Pain type and neuropathic pain components in acute herpes zoster.

OBJECTIVES: The aim of this study was to investigate the pain type (nociceptive or neuropathic) and neuropathic pain components in patients with acute herpes zoster (HZ). METHODS: Patients with acute HZ referred to the outpatient Dermatology and Venereology clinic between January 2021 and January 2022 were retrospectively detected. The demographic data including gender and age, rash localization, pain severity, and neuropathic pain components were recorded. Pain severity and neuropathic pain components were evaluated using a Visual Analog Scale (VAS) and Douleur Neuropathique 4 (DN4), respectively. RESULTS: The study included a total of 58 patients, comprising 33 females and 25 males. Of these patients, 35 (60.3%) were found to have neuropathic pain. Itching, burning, pins and needles, and tingling were the most frequently reported neuropathic pain signs and symptoms. The proportion of female patients with neuropathic pain was found to be significantly higher than that of male patients (p=0.021). No significant differences were observed in the distribution of pain across different body sites or in the age of patients with neuropathic pain (p>0.05). Itching was significantly more common in younger patients (p=0.02). CONCLUSION: In conclusion, the study found that over half of the patients with acute HZ experienced neuropathic pain, and this was more frequently observed in female patients. Analysis of different components of neuropathic pain showed significant differences in age, gender, and site distribution. The findings of this study may have important implications for the manage-ment and treatment of acute HZ.

Massaging as a pain-relieving intervention before performing intravenous access.

PURPOSE: Pain is "an unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of damage". Stimulating the skin by rubbing, stroking, massaging, or applying pressure near the injection site is pain-relieving. Needle-related procedures induce anxiety, distress, and fear in children and adults. The present study aimed to test the effectiveness of massaging the access site in reducing pain associated with intravenous access. DESIGN: After obtaining institutional ethics committee approval, this prospective randomized single-blinded study was performed on 250 ASA I-II patients 18 to 65 years old, scheduled for elective minor general surgery under general anaesthesia. METHODS: Patients were randomized into the Massaging Group (MG) and the Control Group (CG). A Situational Trait Anxiety Inventory (STAI) was conducted to evaluate the anxiety levels of the patients. In addition, the skin adjacent to the intravenous access site was massaged for 15 s in circular motions with moderate intensity by the investigator's right thumb before performing the intravenous access in the MG. The CG did not receive any massage adjacent to the access site. The primary endpoint, the intensity of perceived pain, was rated on a non-graduated 10-cm Visual Analogue Score (VAS). FINDINGS: The groups' demographic data and STAI I-II scores were similar. There was a significant difference between the VAS scores of the two groups (p < 0.05). CONCLUSIONS: Our results support massaging as an effective pain-relieving technique before intravenous intervention. As massaging is a universal and non-invasive intervention that requires no advanced preparation, we recommend massaging before each intravenous cannulation to reduce pain caused by intravenous access.

Impact of the COVID-19 Pandemic on Anaesthesiology and Reanimation Residency Training in Turkey.

OBJECTIVE: The purpose of this study was to evaluate the impact of the pandemic on clinical practice and education of anaesthesiology and reanimation residents in Turkey. METHODS: A 33-question web-based survey was sent to anaesthesiology and reanimation residents in Turkey. Residents were asked about their clinical practice and education before and during the pandemic and personal perspectives on working conditions and training. RESULTS: A total of 223 residents participated. Median working time in the intensive care unit of 2.5 months/year before the pandemic increased to 6 months/year during the pandemic (P < .001). Median working time in the operating room of 9 months/year decreased to 6 months/year (P < .001). The time working in the algology and anaesthesiology outpatient clinic decreased significantly (both P < .001). Neuraxial and peripheral nerve block practices decreased (P = .002 and P = .023, respectively). The number of night shifts per month increased (P < .001). While the average number of beds in intensive care units was 14, it increased to 19.5 beds (P < .001). The education time for lecture and clinical case discussion decreased (P < .001), but medical meeting attendance did not change (P = .174). Eighty-seven percent of the residents reported that night shifts were very intense and intense during the pandemic. For 87.3% of the respondents, the workload increased, and 71.6% of the respondents reported a decrease in theoretical education and 66.7% in practical training. Sixty-three percent of last year residents reported that they were negatively and very negatively affected in making the thesis. CONCLUSION: The pandemic had a negative impact on anaesthesiology and reanimation residency training programs in Turkey.

Ultrasound guided chronic pain interventions (Part I).

Recently, ultrasonography (US) is an indispensible imaging technique in regional anesthesia practice. With the guidance of US, various invasive interventions in chronic pain pathologies of the musculoskeletal system, peripheral and neuroaxial pathologies has become possible. The management includes diagnostic blocks as weel as radiofrequency ablation and institution of neurolythic agents. During these algologic interventions we are able to see the target tissue, the dispersion of the drug and all nearby vascular structures. Besides these the US also protects the team from ionic radiation that one encounters when using flouroscopy or computed tomography. Latest publications in this field show that applicability of US in chronic pain syndromes is rapidly expanding with a good future. The additional equipment (echogenic needles, 3-D US etc.) will also expand its applications in algology practice. This review highlights different applications of US in chronic pain conditions.

Ultrasound guided chronic pain interventions (Part II).

Henceforth, ultrasonography (US) is an indispensible imaging technique in regional anesthesia practice. With the guidance of US, various invasive interventions in chronic pain pathologies of the musculoskeletal system, peripheral and neuroaxial pathologies has become possible. The management includes diagnostic blocks as weel as radiofrequency ablation and institution of neurolythic agents. During these algologic interventions we are able to see the target tissue, the dispersion of the drug and all nearby vascular structures. Besides these the US also protects the team from ionic radiation that one encounters when using flouroscopy of computed tomography. Latest publication in this field show that applicability of US in chronic pain syndromes is rapidly expanding with a good future. The additional equipment (echogenic needles, 3-D US etc.) will also expands its applications in algology practice. This review highlights different applications of US in chronic pain conditions.

Target controlled remifentanil infusion for smooth laryngeal mask airway removal during emergence from desflurane-remifentanil anesthesia.

PURPOSE: Administration of remifentanil can be a reliable method for preventing airway reflex responses during emergence. We therefore investigated the effect of maintaining target controlled infusion (TCI) of remifentanil for smooth cLMA removal during emergence from desflurane-remifentanil anaesthesia. METHODS: Forty-one patients undergoing uretero-renoscopy under general anesthesia with desflurane and at 1-4 ng/ml TCI remifentanil infusion were randomly assigned to a control group (n = 20) or a remifentanil group (n = 21). At the end of the surgery, desflurane and remifentanil infusion were stopped in group C and remifentanil was maintained at the effect-site concentration of 1.5 ng/ml TCI in group R. When LMA removal was accomplished without coughing, teeth clenching, gross purposeful movements, breath holding, laryngospasm, and desaturation to SpO(2) less than 90%, removal was regarded as smooth (successful). The emergence and recovery profiles were also evaluated. RESULTS: The incidence and number of complications (coughing, teeth clenching, gross purposeful movements, breath holding, laryngospasm, desaturation to SpO(2) <90%) were significantly higher in the control group than in the remifentanil group (p = 0.002). CONCLUSION: Maintaining effect-site TCI of remifentanil at 1.5 ng/ml during emergence from anaesthesia enabled smooth removal of cLMA without any delay in recovery time.

The end-tidal desflurane concentration for smooth removal of the laryngeal mask airway in anaesthetised adults.

BACKGROUND AND OBJECTIVE: The end-tidal desflurane concentration required for smooth removal of the laryngeal mask airway (LMA) has not been established. Therefore, we aimed to find the end-tidal desflurane concentration for safe, smooth, and uncomplicated LMA removal. METHODS: The study was approved by the Ethical Committee of the Ministry of Health, Diskapi Yildirim Beyazit Research and the Training Hospital, Ankara, Turkey. All patients provided written consent. A total of 23 adults, 18-60 years of age and American Society of Anesthesiologists physical status class I, who had been scheduled for urological surgery were included in the study. The intravenous induction of anaesthesia was performed with propofol 2.5 mg kg⁻¹ and remifentanil 10 µg within 30 s. The LMA was inserted. Maintenance of anaesthesia was provided by desflurane, with nitrous oxide and oxygen. The LMA was removed at predetermined end-tidal desflurane concentrations at the end of surgery. The concentration at which LMA removal was attempted was determined by Dixon's up-down method with 0.5% as the step size. When LMA removal was accomplished without coughing, teeth clenching, gross purposeful movements, breath holding, laryngospasm, and desaturation to SpO(2) less than 90%, it was considered a smooth (successful) removal. RESULTS: For smooth removal of the LMA, end-tidal desflurane EC50 was 2.1% [95% confidence interval (CI) 1.1-2.9%], and the EC95 value was 3.9% (95% CI 3.1-7.9%). CONCLUSION: The EC95 of end-tidal desflurane for the smooth removal of the LMA is 3.9%. LMA removal in adults receiving desflurane may be possible at approximately 0.7 minimum alveolar concentration.

Current options in local anesthesia for groin hernia repairs.

Inguinal hernia repair is one of the most common procedures in general surgery. All anesthetic methods can be used in inguinal hernia repairs. Local anesthesia for groin hernia repair had been introduced at the very beginning of the last century, and gained popularity following the success reports from the Shouldice Hospital, and the Lichtenstein Hernia Institute. Today, local anesthesia is routinely used in specialized hernia clinics, whereas its use is still not a common practice in general hospitals, in spite of its proven advantages and recommendations by current hernia repair guidelines. In this review, the technical options for local anaesthesia in groin hernia repairs, commonly used local anaesthetics and their doses, potential complications related to the technique are evaluated. A comparison of local, general and regional anesthesia methods is also presented. Local anaesthesia technique has a short learning curve requiring simple training. It is easy to learn and apply, and its use is in open anterior repairs a nice way for health care economics. Local anesthesia has been shown to have certain advantages over general and regional anesthesia in inguinal hernia repairs. It is more economic and requires a shorter time in the operating room and shorter stay in the institution. It causes less postoperative pain, requires less analgesic consumption; avoids nausea, vomiting, and urinary retention. Patients can mobilize and take oral liquids and solid foods much earlier. Most importantly, local anesthesia is the most suitable type of anesthesia in elder, fragile patients and patients with ASA II-IV scores.

The effects of anandamide transport inhibitor AM404 on voltage-dependent calcium channels.

The effects of anandamide transport inhibitor AM404 were investigated on depolarization-induced 45Ca2+ fluxes in transverse tubule membrane vesicles from rabbit skeletal muscle and on Ba2+ currents through L-type voltage-dependent Ca2+ channels in rat myotubes. AM404, at the concentration of 3 microM and higher, caused a significant inhibition of 45Ca2+ fluxes. Radioligand binding studies indicated that the specific binding of [3H]Isradipine to transverse tubule membranes was also inhibited significantly by AM404. In controls and in presence of 10 microM AM404, B(max) values were 51+/-6 and 27+/-5 pM/mg, and KD values were 236+/-43 and 220+/-37 pM, respectively. Inhibitory effects of AEA and arachidonic acid on 45Ca2+ flux and [3H]Isradipine binding reported in earlier studies, were also enhanced significantly in the presence of AM404. In the presence of VDM11 (1 microM), another anandamide transport inhibitor, AM404 continued to inhibit 45Ca2+ fluxes and [3H]Isradipine binding. In rat myotubes, Ca2+ currents through L-type Ca2+ channels recorded in whole-cell configuration of patch clamp technique were inhibited by AM404 in a concentration-dependent manner with an IC50 value of 3.2 microM. In conclusion, results indicate that AM404 inhibits directly the function of L-type voltage-dependent Ca2+ channels in mammalian skeletal muscles.

[The effects of lumbar plexus block and epidural block on total blood loss and postoperative analgesia in total hip arthroplasty]. / Total kalça protez operasyonlarinda lomber pleksus blogu ve epidural blogun total kan kaybi ile postoperatif analjeziye etkileri.

OBJECTIVES: In this study, the effects of lumbar plexus block and epidural block on total blood loss and postoperative analgesia in patients undergoing total hip arthroplasty (THA) under general anesthesia was documented. METHODS: The study included 45 patients undergoing THA under general anesthesia. Group GA (n=15) received general anesthesia, Group GA+E (n=15) received general anesthesia + epidural catheter and Group GA+LPB (n=15) received general anesthesia + lumbar plexus catheterization. Intraoperative blood transfusion (IOBT) requirements and intraoperative bleeding (IOB) were documented. Postoperative hemoglobin, hematocrit and total blood loss through the drains were also documented. All patients received patient-controlled analgesia through the IV route. Time to first analgesic requirement (TFAR), total IV morphine consumption (MORPH 24) and 24-hour visual analogue scale (VAS) values were evaluated. RESULTS: TFAR was the lowest (8.7+/-4.0 min.) in the GA group and highest (42.7+/-14.4 min) in the GA+LPB group, and the GA+E group had lower values than the GA+LPB (32.3+/-16.0 min) group (p<0.05). IOBT, IOB, and MORPH 24 average values were the lowest in the GA+LPB group and highest in the GA group, with GA+E in between (p<0.05). Postoperative first VAS values were significantly different between the GA group and the others (p<0.001). There was also a significant difference between the GA group and the others regarding postoperative average Hb values (p<0.02). CONCLUSION: THA using either regional technique provides less blood loss and better analgesia. We will consider LPB in our future cases in view of the lower intraoperative blood loss and better analgesia.

Endogenous cannabinoid anandamide inhibits nicotinic acetylcholine receptor function in mouse thalamic synaptosomes.

The effects of the endogenous cannabinoid anandamide [arachidonylethanolamide (AEA)] on the function of nicotinic acetylcholine receptor (nAChR) were investigated using the 86Rb+ efflux assay in thalamic synaptosomes. AEA reversibly inhibited 86Rb+ efflux induced by 300 microM ACh with an IC50 value of 0.9 +/- 2 microM. Pre-treatment with the cannabinoid (CB1) receptor antagonist SR141716A (1 microM), the CB2 receptor antagonist SR144528 (1 microM), or pertussis toxin (0.2 mg/mL) did not alter the inhibitory effects of AEA, suggesting that known CB receptors are not involved in AEA inhibition of nAChRs. AEA inhibition of 86Rb+ efflux was not reversed by increasing acetylcholine (ACh) concentrations. In radioligand binding studies, the specific binding of [3H]-nicotine was not altered in the presence of AEA, indicating that AEA inhibits the function of nAChR in a non-competitive manner. Neither the amidohydrolase inhibitor phenylmethylsulfonyl fluoride (0.2 mM) nor the cyclooxygenase inhibitor, indomethacin, (5 microM) affected AEA inhibition of nAChRs, suggesting that the effect of AEA is not mediated by its metabolic products. Importantly, the extent of AEA inhibition of 86Rb+ efflux was significantly attenuated by the absence of 1% fatty acid free bovine serum albumin pre-treatment, supporting previous findings that fatty acid-like compounds modulate the activity of nAChRs. Collectively, the results indicate that AEA inhibits the function of nAChRs in thalamic synaptosomes via a CB-independent mechanism and that the background activity of these receptors is affected by fatty acids and AEA.

Effects of saturated long-chain N-acylethanolamines on voltage-dependent Ca2+ fluxes in rabbit T-tubule membranes.

The effects of saturated long-chain (C: 16-22) N-acylethanolamines and a series of saturated fatty acids with the same length of carbon chains were investigated on depolarization-induced (45)Ca(2+) fluxes mediated by voltage-dependent Ca(2+) channels in transverse tubule membrane vesicles from rabbit skeletal muscle. Vesicles were loaded with (45)Ca(2+) and membrane potentials were generated by establishing potassium gradients across the vesicle using the ionophore valinomycin. Arachidonoylethanolamide and docosaenoylethanolamide but not palmitoylethanolamide and stearoylethanolamide (all 10 microM) caused a significant inhibition of depolarization-induced (45)Ca(2+) fluxes and specific binding of [(3)H]Isradipine to transverse tubule membranes. On the other hand, saturated fatty acids including palmitic, stearic, arachidic, and docosanoic acids (all 10 microM) were ineffective in functional and radioligand binding experiments. Additional experiments using endocannabinoid metabolites suggested that whereas ethanolamine and arachidic acids were ineffective, arachidonoylethanolamide inhibited Ca(2+) effluxes and specific binding of [(3)H]Isradipine. Further studies indicated that only those fatty acids containing ethanolamine as a head group and having a chain length of more than 18 carbons were effective in inhibiting depolarization-induced Ca(2+) effluxes and specific binding of [(3)H]Isradipine. In conclusion, results indicate that depending on the chain length and the head group of fatty acid, N-acylethanolamines have differential effects on the function of voltage-dependent Ca(2+) channels and on the specific binding of [(3)H]Isradipine in skeletal muscle membranes.

A closed chamber method for performing biochemical experiments at accurate concentrations of volatile agents.

Experiments with volatile agents such as general anesthetics present difficulties in maintaining defined concentrations of these agents during in-vitro experimental conditions. In conventional filtration apparatuses, due to their partition between liquid and vapor phases (to open air or headspaces of the incubation vehicles), some degree of inaccuracy in calculated concentrations of these agents may occur in experiments using these types of chambers. In the present study, a method is described which permits the performance of biochemical experiments in a closed system in which the concentrations of a volatile agent, desflurane, in the liquid phase of the assay environment can be maintained constant for a relatively long time period.