Orbital doppler ultrasound as an ancillary test for diagnosing brain death: A prospective, single blind comparative study.

OBJECTIVE: Transcranial Doppler ultrasound (TDUS), computed tomography angiography (CTA), and transcranial Doppler ultrasound to detect cerebral blood flow are among the adjunctive tests in diagnosing brain death. This study aimed to investigate the effectiveness of orbital doppler ultrasound (ODUS). METHODS: This prospective, single-blind study included 66 patients for whom brain death was to be diagnosed. Primary outcome measures were ODUS measurements, Ophthalmic artery peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive indices (RI) measurements recorded during the brain death determination process. Secondary outcome measures were computed tomography angio (CTA), transcranial Doppler ultrasound (TDUS), and demographic data. RESULTS: This study investigating the effectiveness of ODUS in diagnosing brain death provided diagnostic success with 100% sensitivity and 93% specificity compared to CT angiography. It was noted that anatomical variations may limit its use. CONCLUSION: ODUS was found to have high sensitivity and specificity in the diagnosis of clinical brain death. It may assist in early prognostic assessment and shorten patient follow-up and diagnostic processes.

Landmark-guided versus Real-time Ultrasound-guided Combined Spinal-epidural Anesthesia Techniques: Paramedian Sagittal Oblique and Transverse Interlaminar Approach.

Background: There are different types of real-time ultrasound (US)-guided combined spinal epidural (CSE) anesthesia techniques. We aimed to investigate the effect of real-time US-guided paramedian sagittal oblique (PSO), transverse interlaminar (TI) approach method, and landmark-guided (LG) CSE anesthesia. Methods: Ninety patients who underwent CSE block were included in the study. Patients were randomized into LG (n = 30), PSO (n = 30), and TI (n = 30) groups. The primary outcome was number of needle manipulations. The secondary outcomes are the number of attempts, needle visibility, procedure time, procedure success rate, catheter placement difficulty, posterior complex distance, and complications. Results: The number of needle manipulations was statistically significantly lower in the LG technique group (P < 0.000). When the number of attempts, the difficulty of catheter placement, and the procedure's success rate were compared between the three groups, we did not find a statistically significant difference (P > 0.05). In addition, when the procedure times were compared, the time measured for the LG group was statistically significantly lower than in the PSO and TI groups (P < 0.000). Conclusion: In the results of this study, the real-time US-guided CSE anesthesia application had a similar success and complication level with LG technique. The LG method had a shorter processing time and fewer needle manipulations.

Ultrasound-guided external oblique and rectus abdominis plane "EXORA" block for postoperative pain after laparoscopic cholecystectomy: a propensity-matched study.

BACKGROUND: Various types of plane blocks are used for analgesia in the upper abdomen. The purpose of this study was to evaluate the efficacy of the external oblique and rectus abdominis plane (EXORA) block for antero-lateral upper abdominal analgesia. METHODS: This study included 60 patients undergoing laparoscopic cholecystectomy. Patients were divided into control group, intravenous patient-controlled analgesia (IV.PCA) (N.=30) and EXORA group (block with 25 mL 0.25% bupivacaine + IV.PCA [N.=30]). Postoperative pain (at rest) was evaluated at 30 minutes, two, four, six, 12 and 24 hours using Visual Analogue Scale (VAS) scores. Postoperative activity pain at two, four, six, 12 and 24 hours was also assessed using VAS. Secondary outcomes included tramadol use at 12 and 24 hours after surgery, side effect profile, dermatomal spread, and additional analgesic use. RESULTS: The VAS scores were statistically significantly lower in the EXORA group compared to the other groups (P<0.001). In addition, mean tramadol consumption at 12 and 24 hours was statistically significantly lower in the EXORA group (P<0.001). Sensory block was recorded in the lateral and anterior abdomen at T6 to T11 after EXORA block application. CONCLUSIONS: The EXORA block used to provide analgesia after laparoscopic cholecystectomy provides analgesia to the upper abdominal wall. Further data may be obtained from cadaveric studies and other studies.

Effect of interfascial pressure on block success during anterior quadratus lumborum block application: a prospective observational study.

BACKGROUND: The quadratus lumborum block (QLB) has recently been used frequently for postoperative analgesia after abdominal surgery. The aim of this study was to investigate the effect of pressure changes between the middle thoracolumbar fascia layers to which the anterior QLB (aQLB) is applied at the level of the sensory block. METHODS: A total of 67 patients planned to undergo laparoscopic cholecystectomy were evaluated in the context of this prospective study. Bilateral aQLBs were administered to all patients, and a peripheral nerve block catheter was placed between the psoas and quadratus lumborum muscles. The correlation of interfascial pressures (IFPs) during block application, 30 min intraoperatively, and 30 min postoperatively with the sensory block level was determined as the primary outcome measure. Secondary outcome measures were the sensory block levels 30 min after block application and 30 min postoperatively; visual analog scale scores 30 min and 6, 12, and 24 h postoperatively; and 24 h tramadol consumption. RESULTS: The preoperatively and intraoperatively measured IFPs differed significantly between the right and left sides (P < 0.05). The preoperative and postoperative block levels also differed significantly between the right and left sides (P < 0.05). The preoperative and postoperative block levels and preoperatively measured IFPs showed a weakly negative correlation (right: r = 0.374; left: r = 0.470). CONCLUSIONS: The results of this study show that pressure changes between the fasciae may be effective in aQLB application.

The effect of different regional analgesia methods on chronic pain after thoracic surgery.

Introduction: Chronic postsurgical pain (CPSP) is defined as pain persisting for ≥ 3 months after surgery, severely impairing patients' long-term daily activities and quality of life. Aim: To evaluate the effects of various regional analgesia methods, including thoracic epidural (TE), serratus anterior plane (SAP) block, rhomboid intercostal block (RIB) and paravertebral block (PVB), on the incidence of chronic post-thoracic surgery pain. Material and methods: A total of 489 patients (240 thoracotomy, 249 VATS) were included in the analysis. The primary outcome measure was the VAS score (postoperative 6th month), while the secondary outcome measures were the LANSS score (postoperative 6th month), the use of analgesic medication and descriptive information. Results: In thoracotomy patients, VAS scores were statistically significantly lower in patients who underwent RIB and SAP block compared to those who underwent TE and patient-controlled anesthesia (PCA). LANSS scores did not differ between the RIB, SAP and TE groups, while higher scores were found in the PCA group. After VATS, VAS scores were statistically significantly lower in patients who underwent RIB, SAP and PVB block compared to the PCA group. LANSS scores were statistically significantly lower in the RIB and SAP block groups than in the PVB and PCA groups. Conclusions: This study found that patients who received regional anesthesia had lower LANSS scores and VAS values, indicative of neuropathic pain reduction, following thoracotomy and VATS procedures.

Comparison of two different lung ultrasound imaging protocols in COVID-19 pneumonia.

PURPOSE: The aim of this study was to determine the effectiveness of two different lung ultrasonography (LUS) methods that can be used in the diagnosis of coronavirus disease 2019 (COVID-19) and to investigate their correlations with computed tomography (CT). METHODS: In this prospective, randomized, and single-blind study, 60 patients with COVID-19 were included. The patients were randomized to either the 12-zone LUS group (n=30) or the 14-zone LUS group (n=30). The correlation between LUS and thoracic CT scores was evaluated. As a secondary outcome measure, the characteristic features of the findings of thoracic CT and LUS were examined. RESULTS: The study was completed with a total of 59 patients. Moderate and high correlations were found between the total CT and LUS scores in the 12-zone and 14-zone study groups. There were no statistically significant differences in the lesion types detected in patients using LUS and CT (P>0.05). The left lung lower lobe CT scores were statistically significantly lower in the 14-zone study group than in the 12-zone group (P=0.019). The left lower lobe CT and LUS scores were highly correlated in the 14-zone group (P<0.001, r=0.902). CONCLUSION: The results of our study indicated that the two different LUS examination methods performed in different patients had similar findings in terms of the diagnosis and their correlations with CT results.

Application of unilateral rhomboid intercostal and subserratus plane block for analgesia after laparoscopic cholecystectomy: a quasi-experimental study.

BACKGROUND: Interfascial plane block can be used to treat postoperative pain after laparoscopic surgery. This study aimed to investigate the effect of ultrasound-guided unilateral rhomboid intercostal and subserratus plane (RISS) block after laparoscopic cholecystectomy on the amount of analgesic consumption. METHODS: Fifty patients who underwent laparoscopic cholecystectomy were included in this quasi-experimental study. Patients fulfilling the inclusion criteria were analyzed in two groups: RISS group (RISS block with 20 ml of 0.25% bupivacaine + intravenous patient-controlled analgesia [IV-PCA] tramadol [n = 25]); and Control group (IV-PCA tramadol [n = 25]). The primary outcome was the total amount of tramadol used over 24 h. Secondary outcomes included side effects, additional analgesic use, and postoperative pain (at rest and during activity) at 2, 6, 12, and 24 h according to numerical rating scale (NRS) scores. RESULTS: Postoperative tramadol consumption at 24 h was significantly lower in the RISS group than in the Control group (P < 0.001). Resting NRS scores at 2 h and 6 h were significantly lower in the RISS group. NRS scores during movement in the RISS group were significantly lower at 2, 6, and 12 h postoperatively. There was no statistically significant difference in the rate of side effects and additional analgesic use between the groups (P > 0.05). CONCLUSIONS: Unilateral RISS block was an effective method for pain management after laparoscopic cholecystectomy and can be used as a part of multimodal analgesia.

Comparison of lung ultrasonography findings with chest computed tomography results in coronavirus (COVID-19) pneumonia.

PURPOSE: The purpose of our study was to determine the usability of lung ultrasonography (LUS) in the diagnosis of COVID-19, and to match the morphological features of lesions detected on computed tomography (CT) with the findings observed on LUS. METHODS: Sixty patients with COVID-19 were included in this prospective study. Patients were examined by radiology and anesthesia clinic specialists for a visual CT score. A LUS 12-zone ultrasonography protocol was applied by the investigator blinded to the CT and PCR test results. The characteristics of abnormal findings and the relationship of lesions to the pleura and the distance to the pleura were investigated. RESULTS: Forty-five males and 25 females evaluated within the scope of the study had an average age of 61.2 ± 15.3 years. The total CT score was calculated as 14.3 ± 5.3, and the LUS score was found to be 19.9 ± 7.6. There was a statistically significant positive correlation between the measured LUS and CT scores (r = 0.857, p < 0.001). The mean distance of these lesions to the pleura was 5.2 ± 1.76 cm. LUS findings in 51 areas corresponded to non-pleural lesions on CT. There was a negative correlation between the measured distance to the pleura and the LUS scores (p < 0.001, r = - 0.708). CONCLUSION: The results of this study showed that the correlation between CT and LUS findings may be used in the diagnosis of COVID-19 pneumonia, although there are some limitations. ClinicalTrials.gov identifier: NCT04719234.

Effect of Various Modes of Mechanical Ventilation in Laparoscopic Cholecystectomies on Optic Nerve Sheath Diameter and Cognitive Functions.

Aim: In this study, we aim at investigating the effects of volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) modes on changes in the optic nerve diameter and cognitive functions in laparoscopic cholecystectomy operations. Materials and Methods: Sixty patients who underwent laparoscopic cholecystectomy were randomly divided into two groups based on the mode of mechanical ventilation provided: Group P; PCV, Group V; VCV. Optic nerve sheath diameter was measured when the patient was awake (T0), in the 10th minute after induction (T1), in the 10th minute after the initiation of gas insufflation (T2), when maximum gas pressure was reached in the reverse-Trendelenburg position (T3), and pre-extubation (T4). Partial oxygen saturation (PaO2), PCO2, end-tidal carbon dioxide (ETCO2), and peak airway pressure (pPEAK) were also recorded. A Mini-Mental State Examination (MMSE) was conducted on patients preoperatively and in the postoperative third month. Results: Between the groups, a statistically significant difference was found in Group P compared with Group V in terms of optic nerve diameter at measurement times T1 (P < .05). In the intragroup comparison, a significant difference was found in the initial values in all measurements except for measurement times T0 and T4 in both Group P and Group V (P < .05). pPEAK values were identified to be statistically significantly lower in Group P than Group V at all measurement times (P < .05). No difference was identified in the MMSE scores in the intergroup and intragroup comparisons. Conclusion: Laparoscopic cholecystectomy increases the optic nerve diameter due to the mechanical and systemic effects of the operation, and the PCV mode can be preferred. Clinical Trial Number: NCT04413903.

Rhomboid Intercostal and Serratus Anterior Interfascial Plane Blocks for the Treatment of Post-Operative Pain after Video-Assisted Thoracoscopic Surgery: A Retrospective Propensity-Matched Study.

OBJECTIVE: Video-assisted thoracoscopic surgery (VATS) techniques are commonly used for surgical procedures within the thoracic cavity with smaller incisions. There are very few regional anesthesia methods used to achieve this goal. This study aimed to investigate the effect of two fascial plane block technique rhomboid intercostal block (RIB) and serratus anterior plane block (SAPB) administered on pain scores after VATS. METHODS: A total of 90 patients who underwent VATS were included in this study. Patients were divided in three groups: Group R (intravenous patient-controlled analgesia (IV. PCA) +RIB with (25 mL 0.25% bupivacaine; n=30), Group S (IV. PCA + SAPB with (25 mL 0.25% bupivacaine; n=30), and Group C (IV. PCA). The primary outcome was determined as a tramadol consumption amount (at hours 6, 12, and 24). Postoperative pain was evaluated using the VAS (at the 30th minute, 2nd, 6th, 12th, and 24th hours) scores. Secondary outcomes included the side effect profile and additional analgesic use. RESULTS: VAS scores of the Group R were found to be statistically significantly lower to those of Group S and Group C (p<0.05). A comparison of Groups R and S with Group C in terms of tramadol consumption amounts, at all measurement time points, revealed statistically significantly lower values (p<0.005). CONCLUSION: As per the results of this study, we believe that RIB and SAPB administration for pain palliation after VATS is an effective analgesia technique.

Investigation of the effect of kinesiotaping on the respiratory function and depression in male patients with chronic obstructive pulmonary disease: a prospective, randomized, controlled, and single-blind study.

OBJECTIVES: We aimed to investigate the effect of kinesiotaping (KT) on the respiratory parameters as measured by spirometry and depression in the chronic obstructive pulmonary disease (COPD) patients. METHODS: In this prospective, randomized, controlled, single-blind study 42 male patients with COPD diagnosis were randomized into two groups. In Group1 (n = 21) routine COPD medical treatment plus kinesiotaping and in Group2 (n = 21) only routine COPD medical treatment was given. KT was changed on every fifth day (for a total of three times and 15 days). The patients were assessed using Visual Analog Scale (VAS) for difficulty experienced by the patients during respiration, respiratory function test (RFT), modified medical research council (mMRC) dyspnea scale and beck depression inventory (BDI). The data were obtained before treatment and posttreatment. RESULTS: In Group 1; statistically significant improvement was found in all parameters except for FVC and FVC % following treatment compared to pretreatment values. Comparison of the difference scores (the amount of recovery between posttreatment and pretreatment) of the two groups showed significantly superior improvement in Group1 for all parameters except for FVC, FVC % and FEV1% following the treatment (p < .05). CONCLUSIONS: The results of this study showed that supplementary kinesiotaping improved respiratory function and depression significantly compared to only routine medical treatment in COPD patients who were in stable condition.

Ultrasound-guided anterior quadratus lumborum block for postoperative pain after percutaneous nephrolithotomy: a randomized controlled trial.

BACKGROUND: The Quadratus Lumborum Block (QLB), which is reported to provide analgesia to the abdominal region, is a newly defined fascial plane block method. The present study aimed to investigate the effect of ultrasound guided anterior QLB on the postoperative pain scores after percutaneous nephrolithotomy. METHODS: In this prospective, randomized, controlled single-blind study, 60 patients with elective percutaneous nephrolithotomy operations were randomized into 2 groups. In Group B (n = 30): anterior QLB+ intravenous patient-controlled analgesia (PCA) morphine and in Group C (n = 30): intravenous PCA morphine. Outcome measures were included for visual analog scale (VAS) scores and morphine consumption for 24 hours postoperatively. Adverse effects, additional analgesic requirement, and intraoperative opioid requirement were recorded. RESULTS: The mean values of the quantity of morphine used at the 6th, 12th, and 24th hours were found to be statistically significantly lower in Group B (p < 0.05). The VAS scores were found to be statistically significantly lower in Group B (p < 0.05). There were no statistically significant differences in the rate of adverse effects, additional analgesic requirement, and intraoperative opioid requirement between the groups (p > 0.05). CONCLUSION: The study results suggest that anterior QLB is an effective treatment option for postoperative analgesia of percutaneous nephrolithotomy.

Efficacy of rhomboid intercostal block for analgesia after thoracotomy.

Regional anesthesia, including central and plane blocks (serratus anterior plane block and erector spinae block), are used for post-thoracotomy pain. The rhomboid intercostal block (RIB) is mainly performed by injection to the upper intercostal muscle plane below the rhomboid muscle. It has been reported to provide analgesia at the T3-T9 levels. The RIB was performed on 5 patients who had been scheduled for thoracotomy. The catheter was advanced in the area under the rhomboid muscle between the intercostal muscles. Postoperative visual analog scale (VAS) scores were observed and each patient's resting VAS score remained below 3 for 48 hours. The RIB has been observed to be a convenient plane block for post-thoracotomy analgesia. We believe that further information from detailed studies is required.

Ultrasound-guided lateral versus posterior Quadratus Lumborum Block for postoperative pain after laparoscopic cholecystectomy: a randomized controlled trial.

OBJECTIVES: The aim of the present study was to investigate the effect of ultrasound-guided bilateral posterior quadratus lumborum block (QLB) and lateral QLB on postoperative pain scores after laparoscopic cholecystectomy. MATERIAL AND METHODS: In this prospective, randomized, single-blind study; 60 patients with elective laparoscopic cholecystectomy operations were randomized into two groups as group P (n= 30): Posterior Quadratus Lumborum Block + IV patient-controlled analgesia (PCA) tramadol and group L (n= 30): Lateral Quadratus Lumborum Block + IV PCA tramadol. Primary outcome measures included the amount of total consumption (24 hours) of tramadol. Secondary outcome measures; Visual Analog Scala (VAS) scores at rest and on movement (postoperative 30th minute, 2nd, 6th, 12th, and 24th hours) were recorded. Adverse effects (nausea and vomiting), additional analgesic requirement, and intraoperative opioid requirement were recorded. RESULTS: Postoperative total consumption amounts of tramadol and VAS scores (rest and on movement) were compared, and there was no statistically significant difference between the two groups (p> 0.05). There was no statistically significant difference in adverse effects (nausea and vomiting), additional analgesic requirement, and intraoperative opioid requirement between the two groups (p> 0.05). CONCLUSION: Similar postoperative tramadol consumption values and VAS scores were determined in both lateral QLB and posterior QLB block applications in the results of our study.

Ultrasound guided superficial cervical plexus block versus greater auricular nerve block for postoperative tympanomastoid surgery pain: A prospective, randomized, single blind study.

OBJECTIVES: The aim of the study was to investigate the effect of ultrasound guided superficial cervical plexus (SCP) block versus greater auricular nerve (GAN) block for on postoperative tympanomastoid surgery analgesia. METHODS: In this prospective, randomized, single-blind study, a total of 50 patients aged between 25 and 70 years, those who were in the American Society of Anesthesiologists I-II class and underwent tympanomastoid surgery were included in the study. Patients were randomized to either Group Y: intravenous patient-controlled analgesia tramadol (IV PCA) + SCP block; n=25 and Group G: IV PCA + GAN block; n=25. Postoperative pain was evaluated at the 2nd, 6th, 12nd, and 24th hours using the Visual Analogue Scale (VAS) and postoperative 6th, 12nd, and 24th hour follow-up results were evaluated to identify the quantity of tramadol use. RESULTS: The VAS scores at all measures time were found to be no statistically significant difference between groups (p>0.05). The amounts of PCA tramadol consumption at all measures time were significantly lower in Group Y than in Group G (p<0.05). CONCLUSION: The results of this study have indicated that SCP and GAN blocks can be used for pain control after tympanomastoid surgery. We believe that the only disadvantage of SCP block application with lower amounts of tramadol use is that the complications that can occur are more serious than those that can occur in GAN application.

Ultrasound-guided posterior quadratus lumborum block for postoperative pain after laparoscopic cholecystectomy: A randomized controlled double blind study.

STUDY OBJECTIVE: Laparoscopic techniques are commonly used in surgical operations of the gallbladder. There are very few regional anesthesia methods used to achieve this goal. We aimed to investigate the effect of ultrasound-guided posterior quadratus lumborum block (QLB), administered bilaterally on pain scores after laparoscopic cholecystectomy operations. DESIGN: Prospective, double blind, randomized controlled clinical trial. SETTING: Single-institution, tertiary hospital. PATIENTS: 60 patients underwent laparoscopic cholecystectomy were included in the study. INTERVENTIONS: Patients were randomized to either Group B (intravenous patient-controlled analgesia (IV PCA) + posterior QLB with 0.3 ml/kg 0.25% bupivacaine; n = 30) or Group S (IV PCA + posterior QLB with 0.3 ml/kg 0,9% saline; n = 30). MEASUREMENTS: Postoperative pain (during rest) was evaluated at the 30th minute, 2nd, 6th, 12th, and 24th hours using the VAS scores. Postoperative activity pain was also evaluated with VAS at the 2nd, 6th, 12th, and 24th hours. Postoperative 6th, 12th, and 24th hour follow-up results were recorded to identify the quantity of tramadol use. Secondary outcomes included the Ramsey sedation scale (RSS), side effect profile, and additional analgesic use. MAIN RESULTS: The VAS scores between the two groups were found to be statistically significantly lower in Group B (p < 0.001). The mean values of the quantity of tramadol use at the 6th, 12th, and 24th hours were found to be statistically significantly lower in Group B (p < 0.001). There was no statistically significant difference in the rate of side effects (p = 0.309) and RSS (p = 0.505) outcomes between the groups. CONCLUSIONS: As a result of this study, we think that posterior QLB administered for pain palliation after laparoscopic cholecystectomy operation is an effective analgesia technique.

Investigation of the effectiveness of therapeutic ultrasound with high-resolution ultrasonographic cross-sectional area measurement of cervical nerve roots in patients with chronic cervical radiculopathy: a prospective, controlled, single-blind study.

PURPOSE: The purpose of our study was to evaluate the effects of therapeutic ultrasound (US) on chronic cervical radiculopathy (CR) patients using both the clinical parameters and the cross-sectional area (CSA) values of the cervical nerve roots (NR) measured by high-resolution ultrasonography (HRUS). METHODS: Thirty-two patients with chronic CR were included in this prospective, controlled, and single-blind study. All of the patients received therapeutic US at continuous mode, 1-MHz frequency, and 1.5-W/cm2 intensity for 10 sessions. The patients were assessed using VAS for pain, Modified Neck Disability Index, and Short-form 12, and cervical NR were examined with HRUS. The data were obtained before treatment (W0), the second week immediately after treatment (W2), and at the sixth week (W6). RESULTS: Twenty-nine patients and a total of 42 affected cervical NR and 42 unaffected cervical NR (control group) were evaluated. A significant improvement was observed for all clinical parameters and CSA values of affected cervical NR both at W2 and W6 compared to pre-treatment values (p < 0.05). CONCLUSIONS: We found therapeutic US to be beneficial in improvement of pain, disability, and quality of life of patients with chronic CR. We suggest that CSA measurements may also contribute to both diagnosis and post-treatment evaluation in chronic CR.

Investigation of the Effect of Cervical Radiculopathy on Peripheral Nerves of the Upper Extremity With High-Resolution Ultrasonography.

STUDY DESIGN: Prospective, cross-sectional observational study. OBJECTIVE: We aimed to investigate the effects of chronic cervical radiculopathy (CR) on the cross-sectional area (CSA) values of the cervical nerve roots (CNRs), median, ulnar, and radial nerves with high-resolution ultrasonography. SUMMARY OF BACKGROUND DATA: Symptomatic nerve roots are wider than asymptomatic nerve roots due to the presence of edema. Peripheral nerves have also been shown to develop edema, fibrosis, and changes distal to the affected nerve as a result of mechanical compression. In addition according to "double-crush syndrome" hypothesis, the peripheral nerves are more sensitive to pressure, and a proximal nerve lesion makes the distal segment of the nerve more susceptible to anatomic deterioration by causing interruption in the axoplasmic conduction due to compression. METHODS: Forty patients with chronic CR were included to the study. Both affected CNRs and the contralateral nerve roots (control group) were evaluated with high-resolution ultrasonography. Ulnar and median nerve CSA measurements were performed at four measurement points and radial nerve measurements at a single measurement point. RESULTS: CSA measurements were statistically significantly higher at the CNR of the affected side compared to the unaffected side. There was no statistically significant difference when affected and unaffected sides were compared in terms of measurements performed from median, ulnar, and radial nerves at all measurement points. CONCLUSION: The results of the present study indicate that the changes in the CNR caused by CR do not have any effect on the peripheral nerves. We did not find any affection in peripheral nerve CSA that might have been suggestive of double-crush syndrome in CR. LEVEL OF EVIDENCE: 2.