Comparison of cooled and conventional radiofrequency applications for the treatment of osteoarthritic knee pain.

BACKGROUND AND AIMS: Osteoarthritis is a progressive degenerative joint disease that affects the joint cartilage and surrounding tissues. It has been determined that osteoarthritis-induced knee pain is the most common cause of physical disability in the elderly. MATERIAL AND METHODS: In this study, the genicular nerve RF treatments of patients with osteoarthritic knee pain conducted at the Sakarya University Training and Research Hospital in the algology clinic of the Anaesthesiology and Reanimation Department between January 2016 and December 2016 were retrospectively examined. The preoperative and postoperative 2nd, 6th, and 12th week visual analog scale (VAS) and Turkish validated Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were recorded. In addition, any complications after the treatment and side effects (bleeding, neurological damage, infection, etc.) were recorded in the file. RESULTS: When the data of the patients were evaluated statistically, the preoperative VAS and WOMAC scores were found significantly decreased compared with the postoperative 2nd week, 6th week, and 12th week scores in patients who applied both conventional radiofrequency (RF) and cooled RF. However, there was no statistically significant difference between the two techniques. CONCLUSION: We found that both cooled and conventional RF techniques in genicular nerve ablation are similarly effective in reducing pain in patients with osteoarthritis-induced knee pain and improving patients' physical functions. The complication rates are very low and there was no superiority to each other.

The interrelation between body mass index and post-dural puncture headache in parturient women.

BACKGROUND AND AIMS: Post-dural puncture headache is seen more frequently in pregnant women due to stress, dehydration, intra-abdominal pressure, and insufficient fluid replacement after delivery. Obesity protects against post-dural puncture headache in pregnant women; increased intra-abdominal fat tissue reduced cerebrospinal fluid leakage by increasing the pressure in the epidural space. Therefore, this study investigated the influence of body mass index on post-dural puncture headache in elective cesarean section patients in whom 27G spinal needles were used. MATERIAL AND METHODS: The study included 464 women who underwent elective cesarean section under spinal anesthesia. Dural puncture performed with a 27G Quincke spinal needle at the L3-4 or L4-5 intervertebral space and given 12.5 mg hyperbaric bupivacaine intrathecally. The patients were questioned regarding headache and low back pain 6, 12, 24, and 48 h after the procedure, and by phone calls on days 3 and 7. RESULTS: Post-dural puncture headache developed in 38 (8.2%) patients. Of the patients who developed post-dural puncture headache, 23 (60.5%) had a body mass index <30 and 15 (39.5%) had a body mass index ≥30. Of the patients who did not develop post-dural puncture headache, 258 (60, 6%) had a body mass index <30 and 168 (39, 4%) had a body mass index ≥30. CONCLUSION: This prospective study found the body mass index values did not affect post-dural puncture headache in the elective cesarean section performed under spinal anesthesia.

The Effects of the Amount of Fluid Used in Epiduroscopic Laser Neural Discectomy Procedures on Intraocular Pressure and an Evaluation of the Ocular Findings.

INTRODUCTION: During epiduroscopic laser neural discectomy (ELNP) procedures, the amount of fluid used in the epidural area may cause increased intracranial pressure. This study aimed to investigate the effect of increased epidural pressure on intraocular pressure and other ocular findings due to the amount of fluid delivered to the epidural area and the rate of delivery of the fluid. MATERIAL AND METHODS: After obtaining approval from the Ethics Committee of Sakarya University Faculty of Medicine, patients who underwent ELNP in the Department of Anesthesiology and Reanimation Department, Algology Clinic, between January 2017 and May 2017 were included in this retrospective study. To evaluate the ocular findings after the operation, measurements obtained using an optical coherence tomography device were retrieved from the patient files and evaluated. RESULTS: Data from the medical files of 52 patients from the hospital system were evaluated. There was no significant difference between preoperative and postoperative retinal nerve fiber layer (RNFL) thickness, mean central macular thickness, optic disk area, and vertical cup-to-disk ratio (P > 0.05). CONCLUSIONS: Epiduroscopy procedures include intermittent or continuous infusion of saline into the epidural area. Currently, the volume of fluid that should be given to the epidural area in epiduroscopy procedures is very controversial. As a result of this study, we concluded that the amount of fluid used during ELNP, at 107.25 mL and 8.33 mL/min, had no effect on the intraocular pressure, optic disk diameter, macular thickness, or peripapillary RNFL thickness; thus, it was safe for ELNP.

A Novel Combination Technique: Three Points of Epiduroscopic Laser Neural Decompression and Percutaneous Laser Disc Decompression With the Ho:YAG Laser in an MSU Classification 3AB Herniated Disc.

AIM: The aim of this study was to examine the effects of simultaneous epiduroscopic laser neural disc decompression (ELND) and percutaneous laser disc decompression (PLDD) applications using a holmium:yttrium-aluminum-garnet (Ho:YAG) laser in Michigan State University (MSU) classification 3AB herniated discs on VAS and Oswestry Disability Index (ODI) scores. METHODS: In this prospective observational study, ELND and PLDD procedures performed between January 2016 and December 2017 were examined. Preoperative, postoperative week 2, postoperative month 2, and postoperative month 6 ODI and VAS scores were obtained from patient files, and postoperative month 12 ODI and VAS scores were obtained from face-to-face interviews with patients and recorded. RESULTS: The data of 41 patients treated with simultaneous ELND and PLDD using a Ho:YAG laser were included in this study. Postoperative VAS scores of the patients were compared with preoperative values, and it was found that postoperative week 2, postoperative month 2, postoperative month 6, and postoperative month 12 VAS and ODI scores were significantly different compared to preoperative scores (P = 0.001; P < 0.01). 17.1% (n = 7) of the patients had a history of postoperative open surgery. Although dural puncture occurred in 7 patients (17%), only 1 patient had headache. CONCLUSION: We believe that the new combined technique of ELND and PLDD using a Ho:YAG laser is a reliable method in patients with MSU classification 3AB herniated discs, with an acceptable success rate and a low complication rate within 12 months after treatment. We think that randomized controlled studies are required for this method to be included in treatment algorithms.

Cervical vertebroplasty under sedoanalgesia using combined ultrasonography and fluoroscopy guidance: a novel technique.

PURPOSE: The aim of this report was to describe a case using combined USG and fluoroscopy for cervical VP via a percutaneous route under sedoanalgesia. METHODS: A 70-year-old male patient had severe neck pain for 6 weeks because of metastatic mass lesions in C6. After the decision to VP, the patient was placed on the operating table and 2 mg midazolam and 75 µg fentanyl were administered for conscious sedation. Localisation of the carotid artery, internal jugular vein, and trachea had been determined with USG. 3 mL of 2% lidocaine was infiltrated after proceeding a needle from the axis of the trochar to the C6 vertebra corpus. The trochar entered into the vertebra corpus between the carotid artery and trachea right-antero-laterally under C-arm and USG guidance. 6 mL of PMMA was injected into this field. Then C6 VP procedure had been completed without complications. RESULTS: This case has three differences from studies in the literature. First, cervical VP was conducted under sedoanalgesia. The second important feature of this case is that cervical VP was performed via a percutaneous route. A third important feature of this case is that it was performed under USG guidance for the first time in the literature. CONCLUSION: We consider that the combined use of C-arm fluoroscopy and USG should improve success rates and prevent vascular and neural injuries and dura perforation.

Effect of controlled hypotension on regional cerebral oxygen saturation during rhinoplasty: a prospective study.

The aim of this study was to investigate the effect of controlled hypotension on cerebral oxygen saturation (rSO2) using near infrared spectroscopy (NIRS) and evaluation of postoperative cognitive function in patients undergoing rhinoplasty. Fifty adult patients who were scheduled for elective rhinoplasty surgery and required controlled hypotension were enrolled in this prospective study. Controlled hypotension was provided using a combination of propofol and remifentanil infusion supplemented with nitroglycerin infusion as necessary. rSO2 was evaluated during controlled hypotension by NIRS. Cerebral desaturation was observed in 5 out of 50 patients (10 %) during hypotensive anesthesia. The greatest decrease from baseline was 28 % when MAP was 57 mmHg. In both non-desaturated and desaturated patients, postoperative MMSE scores were significantly lower than preoperative scores. There was a 4 % decrease in the non-desaturated patients and a 7 % decrease in the desaturated patients when preoperative and postoperative MMSE scores were compared. A decline in cognitive function 1 day after surgery was observed in 23 patients (46 %) and in all patients with intraoperative cerebral desaturation. The current study showed that even if SpO2 is in the normal range, there might be a decrease of more than 20 % in cerebral oxygen saturation during controlled hypotension.

The role of fiberoptic bronchoscopy monitoring during percutaneous dilatational tracheostomy and its routine use into tracheotomy practice.

OBJECTIVE: To evaluate percutaneous dilatational tracheostomy with and without the use of the bronchoscope and compare the safety and complications of the procedure. METHODS: The prospective, randomised-controlled study was conducted at the Professor A. Ilhan Ozdemir State Hospital, Giresun, Turkey, between October 2013 and February 2014, and comprised patients ≥18 years of age who were dependent on mechanical ventilation for an extended duration and were scheduled to undergo percutaneous dilatational tracheostomy with Griggs technique. The patients were randomly divided into two groups; group A received standard c that was opened without using fiberoptic bronchoscopy, while group B received percutaneous dilatational tracheostomy that was opened using fiberoptic bronchoscopy. Complications and number of applied needle approaches were recorded. RESULTS: Of the 60 patients, 35(58.3%) were women. The patients were divided into two groups of 30(50%) each. None of the patients developed pneumothorax, subcutaneous emphysema, or oesophageal perforation. The numbers of needle interventions and total complications were significantly higher in group A than group B (p<0.05). Procedure duration was significantly longer in group B (p<0.05). CONCLUSIONS: Percutaneous dilatational tracheostomy was reliable when applied with fiberoptic bronchoscopy due to the significantly lower complication rates.

Combined Use of High Radiofrequency Disk Ablation, Annulus Modulation, and Manual Nucleotomy in a Patient with Extruded Disk Herniation.

UNLABELLED: Different minimally invasive procedures are used to treat lumbar disk herniation. It is important to differentiate these techniques due to their specific effects and the disparate technical issues associated with each. This report describes a successful case involving the use of mechanical decompression in conjunction with radiofrequency ablation to treat a patient with pain and neurological deficits due to an extruded disk hernia. CASE REPORT: A 43-year-old male had magnetic resonance imaging (MRI) demonstrating an extruded disk herniation in the left foraminal region, compression at the left spinal nerve root, and obliteration of the left foraminal entrance of the L5-S1 distribution. In the operating room, sufficient disk material was removed using grasping forceps, and then, the Disc-FX system with a Trigger-Flex probe (Elliquence, Baldwin, NY, U.S.A.) was inserted. Modulation of the annulus was performed in bipolar hemo mode, and nucleus ablation was conducted in bipolar turbo mode within a 1.7-MHz frequency range. Among the available minimally invasive techniques, newly developed technologies may become important treatment options if they enable faster rehabilitation, lower rates of recurrence, shorter hospital stays, and reduced medical costs.

Knowledge and experience of dentists with patients with trigeminal neuralgia: A prospective, cross-sectional survey study.

OBJECTIVE: Trigeminal neuralgia (TN) and orofacial pain (OFP) patients frequently refer to dentists. It is often confused with odontogenic pain and dental procedures are performed. In this study, the authors aimed to reveal the knowledge and experience of dentists about TN. METHODS: This is a cross-sectional study that includes dentists who participate in volunteering via an online questionnaire. The questionnaire form contains demographic data, TN treatment, and diagnosis consisting of 18 questions. RESULTS: The data of 229 dentists were examined. Almost 82% of the participants reportedly knew the diagnostic criteria of TN and 61.6% reported that they had previously referred patients with TN. The most frequently confused diagnosis was odontogenic pains (45.9%). CONCLUSION: TN diagnostic criteria should be included more often in the education of dentists. Thus, it is possible to prevent unnecessary dental procedures. There is a need to increase knowledge on this subject with further studies involving dental students.

Comparison of efficacy of intra-articular morphine and steroid in patients with knee osteoarthritis.

INTRODUCTION: Primary therapeutic aim in treatment of osteoarthritis of the knee is to relieve the pain of osteoarthritis. The aim of this study was to compare the efficacy of intra-articular triamcinolone with intra-articular morphine in pain relief due to osteoarthritis of the knee in the elderly population. MATERIALS AND METHODS: Patients between 50 and 80 years of age were randomized into three groups. Group M received morphine plus bupivacaine intra-articularly, Group T received triamcinolone plus bupivacaine intra-articularly, and Group C received saline plus bupivacaine intra-articularly. Patients were evaluated before injection and in 2nd, 4th, 6th, and 12th weeks after injection. First-line supplementary analgesic was oral paracetamol 1500 mg/day. If analgesia was insufficient with paracetamol, oral dexketoprofen trometamol 50 mg/day was recommended to patients. RESULTS: After the intra-articular injection, there was statistically significant decrease in visual analog scale (VAS) scores in Groups M and T, when compared to Group C. The decrease of VAS scores seen at the first 2 weeks continued steadily up to the end of 12th week. There was a significant decrease in Groups M and T in the WOMAC scores, when compared to Group C. There was no significant difference in the WOMAC scores between morphine and steroid groups. Significantly less supplementary analgesics was used in the morphine and steroid groups. CONCLUSION: Intra-articular morphine was as effective as intra-articular triamcinolone for analgesia in patients with osteoarthritis knee. Intra-articular morphine is possibly a better option than intra-articular steroid as it has lesser side effects.

Regional anaesthesia in paediatric surgery: results of 2200 children.

OBJECTIVES: To evaluate paediatric regional anaesthesia applications in 2200 children at Diyarbakir Children's Hosptial, Turkey. METHODS: This is a cross-sectional study done from January 2005 and October 2009. Paediatric regional anaesthesia applications in 2200 children were retrospectively analysed and included in this study. Demographic data, operation type, choice of regional anaesthesia, local anaesthetics, adjuvant drugs, side effects and complications were recorded. RESULTS: Mean age was 6 +/- 4 years and mean weight 21.1 +/- 10.7 kg. There were 317 (14.4%) girls, and 1883 (85.6%) boys. Of the 2200 cases studied, 2088 (94%) received caudal epidural block, 59 (3%) received spinal block, 34 (%2) had lumbar epidural block and 19 (1%) received dorsal penile nerve block CONCLUSION: In paediatric anaesthetic practice, caudal epidural block is used widely. However, paediatric regional anaesthesia should be supported and developed further by obtaining essential materials and devices. Variety of both neuraxial blocks and peripheral nerve blocks under sedation/general anaesthesia should also be increased.

Total Knee Arthroplasty Postsurgical Chronic Pain, Neuropathic Pain, and the Prevalence of Neuropathic Symptoms: A Prospective Observational Study in Turkey.

PURPOSE: Chronic post-surgical pain (CPSP) is a detrimental condition that persists at least two months after surgical procedures and seriously affects patients' quality of life. Although its incidence varies according to operation types and definitions, its prevalence is between 3% and 85%. The purpose of this study is to evaluate the prevalence of CPSP and neuropathic pain in patients undergoing TKA for osteoarthritis. PATIENTS AND METHODS: In this study, patients who had undergone total knee arthroplasty (TKA) were examined prospectively and observationally. 42 patients were included in the study. Numeric rate scale (NRS) for developing chronic pain, Douleur Neuropathique 4 (DN-4) questionnaire to evaluate neuropathic pain and symptoms, and von Frey filaments to evaluate mechanical hyperesthesia and alladony. RESULTS: NRS scores were 1 or higher for all patients. Twenty-seven patients constituted the mild pain group (NRS: 1-4), and 15 patients constituted the moderate pain group (NRS: 4-7). The number of patients defined as having "neuropathic pain," according to DN-4 scores, was 17 (40.4%; DN-4 ≥ 4). The moderate pain group reported greater severity of neuropathic symptoms on average than the mild pain group (p = 0.039). When patients knees affected by TKA were divided into suprapatellar, patellar, and infrapatellar regions and evaluated with von Frey filaments, a significant difference was found between the three regions (p < 0.05). CONCLUSION: In this study, we showed-unlike other studies-that the rate of neuropathic pain was higher among CPSP patients, and all patients had neuropathic symptoms. In evaluating patients knees with von Frey filaments, we showed that the neuropathic component of patients' pain occurred mostly in the knee's infrapatellar region. Although the incidence of CPSP and neuropathic pain in these patients was higher than expected, we think CPSP, its diagnosis, and its treatment present an important issue that requires further examination.

Evaluation of Increased Intracranial Pressure with the Optic Nerve Sheath Diameter by Ultrasound in Epiduroscopic Neural Laser Discectomy Procedures.

BACKGROUND: In order to clarify the camera image and open the adhesions mechanically during epiduroscopy, saline is injected continuously in the epidural area. As a result, an increase in intracranial pressure is to be expected in theory. Increased intracranial pressure can be evaluated by measuring by optic nerve sheath diameter. OBJECTIVES: This study was designed to evaluate the relationship between optic nerve sheath diameter measurements and intracranial pressure, after injecting fluid to the epidural area during epiduroscopy procedures performed in our clinic. STUDY DESIGN: Retrospective study. SETTING: Sakarya University Training and Research Hospital. METHODS: During the epiduroscopy procedure, pre and postoperative bilateral optic nerve sheath diameters were measured with an ultrasonography probe. With the patients' eyelids closed, the probe was placed on the orbita in the sagittal plane, measuring 3 mm posterior of the papilla. RESULTS: While there was a statistically significant difference between pre- and post-operative optic nerve sheath diameter measurements, there was no significant correlation with processing time, amount of fluid delivered, or fluid delivery rates. LIMITATIONS: One of the limitations of this study is the retrospective collection of data. A second limitation is that repetitive measurements were not performed, instead of a single postoperative measurement. CONCLUSION: We think more prospective randomized controlled studies are required to examine the increase in the diameter of the optic nerve sheath, which is an indirect indicator of increased intracranial pressure after epiduroscopy applications, in order to determine whether the pressure increase is associated with the rate of fluid delivery, the total fluid amount, or the processing time.

Epidural blockade for alternative management of priapism: A case report of child with T-cell acute lymphoblastic leukemia.

Priapism is a clinical condition that rarely presents with leukemia in childhood. Management of priapism treatment can become more complex and difficult when accompanied by acute leukemia. We presented a 16 years old child with t-cell acute lymphoblastic leukemia (ALL) who developed priapism. Due to the failure of conservative methods and intracavernosal drainage, we performed epidural blockade which has limited data reported with successful results in the literature before shunt surgery.

Evaluation of the Efficacy of Epiduroscopic Laser Neural Discectomy in Lumbar Disc Herniations: Retrospective Analysis of 163 Cases- Evaluation of the Efficacy of ELNP.

Background: Epiduroscopy, or spinal endoscopy, is the visualisation of the epidural space using a percutaneous and minimally invasive imaging fiberoptic device. Recently, as a result of some studies, it has been reported that laser therapy with epiduroscopic laser neural discectomy (ELND) was applied during multiple lesions. Methods: In this study, ELND performed between January 2012 and July 2016 at the Algology Clinic of the Department of Anesthesiology and Reanimation, Sakarya University Training and Research Hospital, was examined retrospectively. The Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) scores were recorded preoperatively, as well as after 2 weeks and 2, 6, and 12 months after the ELND. Results: According to the preoperative VAS and ODI scores, the decrease in postoperative 2nd week, 2nd, 6th, and 12th month VAS and ODI scores was significant (p=0.001). Similarly, according to the postoperative 2nd week VAS and ODI scores, decrease in postoperative 6th and 12th VAS and ODI scores was significant (p=0.001). Conclusions: As a result, ELND with Holmium: YAG laser, which is a new technique in patients with lumbar disc herniated low back and/or leg pain, can reduce VAS and ODI scores from 2 weeks without any complications that open surgery can bring with it. We believe that it is a useful and advanced technique in treatment of lumbar disc herniation and has low complication rates that provides maximum efficacy from the first year.

Cardiopulmonary Arrest and Pneumoencephaly Developing after Epidural Oxygen-ozone Mixture Therapy.

Pain treatment can comprise a combination of pharmacological, interventional, surgical, physical, psycological methods. Interventional procedures, particularly minimally invasive percutaneous therapies, have been widely used in recent years. Corticosteroid, hyperbaric saline or oxygen-ozone therapy is a safe procedure for patients in whom pain cannot be relieved by epidural adhesiolysis or other treatments. Complication related to oxygen-ozone therapy have been reported rarely in lumbar sciatalgia. Herein, we present a patient who developed cardiopulmonary arrest and pneumoencephaly as a rare but life-threatening complication of oxygen-ozone therapy, for epidural lysis, applied to the epidural space due to low back pain.