Investigation of efficacy of erector spinae plane block administered in different volumes on intraoperative opioid consumption and postoperative analgesia in breast surgery: Randomized, prospective, double-blind study.

OBJECTIVES: We investigated the efficacy of the erector spinae plane block, which has been proven to be effective in breast surgery, on intraoperative opioid consumption and postoperative analgesia when administered in different volumes with the same concentration of local anesthetic. METHODS: This study is designed as randomized, prospective, and double-blind. Seventy patients aged between 18-70 years, undergoing ASA I-III elective breast surgery, were included. Unilateral erector spinae plane block was achieved by administering 20 mL of 0.375% bupivacaine hydrochloride in 35 patients in Group I and 30 mL of 0.375% bupivacaine hydrochloride in 35 patients in Group II. The analgesic requirement of the patients was monitored with the surgical plethysmographic index throughout the surgery. Intraoperative and postoperative opioid consumption, rescue analgesic requirements in the first 24 hours, and NRS scores at the 10th minute, 1st hour, 6th hour, 12th hour, and 24th hour postoperatively were recorded. RESULTS: Both intraoperative and postoperative opioid consumptions were similar between groups (p>0.05). The number of involved dermatomes was significantly higher in Group II (p<0.05). No significant difference was found between postoperative NRS scores (p>0.05). CONCLUSION: In elective breast surgery, erector spinae plane block administered at the same concentration in 20 or 30 mL volumes does not make a difference in opioid consumption and postoperative analgesia.

Comparison of pupillometer, critical care pain observation scale, and vital findings in the evaluation of pain in intensive care patients without oral communication.

OBJECTIVES: The aim of this study was to investigate the effects of portable infrared Pupillometer, Critical Care Pain Observation Scale (CPOT), and vital sign changes during painful procedures on patients with mechanical ventilators in the intensive care unit (ICU), and comparing the efficacy of these methods to detect the presence of pain. METHODS: In 50 patients who could not verbally state pain, admitted to Necmettin Erbakan University Meram Faculty of Medicine ICU, aged 18-75 years, and connected to a mechanical ventilator, vital sign changes, CPOT scale assessments, and pain evaluation with a portable infrared pupillometer were performed during endotracheal aspiration and position changes, which are defined as painful stimuli. RESULTS: Data were collected from 50 patients with a mean age of 57.4±17.9 years and 48% of males. The systolic, diastolic, and mean arterial pressure and heart rate values, CPOT scores, and pupillometric measurements of the patients increased significantly at the time of aspiration and change of position (p<0.05). Neurological pupil index scores showed a significant decrease at the time of painful stimulation (p<0.05). CONCLUSION: It was found that pupil diameter changes evaluated using a portable infrared pupillometric measuring device can be used effectively and reliably in pain assessment in patients who are treated in the ICU, supported by mechanical ventilation and who cannot communicate verbally.

Evaluation of pupil diameter for pain assessment in interventional headache management.

OBJECTIVES: Pain is a subjective experience. Besides, sensory, affective and behavioral responses, and autonomic response are part of pain response to noxious stimuli. Evaluation of pupil diameter by pupillometry has been used as an alternative method for pain assessment. In algologic procedures like interventional headache management have not been addressed in the literature. Herein, we investigated changes in pupil diameter during interventional headache management as an objective method for pain assessment. METHODS: Demographic data of the patients were collected before the bilateral major occipital nerve blockage (MONB) procedure. Numeric rating score (NRS) and pupil diameter measurements by pupillometer were recorded before MONB. Standard MONB procedure was applied to all patients. Pain assessment and pupillary diameter measurements were obtained after nerve blockage. RESULTS: Twenty-eight patients were included in this study. Mean age was 41.03+-12.63 years. There is no difference between the hemodynamic parameters before and after the procedure. Post-procedure NRS and pupil diameter values were significantly lower than pre-procedure values. There was a positive correlation between changes in NRS scores and changes in the right and left pupil diameters. CONCLUSION: There was a significant correlation between NRS score and pupil diameter in patients who underwent MONB. Monitoring of pupil diameter can be used for pain assessment during headache treatment. Evaluation of pupil diameter is a new approach in pain palliation. Future research is needed to study the effect of other parameters, that is, gender, age, origin of pain, acute, and chronic pain on pupil diameter and to evaluate its application in different algological procedures.

A comparison of ketamine and paracetamol for preventing remifentanil induced hyperalgesia in patients undergoing total abdominal hysterectomy.

BACKGROUND: The aim of this prospective, randomized, placebo-controlled study was to compare the effects of ketamine and paracetamol on preventing remifentanil induced hyperalgesia. METHODS: Ninety patients undergoing total abdominal hysterectomy were randomly assigned to one of three groups to receive (I) either saline infusion; (II) 0.5 mg/kg ketamine iv bolus or (III) 1000 mg iv paracetamol infusion before induction of anesthesia. Until the skin closure, anesthesia was maintained with 0.4 µg/kg/min remifentanil infusion in all groups, additionally Group II received 5 µg/kg/min ketamine infusion. Pressure pain thresholds were measured the day before surgery during the preoperative visit for baseline measurements and repeated postoperatively at 24 and 48 hours (hrs). Pressure pain thresholds were established by digital algometer on three different peri- incisional regions for calculating mean pressure pain threshold values. The visual analogue scale (VAS), sedation scores, total morphine consumption and side effects were assessed postoperatively. RESULTS: Demographic characteristics, duration of surgery and anesthesia were similar in the three groups. Pain thresholds at the incision region were significantly lower at 24 and 48 hrs postoperatively in Group I than the other Groups (p<0.05). In Group І, pain thresholds were lower compared with preoperative baseline values. Thresholds in Group ІІ and Group ІІІ were higher compared with preoperative baseline values (p<0.05) The VAS scores at all evaluation times were significantly higher in Group І when compared to Group ІІ and at 2, 4, 6 ,12 hrs were higher in Group I than Group ІІІ (p<0.05). The morphine consumption was higher in Group ІІІ at 24 and 48 hrs postoperatively (p<0.05). CONCLUSION: It was shown that ketamine and paracetamol were both effective in preventing remifentanil induced hyperalgesia.

Research for the factors effecting the headache experienced by the health-care personnel in COVID-19 pandemic: A monocentric survey study.

OBJECTIVES: The aim of this study is to determine the factors that may be related to the headache experienced by health-care professionals in the coronavirus disease 2019 (COVID-19) pandemic. METHODS: The target population of the study consisted of the health-care professionals working in the COVID-19 pandemic. The questionnaire form consisted of 40 questions. The demographic information of the participants, the presence of contact with the COVID-19 patient, they used which personal protective equipment (PPE) and how often, the effect of the pandemic process on the lifestyle, the presence of visual defects, the effect of the pandemic process on water consumption, the presence of old or de novo headaches, the factors that may affect this headache, and the factors that reduce the pain were questioned in the survey. RESULTS: A total of 177 health-care professionals participated in the study. About 93.8% of the participants use masks daily for more than 4 h. About 62.7% of the participants stated that their water consumption increased on the days when they used PPE. About 72.3% of the participants reported disruption in sleep patterns, 83.1% of them reported increase in their stress and anxiety. About 65.5% of the participants experienced headaches during the pandemic process. They reported that the most likely causes of headache were excessive sweating and difficulty in breathing due to the use of PPE. CONCLUSION: During the pandemic, a substantial portion of health-care professionals experiences headaches. Besides the physical difficulties caused by the use of PPE, the stress caused by the pandemic process should not be ignored.

Immunological mechanism of postherpetic neuralgia and effect of pregabalin treatment on the mechanism: a prospective single-arm observational study.

BACKGROUND: Although neuropathic pain is a severe and common pain, its pathophysiology has not been elucidated yet. Studies in recent years have focused on the immune system's role in the pathogenesis of neuropathic pain. The aim of this study was to investigate the role of immunological mechanisms in neuropathic pain and the effect of pregabalin by measuring immunological marker levels in peripheral blood before and after pregabalin treatment in postherpetic neuralgia (PHN) patients with neuropathic pain. METHODS: Forty patients diagnosed with PHN were included in the study. CD4, T follicular cells (Tfh: CD4+CXCR5+PD1+), Th17 (CD4+CCR6+ and CD4+IL17A+), regulatory T cells (Treg: CD4+ CD25+foxp3+), Th1 (CD4+ CXCR3+ and CD4+ IFN-γ+) and Th2 (CD4+ IL-4+) cell ratios were measured in peripheral blood samples before treatment and after 3 months of treatment. RESULTS: When immunological marker and inflammation parameter levels were compared before and after treatment, the helper T cell ratio (CD3+, CD4+) was 30.28 ± 12.27% before treatment and 34.93 ± 11.70% after treatment, so there was a statistically significant increase (P = 0.028). Th17 was 4.75 ± 5.02% before treatment and 5.80 ± 3.13% after treatment, and there was a statistically significant increase (P = 0.036). CONCLUSIONS: Immunological mechanisms play an essential role in the pathogenesis of neuropathic pain, immunologically based treatment approach will be the critical point of treatment.

[Pharmachologic treatment of acute postoperative pain: A clinical practice guideline of The Turkish Society of Algology]. / Akut postoperatif agrinin farmakolojik tedavisi: Türk Algoloji-Agri Dernegi klinik uygulama kilavuzu.

Satisfactory pain relief is a fundamental right of every patient suffering from pain. Despite the developments on pharmachologic treatment modalities and interventions for pain control, inadequacy of postoperative pain management is still a major problem. After surgical intervention, 66% of patients experience moderate to severe pain during discharge, 9% after two weeks. Untreated postoperative pain may lead to prolonged hospital stay, increased intensive care needs, development of chronic pain, and reduced the patients quality of life. In the following guideline all aspects of postoperative pain briefly evaluated. The clinical practice of postoperative analgesia, recommendations, the diagnosis, assessment and pharmachologic treatment of acute postoperative pain with the current available agents in Turkey are discussed in this article. Our aim is to promote awareness of effective, and safe postoperative pain management strategies to meet the needs of the patients; minor patient groups, such as paediatric population, pregnant patients, elderly, patient with high body mass index and covid 19 diesease. Despite all the recommendations, any guidelines special cases where standard modalities fail to treat postoperative pain management as in patients with chronic pain who previously used opioids, drug addicts, the patient should be consulted with an pain specialist.

[The effects of intravenous paracetamol on postoperative analgesia and tramadol consumption in cesarean operations]. / Sezaryen cerrahisinde intravenöz parasetamolün postoperatif analjezi ve tramadol tüketimine etkisi.

OBJECTIVES: In this study, the effects and side effects of intravenous paracetamol application, combined with patient-controlled intravenous tramadol analgesia, were investigated in elective cesarean operations for postoperative pain control and its tramadol-sparing effect. METHODS: Fifty ASA I-II patients scheduled for cesarean operation were enrolled in this study. Patients were randomly divided into two groups: group I served as a control group, with saline administration (100 ml) 15 min before the end surgery and every 6 h for 24 h, whereas group II received paracetamol (1 g/100 ml) at the stated time points. All patients received a standard anesthetic protocol. At the end of surgery, all patients received tramadol i.v. via a PCA (patient-controlled analgesia) device. Pain and sedation scores were assessed at 1, 3, 6, 12 and 24 h postoperatively. RESULTS: Tramadol consumption and adverse effects were noted in the first 24 hours following surgery. The pain scores were significantly lower in the paracetamol group when compared with the control group (p<0.05). The cumulative tramadol consumption was lower in the paracetamol group than the control group (p<0.05). No significant difference was observed in sedation scores and nausea-vomiting scores between the groups (p>0.05). CONCLUSION: We conclude that paracetamol is a safe and effective treatment option in post-cesarean pain for combination with tramadol, as it produces effective analgesia and reduces tramadol consumption.

A probable case of pregabalin - related reversible hearing loss.

Pregabalin and gabapentin are similar compounds with analgesic, anticonvulsant, and anxiolytic characteristics. Due to these pharmacological features, they are commonly used throughout the world in neuropathic pain treatment and anxiety disorders. Mild to moderate side effects of the central nervous system, such as dizziness and somnolence, are important factors in deciding to terminate the use of pregabalin. Studies have also reported that the use of dose-dependent pregabalin resulted in peripheral edema and weight gain. Described in this case report is hearing loss occurring after an increase in the drug dose of a patient using pregabalin.In this case, we wanted to present the occuring hearing-loss after an increase in the drug dose of the patient already using pregabalin.

Evaluation of the efficacy of erector spinae plane block and intercostal nerve block in the postherpetic neuralgia.

OBJECTIVES: The aim of this study was to compare the efficacy of an intercostal nerve block, which has been used for many years in the treatment of postherpetic neuralgia, and the more recent alternative of an erector spinae plane (ESP) block. METHODS: The records of 39 patients who were treated in the algology department for postherpetic neuralgia between May 1, 2015 and May 1, 2018 were evaluated retrospectively. Patients who received an intercostal nerve block constituted Group 1 and those who received an ESP block were categorized as Group 2. The change in numeric rating scale (NRS) and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scores in the short term and in the long term were the primary results of the study. RESULTS: The NRS, LANSS, and sleep interference scale (SIS) scores of the patients in Group 1 and Group 2 were found to be significantly lower at the 24th hour, week 4, and week 12 compared with the values obtained before block application. In Group 1, the scores recorded at week 4 and week 12 were significantly higher than the 24th hour values, whereas no difference was observed between these results in Group 2. There was no significant difference between the groups in the week 4 and week 12 scores. Similarly, no significant difference was observed in the NRS, LANSS, or SIS scores before the block application or at the 24th hour. However, the scores at week 4 and week 12 were significantly lower in Group 2 compared with Group 1. CONCLUSION: The results indicated that an ESP block significantly decreased neuropathic pain symptoms and the need for additional treatment in postherpetic neuralgia treatment in the long term.

Fluoroscopy-guided genicular nerves pulsed radiofrequency for chronic knee pain treatment.

OBJECTIVES: The primary objective of this study was to investigate the effects of Pulsed RF application in the genicular nerve on pain and function in patients with osteoarthritis (OA) and its side effects. METHODS: This study was conducted between February 2018 and June 2018. Patients who were previously administered diagnostic blocks were evaluated a day later; a drop of at least 50% in numeric pain scores was considered a positive response, and these patients were included in the Pulsed RF neurotomy procedures. Radiofrequency (RF) cannula was advanced towards targeted nerves under the guidance of fluoroscopy. RF lesions were created by applying Pulsed RF treatment to the three genicular nerves three times with five minutes intervals at 42 °C using NT1000 RF Generator. Following the Pulsed RF application, 2 mL 0.5% bupivacaine was injected into each genicular nerve as an anesthetic agent. VAS, pain DETECT scores, WOMAC scores were evaluated preoperative baseline and postprocedure weeks 1, 4, and 12. Patient Global Impression of Change (PGIC) score was evaluated postprocedure weeks 12. RESULTS: This study included 20 patients who were administered genicular nerve Pulsed RF. The mean age was 55.2±3.24 years, and F/M ratio was 12/8. Compared to the pre-procedure period, patients' pain and function evaluation, WOMAC and VAS values decreased by approximately 50% at the end of the 12th week. No side effect was observed in any patients. CONCLUSION: Our findings suggest that Pulsed RF neurotomy of the genicular nerves is an efficient and safe treatment method for patients with chronic knee osteoarthritis.

Effects of desflurane, sevoflurane and propofol on phagocytosis and respiratory burst activity of human polymorphonuclear leucocytes in bronchoalveolar lavage.

BACKGROUND AND OBJECTIVE: In polymorphonuclear leucocytes, phagocytosis and respiratory burst activity are mainly responsible for bacterial killing. We aimed to investigate the effects of anaesthesia with desflurane, sevoflurane and propofol on these functional activities of polymorphonuclear leucocytes in bronchoalveolar lavage fluid. METHODS: Sixty patients scheduled to have tympanoplasty surgery were studied. The patients were divided into three groups (group D, desflurane; group S, sevoflurane; group P, propofol). Anaesthesia was induced with propofol, fentanyl and rocuronium in all groups. Anaesthesia was maintained with inhalation agent or propofol. Bronchoalveolar lavage was performed immediately after induction of anaesthesia and after surgical procedure by a fibreoptic bronchoscope. Leucocyte respiratory burst and phagocytic activity in bronchoalveolar lavage fluid were determined by flow cytometric analysis of gated leucocyte populations within 2 h after each bronchoalveolar lavage sample. Changes in leucocyte functions with time were expressed as mean fluorescence intensity. RESULTS: There were no significant differences in phagocytic activity of polymorphonuclear leucocytes within and between the groups. The respiratory burst function of polymorphonuclear leucocytes showed a significant increase after surgery in group P (P < 0.05). When we compared the differences between the three groups, we found the difference in mean fluorescence intensity as statistically significant between group P and group S. CONCLUSION: This study showed that propofol anaesthesia increased the respiratory burst function of polymorphonuclear leucocytes in bronchoalveolar lavage fluid.

Auditory function after spinal anaesthesia: the effect of differently designed spinal needles.

BACKGROUND AND OBJECTIVE: Recurrent, bilateral or unilateral, persistent or transient, mild or profound hearing loss has been reported after spinal anaesthesia. We studied the effects of the needle type (Quincke, ballpen, pencil-point spinal needles) on hearing loss after spinal anaesthesia with the use of pure-tone audiometry. METHODS: Forty-five ASA physical status I patients scheduled for elective inguinal herniorraphy with spinal anaesthesia were enrolled in the study. The patients were randomly divided into three groups. Group Q (n = 15) patients received spinal anaesthesia through a 25-gauge (G) Quincke spinal needle, group B (n = 15) patients received the same through a 25-G ballpen spinal needle and those in group P (n = 15) received the same through a 25-G pencil-point spinal needle. Patients were interviewed about postoperative complaints such as postdural puncture headache, vertigo, nausea-vomiting, transient neurological symptoms and major neurological deficits. Pure-tone audiometry was performed by an audiologist at specific time intervals. RESULTS: The number of patients who had greater than 10 dB hearing loss in group Q was significantly more than that found in group B and group P at 250, 500, 4000 and 6000 Hz on postoperative day 1. When group B and group P were compared for change in hearing, no statistically significant difference was detected at any frequency tested. CONCLUSION: Because the use of ballpen and pencil-point needles reduces hearing loss after spinal anaesthesia, these needles are preferred.

[The effects of lornoxicam in preventing remifentanil-induced postoperative hyperalgesia]. / Remifentanile bagli gelisen postoperatif hiperaljezinin önlenmesinde lornoksikamin etkisi.

OBJECTIVES: Intraoperative remifentanil administration results in acute opioid tolerance that is manifested by increased postoperative pain, opioid requirement and specifically peri-incisional hyperalgesia. The aim of this study was to investigate the effect of lornoxicam in preventing remifentanil-induced hyperalgesia. METHODS: Patients were randomly divided into two groups. Fifteen minutes before surgery, saline solution was given to the patients in group I and 16 mg i.v. Lornoxicam in group II. Anesthesia was induced with 1 microg/kg remifentanil combined with 1.5-2 mg/kg propofol and maintained with 0.5 MAC desflurane and 0.4 microg/kg/dk remifentanil in both groups. Desflurane concentration was titrated according to autonomic responses. All patients were given i.v. 0.15 mg/kg morphine 30 min before the end of surgery. At the end of surgery, patients received morphine i.v. Via a PCA (Patient Controlled Analgesia) device. Pain score, morphine demand and delivery were assessed at 2, 4, 6, 12 and 24 h after surgery. Total morphine consumption was recorded for 24-48 h. Peri-incisional hyperalgesia was assessed by measuring pain threshold to pressure using an algometer before operation and at 24-48 h postoperatively. RESULTS: The pain scores and cumulative morphine consumption were significantly lower in the lornoxicam group when compared with the control group (p<0.05). Pain thresholds were significantly less at 24-48 h postoperatively in the control group than in the lornoxicam group. No significant difference was observed in side effects (p>0.05). CONCLUSION: Lornoxicam administered preemptively prevented remifentanil-induced hyperalgesia.

Sugammadex for Cesarean in a Patient with Multiple Sclerosis.

The aim of the present study was to discuss the management of anesthesia in our case with multiple sclerosis (MS) and to present the effects of sugammadex administration. A 36-year-old pregnant patient with MS disease was followed up for 6 years. She was on steroid treatment. The patient had not suffered the entire pregnancy. In addition to performing routine monitoring, "train of four" (TOF) monitorization was used. General anesthesia was given using propofol and rocuronium. At the end of the operation, muscle relaxation was reversed using sugammadex in the patient with a low TOF score. The patient was discharged on postoperative day 3. The most reliable method should be preferred in patients with MS. In patients under general anesthesia, the muscle relaxant effect is prolonged, and sugammadex can be safely used.

Caudal anesthesia for minor subumbilical pediatric surgery: a comparison of levobupivacaine alone and levobupivacaine plus sufentanil.

STUDY OBJECTIVES: To compare the postoperative analgesic efficacy and duration of analgesia after caudal levobupivacaine 0.20% with and without the addition of sufentanil 0.5 microg kg(-1). DESIGN: Prospective, randomized study. SETTING: University teaching hospital. PATIENTS: 40 ASA physical status I pediatric patients, aged one to 7 years, who were scheduled for elective minor subumbilical surgery. INTERVENTIONS: Patients were divided into two groups to receive either a single caudal injection of one mL kg(-1) levobupivacaine 0.20% (Group L) or levobupivacaine 0.20% plus sufentanil 0.5 microg kg(-1) (Group LS). MEASUREMENTS: Analgesia (Children and Infants Postoperative Pain Scale score), motor block (Motor Blockade Scoring), and side effects were assessed at predetermined time points during the first 24 postoperative hours. MAIN RESULTS: The Children and Infants Postoperative Pain Scale scoring at the first hour was significantly lower in Group LS than in Group L. No significant differences were found between the two groups for pain scores at two, three, 4, 5, 6, 9, 12, and 24 hours. Degree of motor block was comparable between the two groups. CONCLUSION: The effect of adding sufentanil to caudal levobupivacaine on postoperative pain scores is brief after elective minor subumbilical surgery in children.

A probable case of movement disorder (Tardive dyskinesia) due to duloxetine treatment.

Tardive dyskinesia and tardive dystonia are caused by dopamine receptor blocking agents, mostly antipsychotics and sometimes antidepressants or calcium channel blockers. Duloxetine is a serotonin-noradrenaline reuptake inhibitor used in the treatment of diabetic neuropathic pain and fibromyalgia, as well as major depression. In this case, we aimed to discuss the tardive dyskinesia-like appearance of a patient using duloxetine due to fibromyalgia.

Effect of dexmedetomidine on haemodynamic responses to laryngoscopy and intubation : perioperative haemodynamics and anaesthetic requirements.

BACKGROUND: Dexmedetomidine reduces the dose requirements for opioids and anaesthetic agents. The purpose of this study was to evaluate the effect of a single pre-induction intravenous dose of dexmedetomidine 1 microg/kg on cardiovascular response resulting from laryngoscopy and endotracheal intubation, need for anaesthetic agent and perioperative haemodynamic stability. METHODS: Fifty patients scheduled for elective minor surgery were randomised into two groups (dexmedetomidine group and placebo group, n = 25 in each group). During and after drug administration, the Ramsey sedation scale was applied every 5 minutes. Fentanyl 1 microg/kg was administered to all patients and thiopental was given until lash reflex disappeared. Anaesthesia continuation was maintained with 50% : 50%, oxygen : nitrous oxide. Sevoflurane concentration was adjusted to maintain systolic blood pressure within 20% of preoperative values. After extubation, the Steward awakening score was applied at 5 and 10 minutes. Haemodynamic parameters and adverse effects were recorded every 10 minutes for 1 hour after surgery. RESULTS: During intubation the need for thiopental and sevoflurane concentration were decreased by 39% and 92%, respectively, in the dexmedetomidine group compared with the placebo group. In all groups, blood pressure and heart rate increased after tracheal intubation; both were significantly lower in the dexmedetomidine group than in the placebo group (p < 0.05). Fentanyl requirement during the operation was 74.20 +/- 10.53microg in the dexmedetomidine group and 84.00 +/- 27.04microg in the placebo group (p < 0.05). At 5 minutes, the Steward scores were >6 in 56% of the dexmedetomidine group and in 4% of the placebo group (p < 0.05). At 10 minutes, sedation scores were > or =4 in all patients in the dexmedetomidine group (p < 0.05). Arterial blood pressure and heart rate in the postoperative period were significantly lower in the dexmedetomidine group compared with the placebo group (p < 0.05). CONCLUSION: Preoperative administration of a single dose of dexmedetomidine resulted in progressive increases in sedation, blunted the haemodynamic responses during laryngoscopy, and reduced opioid and anaesthetic requirements. Furthermore, dexmedetomidine decreased blood pressure and heart rate as well as the recovery time after the operation.

Prevention of postoperative nausea and vomiting after thyroidectomy: combined antiemetic treatment with dexamethasone and ginger versus dexamethasone alone.

BACKGROUND: The aim of this study was to compare the prophylactic effects of dexamethasone plus ginger and dexamethasone alone on postoperative nausea and vomiting (PONV) in patients undergoing thyroidectomy. METHODS: One hundred and twenty patients undergoing general anaesthesia for thyroidectomy were enrolled in this randomised, double-blind study. Patients received oral diazepam 10mg with either oral placebo (group I) or 0.5g of ginger (group II) as premedication 1 hour prior to surgery. Standard general anaesthetic techniques and postoperative analgesia were employed. Both group I and group II received intravenous dexamethasone 150 microg/kg immediately before the induction of anaesthesia. Data were recorded over a 24-hour observation period after surgery. RESULTS: In the dexamethasone-treated group, 14 patients experienced nausea, two patients retched, three patients vomited once, two patients vomited repeatedly, and 14 patients required a rescue antiemetic. In the dexamethasone-plus-ginger-treated group, 12 patients experienced nausea, one patient retched, four patients vomited once, no patients vomited repeatedly, and 13 patients required a rescue antiemetic. Dexamethasone plus ginger did not significantly reduce nausea and vomiting compared with dexamethasone alone during the observation period. CONCLUSION: In conclusion, the prophylactic combination of antiemetic treatment with dexamethasone and ginger was not clinically or statistically superior to dexamethasone alone in preventing PONV in patients undergoing thyroidectomy.

[Transdermal fentanyl for neuropathic pain: a case report]. / Nöropatik agrida transdermal fentanil kullanimi: Olgu sunumu.

The mechanisms responsible for neuropathic pain are not fully understood. Most treatment modalities are ineffective or insufficient for this important clinical condition. Better understanding of pain mechanisms and opioid drug action has widened the indications for opioids in pain therapy of non-malignant pain including neuropathic pain. In this report of a female patient with chronic non-malignant neuropathic pain was followed-up for pain and side effects, for approximately fourteen months with the use of transdermal fentanyl (TDF). Pain reduction was good throughout the study. Severe side effects did not occur. TDF was effective and well tolerated in the treatment of chronic neuropathic pain of non-malignant origin.