Ultrasound-guided erector spinae block versus mid-transverse process to pleura block for postoperative analgesia in lumbar spinal surgery.

BACKGROUND: In recent years, promising results were achieved with the use of ultrasound (US)-guided interfascial plane blocks for effective postoperative analgesia in several surgeries. Erector spina plane (ESP) block and mid-transverse to pleura plane (MTP) block are the latest techniques in this area. The aim of this prospective and randomized study was to compare the postoperative analgesic efficacy of bilateral ESP and MTP blocks in patients undergoing lumbar spinal surgery under general anesthesia (GA). METHODS: A total of 120 adult patients were included in the study and randomized into 3 groups: group ESP (n = 40), group MTP (n = 40) and group Control (n = 40). The patients in the group ESP received a bilateral block by injecting 20 ml of 0.25% bupivacaine at a vertebrae level in the mid-point of the incision before GA. The same LA was administrated bilaterally at the T12/L1 level in the group MTP. Postoperatively, a multimodal analgesic regimen including an intravenous tramadol patient-controlled analgesia (PCA), paracetamol and dexketoprofen was used in all groups. Postoperative pain was assessed using a visual analogue scale (VAS) during the first 48 postoperative hours. Pethidine was used as a rescue analgesic when VAS score was >3. Primary outcome measure was mean pain scores. Secondary outcome measures were consumption of rescue analgesic and the amount of tramadol delivered by PCA. A p < 0.05 was considered statistically significant. RESULTS: Mean VAS scores were significantly higher in the group Control than in the group MTP and group ESP at all-time points during 48 h (Control > MTP > ESP; p < 0.001). Mean VAS scores were lower in group ESP than group MTP in postoperative 12 h (p < 0.001). Rescue analgesic consumption, number of bolus demand on PCA, PCA bolus demand dose, total PCA dose, and complications related to opioid consumption were highest in control group and lowest in ESP group (Control > MTP > ESP; p < 0.001). CONCLUSION: Both ESP and MTP blocks provided effective pain relief after lumbar spinal surgery but the ESP block was superior to MTP block regarding postoperative analgesia in the first 24 h.

A Novel Technique: Ultrasound-Guided Serratus Anterior Plane Block for the Treatment of Posttraumatic Intercostal Neuralgia.

Serratus anterior plane block has been used for pain management during the acute period of conditions affecting the thorax, such as postthoracotomy recovery, rib fracture, and breast surgery recovery. Here, we report the use of serratus anterior plane block in posttraumatic chronic pain treatment. We describe a case of posttraumatic chronic intercostal neuralgia, in which successful pain relief was achieved via repeated injections of local anesthetic and steroid combinations in the serratus anterior plane under ultrasonographic guidance. This novel technique is easy to administer, reliable, and warrants further investigation with regard to its use for rehabilitation of patients who are experiencing posttraumatic chronic neuropathies of the chest wall.

Sedoanalgesia for cardioversion: comparison of alfentanil, remifentanil and fentanyl combined with propofol and midazolam: a prospective, randomized, double-blind study.

OBJECTIVE: Electrical cardioversion (EC) is a short but painful procedure to restore sinus rhythm. The aim of this study is to compare the effect of fentanyl, remifentanil and alfentanil in association with propofol and midazolam for elective EC. PATIENTS AND METHODS: Ninety-nine patients older than 18-years, American Society of Anesthesiologists I/II/III grades undergoing elective EC were randomized into 3 groups. All patients received 2 mg midazolam and propofol (0.5 mg/kg). Group A received alfentanil (5 µg/kg i.v. bolus), Group F received fentanyl (0.5 µg/kg i.v. bolus) and Group R received remifentanil (0.25 µg/kg i.v. bolus). Hemodynamics and respiratory variables [Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), SpO2, respiratory rate (RR)], and Modified Aldrete recovery score (MARS) were assessed at six different time points (baseline, right after EC, and 3rd min, 5th min, 10th min, 30th min following EC). Also, induction times (time to reach RSS to 5) and recovery times (time to reach MARS to 8) were recorded. The incidence of respiratory depression, bradycardia, hypotension and adverse effects were also recorded. RESULTS: Hemodynamic variables were similar in all groups. SpO2 values in Group R were significantly lower at 3rd min (p = 0.005). Induction and recovery times were longest in Group F. There were significant differences at 3rd, 5th and 10th minute MARS values between groups. The incidence of hypotension and bradycardia were similar in all groups (p > 0.05) but respiratory depression was higher in Group R (p = 0.047). CONCLUSIONS: Propofol alfentanil combination has more beneficial advantages in their rapid onset, early recovery time and less respiratory depression than remifentanil and fentanyl.

Acute high dose-fentanyl exposure produces hyperalgesia and tactile allodynia after coronary artery bypass surgery.

OBJECTIVE: Opioid-induced hyperalgesia is well known complication of acute high dose and chronic opioid therapy. In this study, we evaluated development of opioid-induced hyperalgesia following intraoperative short-term use of µ-opioid agonist fentanyl after coronary artery bypass surgery. PATIENTS AND METHODS: 100 patients undergoing elective coronary artery bypass graft surgery is divided into two groups. In group I (low dose), anesthesia was induced with propofol 1-2.5 mg/kg and fentanyl 2 mcg/kg, in group II (high dose) fentanyl 40-70 mcg/kg was used. In group I, propofol 5-10 mg/kg/h, fentanyl 1-3 mcg/kg/h, in group II fentanyl 5-10 mcg/kg/h was used for maintenance of anesthesia. The tactile and thermal thresholds were measured before surgery and in 1st, 3rd and 7th postoperative days by using Von Frey filaments and a thermal source, respectively. RESULTS: Tactile thresholds were significantly decreased at the first (6,08±0.21 and 3.76±0.13 g; p<0.001) and third (6.76±0.24 and 4.96±0.16 g; p<0.001) postoperative days compared to baseline preoperative values (7.72±0.26, and 7.60±0.21 g; p=816) in two groups. Postoperative 1st (13.45±0.33 and 10.05±0.24 sec; p<0.001) and 3rd day (14.77±0.28 and 13.17±0.26 sec; p<0.001) assessments showed a statistically significant thermal hyperalgesia compared to the preoperative baseline values (16.67±0.51 and 16.45±0.42 sec; p=0.997) in two groups. This decrease in both tactile and thermal thresholds returned to baseline control values at the 7th day of measurement. CONCLUSIONS: Our results showed that patients undergoing coronary artery bypass surgery receiving fentanyl anesthesia developed postoperative tactile allodynia and thermal hyperalgesia and this was more prominent in high dose group.

Social problem-solving, perceived stress, negative life events, depression and life satisfaction in psoriasis.

BACKGROUND: Psoriasis is a chronic dermatosis which may cause significant impairment of the patient's quality of life. OBJECTIVE: The purpose of this study was to investigate the social problem-solving skills, perceived stress, negative life events, depression and life satisfaction in psoriasis patients. METHODS: Data were gathered by means of questionnaires and clinical evaluations from 51 psoriatic patients and 51 matched healthy controls. RESULTS: Average disease duration was 16.47 years and average Psoriasis Area and Severity Index score was 3.67. Compared with the controls, the patients displayed lower social problem-solving skills. They displayed higher negative problem orientation and impulsive-careless problem-solving style scores than the controls. Patients tended also to show more avoidant problem-solving style and lower life satisfaction than controls. There was no difference between psoriatic patients and controls in terms of depression, perceived stress and negative life events. Higher social problem-solving skills were associated with lower depression, perceived stress and fewer numbers of negative life events but higher level of life satisfaction. LIMITATIONS: The patient group largely included mild and moderate psoriatic cases. CONCLUSION: The findings of the study suggest that problem-solving training or therapy may be a suitable option for alleviating levels of psychological distress in patients suffering from psoriasis.

[A different approach to the percutaneous nephrostomy by urologists]. / Un abordaje diferente a la nefrostomía percutánea por urólogos.

INTRODUCTION: Percutaneous nephrostomy (PCN) tube placement is generally performed in radiologic departments worldwide. However, there are a few urologist-directed studies about PCN performed with ultrasound guidance. Needle direction using a convex abdominal ultrasound probe might be difficult in unexperienced hands. In order to perform this procedure easily, we propose that a probe placed on flank or intercostal region and a long grooved needle director that never allows needle movement would be useful. We considered a transrectal ultrasound (TRUS) probe was suitable to resolve this issue. MATERIAL AND METHOD: From January 2007 to April 2011, a total of 113 percutaneous renal access (PRA) were performed using a TRUS probe in 102 patients, aged 20 to 84 years old. Because of the insufficient imaging capability of the TRUS probe in obese patients whose body mass index (BMI) greater than 30kg/m(2) were excluded. Forty two PRA were performed under local anesthesia and this group was named local anesthesia (LA) group. Seventy one PRA were performed for nephrostomy insertion under local anesthesia supplemented by deep sedation and this cluster was named deep sedation (DS) group. RESULTS: Targeted calyx puncture and guide wire placement was performed in all patients (100%) but success rate of tube insertion in each group was different. Successful PCN insertion rate was 69.1% (29 of 42 cases) in LA group and 95.8% (68 of 71 cases) in DS group. No major vascular injury and/or adjacent organ injury to bowel, liver, spleen or lung was seen in any patient. CONCLUSION: Guidance of TRUS probe, deep sedation, and modified dilators may offer a high success rate to the urologists with little experience in PCN insertion which they would find it difficult to perform.

Acne: prevalence, perceptions and effects on psychological health among adolescents in Aydin, Turkey.

BACKGROUND: Acne vulgaris is a common disease among adolescents and known to have adverse effects on psychological status. METHODS: A cross-sectional study was conducted on 600 participants by means of a questionnaire designed for this study in high school students. In addition, an objective evaluation of acne in participants was undertaken. The questionnaire consisted of questions about acne, General Health Questionnaire (GHQ) and Rosenberg Self-Esteem Scale (RSES). RESULTS: Five hundred and sixty-three questionnaires out of 600 were answered and 550 adolescents who gave permission for examination were evaluated. The study population consisted of 303 girls and 260 boys between the ages 13 and 19, and the mean age was 15.24 +/- 1.05 years. Acne prevalence was 63.6% with 29.2% non-inflammatory and 34.4% inflammatory acne. It was more prevalent and severe in boys than in girls. Not the objective but the subjective severity of acne and opinion that one could benefit from acne treatment was found to be related to anxiety, depression and self-esteem. Factors implicated among causes of acne were food, bad skin hygiene and hormones in decreasing frequency. Forty-eight per cent of adolescents expect a maximum duration of 4 weeks for treatment. CONCLUSION: Despite the high prevalence of acne, there is still much deficiency of knowledge and wrong beliefs about acne. This indicates that there is an urgent need for education about etiopathogenesis, potential complications and importance of effective treatment for acne. Effective treatment may make significant contributions for the mental health of adolescent and as well as adult populations.

Social reactions of Swedish and Turkish adolescents to a close friend's suicidal disclosure.

BACKGROUND: The prevalence of nonfatal suicidal behavior has been shown to be equal in Swedish and Turkish adolescents, but more Swedish than Turkish adolescents kill themselves. Social attitudes towards self-killing are liberal/permissive in Sweden compared to condemnatory/prohibiting attitudes in Turkey. Against this background, this study investigated Swedish and Turkish adolescents' reactions to a close friend's suicidal disclosure. It also compared students' beliefs about whether or not the suicidal friend needed treatment, and their perceptions of mental illness in, and prognosis for, the suicidal friend. METHOD: A questionnaire was used to assess adolescents' attitudes towards a hypothetical close friend who discloses his/her suicidal plan. RESULTS: Swedish students were more accepting of a suicidal friend, but were also more disapproving of a suicidal disclosure by a close friend, than their Turkish peers. Turkish students, on the other hand, were more emotionally involved with, and took more responsibility for, a suicidal close friend than their Swedish counterparts. CONCLUSIONS: Due to disapproving social attitudes towards suicidal disclosures in Sweden compared to Turkey, persons undergoing suicidal crises in Sweden may choose not to communicate their suicidal intent, and hence can not make use of social support systems to combat personal crises of a suicidal nature.

Adolescents' attitudes toward suicide, and a suicidal peer: a comparison between Swedish and Turkish high school students.

The present paper first presents the attitudes toward suicide and a suicidal classmate among 98 female and 69 male (N = 167) Swedish high school students. Secondly, the Swedish sample was compared with 167 (89 female and 78 male) Turkish high school students from a previous study. Among Swedish students, more males than females said that people have the right to commit suicide and suicide can be a solution to some problems. More females than males expressed a belief in life after death. Swedish adolescents were found to be holding more liberal attitudes toward suicide than Turkish adolescents. However, Turkish adolescents showed greater acceptance for a suicidal peer than Swedish adolescents. The results are discussed in terms of socio-cultural factors and related literature. The need for educational programs to provide basic knowledge about suicide and, effective ways of dealing with and helping suicidal peers is implicated.

Suicidal behavior as related to social support and assertiveness among Swedish and Turkish high school students: a cross-cultural investigation.

Among 652 Swedish and 654 Turkish adolescents, the study found that 61 Swedish (9.4%) and 71 Turkish (10.9%) adolescents reported that they had made previous suicide attempts. Previous psychiatric contact, female gender, low perceived family support, and suicide attempts in the family for the Swedish group and suicide attempts in the family, low perceived family support, psychiatric disorder in the family, and previous psychiatric contact variables in the Turkish sample were found to be associated with previous attempts. Low perceived family support, previous suicide attempts, low perceived peer support, female gender, previous psychiatric contact, low positive assertion skills, and a small number of friends for the Swedish; and low perceived family support, previous suicide attempts, low perceived peer support, suicide attempts in the family, and previous psychiatric contact variables for the Turkish group were found to be significant predictors of current suicidal risk.

Swedish translations of the Suicide Probability Scale, Perceived Social Support from Friends and Family Scales, and the Scale for Interpersonal Behavior: a reliability analysis.

The Suicide Probability Scale (SPS), the Perceived Social Support (PSS) from Friends (PSS-Fr) and Family (PSS-Fa) scales, and the Scale for Interpersonal Behavior (SIB) were translated into Swedish and their reliability was estimated in a university student sample. The reliability coefficients indicated that both subscales and the total scales of the SPS, PSS, and SIB possess highly adequate reliabilities. The intercorrelations among the subscales and between the subscales and the total scales were found to be highly significant. The results of the study supported the use of SPS, PSS-Fr and PSS-Fa, and the SIB as reliable methods for assessing suicide risk, perceived social support from friends and family, and assertive behavior.

Reliability of the Turkish version of the Perceived Social Support from Friends and Family scales, Scale for Interpersonal Behavior, and Suicide Probability Scale.

This study investigated the reliability of the Turkish version of the Perceived Social Support (PSS) from Friends (PSS-Fr) and Family (PSS-Fa) scales, the Scale for Interpersonal Behavior (SIB), and the Suicide Probability Scale (SPS). Both test-retest and internal consistency reliability estimates were computed. Highly adequate reliability coefficients are recorded for the subscales and the total scales of the PSS, SIB, and SPS. The results of the present study clearly support the use of Turkish versions of the PSS-Fr, PSS-Fa, SIB, and SPS as reliable methods for assessing perceived social support from friends and family, assertiveness, and suicide risk.

Opinions about and reactions to suicide, and the social acceptance of a suicidal classmate among Turkish high school students.

The present study investigated the opinions about suicide and reactions to a suicidal peer among 89 female and 78 male Turkish high school students. Females more than males believed that suicide should be discussed among friends. More males than females perceived suicidal persons to be mentally ill and to be punished in the other world. Females showed greater acceptance for a suicidal classmate than males. An attitude for openly discussing suicide was associated with higher acceptance of a suicidal classmate. Perceiving suicidal individuals to be mentally ill was associated with lower acceptance of a suicidal peer.

Rural population's opinions about the causes of mental illness, modern psychiatric help-sources and traditional healers in Turkey.

Ninety six males and ninety six females from a Turkish village have been questioned regarding their opinions about the causes of mental illness, psychiatric help-sources and traditional healers. Psychological, social and medical responses prevailed among the sample studied. Males gave more social whereas females tended to give more psychological responses. Psychiatrists were ranked as most helpful, mental hospitals as second most helpful and traditional healers were ranked as least helpful in treating mental illness.

Nailbiting and oral aggression in a Turkish student population.

The study investigated the relationship between the occurrence and intensity of nailbiting in a Turkish student population and the association with questionnaire measures of oral aggression, trait anxiety and intropunitive and extrapunitive hostility. The results indicated that the most consistent trait associated with nailbiting was oral aggression. Taken together with other previous research these findings are thought to offer some support to the construct of oral personality.