Objectives: This study aimed to explore sleep quality in patients with ankylosing spondylitis (AS) and to reveal the clinical parameters that predict sleep quality and depression in AS.

Methods: This study included 100 AS patients and 100 age/sex-matched healthy individuals. The AS activity was assessed by Bath AS Disease Activity Index (BASDAI), AS Disease Activity Score (ASDAS-ESR, ASDAS-CRP), and Visual Analog Scale (VAS). The functional status was assessed by the Bath AS Functional Index (BASFI). AS Quality of Life Questionnaire was administered for the assessment of the disease-related quality of life. Pittsburgh Sleep Quality Index for sleep assessment and Beck Depression Inventory for psychological assessment were administered to all participants.

Results: Sleep problems and depressive symptoms were significantly higher in AS patients compared to healthy individuals. All of the AS clinical parameters were significantly higher in AS patients with poor sleep quality than in AS patients with good sleep quality. In the correlation analysis, it was determined that poor sleep quality, depressive symptoms and low quality of life were strongly correlated with each other and AS clinical parameters. The most effective predictor for sleep problems was higher BASDAI scores, followed by higher BASFI, VAS, ASDAS-ESH scores, and younger age. Higher BASFI and VAS scores were predictors for depressive symptoms.

Conclusion: The findings indicate that poor sleep, depressive symptoms and low quality of life may negatively affect the AS clinic, and therefore sleep quality and depression should not be ignored in the examinations of AS patients.

Objectives: Ultrasonography (US) is an important visualization technique in regional anesthesia. Increasing in quality of images may lead to better conclusions. Our aim in this study was to evaluate the effect of artificial-coloring on image quality and practitioner’s preferences.

Methods: Ultrasound images of five block regions, interscalene, supraclavicular, infraclavicular, femoral, and popliteal were taken on a volunteer using gray scale. Then, the images were colored in seven different color scales using artificial-coloring technique. All participants were asked to fill in the structured questionnaire.

Results: All created images were assessed by three specialist and 14 resident anesthesiologists. The highest scores about nerve recognition, distinguishing nerve from surrounding tissues, and visual clarity of fascicles were obtained with blue scale images; however, these findings were not significant compared to gray scale (p>0.05). Blue scale was chosen as a favorite scale by 53% of participants.

Conclusion: Increasing the image quality and resolution while performing regional anesthesia under ultrasound guidance increases success and reduces complications. Artificial-coloring is one of the adjustments that can improve image quality. In our study, the results of coloring with blue were remarkable. However, more importantly than the color chosen, we believe that routine adjustments such as gain, depth, and focusing will bring important advantages.

Objectives: Disorders in the cervical muscles, such as myofascial trigger points and tightness, are common factors in patients with cervicogenic headache (CEH). We aimed to evaluate the effectiveness of ultrasound-guided interfascial blocks of the trapezius muscle in patients with CEH who showed tenderness in the upper cervical muscle groups.

Methods: A total of 23 patients were evaluated in the prospective observational trial. The injection was performed between the trapezius muscle and levator scapula muscle fascia with a disposable 25-gauge, 10-cm Quincke-tip spinal needle. 10 mL of 0.125% bupivacaine was injected between the muscle fascia. Numeric rating scale (NRS), neck disability index (NDI), pain frequency, and analgesic consumption in the pre-treatment and post-treatment period were evaluated.

Results: The NRS scores at 10 min, 1 week, 2 weeks, and 4 weeks after treatment were significantly better than the pre-treatment NRS score. The NDI scores at 1, 2, and 4 weeks after treatment were significantly better than the pre-treatment NDI score. The pain frequency at 1 and 2 weeks after treatment was significantly lower than that recorded in the pre-treatment period. Statistically significant reductions were observed in analgesic consumption at 1, 2, and 4 weeks after treatment, in comparison with consumption in the pre-treatment period.

Conclusion: We suggest that an ultrasound-guided interfascial block of the trapezius muscle is effective for the treatment of CEH caused by muscle disorders.

Objectives: Pain is a subjective experience. Besides, sensory, affective and behavioral responses, and autonomic response are part of pain response to noxious stimuli. Evaluation of pupil diameter by pupillometry has been used as an alternative method for pain assessment. In algologic procedures like interventional headache management have not been addressed in the literature. Herein, we investigated changes in pupil diameter during interventional headache management as an objective method for pain assessment.

Methods: Demographic data of the patients were collected before the bilateral major occipital nerve blockage (MONB) procedure. Numeric rating score (NRS) and pupil diameter measurements by pupillometer were recorded before MONB. Standard MONB procedure was applied to all patients. Pain assessment and pupillary diameter measurements were obtained after nerve blockage.

Results: Twenty-eight patients were included in this study. Mean age was 41.03±12.63 years. There is no difference between the hemodynamic parameters before and after the procedure. Post-procedure NRS and pupil diameter values were significantly lower than pre-procedure values. There was a positive correlation between changes in NRS scores and changes in the right and left pupil diameters.

Conclusion: There was a significant correlation between NRS score and pupil diameter in patients who underwent MONB. Monitoring of pupil diameter can be used for pain assessment during headache treatment. Evaluation of pupil diameter is a new approach in pain palliation. Future research is needed to study the effect of other parameters, that is, gender, age, origin of pain, acute, and chronic pain on pupil diameter and to evaluate its application in different algological procedures.

Objectives: The authors aim to present when to do physical therapy or surgery in geriatric patients with degenerative lumbar stenosis.

Methods: The authors retrospectively analyzed 250 patients who underwent physical therapy due to lumbar degenerative stenosis between December 2014 and April 2017. The patients were divided into two groups: Central canal stenosis and lateral recess/foraminal stenosis groups. Visual analogue scale and neurological claudication values of both patient groups were evaluated before and after physical therapy. The association between comorbid diseases and the frequency of surgery was also evaluated.

Results: 142 of the patients were female and 108 were male, and the mean age of these patients was 69 years. The mean onset of symptoms was 55 months. In the visual analog scale value of patients after physical therapy, the authors observed decreases of 4–6° in patients with central canal stenosis and 2–3° in patients with lateral recess/foraminal stenosis. In addition, the authors observed that patients with lateral recess/foraminal stenosis together with diabetes mellitus benefit less from physical therapy.

Conclusion: Physical therapy and rehabilitation play an important role in the treatment of lumbar stenosis. Physical therapy is the primary treatment option for patients who do not have motor muscle strength losses and incontinence and who have pain control through medications. The authors can consider surgical interventions in patients with lateral recess/foraminal stenosis who do not benefit from physical therapy at a satisfactory level.

Ischemic monomelic neuropathy (IMN) is a rare type of acute axonal neuropathy which results from ischemia of multiple nerves in affected limb. The electroneuromyography is useful in detecting characteristic features of this neuropathy. It usually occurs after vascular interventions. Here, we present the first case who has IMN secondary to lung cancer and/or chemo-therapy and aim to draw attention to this infrequently recognized entity.

Spinal cord stimulation (SCS) has been used for the treatment of chronic pain for almost 50 years. There have been several reports regarding to thoracic and lumbar SCS, while fewer publications have been documented for cervical SCS administration. In this article, we presented patient satisfaction after cervical SCS application in patients with chronic upper extremity pain. Three patients with cervical spinal nerve root or brachial plexus injury who reported no pain relief with the previous treatment modalities were identified. The patients were performed percutaneous cervical SCS. Cervical SCS implantation was successful in the first and the second patients, and with respect to decrease in VAS scores, analgesic drug requirements, and an increase in their quality of life, while the third patient had no pain relief. Cervical SCS may be an effective treatment option in upper extremity chronic pain syndromes as in the lower extremity pain syndromes treated with thoracolumbar SCS.

Interlaminar epidural steroid injections corresponding to dermatomes affected by post-herpetic neuralgia (PHN) were found effective in reducing pain. Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory condition that mainly occurs with calcification and ossification of spinal ligaments such as anterior and posterior longitudinal, interspinous, supraspinous ligament, and ligamentum flavum. In this case, it is presented that the failure of the access to the T7-T8 interlaminar space due to the supra/interspinous ligament calcification and ossification accompanied by thoracic DISH in a 73-year-old male for the treatment of PHN.

Carotid endarterectomy (CEA) surgery is generally performed for patients who under the risk of ischemic cerebral stroke due to the critical obstruction of the carotid artery. Ischemic complications may occur during the surgery. So, the awakeness of the patient is very important during the surgery. Regional anesthesia techniques may be performed instead of general anesthesia for shunt placement during CEA surgery. Herein, we aimed to share our successful US-guided carotid sheath block experience for anesthesia management during CEA surgery.