Evaluation of pain in patients with COVID-19.

OBJECTIVES: A new type of coronavirus outbreak has emerged in China and caused a pandemic. World Health Organization (WHO) announced the official name of this disease 'COVID-19'. The main purpose of this study is to evaluate pain in COVID-19 patients. METHODS: Patients who were followed in the ward of an infectious diseases department because of possible or confirmed COVID-19 between May and September of 2020 were included in the study. The Turkish version of the Brief Pain Inventory (BPI) was applied. Demographic features, frequency, location, the intensity of pain, and response to analgesics were analyzed. RESULTS: A total of 178 participants were included in the study. Ninety-one (51.1%) of patients had pain complaints and the mean pain score (MPS) was 2.28±2.81 over 10. Fifty-nine (56.0%) of participants with pain required analgesic therapy and 41 (80.3%) of them showed ≥50% pain relief with simple analgesics. Twelve of the remaining 18 who did not get enough pain relief with simple analgesic were taking their analgesics pro re nata (PRN) rather than around the clock (ATC). Pain frequency and intensity and mean hospitalization duration (MHD) were similar between confirmed and possible cases. CONCLUSION: Regarding the results, we conclude that pain is not one of the challenging symptoms and easily manageable in patients with a mild-moderate intensity of COVID-19. Our results were not enough to make a correlation between pain and the clinical course of the disease. Further studies are required for the evaluation of pain including patients in intensive care units.

The antinociceptive effects of intravenous dexmedetomidine in colorectal distension-induced visceral pain in rats: the role of opioid receptors.

BACKGROUND: In comparison with cutaneous pain, the role of alpha(2)-adrenoceptor (alpha(2)-AR) agonists in visceral pain has not been extensively examined. We aimed to characterize the antinociceptive effect of IV dexmedetomidine on visceral pain in rats and to determine whether antinociception thus produced is mediated by opioid receptors. METHODS: Male Sprague Dawley rats (250-300 g) were instrumented with a venous catheter for drug administration and with enameled nichrome electrodes for electromyography of the external oblique muscles. Colorectal distension (CRD) was used as the noxious visceral stimulus, and the visceromotor response to CRD was quantified electromyographically before and 5, 15, 30, 60, 90, and 120 min after dexmedetomidine or clonidine administration. Antagonists were administered 10 min before dexmedetomidine. After confirmation of normal distribution of data, one-way analysis of variance with the Tukey-Kramer post hoc test was used for multiple comparison. RESULTS: IV administration of dexmedetomidine (2.5-20 microg/kg) and clonidine (10-80 microg/kg) produced a dose-dependent reduction in visceromotor response with 50% effective dose values of 10.5 and 37.6 microg/kg, respectively. Administration of the nonspecific alpha(2)-AR antagonist yohimbine (1 mg/kg), but not the peripherally restricted alpha(2)-AR antagonist MK-467 (1 mg/kg), abolished the antinociceptive effect of dexmedetomidine (10 microg/kg). In addition, inhibition of opioid receptors by naloxone (1 mg/kg) attenuated the antinociceptive effect of dexmedetomidine. CONCLUSION: Our data indicate that IV dexmedetomidine exerts pronounced antinociception against CRD-induced visceral pain and suggest that the antinociceptive effect of dexmedotimidine is mediated in part by opioid receptors, but peripheral alpha(2)-ARs are not involved.

[Effect of intravenous dexketoprofen use on postoperative analgesic consumption in patients with lumbar disc surgery]. / Lomber disk cerrahisi uygulanan olgularda intravenöz deksketoprofen kullaniminin ameliyat sonrasi analjezik tüketimine etkisi.

OBJECTIVES: The objective of this study was to evaluate the postoperative analgesic effect of a preemptive, single-dose intravenous dexketoprofen administration in patients undergoing lumbar microdiscectomy. METHODS: A total of 50 ASA I-II patients candidate to laminectomy were included in this study. They were divided in two groups. Patients in Group A were given 50 mg (2 mL) dexketoprofen and those in Group K 2 mL normal saline intravenously by a blinded anesthesia physician, 10 minutes before the start of intervention. All cases underwent general anesthesia. All patients received postoperative patient-controlled analgesia with tramadol. The VAS scores 1, 4, 8, 16 and 24 hours following the operation, sedation and patient satisfaction scores and tramadol consumption were evaluated. RESULTS: VAS scores recorded during the first 8 postoperative hours and total tramadol amounts were lower, and the patient satisfaction scores higher, in patients given dexketoprofen than control group. Sedation scores and side effects were similar in both groups. CONCLUSION: Single-dose preemptive intravenous dexketoprofen provides effective analgesia especially in the first 8 postoperative hours, reducing tramadol use.

[Who is responsible for the postoperative nerve injury? Anesthesia? Orthopedics? Trauma?]. / Ameliyat sonrasi sinir hasarinda sorumlu kim? Anestezi? Ortopedi? Travma?

In the pathogenesis of peripheral nerve injury, mechanical as well as vascular pressure, and chemical reasons play a role. In the applications of peripheral nerve block, there can be mechanical injury due to the type of needle and intrafascicular injections. In humerus fractures, nerve injury can be seen due to the surgical retractions and close proximity of the nerves with the bone. In addition, trauma may be the reason for posttraumatic nerve injury. In this presentation, we discussed the causes of postoperative nerve damage, which is seen after the operation of the distal humerus fracture.

Comparison of LMA CTrach and Video Laryngoscope in Endotracheal Intubation.

OBJECTIVE: In this study, our objective was to compare the Cormack and Lehane (C-L) sight scores of direct laryngoscopy in endotracheal intubation with the endoscopic sight scores of the LMA CTrach and video laryngoscope. We also compared the success of endoscopy with the LMA CTrach and video laryngoscopy, intubation time, and its effects on haemodynamic and stress responses. METHODS: The study included 100 patients, with American Society of Anesthesiologists (ASA) scores I-III and aged 18-65, who will undergo elective surgery. Patients were randomly divided into two groups: Group C and Group V. The patients in both groups underwent direct laryngoscopy with a Macintosh laryngoscope, and their C-L scores were recorded. In Group C, the patients were intubated with the LMA CTrach, and in Group V, the patients were intubated with a video laryngoscope. Patients' haemodynamic parameters, oxygen saturation, end-tidal carbondioxide, and endoscopic sight scores were recorded. RESULTS: The demographic characteristics and the ASA classifications of the groups were similar. When endoscopic sight scores were compared with C-L, better sight was obtained in the LMA CTrach group; no significant difference was detected in Group V. Regarding the success of the intubation, no significant difference was detected between groups. However, when intubation times were compared, there was a significant difference between groups. The intubation time was longer in Group C. There was no difference between groups in terms of the percentage changes of haemodynamic parameters, oxygen saturation, and end-tidal carbondioxide values of the patients. CONCLUSION: In this study, when endoscopic sight scores were compared, better visualization was obtained in the LMA CTrach group. Therefore, in cases where intubation is difficult to apply in patients, the LMA CTrach can be an alternative application.

[The epidural blood patch technique for the management of headache due to spontaneous intracranial hypotension]. / Spontan intrakraniyal hipotansiyona bagli bas agrisinin tedavisinde epidural kan yamasi

Spontaneous intracranial hypotension is a clinical entity characterized by orthostatic headache, low CSF pressure and specific cranial imaging techniques. Headache can be accompanied by the symptoms such as tinnitus, vertigo, diplopia, nausea and vomiting. It is important for the diagnosis to show the level of CSF leakage. Epidural blood patch should be planned for the treatment of patients with no reduction of the complaints following conservative treatment. In this case report, we have discussed the diagnostic methods of spontaneous intracranial hypotension and the importance of an epidural blood patch for its treatment in the light of the literature.

[The effect of gender and working conditions on pain threshold in healthy volunteers]. / Saglikli gönüllülerde cinsiyet ve çalisma sartlarinin agri esik degeri üzerine etkisi.

OBJECTIVES: The aim of this study was to evaluate the sensorial/affective dimension pain levels of patients using an electrostimulation method and to investigate the effects of gender and working conditions on pain thresholds. METHODS: The sensorial dimension of pain and pain threshold levels of 262 healthy volunteers, aged between 20 and 40 years, were assessed using a Painmatcher machine. Patients were divided into four groups during the assessment period: Group I female medical staff (KS) (female doctors/nurses), Group II male medical staff (ES) (male doctors), Group III female sanitation workers (KT), and Group IV male sanitation workers (ET). RESULTS: The sensorial dimension of pain was significantly higher in male and female sanitation workers than among female medical staff (p<0.05). Sensorial dimension of pain were similar between male medical staff and female sanitation workers (p>0.05). Pain threshold levels were significantly higher in male sanitation workers than male medical staff (p<0.05). Female sanitation workers and female medical staff had similar pain threshold levels (p>0.05). The correlation between pain threshold levels and sensorial dimension of pain was not significant in Groups KS and ET, however this correlation was significant in groups ES and KT (p<0.05). CONCLUSION: The sensorial dimension of pain and pain threshold levels are more strongly associated with working conditions than gender. The threshold level of pain was high in individuals with physically demanding jobs.

[Retrospective evaluation of the patients with chronic pain admitted to the algology polyclinic between 2000-2010]. / 2000-2010 yillari arasinda algoloji poliklinigine basvuran kronik agrili hastalarin geriye dönük degerlendirilmesi.

OBJECTIVES: The aim of this study is to evaluate the patients who admitted to algology polyclinic with malign and non-malign pain, sociodemographic characteristics, type of pain and pain management retrospectively. METHODS: In this study we examined the medical assessement files of patients who admitted to our outpatient clinic of Algology Department for chronic pain between January 2000- December 2010. The sociodemographic characteristics of the patients, pain properties and treatments were reviewed retrospectively. RESULTS: Within the eleven years period, a total of 6647 patients have been admitted to our clinic. 66.9% of the patients were between the ages of 19 and 64. There was no significant difference between gender. The most common causes of pain were myofascial pain, neuropathic pain, low back pain and headache. Among malignancy related cases the most common sources were gastrointenstinal system, lung and breast regions. In 83.4% of patients, pharmacological and invasive treatments were utilized. The most common invasive treatment modalities were, trigger point injection, dry needle application and epidural catheter application. CONCLUSION: In conclusion, pain treatments with multidisciplinary approach applied by the increasing number of pain clinics provide favorouble results and patients quality of life is also increased. We hope our retrospective study may provide helpful data for future studies on chronic pain with its comprehensive base of patient data which covers an eleven years period.

Comparison of neonatal effects of epidural and general anesthesia for cesarean section.

We assessed the influence of anesthetic technique for cesarean section on neonatal outcome. Thirty parturient women (ASA I/II) were randomly allocated into two groups. In Group GA general anesthesia was induced with 4 mg.kg(-1) thiopental and 1.5 mg.kg(-1) succinylcholine. In group EA epidural anesthesia was performed with 20 ml 0.375% bupivacaine through L(3-4) inter-space. 1-min Apgar scores were significantly higher in group EA (p < 0.001). Neurologic and Adaptive Capacity scores at 2 and 24 h were higher in group EA (p < 0.001). In terms of blood gas values, umbilical arterial pH and pO(2) values were higher in group EA (p < 0.05 and p < 0.001, respectively). The first breast-feeding intervals were found to be shorter in group EA (p < 0.001). We conclude that in terms of better Apgar and NAC scores, acid-base status and earlier initiation of breast-feeding, the epidural anesthesia may be preferred to general anesthesia in cesarean section.

Comparison of fentanyl-bupivacaine or midazolam-bupivacaine mixtures with plain bupivacaine for caudal anaesthesia in children.

BACKGROUND: The aim of this study was to evaluate the intensity and effectiveness of 0.75 ml.kg-1 bupivacaine 0.25% with the addition of fentanyl or midazolam for caudal block in children undergoing inguinal herniorrhaphy. METHODS: Seventy-five children were allocated randomly to three groups to receive a caudal block with either 0.25% bupivacaine with fentanyl 1 microg.kg(-1) (group BF) or with midazolam 50 microg.kg(-1) (group BM) or bupivacaine alone (group B) after induction of anaesthesia. Haemodynamic parameters, degree of pain, additional analgesic requirements and side-effects were evaluated. RESULTS: The mean systolic arterial pressure at 10, 20, 30 min after caudal block was higher in group B compared with groups BF and BM. Mean intraoperative heart rate was lower in group BF than the other groups. Adequate analgesia was obtained in all patients (100%) in group BF, 23 patients (92%) in group BM and 21 patients (84%) in group B (P > 0.05). The time to recovery to an Aldrete score of 10 was significantly shorter in group B than group BM (P < 0.05). Although not significant, it was also shorter in group B than group BF. There was no difference in additional analgesic requirements between the groups in the first 24 h. Sedation score was higher in the midazolam group at 60 and 90 min postoperatively than the other groups. CONCLUSIONS: Caudal block with 0.75 ml.kg(-1) 0.25% bupivacaine and 50 microg.kg(-1) midazolam or 1 microg.kg(-1) fentanyl provides no further analgesic advantages to bupivacaine alone when administered immediately after induction of anaesthesia in children undergoing unilateral inguinal herniorrhaphy.

Is tissue coring a real problem after caudal injection in children.

BACKGROUND: The aim of this study was to determine whether tissue coring occurs with 22-G hollow needle and 22-G caudal block needle during caudal injection in children, as well as evaluating the nature of the coring material if it did occur. METHODS: Seventy children were randomly allocated to two groups and caudal block was performed with either 22-G hollow (group I) or 22-G caudal block (group II) needle under general anesthesia. The needles and guides were washed with 0.5 ml of 70% ethanol in a sterile tube and were evaluated by a pathologist blinded to the type of needle used, for the type and number of cells. RESULTS: Nucleated cells, which have no mitotic activity, were present in 8.5% in each study group and bloody material was present in 8.5 and 2.8%, in group I and II, respectively. Non-nucleated epidermal cells were detected in 94.2 and 97.1% of the patients in group I and II, respectively. However, cells with mitotic activity from the stratum basale were not detected in any slides. CONCLUSIONS: The incidence of transporting nucleated epidermal cells with no mitotic activity from stratum spinosum during puncture for caudal block is low and no differences exist between different types of needle used. However, it may also suggest that transporting nucleated cells with mitotic activity from the stratum basale may be possible during caudal puncture.