Evaluation of the efficacy of pulsed radiofrequency therapy in patients with lumbosacral radicular pain: An analysis of single-center data.

OBJECTIVES: Lumbosacral radicular pain (LRP) is one of the most common causes of neuropathic pain. This pain often arises from inflammation in the dorsal root ganglia (DRG) or spinal nerves. Despite various treatment modalities, success rates are not very high in chronic LRP cases. Pulsed radiofrequency (PRF) therapy, frequently applied to the DRG, is widely used, but its effectiveness is often questioned in various studies. The primary aim of our study is to evaluate the effectiveness of PRF treatment in 154 patients. METHODS: Patients with LRP for longer than 3 months, treated with PRF, were included in this study. To assess the efficacy of PRF treatment, numerical rating scale (NRS) scores were evaluated at the 4th-week and 6th-month follow-ups. RESULTS: The NRS scores were significantly lower at the 4th-week and 6th-month follow-ups compared to pre-treatment levels (p<0.001). However, there was no significant difference between the mean NRS scores at the 4th week and 6th month. CONCLUSION: Success in interventional pain procedures is often considered as at least a 50% reduction in pain scores. The success rate for PRF treatment for LRP in the literature varies between 30% and 60%, which is similar to our findings at the 4th week and 6th month. PRF treatment is widely used due to its low side-effect profile and cost-effectiveness in the long term. There is no fully standardized practice regarding procedural aspects, such as the duration of the application, and prospective studies with larger participation are needed.

Effect of neuropathic pain on sphenopalatine ganglion block responses in persistent idiopathic facial pain.

OBJECTIVES: Management of persistent idiopathic facial pain (PIFP) can be challenging. Sphenopalatine ganglion (SPG) has been the target for the interventional treatment of many facial pain syndromes. However, possible factors that may affect SPG block success are unknown. It was aimed to investigate the effect of neuropathic pain on SPG block outcomes in PIFP, which includes a heterogeneous patient group. METHODS: All of the patients underwent fluoroscopy-guided SPG block with an injection of 40 mg of 2% lidocaine and 8 mg of dexamethasone. The patients were assigned to 2 groups according to existence of neuropathic pain determined with the DN4 questionnaire score: 19 patients with neuropathic pain (Group 1) and 15 patients without neuropathic pain (Group 2). Preprocedural and postprocedural Visual Analog Scale (VAS) scores were compared between the 2 groups. RESULTS: The mean age of the patients was 47.65 ± 6.50 years. The average pain duration was 52.95 ± 34.81 weeks. A significantly greater decrease was detected in the VAS scores at 1 week (p = 0.036) and 1 month (p < 0.001) in Group 1 when compared to Group 2. Moreover, the proportion of patients with >50% improvement in the VAS scores at 1 week (p = 0.012) and 1 month (P = 0.017) was significantly lower in Group 1 than in Group 2. DISCUSSION: SPG block appears as a safe, effective, and rapid method to treat PIFP, especially in cases with neuropathic pain. Neuropathic pain may be a predictor for pain relief in interventional procedures targeting SPG in the treatment of PIFP.

Effectiveness of Intraoperative Laser Acupuncture Combined with Antiemetic Drugs for Prevention of Postoperative Nausea and Vomiting.

Introduction: Postoperative nausea and vomiting (PONV) are frequent in patients undergoing laparoscopic cholecystectomy. The aim of this study is to evaluate the effectiveness of intraoperative laser acupuncture stimulation of Pericardium 6 (PC6) and Large Intestine 4 (LI4) acupoints combined with antiemetic drug prophylaxis on PONV. Methods: A total of 88 patients, scheduled for laparoscopic cholecystectomy, were assigned into 2 groups. Group I received bilateral laser acupuncture on PC6 and LI4 acupoints after induction of anesthesia and also received antiemetic drug (metoclopramide) prophylaxis. Patients in Group II received only antiemetic drug prophylaxis. Nausea and vomiting frequencies and need for rescue antiemetic drug (ondansetron) were recorded after extubation, at 30th minute at recovery room and at 6th hour at ward. Results: The incidence of nausea and rescue antiemetic drug need was higher at postoperative 6th hour in Group II. Vomiting was not different in groups at any time. Conclusion: Intraoperative laser acupuncture stimulation of PC6 and LI4 acupoints combined with antiemetic drug prophylaxis decreases nausea and rescue antiemetic drug need in late postoperative period in patients undergoing laparoscopic cholecystectomy.

Red Cell Distribution Width in Diagnosis of Brain Death.

INTRODUCTION: Red blood cell distribution (RDW) is a hematologic index automatically calculated by blood cell counters. Research about RDW in traumatic brain injury showed positive correlation between high RDW values and mortality, which inspired us to investigate whether RDW could be used as a supportive diagnostic biomarker for diagnosis of brain death. Our hypothesis is that RDW may be useful as a biomarker that supports the diagnosis of brain death. METHODS: After approval of the ethics committee, 209 patients who had been diagnosed with brain death between January 2012 and July 2018 were retrospectively reviewed. The RDW values of patients on the days of admission, brain death, and cardiac arrest were recorded. Data were collected from hospital database and patient charts. RESULTS: Statistical analysis revealed that the RDW values on the days of brain death and cardiac arrest were significantly higher than on the day of admission. In addition, the RDW values for the cardiac arrest day were significantly higher than on the day of brain death (P < .001). CONCLUSIONS: We can say that the increase in RDW, which is reported to be an indicator of mortality for many diseases, can be a supporting biomarker for brain death diagnosis when evaluated concomitantly with clinical diagnostic criteria.

[An assessment of physicians attitudes toward opioid usage and opiophobia: Results of a survey from a training and research hospital]. / Doktorlarin opioid kullanimi ve opiofobiye yaklasimlarinin degerlendirilmesi: Bir egitim ve arastirma hastanesinden anket sonuçlari.

OBJECTIVES: When researches examined, cancer pain and other cronic pain, serious mismanagement and undermedication in treating chronic pain especially using opioids continuing problem. This study was designed to examine the barriers to adequate opioid usage, especially as they could be associated with experience and medical discipline. METHODS: The survey conducted among phycians working in Ankara Numune education and research hospital on July of 2015. A 29 item survey was used to measure physicians attitudes and knowledge about using opioids. RESULTS: We have included 156 doctors in our study.We found that %82.7 of doctors have not been educated in the pain subject.%48.8 of doctors see themselves capable of prescribing opioid medication and %67.9 of doctors are feeling uneasy when prescribing opioids also a lot of doctors are not willing to give prescriptions of opioids.When analyzing our data we have found that opioids related prejudices are not related with title or experience.It is interesting that the doctors who were anxious when prescribing opioids to their patients they want for themselves when in need opioid precriptions and again when in need they want increasing doses of opioid. CONCLUSION: Resembling the studies in the literature in our study, we've found that doctors have poor knowledge about opioids and opiophobia it's frequent among the doctors.Poor knowledge of opioids and overcoming the opiophobia and medicating with opioids when medical status of patients emposes made us think that in service training should be started immeadiately.

Can ephedrine pretreatment be effective in alleviating rocuronium injection pain?

OBJECTIVE: The aim of this randomized, double-blind, placebo-controlled study was to evaluate the effect of ephedrine pretreatment on the intensity of rocuronium injection pain when rocuronium was applied by timing principle and also to compare this effect with lidocaine and placebo. SUBJECTS AND METHODS: 120 American Society of Anesthesiology risk score I-II patients scheduled for elective surgery under general anesthesia were randomized into three groups to receive either 70 µg/kg ephedrine (ephedrine group, n = 40) or 0.5 mg/kg lidocaine (lidocaine group, n = 40) or 5 ml NaCl 0.9% (placebo group, n = 40) as pretreatment. Thirty seconds after pretreatment drugs, rocuronium 0.6 mg/kg was administered by the timing principle and rocuronium injection pain scores were recorded. Twenty seconds after rocuronium administration, anesthesia was induced with thiopental and the patient's trachea was intubated. Hemodynamic parameters and adverse effects were recorded. RESULTS: The overall frequency of having pain was 82.5, 52.5 and 22.5% in placebo, ephedrine and lidocaine groups, respectively. Although the frequency of mild and moderate pain scores was higher in the ephedrine group than in the lidocaine group, this difference was not statistically significant (p = 0.032 and p = 0.001, respectively). CONCLUSION: Although not as effective as lidocaine 0.5 mg/kg, 70 µg/kg ephedrine pretreatment was able to alleviate rocuronium injection pain when rocuronium was applied by timing principle.

Low dose levobupivacaine 0.5% with fentanyl in spinal anaesthesia for transurethral resection of prostate surgery.

BACKGROUND: Levobupivacaine 0.5% and bupivacaine 0.5% were shown to be equally effective in spinal anaesthesia. In previous studies, low dose bupivacaine with an intrathecal opioid was used successfully in urological surgery. The aim of this study was to evaluate the clinical effectiveness and block quality of low dose levobupivacaine, and compare it with low dose bupivacaine when they are combined with fentanyl in transurethral resection of prostate surgery. METHODS: Forty nine patients undergoing transurethral prostate surgery were enrolled in this prospective, randomized and double blind study. Patients in levobupivacaine group received 5 mg levobupivacaine + 25 µg fentanyl and bupivacaine group received 5 mg bupivacaine + 25 µg fentanyl. Demographic data, surgery times, hemodynamic parameters, block qualities and patient and surgeon satisfactions were recorded. RESULTS: Demographic data, surgery times and patient and surgeon satisfactions were similar in both groups. Hemodynamic parameters were comparable and stable during the procedure in both groups. Sensory block characteristics were comparable and clinically effective in both groups. While 3 patients in bupivacaine group had Bromage score of 3 at the beginning of the surgery, no patient in levobupivacaine group had this score and this difference was significant (p = 0.042). Bromage scores at the end of the surgery were comparable in both groups. CONCLUSIONS: In conclusion, for transurethral prostate surgery 5 mg levobupivacaine with 25 µg fentanyl can provide stable hemodynamic profile, patient and surgeon satisfaction and effective sensorial blockade with less motor blockade in spinal anaesthesia; so it could be used at low doses as a good alternative to bupivacaine.

Thoracic paravertebral block performance for modified radical mastectomy with axillary dissection in a patient with severe chronic obstructive pulmonary disease.

We present the case of an 86-year-old patient with severe chronic obstructive pulmonary disease undergoing modified radical mastectomy with axillary dissection by thoracic paravertebral block (PVB). Use of thoracic PVB provided hemodynamic and respiratory stability, excellent unilateral anesthesia and high patient satisfaction.

"Anesthesia mumps" after electroconvulsive therapy anesthesia.

Acute transient swelling of the parotid gland in association with anesthesia is known as "anesthesia mumps." We report an acute bilateral parotid swelling in a patient after electroconvulsive therapy anesthesia.

Comparison of paravertebral block versus fast-track general anesthesia via laryngeal mask airway in outpatient inguinal herniorrhaphy.

PURPOSE: Outpatient inguinal herniorrhaphy (IH) can be successfully performed under general, regional, or local anesthesia. In this study recovery profile, postoperative pain scores, incidence of adverse effects, and patient and surgeon satisfaction were compared between paravertebral block (PVB) and fast-track general anesthesia (GA) via laryngeal mask airway (LMA) for outpatient IH. METHODS: Sixty patients were randomly assigned to receive either PVB or GA under standardized protocols (group PVB: at T9-L1 levels, 5 mL of 0.5% levobupivacaine for both procedures, and continuous propofol sedation; group GA: GA with 2 mg kg⁻¹ propofol induction and 2-4% desflurane maintenance via LMA, and routine antiemetic prophylaxis and multimodal analgesic treatment). Anesthesia-related, onset, recovery, and home discharge times, hemodynamic changes, pain, and incidence of adverse effects were compared. RESULTS: Anesthesia-related time and onset time were longer, but recovery and home discharge times were shorter in group PVB. Verbal rating scores (VRS) at 30, 60, 120, and 180 min and 6, and 12 h post-surgery were significantly lower in group PVB patients. VRS at 18, 24, and 48 h were comparable in both groups. No patient in group PVB and eight patients in group GA needed meperidine in the post-anesthesia care unit, and time to first analgesic and first rescue analgesic requirements were significantly longer in group PVB. CONCLUSION: In outpatient IH, PVB with 0.5% levobupivacaine provided improved recovery, long-lasting analgesia, shorter recovery room stays, and earlier home readiness time than fast-track GA via LMA.