A comparison of dexmedetomidine versus midazolam for sedation, pain and hemodynamic control, during colonoscopy under conscious sedation.

OBJECTIVE: The intent of our study was to compare the effects of dexmedetomidine versus midazolam on perioperative hemodynamics, sedation, pain, satisfaction and recovery scores during colonoscopy. MATERIAL AND METHODS: A total of 60 ASA I-II patients, between 20 and 80 years of age were included in the study. Patients were randomly assigned to two groups. Midazolam 0.05 mg kg(-1) and fentanyl citrate 1 microg kg(-1) were administered intravenously to cases in Group I (n = 30). An initial loading dose of 1 microg kg(-1) dexmedetomidine was administered intravenously in 10 min to cases in Group II (n = 30) before the procedure and as a continuous infusion dose of 0.5 microg kg(-1) h(-1) just before the procedure started. Also 1 microg kg(-1) fentanyl citrate was administered intravenously immediately before the procedure. Peripheral oxygen saturation (S(pO2)), mean arterial pressure (MAP), heart rate (HR), Ramsay Sedation Scale (RSS), Numeric Rating Scale (NRS) scores and colonoscopist satisfaction scores of the cases were recorded. RESULTS: Although statistically significant values were not detected between the two groups with regard to mean arterial pressure, in Group I heart rates were higher and S(pO2) scores were lower in a statistically significant manner. When the groups were compared with regard to RSS, the RSS scores of Group I at the 10th and 15th minutes were significantly lower than Group II. There was no statistically significant difference between the two groups when compared with regard to NRS scores. Satisfaction scores were significantly lower in Group II. CONCLUSION: Dexmedetomidine provides more efficient hemodynamic stability, higher Ramsay sedation scale scores, higher satisfaction scores and lower NRS scores in colonoscopies. According to our results we believe that dexmedetomidine can be used safely as a sedoanalgesic agent in colonoscopies.

[Pain treatment practice according to the WHO analgesic ladder in cancer patients: eight years experience of a single center]. / Kanser hastalarinda WHO analjezik basamak tedavisine göre agri tedavisi. Bir merkezin sekiz yillik deneyimi.

In this study we evaluated the results of pain treatment practices according to the World Health Organization analgesic ladder treatment. and other treatment modalities in cancer patients who were admitted to an anesthesiology-based pain service. Patient characteristics, distribution of the patients according to the primary pathologic sites, initial and last distribution of the patients according to analgesic ladder treatment, other invasive or non-invasive treatment modalities, side effects, and other data related with the patients were examined. 416 of 475 (87.5%) patients were treated using the WHO analgesic ladder treatment, 57 patients (12 %) were treated by invasive techniques. The number of successfully treated patients in step I, II and III were 49 (11.77%), 307 (73.79%) and 60 (14.42) respectively. 181 of 416 (43.50%) patients used anticonvulsants or neuroleptics, 341 of 416 (81.97%) patients used antidepressants. In 31 of 416 patients (7.5%), non-invasive or invasive treatment modalities had become necessary to augment the WHO analgesic ladder treatment. Over the entire treatment period, side effects were reported in 17.05% of the patients. The follow-up time for the patients was 42 +/- 109.7 days, the mean interview number was 5.6+/-7.6, the longest follow-up time was 1380 days, and the maximum number of the interviews made by the same patient was 68. In conclusion, we think that, using the World Health Organization analgesic ladder treatment and administering appropriate analgesics and adjuvants in appropriate oral doses determined for appropriate subjects could successfully treat a great number of these patients.

Evaluation of patients' response to pulsed radiofrequency treatment applied to the suprascapular nerve in patients with chronic shoulder pain.

BACKGROUND AND OBJECTIVE: The aim of this study was to evaluate patient satisfaction, efficacy and safety of the pulsed radiofrequency (PRF) technique applied to the suprascapular nerve for the treatment of refractory shoulder pain. METHODS: After obtaining Institutional Research Board approval and patients' written informed consent, patients with chronic shoulder pain resistant to medical treatment were included in prospective study and PRF technique was applied to the suprascapular nerve for 480 seconds. Verbal Numerical Rating Scale (VNRS) at 0, 3, and 6 months post procedure and Modified MacNab score before and 6 months after procedure are performed. Fifty percent or more decrease in VNRS and Modified MacNab score as Excellent and Good are accepted as a significant pain relief, 20 to 49% decrease is accepted as partial. Any complication related to procedure was also recorded. RESULTS: Fifty-seven patients were included in the study. PRF treatment significantly relieved at the pain in 73.7% patients [42 patients out of 57]. Ten patients [17.5%] showed partial improvement and there were no changes at the pain scores in 5 patients [8.7%]. Forty-five patients [78.9%] showed improvement in VNRS scores as well as in Modified MacNab scores at 6 months after treatment. No side effects were reported. Pain scores were given as mean ± SD. Also, The Kaplan-Meier analysis was done for patients' shoulder pain after treatment with pulsed radiofrequency. CONCLUSION: Pulsed radiofrequency technique application to the suprascapular nerve for 480 seconds shows remarkable improvement at patients' chronic shoulder pain.

Efficacy of pulsed radiofrequency treatment on the saphenous nerve in patients with chronic knee pain.

BACKGROUND AND OBJECTIVE: We studied the long-term efficacy of pulsed radiofrequency treatment (PRF) on the saphenous nerve in 115 patients with chronic knee pain. MATERIALS AND METHODS: 115 patients with chronic knee pain were investigated in a period of 22~months retrospectively. All patients had pulsed radiofrequency to the saphenous nerve. The mean age was 59 (range, 51-67). All patients were accessed with the visual analog scale (VAS) and WOMAC score pain at rest, pain on movement, and pain in flexion at 10th day, 3rd and 6th~months post procedure. RESULTS: All patients showed improvement in their VAS scores as well as in their WOMAC scores after ten day, three month, and 6 months (p=0.001). No side effects were reported. CONCLUSION: PRF application to the saphenous nerve for eight minutes showed remarkable amount of patient satisfaction. Application of PRF for the second time could be recommended if it shows some benefit after the sixth month. But none of our patients needed a second application of PRF after six months period.

[Pasha-Cath in the treatment of post-thoracotomy pain syndrome]. / Posttorakotomi agri sendromu tedavisinde Pasha-Cath uygulamasi.

Post-thoracotomy pain syndrome is a chronic pain syndrome and is seen in approximately 5-65% of patients after thoracotomy. Post-thoracotomy pain syndrome is generally considered to be neuropathic pain due to intercostal nerve injury. A 21- year-old male patient experienced pain radiating along the incision after the thoracotomy operation. Allodynia and hyperalgesia were determined in the upper part of the incision; visual analogue scale (VAS) score was 10. Gabapentin and amitriptyline were started as medical treatment. Three months later, the patient complained of concentration difficulty at work and in daily life. Medical therapy was planned again. In view of the persisting complaints, epidural pulse radio frequency with Pasha-Cath was scheduled. After 3 weeks and also at 3 months, the VAS was 2. After 6 months, VAS remained at 2. As a result, we concluded that epidural pulse radio frequency with Pasha-Cath is an alternative and effective choice of treatment in post-thoracotomy pain syndrome when the medical treatment alone is not sufficient.

A rare cause of a piriformis syndrome.

BACKGROUND AND OBJECTIVE: A less common but important cause of buttock and leg pain known as "Piriformis Syndrome". Piriformis syndrome is all intrinsic pathology of the piriformis itself, such as myofascial pain, anatomical variations, hypertrophy, and myositis ossificans or it is caused by trauma to the pelvis or buttock. In this case report we are going to present a rare cause of piriformis syndrome. CASE REPORT: Our first case was a 32 year old woman. She was referred to our pain clinic for leg pain that radiates from buttock to backside of the knee for 5 years. She did not have any problems in her history or laboratory findings. But in her lower extremity ortho roentgenogram, her leg was 2 cm short at the effected side. Second case was a 23 year old woman who had pain radiating from gluteal region to backside of the knee. In her history she had a car accident two years ago. In this accident, she had a fracture of collum femoris, and her leg was 1 cm short at the effected side. CONCLUSION: We conclude that "short leg" is one of the rare causes of piriformis syndrome and can be seen alone or with the other causes. The injection on piriformis muscle could be more effective for the patients who have PS after the "short leg" treated.

Ecthyma-gangrenosum-like lesions associated with methicillin-resistant Staphylococcus aureus infection.

Ecthyma gangrenosum (EG) manifests as a skin lesion and is commonly associated with Pseudomonas aeruginosa septicemia in immunocompromised patients. Other viral, fungal and bacterial agents can also cause EG. The first clinical observation is grouped vesicles with surrounding erythema. Within a few days, they evolve into a gangrenous ulcer with a black/gray eschar surrounded by an erythematous halo. Herein, we present a patient with chronic obstructive pulmonary disease who developed EG-like lesions due to methicillin-resistant Staphylococcus aureus infection while he was in the intensive care unit.

A complication during caudal steroid injection.

BACKGROUND AND OBJECTIVE: Epidural injections in the lumbar spine are provided by caudal, lumbar interlaminar or transforaminal routes. Caudal epidural steroid injections are often used for low back pain. Fluoroscopic guidance has been frequently cited as a requirement for this procedure. In this case report, we demonstrate the importance of fluoroscopic guidance during caudal epidural injection. CASE REPORT: A 60 years old male patient was admitted to our Algology Department for low back pain. After physical examination caudal epidural steroid injection was planned. The caudal space was identified under fluoroscopic control initially using an anteroposterior projection. After the resultant epidurogram demonstrated vascular spread along the caudal epidural space the needle was withdrawn and the procedure was completed after reinserting the needle. CONCLUSION: A careful real time fluoroscopic monitoring should be applied with the injection of opaque material to minimize the risk of vascular injection.

The comparison of the effects of different doses of levobupivacaine infiltration on wound healing.

UNLABELLED: INTRODUCTION-AIM: The easiest method in postoperative analgesia is the infiltration of the wound with local anesthetic drugs. Although many local anesthetic drugs have been used for this type of infiltration, studies on levobupivacaine are rare. The aim of this study was to investigate the effects of different concentrations of levobupivacaine infiltration on wound healing. METHOD: Forty female Wistar-Albino rats (280-300 g) were included in the study, which were randomly separated into four groups. Rats were infiltrated with 1.25 mg/mL levobupivacaine in group L(1.25) (n = 10), with 2.50 mg/mL levobupivacaine in group L(2.5) (n = 10), with 3.75 mg/mL levobupivacaine in group L(3.75) (n = 10), and with normal saline in control group (n = 10). Breaking-strength measurements, levels of hydroxyproline, and fibrotic index were evaluated in the tissue samples taken from the rats. RESULTS: When the breaking-strength measurements were evaluated, we have found a significant difference between the control and the study groups (p < 0.05). In the intergroup comparison the difference between groups L(1.25) and L(3.75) was statistically significant (p < 0.05). In all of the levobupivacaine groups the levels of hydroxyproline were higher compared to the control group. Also significant differences were observed between groups L(1.25) and L(2.5) and groups L(1.25) and L(3.75) (p < 0.05). The levels of tissue fibrotic index were higher in all of the levobupivacaine groups compared to the control group (p < 0.05) and also a difference was observed between groups L(1.25) and L(3.75) in terms of tissue fibrotic index (p < 0.05). CONCLUSION: We have concluded that levobupivacaine used in clinical doses have a significant effect on the fastening of wound healing and this effect increases with an increase in the concentration of the levobupivacaine. We believe that levobupivacaine will be more widely preferred in the near future in the postoperative analgesia.