Toraks cerrahisinde rejyonal anestezi uygulamasýndan uzun yýllardýr anlaþýlan sadece epidural anestezi ve torakal paravertebral bloktur. Rejyonal anestezi uygulamalarýnda ultrasonografi kullanýmýnýn yaygýnlaþmasý ile interfasyal plan bloklarý olarak adlandýrýlan yeni bloklar uygulamaya girmiþtir. Ýnterfasyal plan bloklarý toraks cerrahisinde cerrahi anestezi saðlamakta yetersiz iken klinik açýdan anlamlý analjezik etki saðlamaktadýrlar. Bu derlemede toraks cerrahisinde günümüzde daha yaygýn kabul gören pektoral bloklar, serratus anterior plan bloðu, erektor spina plan bloðu ve rhomboid bloklardan bahsedilecektir.

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.

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Amaç: Yeni bir tip koronavirüs salgýný Çin’de ortaya çýktý ve pandemik oldu. Dünya Saðlýk Örgütü (DSÖ) bu hastalýðýn resmî adýný ‘COVID-19’ olarak ilan etti. Bu çalýþmanýn ana amacý COVID-19 hastalarýnda aðrýyý deðerlendirmektir.
Gereç ve Yöntem: 2020 yýlýnýn Mayýs ve Eylül aylarý arasýnda muhtemel veya kesin COVID-19 tanýsýyla enfeksiyon hastalýklarý servisinde takip edilmiþ olan toplam 178 hasta çalýþmaya dahil edildi. Kýsa Aðrý Envanteri’nin (BPI) Türkçe versiyonu uygulandý. Demografik özellikler, aðrýnýn sýklýðý, lokasyonu, þiddeti ve analjeziklere yanýtý analiz edildi.
Bulgular: Hastalarýn doksan birinde (%51.1) aðrý þikayeti vardý ve ortalama aðrý skoru (OAS) 10 uzerinden 2,28±2,81’di. Aðrýsý olan hastalardan elli dokuzu (%56.0) aðrý kesiciye ihtiyac duydu ve kýrk birinde (%80.3) basit aðrý kesicilerle yuzde elliden daha fazla aðrý azalmasý saptandý. Yeterli aðrý palyasyonu saðlanamayan on sekiz hastanýn on ikisinin aðrý kesicilerini duzenli olarak almak yerine aðrý oldukca almýþ olduklarý gozlendi. Muhtemel ve kesin vakalarýn aðrý frekansý, þiddeti ve hastanede kalýþ suresi benzerdi.
Sonuç: Sonuçlarýmýza göre COVID-19 hastalarýnda aðrýnýn baþ edilmesi zor bir semptom olmadýðý ve hafif-orta klinik þiddetteki hastalarda kolaylýkla tedavi edilebildiði kanaatine vardýk. Sonuçlarýmýz aðrý ve hastalýðýn klinik seyri arasýnda bir baðlantý kurmak için yeterli deðildi. Aðrý deðerlendirmesi için yoðun bakým hastalarýný içeren baþka çalýþmalara ihtiyaç vardýr.

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.

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Amaç: Kronik lomber radiküler aðrýsý olan hastalarda transforaminal epidural steroid enjeksiyonu (TESE) ve darbeli radyofrekans (DRF)’ýn lomber dorsal kök gangliyonuna (DKG) eþzamanlý uygulanmasýnýn ile yalnýz baþýna TESE tedavisi ile karþýlaþtýrýlmasý amaçlanmýþtýr.
Gereç ve Yöntem: Çalýþmaya toplam 129 hasta dahil edildi. 67 hastaya TESE, 62 hastaya TESE+ DKG-DRF uygulandý. Demografik veriler, cerrahi müdahaleler ve ilaçlarýn tipleri, iþlemin yapýldýðý vücut tarafý ve sayýsý kaydedildi. Hastalar ameliyat öncesi ve sonrasý 10. gün, birinci ve üçüncü ay takip ziyaretlerinde deðerlendirildi ve Görsel Analog Skala (VAS, 0–10) ile aðrý skorlarý deðerlendirildi. Üçüncü ay takip vizitlerinde memnuniyet deðerlendirmeleri ölçüldü. Baþarýlý terapötik yanýt, VAS skorlarýnda %50 veya daha fazla oranda azalma olarak tanýmlandý.
Bulgular: Her iki grupta postoperatif VAS skorlarý preoperatif düzeylerden anlamlý olarak düþüktü (p<0.001). Tüm takip dönemlerinde TESE+ DKG-DRF grubundaki VAS skorlarý TESE grubundan anlamlý olarak düþüktü (p˂0.001). Tüm takip vizitlerinde VAS skorlarýndaki azalma oranlarý TESE+ DKG-DRF grubunda anlamlý olarak daha yüksekti (p˂0.001). Tedavi memnuniyeti düzeyleri TESE+ DKG-DRF grubunda anlamlý olarak yüksekti (p˂0.01).
Sonuç: Çalýþmamýzýn bulgularýna göre TESE, kronik lomber radiküler aðrýsý olan hastalarda kýsa-orta derecede rahatlama saðlamaktadýr. Tedaviye yanýtý iyileþtirmek için TESE ile ayný seansta DRF’nin eþzamanlý uygulanmasýnýn bir seçenek olarak göz önünde bulundurulmasý önerilmektedir.

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.

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Amaç: Duygusal ve biliþsel faktörlerin aðrýyý etkilediði gösterilmiþtir ve bu etkinin geliþimindeki ana faktörlerden biri aðrýyý felaketleþtirme durumudur. Bu çalýþmada, omuz lezyonlarýnda ki aðrýyý felaketleþtirme durumunun ve sýklýðýnýn belirlenmesi, aðrýyý felaketleþtirme durumu ile ameliyat öncesi ve ameliyat sonrasý fonksiyonel sonuçlarý deðerlendirmeyi amaçladýk.
Gereç ve Yöntem: Omuz artroskopisi yapýlan toplam 114 hasta çalýþmaya dahil edildi. Hastalarýn ameliyat öncesi ve sonrasý aðrý ve fonksiyonel durumlarýný deðerlendirmek için aðrý felaketleþtirme ölçeði, Tampa kinezyofobi ölçeði, görsel analog skala ve Los Angeles California Üniversitesi omuz skalasý kullanýldý.
Bulgular: Katastrofizasyon, 114 hastanýn 42’sinde (% 37) saptandý. Kinezyofobi aðrýyý felaketleþtiren hastalarda daha yüksekti (p<0.0001). Hastalarýn labrum (p=0,038), supraspinatus (p=0,043) veya biseps patolojisi (p=0,032) varsa, aðrýyý felaketleþtirme daha sýk belirlendi. postoperatif Los Angeles Kaliforniya Üniversitesi skoru orta/zayýf olan hastalarýn % 50’sinde katastrofizasyon mevcuttu (p=0,039).
Sonuç: Bu çalýþmanýn ameliyat öncesi ve sonrasý sonuçlarý felaketleþtirmenin önemi hakkýndaki verileri güçlendirmiþtir. Felaketleþtirme (+) hasta grubu Felaket (-) hasta grubundan daha düþük fonksiyonel kapasite sonuçlarýna sahipti. Cerrahi ve konservatif tedavi edilen hastalarda aðrýyý felaketleþtirmenin azalmasý ve kinezyofobi düzeylerinde azalma, daha tatmin edici klinik sonuçlara yol açacaktýr.

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.

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Amaç: Kolay uygulanabilir periferik sinir bloklarýnýn klinik etkinliði, geliþmiþ ekipman gerektiren açýk ve kapalý cerrahi prosedürler haricinde ilgi konusudur. Trigeminal nevraljide periferik sinir dallarýna triamsinolon ve lidokain enjeksiyon uygulamasýnýn klinik etkinliðini aðrý þiddeti, aðrý sýklýðý ve kullanýlan ilaç dozlarý açýsýndan deðerlendirmeyi amaçladýk.
Gereç ve Yöntem: Bu retrospektif kohort çalýþmada 2011–2018 yýllarý arasýnda lidokain ve triamsinolon ile periferik trigeminal sinir bloðu yapýlan trigeminal nevraljili 72 hastanýn sonuçlarý deðerlendirildi. Aðrý þiddeti, aðrý sýklýðý, karbamazepin ile pregabalin eþdeðer dozlarýnýn iþlem öncesine göre iþlem sonrasý 1, 3 ve 6. aylardaki sonuçlarý deðerlendirildi. Ayrýca iþlem baþarýsý ile baðýmsýz deðiþkenler arasýnda bir korelasyon olup olmadýðýný deðerlendirildi.
Bulgular: Ýþlem öncesi aðrý þiddeti ve aðrý sýklýðý deðerleri ile iþlem sonrasý 1, 3 ve 6. aylar arasýnda istatistiksel olarak anlamlý bir fark vardý (p=0.000). Ýþlem öncesi karbamazepin eþdeðer dozlarý ile iþlem sonrasý 3 ve 6. aydaki deðerler arasýnda istatistiksel olarak anlamlý bir fark vardý (sýrasýyla p=0.002, 0.005). Retrospektif analizde, bir hastada iþlem alanýna baðlý olarak yaklaþýk bir hafta süren aðrýsýz parestezi ve iki hastada iþlem bölgesinde ekimoz geliþmiþ olduðu saptandý.
Sonuç: Trigeminal sinirin periferik dallarýna lidokain ve kortikosteroid enjeksiyonu ile kýsa ve orta vadede klinik rahatlama saðlanabilir. Periferik sinir bloklarý, nadir görülen komplikasyonlarý kýsa-orta vadede aðrý tedavisi için tercih edilebilir.

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.

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Amaç: Bu araþtýrma, hemþirelerde bel aðrýsý ve bel aðrýsýyla baþ etme yöntemlerinin belirlenmesi amacýyla yapýldý.
Gereç ve Yöntem: Tanýmlayýcý, kesitsel tipte olan çalýþma, Nisan–Aðustos 2016 tarihlerinde Ýstanbul Ýli’nde yer alan 3 üniversite hastanesinde, 356 hemþireyle gerçekleþtirildi. Ýstatistiksel deðerlendirmede yüzdelik hesaplama, ki-kare testleri kullanýldý.
Bulgular: Çalýþmada, hemþirelerin yaþ ortalamasý 28.70±5.92 olup, %25,3’ünün yoðun bakýmda çalýþtýðý, %46,6’sýnýn haftada 41- 48 saat arasý çalýþtýðý, %55,6’sýnýn 24 saat içerisinde 5-8 saat arasý ayakta kaldýðý belirlendi. Katýlýmcýlarýn %75,8’inde mevcut bel aðrýsý þiddetinin orta düzeyde olduðu, %43,3’ünde (n=154) bel aðrýlarýnýn çalýþma verimini bazen etkilediði görüldü. Baþ etme yöntemi olarak, büyük bir çoðunluðun hekime gitmediði, analjezik aldýðý, topuklu ayakkabý giymedikleri, sert yatakta yattýklarý görüldü. Katýlýmcýlarýn yaþ gruplarý, çalýþtýðý birim, görev durumu, ayakta durma süresi, ayný pozisyonda durma süresi ile bel aðrýsý arasýnda istatistiksel anlamlýlýk (p<0.05) olduðu görüldü.
Sonuç: Çalýþmadan elde edilen sonuçlar doðrultusunda; hemþirelerin orta düzeyde bel aðrýsý deneyimlediði, bel aðrýsý yaþamanýn, uzun süreli çalýþma ve ayakta kalma nedeniyle hemþireler için sürekli bir risk olduðu; bu sonuç doðrultusunda çalýþma saatlerinin düzenlenmesi ve doðru vücut mekaniklerine eðitimlerde yer verilmesi gereði düþünüldü.

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.

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Amaç: Çalýþmamýzda Postlaminektomi sendromu tanýsý almýþ, aðrýsý sayýsal derecelendirme ölçeðine (SDÖ) göre 7 ve üzeri hastalara uygulanan giriþimsel iþlemleri; iþlem sonrasý SDÖ puanýndaki deðiþimin deðerlendirilmesini amaçladýk.
Gereç ve Yöntem: Bu çalýþma, 01.02.2010-01.02.2015 tarihleri arasýnda baþvurusu bulunan ve giriþimsel iþlem yapýlan 18 yaþ ve üzerindeki 69 kadýn, 38 erkek olmak üzere 107 hastanýn dosyalarýnýn incelenmesi ile gerçekleþtirildi. Polikliniðimizde bulunan aðrý takip formlarý ve hastane otomasyon sistemi kullanýlarak, hastalarýn aðrý lokalizasyonu, postoperatif süreleri, yapýlan giriþimsel iþlemler ve iþlem sonrasý aðrý durumlarý tesbit edildi. Elde edilen verilerin istatistiksel anlamlýlýðý Pearson Ki-Kare testi, Kruskal Wallis H testi, Friedman ve Mann Whitney U testleri ile deðerlendirildi. P>0.05 anlamsýz, p<0.05 anlamlý kabul edildi.
Bulgular: Giriþimsel iþlemler ile hastalarýn %48,5’inde, %50’den fazla aðrýda azalma tesbit edilmiþtir. Radiküler karekterde aðrýsý bulunan hastalarda baþarý oraný %66,7 olarak tesbit edilmiþtir. Transforaminal epidural steroid enjeksiyonu uygulanan hastalarýn %28,8’inde aðrý palyasyonu saðlanýrken, dorsal root ganglion pulsed radyofrekans iþlemi uygulanan hastalarda bu oran %44,4 olarak tesbit edilmiþtir. Kalýcý Spinal kord stimülatörü (SKS) takýlan hastalarýn aðrý puanlarý diðer hasta gruplarý ile karþýlaþtýrýldýðýnda ise kalýcý SKS, hem istatistiksel hem de klinik olarak anlamlý derece etkin bulunmuþtur (p<0,001).
Sonuç: Postlaminektomi sendromu çoðu zaman tek bir patolojiden kaynaklanmaz ve çoðu zaman birden fazla giriþime ve tekrara ihtiyaç duyulur. Postlaminektomi sendromu multisidipliner yaklaþým gerektiren ve çoklu tedavi seçeneklerinin hastaya göre karar verilerek uygulanmasýný zorunlu kýlan bir hastalýktýr. Tedavi seçenekleri ile ilgili daha fazla çalýþmaya ihtiyaç vardýr.

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.

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Postdural ponskiyon baþaðrýsý (PDPB) kazara yapýlan dural yýrtýðýn en sýk rastlanan komplikasyonudur. Tanýsal semptomu ayaða kalkýnca veya oturunca baþlayan, yatýnca düzelen postural baþ aðrýsýdýr. Bu semptom, BOS göllenmesi sonucu BOS basýnç veya volüm düþüklüðü ile ortaya çýkar. Ayaða kalkýnca aðrýya duyarlý yapýlarýn traksiyonu, intrakraniyal içeriðin þifti postural baþ aðrýsýna yol açar. PDPB genellikle kendini sýnýrlayan, 2 hafta içinde kendiliðinden düzelen bir tablodur. Daha az sýklýkla epidural kan yamasýna ihtiyaç duyulur. Spontan intrakraniyal hipotansiyonun tekrarlamasý nadir deðildir, ancak PDPH spontan ve geç dönemde rekürensi oldukça nadir rapor edilmiþtir. Bu yazýnýn amacý epidural kan yamasýndan sonra düzelip, 10 ay sonra postural baþ aðrýsý tekrarlayan olguyu tartýþmaktýr.

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.

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Daha önce tek taraflý izole alar ligament rüptürü yedi vaka bildirilmiþtir. Yazarlar, bu nadir yaralanmanýn ilk yetiþkin kadýn olgusunu bildirmektedir. 36 yaþýnda kadýn hasta düþme sonrasý merkezimize baþvurdu. Düþme esnasýnda aldýðý travma sonucu baþlayan boyun ve baþ arasýnda yoðun aðrý tarifledi. Radyolojik incelemeler (manyetik rezonans görüntüleme ve grafiler) normal olarak yorumlandý. Muayenesinde sað tarafta alar ligaman testi pozitif bulundu. Çekilen ince kesitli baþ boyun bileþke tomografisinde odontoid proçesin sol tarafta asimetrik olduðu farkedildi. Sonrasýnda çekilen menyetik rezonans görüntülemede izole sað alar ligaman rüptürü saptandý. Bu nedenle hastaya iki taraflý oksipital sinir blokajý, pulsed radyofrekans ve splenius capitis, levator scapula, trapezius kaslarýna tetik nokta enjeksiyonu uygulanarak hasta üç ay boyunca halo ortez ile takip edildi. Ýlerleyen takiplerinde hastanýn aðrýsýz olduðu gözlendi. Tek taraflý izole alar ligaman rüptürü ile atlantooksipital eklemde ayrýþma gözlenmezken, kraniovertebral bileþkede instabilite geliþmediði gözlendi. Günümüze kadar izole alar ligaman rüptürü 8 kez rapor edilmiþ olup bunlardan sadece biri 25 yaþýnda erkekti. Diðer hastalar çocukluk çaðýndaydý. Tüm olgularýn 4 hafta ile 4 aylýk eksternal fiksatörlerle tedavi edildiði gözlendi. Bizim olgumuz ise tek taraflý izole alar ligaman rüptürü geliþen ilk eriþkin kadýn hastadýr.

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.

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Duloksetin çeþitli hastalýklarda kronik aðrý tedavisinde sýk olarak kullanýlýlan serotonin-noradrenalin geri alým inhibitörüdür. Hiperprolaktinemi ve galaktore bu tedavinin nadir görülen bir yan etkisidir. Burada, multipl skleroz tanýsý olan 34 yaþýnda bir kadýn hastada aðrý ve duygu durum bozukluðu nedeni ile duloksetin kullanýmý ve medikal tedviye baðlý geliþen galaktore olgusunu sunmaktayýz.

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.

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Kadýnlarýn hayatlarý boyunca yaþayabilecekleri en þiddetli aðrýlardan biri doðum aðrýsýdýr. Epidural analjezi, vajinal doðumda aðrý kontrolünü saðlamak için ideal bir yöntemdir. Horner sendromu epidural analjezinin nadir görülen bir komplikasyonudur. Hamilelerde epidural analjezi nedeniyle Horner sendromu daha sýk görülebilir. Bu sendrom, pitozis, miyozis, enoftalmi, anizokori, konjonktival hiperemi, etkilenen yüz tarafýnda kýzarma (flashing) ve terleme kaybý (anhidrozis) ile karakterizedir. Genellikle kalýcý bir nörolojik defekt olmadan düzelir. Stellat, servikal ve brakiyal pleksus bloklarý, torasik, lomber ve sakral bölge epidural anestezi uygulamalarý, anestezi uygulamalarýna baðlý Horner sendromunun en sýk nedenleri arasýndadýr. Horner sendromunun anesteziye baðlý olmayan nedenleri arasýnda baþ ve boyun cerrahisi, hipotalamus-talamus ve beyin sapý ile ilgili lezyonlar, baþ ve boyun travmasý ve malignite ile iliþkili pulmoner apikal tümörler bulunur. Bu olgu sunumunda, epidural analjezi ile vajinal doðum sonrasý geliþen Horner sendromunu sunmak istedik. Epidural analjezi uygulanan tüm gebeler olasý komplikasyonlar göz önünde bulundurularak ve gerekli önlemler alýnarak yakýndan takip edilmelidir.

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.

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Miyofasyal aðrý sendromu düþünülenden daha yaygýn bir problemdir. Adeziv kapsülitte miyofasyal tetik nokta tedavisi aðrý ve fonksiyonellik parametrelerine katkýda bulunabilir. Özellikle subskapularis kasý ayrýntýlý olarak deðerlendirilmelidir.

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.

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Servikojenik baþ aðrýsý faset eklemler, intervertebral diskler, kaslar ve ligamentler gibi çeþitli yapýlardan kaynaklanan bir baþ aðrýsýdýr. Miyofasiyal tetik noktalar servikojenik baþ aðrýlý hastalarda yaygýn bir nedendir ve aðrý ve sakatlýða katký yapar. Bu raporda üst trapezius kasýnda tetik noktalarý olan iki servikojenik baþ aðrýlý hastayý sunduk. Her iki hastaya ultrason eþliðinde trapezius kasý interfasiyal bloðu uygulandý.

Vaka 1
79 yaþýnda bayan hasta üst trapezius kasýndaki tetik noktaya baðlý baþ aðrýsý þikayeti ile baþvurdu. Numerik Rating Skala (NRS) skoru 10'du. Hastaya ultrason eþliðinde trapezius kasý interfasiyal bloðu uygulandý. Ýþlemden 30 dakika sonra NRS skoru 2 idi ve iþlem sonrasý 2 ay boyunca aðrýsýzdý.

Vaka 2
55 yaþýnda bayan hasta üst trapezius kasýndaki tetik noktaya baðlý baþ aðrýsý þikayeti ile baþvurdu. Numerik Rating Skala (NRS) skoru 8'di. Hastaya ultrason eþliðinde trapezius kasý interfasiyal bloðu uygulandý. Ýþlemden 30 dakika sonra NRS skoru 3 idi ve iþlem sonrasý 2 hafta boyunca aðrýsýzdý.

Fasyanýn yapýsý enjekte edilen anestezi ajanlarýn difüzyonunu kolaylaþtýrabilir ve interfasiyal enjeksiyonlar giderek daha fazla kullanýlmaya baþlamýþtýr. Biz tetik noktalara baðlý servikojenik baþ aðrýsýnda bu tedavi þeklinin pozitif etkiler yaratacaðýný düþünmekteyiz.

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.

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