nevralji tedavisinde erektör spina düzlem bloðunun özellikle uzun dönemde nöropatik aðrý
semptomlarý ile ek tedavi ihtiyacýný belirgin azalttýðýný göstermiþtir.

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.

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Fungus Ball (FB) genellikle immüncompetent kiþileri etkileyen non-invaziv bir fungal sinüzit þeklidir. Sýklýkla maksiller sinüsleri etkiler. Biz bu vaka sunumunda bir tanesi bilateral maksiller sinüsü tutan 3 hastadaki maksiller sinüs FB unu deðerlendirdik. Bu vakalarýn tümünde fungal debris Endoskopik Sinüs Cerrahisi (ESC) ile temizlenmiþtir. Vakalarýn ayrý ayrý 6, 7 ve 26. ayýndaki takiplerinde rekürrens izlenmedi. Hastalarýn özelikle yüz aðrýsý ve baþ aðrýsý semptomlarý tamamen gerilemiþtir. Maksiller sinüsün özellikle anterior duvarýnýn iyi bir þekilde temizlenmesi rekürrens oranlarýný azaltacaktýr.

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.

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SAK olgularýnda baþaðrýsý sýk görülen semptomdur. Çoðu zaman aðrý kontrolü güç olmakta ve opioid kullanýlarak hastanýn þuur durumu daha karmaþýk hale gelmektedir. Çalýþmada, ultrason eþliðinde bilateral büyük oksipital sinir bloðu ile intrakraniyal anevrizmalarýn endovasküler tedavisi (EVT) sonrasý görülen baþaðrýsýnýn etkili kontrolünü ve opioid tüketimini azaltmayý amaçladýk. Olgu1 – Fisher 3 grade SAK tanýsýyla gelen, GKS: 13 olan 59 yaþýnda erkek hastaya, anteriör kominikan arterde anevrizma nedeniyle koilizasyon ve stent uygulamasý yapýldý. Lomber spinal kateterle BOS drenajý saðlandý. Olgu 2 – Baziller arter anevrizmasý nedeniyle, sol baziller arterde fusiform anevrizmaya koilizasyon ve stenotik bölgeye stent uygulanan GKS: 15 olan 55 yaþ erkek hasta deðerlendirildi. VAS skorlarý sýrasýyla 9–7 olan hastalara, ultrasound eþliðinde bilateral büyük oksipital sinir bloðu saðlandý. Her iki hastanýn VAS skoru 3 ün altýna düþtü. Skor takip boyunca 3’ü aþmadý ve ek analjezik ihtiyacý olmadý. Sonuç olarak, iki olguda da bilateral oksipital sinir bloðu ile etkili analjezi saðlanmýþtýr ve ek analjezik ihtiyacý çok azalmýþtýr.

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.

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Osteonecrosis, also called avascular necrosis, of the femoral head is a pathologic process resulting from an inadequate blood supply. The death of cells in bone tissue can cause the collapse of the affected joint. It is a progressive disease primarily affecting adults in middle age and can lead to substantial loss of joint function. Osteonecrosis of the femoral head during or just after pregnancy is a rare clinical entity. Although many causes of femoral head osteonecrosis have been identified, little is known about pregnancy as an etiological factor. Presently described is the case of a 30-year-old female with bilateral osteonecrosis of the femoral head that developed during the peripartum period.

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.

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Birden çok ekstremitede cerrahi iþlem gereken olgularla anestezi pratiðinde karþýlaþýlabilmektedir. Bu olgularda uygulanan rejyonal giriþimlerde lokal anestezik ilaç doz aþýmý olabileceðinden sýklýkla genel anestezi tercih edilmektedir. Ultrasonografinin rejyonal anestezi pratiðine girmesinin en önemli faydalarýndan bir tanesi baþarýlý blok oluþturmak için gereken lokal anestezik ilaç dozunun düþürülmesine olanak saðlamasýdýr. Özellikle yüksek riskli hastalarda genel anestezi yerine ultrasonografi eþliðinde çoklu ekstremite bloðu uygulamasý mantýklý bir yaklaþým olabilir. Sol önkol lateralinde malign melanom saptanan olguya cerrahi olarak yaranýn rezeksiyonu, aksiller sentinel lenf nodu diseksiyonu ve lateral uyluktan greftleme planlanmýþtýr. Cerrahi iþlem farklý ekstremiteleri kapsadýðýndan kombine blok uygulanmýþtýr. Bu olgu ile;ultrasonografi eþliðinde supraklavikular, interkostobrakiyal ve lateral femoral kutanöz blok uygulamalarýmýzý sunmayý amaçlýyoruz.

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.

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Pediatrik postoperatif aðrý yönetimi multimodal yaklaþým gerektirebilir. Tek enjeksiyon erektor spina plan (ESP) bloðu, pediyatrik hastalarda opioid koruyucu ve uzun süreli postoperatif analjezi saðlayabilir. Ýntussepsiyon cerrahisi sonrasý postoperatif analjezi için uygulanan ESP bloðu olgusunu sunmak istedik. Hidrostatik lavman ile intussepsiyon düzeltme denemesinin baþarýsýz olmasýndan sonra 9 aylýk hastaya cerrah iredüksiyon planlandý. Ultrason eþliðinde tek taraflý iki seviyeli ESP bloðu yapýldý. ESP bloðu olgumuzda etkin postoperatif visceral, somatik ve opioid koruyucu analjezi saðladý.

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.

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Amaç: Osteoporoz nedeniyle vertebral kompresyon kýrýklarý sýklýkla görülmektedir. Osteoporotik kompresyon kýrýklarý þiddetli aðrýya, fiziksel aktivitelerin sýnýrlandýrýlmasýna ve yaþam kalitesinin bozulmasýna neden olabilir. Minimal invaziv bir prosedür olan kifoplasti, birçok durumda etkili olabilir ve hýzla aðrýda azalma saðlayabilir.
Olgu: 8 aydan uzun süredir yakýnmasý olan hasta, aðrý kliniðine baþvurdu. Opioidler ve antienflamatuar analjezikler ile birlikte, fizik tedavi ve faset eklem enjeksiyonlarý uygulanan hastada düzelme olmadý. Hastanýn radyolojik incelemesinde, þiddetli osteoporozun üst kýsmýnda L2 ve L4 vertebralarda çökme kýrýðýný görüldü. Kifoplasti, L2 vertebra seviyesinde gerçekleþtirildi, takibinde aðrýsýný % 50'si azalttý (VAS skoru 8'den 3'e düþtü) ve böylece günlük aktivitelerine devam edebiliyordu.
Sonuç: Perkütan balon kifoplasti, osteoporotik vertebral kompresyon kýrýðý olan yaþlý hastanýn tedavisi için güvenli ve etkili bir iþlemdir.

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.

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