Epidural anesthesia and thoracic paravertebral blocks have been the mainstay of regional anesthesia for thoracic surgery for many years. Following introduction of ultrasound use during regional anesthesia practices, new blocks named interfascial plane blocks have been introduced into clinical practice. Although interfascial plane blocks fail to provide surgical anesthesia their contribution to providing analgesia is clinically important. In this review we mention the most commonly accepted blocks namely pectoral blocks, serratus anterior plane block, erector spinae plane block and rhomboid blocks.

Objectives: A new type of coronavirus outbreak has emerged in China and caused a pandemic. World Health Organization (WHO) announced the official name of this disease ‘COVID-19’. The main purpose of this study is to evaluate pain in COVID-19 patients.
Methods: Patients who were followed in the ward of an infectious diseases department because of possible or confirmed COVID-19 between May and September of 2020 were included in the study. The Turkish version of the Brief Pain Inventory (BPI) was applied. Demographic features, frequency, location, the intensity of pain, and response to analgesics were analyzed.
Results: A total of 178 participants were included in the study. Ninety-one (51.1%) of patients had pain complaints and the mean pain score (MPS) was 2.28±2.81 over 10. Fifty-nine (56.0%) of participants with pain required analgesic therapy and 41 (80.3%) of them showed ≥50% pain relief with simple analgesics. Twelve of the remaining 18 who did not get enough pain relief with simple analgesic were taking their analgesics pro re nata (PRN) rather than around the clock (ATC). Pain frequency and intensity and mean hospitalization duration (MHD) were similar between confirmed and possible cases.
Conclusion: Regarding the results, we conclude that pain is not one of the challenging symptoms and easily manageable in patients with a mild-moderate intensity of COVID-19. Our results were not enough to make a correlation between pain and the clinical course of the disease. Further studies are required for the evaluation of pain including patients in intensive care units.

Objectives: We aimed to compare the treatment response with simultaneous application of transforaminal epidural steroid injection (TESI) and pulsed radiofrequency (PRF) to the lumbar dorsal root ganglion (DRG) with TESI in patients with chronic lumbar radicular pain.
Methods: A total of 129 patients were enrolled. TESI was performed to 67 patients and TESI+DRG-PRF was performed to 62 patients. Demographic data, surgical records, and medications, side, and level of the procedure were recorded. Patients were evaluated on the pre-operative and post-operative 10th day, 1st and 3rd month follow-up visits, and visual analog scale (VAS, 0–10) scores, and patients’ satisfaction assessment on the 3rd month follow-up were collected. A successful therapeutic response was defined as a 50% or more reduction in VAS scores.
Results: In both groups, post-operative VAS scores were significantly lower than the pre-operative levels (p˂0.001). VAS scores in the TESI+DRG-PRF group were significantly lower than the TESI group at all follow-up periods (p˂0.001). Reduction ratios in VAS scores were significantly higher in the TESI+DRG-PRF group in all follow-up visits (p˂-0.001). Satisfaction levels were significantly higher in the TESI+DRG-PRF group (p˂0.01).
Conclusion: According to our study, TESI provides short-moderate pain relief in patients with chronic lumbar radicular pain. A simultaneous application of PRF in the same session with TESI should be considered as an option to improve the treatment response.

Objectives: Emotional and cognitive factors have been shown to affect pain, and one of the main factors in the development of this effect is pain catastrophizing. The present study aims to determine the effect and frequency of the pain catastrophizing in shoulder lesions and to examine the association between pain catastrophizing and to assess the pre-operative and post-operative functional outcomes.
Methods: A total of 114 patients who underwent shoulder arthroscopy were included study. Pain catastrophizing scale, Tampa kinesiophobia scale, visual analog scale, and University of California at Los Angeles shoulder scale were used for evaluating patients’ pre- and post-operative pain and functional situation.
Results: Pain catastrophizing was detected 42 of 114 patients (37%). Kinesiophobia was higher in patients who catastrophized shoulder pain (p<0.0001). If participant had a labrum (p=0.038), supraspinatus (p=0.043), or biceps pathology (p=0.032), catastrophization was determined more often. There was catastrophization in 50% of patients with post-operative University of California at Los Angeles score which was evaluated as fair/poor (p=0.039).
Conclusion: Pre- and post-operative results of the current study strengthened the data about importance of catastrophization. Catastrophization (+) patient group had lower functional capacity outcomes than that of the catastrophization (−) patient group. Decreased levels of pain catastrophizing and kinesiophobia in surgically and conservatively treated patients will result in more satisfactory clinical outcomes.

Objectives: Clinical efficacy of easily applicable peripheral nerve blocks has been in interest except open and closed surgical procedures requiring advanced equipment. We aimed to evaluate the clinical efficacy of triamcinolone and lidocaine injection for peripheral nerve branches in trigeminal neuralgia (TN) in terms of pain severity, pain frequency, and drug doses used.
Methods: This study was a retrospective cohort study. A total of 72 patients with TN, who underwent peripheric trigeminal nerve injection with lidocaine and triamcinolone between 2011 and 2018, were included in the study. Pain severity, pain frequency, changes in carbamazepine (CBZ) equivalent doses, and pregabalin equivalent doses were evaluated. We also evaluated whether there was a correlation between the success of the procedure and independent variables.
Results: There was a statistically significant difference in pain intensity and frequency between baseline and post-procedure at 1, 3, and 6 months (p=0.000). There was a statistically significant difference between CBZ equivalent doses at baseline, and 3 and 6 months after the procedure (p=0.002 and 0.005, respectively). Two complications were evaluated, one patient had prolonged painless paresthesia related to the procedure area lasting about 1 week and two patients had ecchymosis at the procedure area.
Conclusion: The injection of lidocaine and corticosteroid combination for peripheral branches of the trigeminal nerve may result in short and mid-term clinical relief. Peripheral nerve blocks may be preferred for short-medium-term pain management with rare complications and simple device requirements also need little experience and skills.

Objectives: This research was conducted to determine low back pain in nurses and their methods of coping with low back pain.
Methods: This descriptive, cross-sectional study was performed with 356 nurses in three university hospitals in the province of Istanbul in April–August 2016. Percentage calculations and Chi-square tests were used in statistical analyses.
Results: The mean age of the nurses in the study was 28.70±5.92, 25.3% were working in intensive care, 46.6% worked 41–48 h a week, and 55.6% stood for 5–8 h within a 24 h period. Low back pain was moderate in 75.8% of participants, and low back pains sometimes affected work efficiency in 43.3% (n=154). In terms of coping, the great majority of participants did not visit a physician, but used analgesics, avoided wearing high-heeled shoes, and slept in hard beds. Statistical significance (p<0.05) was observed between participants’ age groups, the unit where they worked, type of duty, the amount of time spent standing, and the amount of time standing in the same position and low back pain.
Conclusion: Based on the results obtained, nurses experienced a moderate level of low back pain, and we think that experiencing low back pain is a continuous risk for nurses because of their lengthy hours of work and time spent standing, and that their working hours should, therefore, be adjusted and that correct body mechanics should be included during in-service training.

Objectives: In our study, we aimed to evaluate the change in numerical rating scale (NRS) score and interventional procedures performed on patients with post-laminectomy syndrome whose NRS score 7 and above according to the NRS.
Methods: This study was carried out by examining the files of 107 patients, including 69 women and 38 men, aged 18 years and over who had applied between February 1, 2010, and February 1, 2015. Pain localization, post-operative periods, interventional procedures, and post-procedural pain status were determined using pain monitoring forms and hospital automation system in our clinic. Statistical significance of the obtained data was evaluated by Pearson Chi-square test, Kruskal–Wallis H test, Friedman test, and Mann–Whitney U-test. p>0.05 was not statistically significant, p<0.05 was considered statistically significant.
Results: With interventional procedures, 48.5% of patients had a reduction in pain of more than 50%. The success rate was 66.7% in patients with radicular pain. Pain palliation was achieved in 28.8% of patients who underwent transforaminal epidural steroid injection, whereas in patients undergoing dorsal root ganglion pulsed radiofrequency, this rate was 44.4%. When the pain scores of patients with permanent spinal cord stimulator (SCS) were compared with other patient groups, permanent SCS was found to be statistically and clinically significant (p<0.001).
Conclusion: Post-laminectomy syndrome is not usually caused by a single pathology, and more than 1 intervention and recurrence are often needed. Post-laminectomy syndrome is a disease that requires a multidisciplinary approach and multiple treatment options must be decided according to the patient. More research is needed on treatment options.

The term post-dural puncture headache (PDPH) refers to a common complication that occurs after accidental dural puncture. One of the diagnostic symptoms of PDPH is a postural headache, which worsens dramatically while sitting or standing and is relieved mostly by lying down. This symptom is caused by a cerebrospinal fluid (CSF) leak, leading to decreased CSF pressure or low CSF volume, which provokes a shift of intracranial contents and traction on pain-sensitive structures in the upright position. PDPH is commonly a self-limited condition and remits spontaneously within 2 weeks, or becomes less severe after surgical intervention to seal the leak with autologous epidural blood patch (EBP). Although recurrence of spontaneous intracranial hypotension following an EBP is not rare, spontaneously late recurrence of PDPH has been rarely reported. The purpose of this paper is to discuss this case with late recurrence of PDPH after 10 months following EBP.

Only seven cases of isolated unilateral rupture of the alar ligament had been previously reported. The authors report the first adult female case of this rare injury. The patient in their case, a 36-year-old female presented after a trauma due to falling, and at that moment, she had fainted due to a sudden pain between the neck and head. The radiological examinations [magnetic resonance imaging (MRI) and X-rays] had been interpreted as normal. She had a positive Alar ligament test at the right side, and a thin section craniovertebral junction computed tomography was obtained which revealed an asymmetrically left-sided odontoid process and a new MRI revealed a right-sided alar ligament rupture. Thus she underwent a bilateral greater occipital nerve block together with pulse radiofrequency and trigger point injection at splenius capitis, levator scapula, and trapezius followed by the application of a halo orthosis to be worn for 3 months. The patient was found to be pain-free in the follow-up examinations. With pure unilateral alar ligament rupture, the atlantooccipital joint is not disrupted and the craniovertebral junction is not destabilized. To date, only eight cases of isolated unilateral alar ligament rupture have been reported one of which was a 25 years old male; all of whom presented with marked neck pain and treated by external immobilization for 4 weeks to 4 months and our case is the first adult female patient.

Duloxetine is a serotonin-norepinephrine reuptake inhibitor that is widely used in chronic pain treatment in various diseases. Hyperprolactinemia and galactorrhea are rare side effects of this medication. Here, we reported a 34-year-old female with multiple sclerosis who used duloxetine for pain management and mood disorder and experienced galactorrhea.

One of the most severe pains that women can experience throughout their lives is birth pain. Epidural analgesia is the ideal method to provide pain control in vaginal delivery. Horner syndrome is a rare complication of epidural analgesia. In pregnant women, Horner syndrome may be seen more frequently due to epidural analgesia. It is characterized by ptosis, myosis, enophthalmos, anisocoria, conjunctival hyperemia, flashing on the affected face and sweating record (anhydroz). It usually resolves without a permanent neurological defect. Stellate, cervical and brachial plexus blocks, thoracic, lumbar and sacral region epidural anesthesia applications are among the most common causes of Horner syndrome associated with anesthesia applications. The non-anesthetic causes of Horner syndrome include head and neck surgery, hypothalamus-thalamus and brainstem-related lesions, trauma to the head and neck, and pulmonary apical tumors associated with malignancy. In this case report, we want-ed to present Horner syndrome in vaginal delivery with epidural analgesia. All pregnant women undergoing epidural analgesia should be closely followed up, taking into account possible complications and taking necessary precautions.

Myofascial pain syndrome is a more common problem than thought. Treatment of miyofasyal trigger point may contribute to the pain and functionality parameters in adhesive capsulitis. In particular, the subscapulis muscle should be evaluated in detail.

Cervicogenic headache (CEH) is a headache arising from cervical nociceptive structures such as facet joints, disci intervertebrales, muscles and ligaments. Myofascial trigger points (TrPs) are common factors in patients with CEH and contribute to the pain and disability. In this report, we present two patients with CEH who had TrPs in their upper trapezius muscles. Each patient received an ultrasound-guided interfascial block of the trapezius muscle.

Case 1
A 79-year-old female patient presented with a complaint of headache due to trigger point in her upper trapezius muscle. Her Numerical Rating Scale (NRS) score for pain intensity was 10. We performed an ultrasound-guided interfascial block of the trapezius muscle. Her NRS score at 30 minutes after the procedure was 2. The patient was pain free during the two months follow-up period.

Case 2
A 55-year-old female patient presented with a complaint of headache due to trigger point in her upper trapezius muscle. Her Numerical Rating Scale (NRS) score for pain intensity was 8. We performed an ultrasound-guided interfascial block of the trapezius muscle. Her NRS score at 30 minutes after procedure was 3. The patient was pain free during the two weeks follow-up period.

The structure of the fascia can ease diffusion of an injected anaesthetic during diagnostic and therapeutic blocks, and interfascial injections are becoming more common. We suggest that this treatment may produce positive effects for patients with CEH caused by trigger points.