Avni Babacan

Percutaneous pulsed radiofrequency reduces mechanical allodynia in a neuropathic pain model.

BACKGROUND: Neuropathic pain is a result of a primary lesion or dysfunction of the peripheral or central nervous system, and its treatment is challenging. Animal models have been helpful in understanding mechanisms of neuropathic pain and in developing new treatment strategies. In this study, we examined the effect of percutaneous pulsed radiofrequency (PRF), which is a minimally invasive pain treatment method, on mechanical allodynia in a neuropathic pain rat model. METHODS: Neuropathic pain was achieved in a peripheral nerve pain model by performing L5–6 spinal nerve ligation. On the 14th postoperative day, percutaneous PRF was applied to the plantar side of the left rear paw. Animals were evaluated for mechanical allodynia with both dynamic plantar aesthesiometer (DPA) (weight and paw withdrawal time) and von Frey filaments (VF) on the 14th postoperative day and 1, 3, 5, 7, 10, and 14 days after PRF treatment. Experiments were conducted in six groups: Sham-operated + placebo PRF 6 min, sham-operated + PRF 6 min, neuropathic (NP) + 2 min placebo PRF, NP + 2 min PRF, NP + 6 min placebo PRF, and NP + 6 min PRF. RESULTS: Allodynia developed in all animals in the NP groups compared to sham-operated animals (P = 0.0001). DPA and VF showed that PRF application for 2 min significantly improved allodynia on 1–14th post-PRF day, compared to placebo PRF (P = 0.0001). Although DPA (both weight and paw withdrawal time) did not show any therapeutic effect from 6 min PRF application on 1–14th post-PRF days (P = 1.00), VF demonstrated transient improvement for the first week, which disappeared on later evaluations of the 6 min PRF group. CONCLUSIONS: Percutaneous PRF is an effective treatment option in the NP pain model, and further studies are needed to clarify its underlying mechanisms of action.

RELIEF OF CHRONIC REFRACTORY HICCUPS WITH GLOSSOPHARYNGEAL NERVE BLOCK

hours. The microscope was moved in close to the operating table, and thereafter the damping was observed. A search for common causes included lack of pressure in the pressure bag, position of the arterial line at the wrist, and any evidence of blood clots in the line, all of which were negative. The microscope was not interfering with the arterial line. Both the flushing and the withdrawal of blood from the line was successful. The noninvasive blood pressure on the opposite hand showed the patient to be normotensive. We were considering inserting a new radial line when we discovered that a surgical clamp was occluding the pressure line. The clamp had been put in by the nurse to secure all the wires from the microscope along the bed and had inadvertently clamped our radial artery line. When damping occurs, it is important to inspect the pressure line between the transducer and the radial artery.

Comparison of Parasacral and Posterior Sciatic Nerve Blocks Combined with Lumbar Plexus Block.

OBJECTIVE The aim of this study is to compare the effects of parasacral and posterior Winnie approaches when combined with the inguinal paravascular approach for lumbar plexus block. METHODS After the approval of the Ethics Committee, 40 patients scheduled to undergo arthroscopic knee surgery were enrolled. The patients were randomly assigned into two groups in a double-blind manner to perform sciatic nerve block either by the parasacral technique (Group I) or by the posterior approach (Group II). RESULTS The obturator nerve motor block success rate was found to be 80% (16/20) in Group I, whereas it was 10% (2/20) in Group II (p<0.05). CONCLUSION Inguinal paravascular block with parasacral sciatic nerve block led to a much higher incidence of obturator nerve motor block when compared to the inguinal paravascular block with posterior sciatic nerve block during knee arthroscopies.

Continuous spinal anesthesia after unintentional dural puncture during attempted epidural anesthesia for mastectomy

(1:200,000) was used subcutaneously in the axilla of all patients to abolish tourniquet sensation transmitted by the intercostobrachial and medial brachial cutaneous nerves. Axillary blocks were placed using either a transarterial technique, a paresthesia technique, or by a perivascular technique. A nerve stimulator was not used. Each patient recorded the number of pain pills used on the day of surgery and for the following 2 days. The duration of sensory analgesia (the time in which they felt no pain) lasted an average of 23 hours in blocks using methylprednisolone as compared with 16 hours without the steroid (P .01). Motor block (when they could not move their hand or fingers) averaged 19 hours with the steroid and 13 hours without the steroid (P .001). Using 95% confidence interval analysis, we found that the motor blocks were prolonged between 3.4 and 9.4 hours. The sensory blocks, which were associated with larger standard deviations, were extended between 1.7 and 12.1 hours. The 2 groups did not differ in the number of analgesics they required or in the level of pain they experienced after the day of surgery. However, on the day of surgery itself, patients who had received the steroid had significantly lower pain scores. The difference in the number of pain pills taken did not reach statistical significance. There were no anesthetic complications noted by the anesthesia staff or surgeons in the postoperative period. Adding a steroid to the local anesthetic solution may not be indicated for all patients. Diabetic patients may experience hyperglycemia. Patients with an ongoing infectious process may be detrimentally affected by the anti-inflammatory effects of steroids. Our preliminary data suggest that methylprednisolone can increase the duration of sensory and motor block. Although we relied on the patients to determine the duration of their block, the results from the questionnaires were consistent. The applicability of these findings to clinical practice must be verified in a randomized prospective clinical trial.

Chronic Unexplained Thigh Pain from Saphenous Nerve Entrapment due to a Leiomyoma

Dear Editor, Lower extremity entrapment syndromes are seen less commonly than those pertaining to the upper limbs and, despite the use of various diagnostic tools, their diagnoses can really be challenging [1]. Likewise, entrapment of the saphenous nerve is quite rare [2] and has been reported to ensue mainly due to local trauma (e.g., surgery and fracture) or soft tissue (i.e., mass, scar) compression [2–4]. In this report describing a patient with unexplained chronic severe thigh pain, we would like to underscore the complementary roles of ultrasonography and electrodiagnostic evaluations for the prompt diagnosis of a rare scenario of saphenous nerve entrapment. A 40-year-old man was seen for left medial thigh pain for the last 5–6 years (worse in the last 4 months). His pain was stabbing and very …

EHMTI-0017. Investigation of behavior of rats by nitroglicerine induced headache

Chronic migraine is a debilitating disease particularly in women and underlying pathophysiology remains unclear. Clinically relevant migraine models are missing.

435 PERIPHERIC PULSE RADIOFREQUENCY THERMOCAOGULATION FOR A CANCER PATIENT WITH OPTHALMIC ZONA ZOSTER

thermo detection and pain thresholds and pressure algometry). Structured interviews by a psychologist highly experienced in evaluation of sexual dysfunction were performed to evaluate the psycho-sexual profile of the patients. Result: 9 patients were examined. Sensory dysfunctions in the operated groin compared with the non operated groin were present in all (hypoesthesia and hyperalgesia, decreased pressure pain detection threshold, tactile allodynia and wind-up pain phenomenon). Maximum pain was always located over the annulus inguinalis externus. Psychological evaluation did not reveal any psychological disturbances, and the sexual dysfunction disturbance was attributed to the chronic pain state. Conclusion: Sensory disturbances of are present in patients with ejaculatory pain related sexual dysfunction following groin hernia repair. Psychosexual evaluation indicates a somatic origin (nerve damage) rather than a psychological pathogenesis.

436 PERIPHERAL PULSE RADIOFREQUENCY THERMOCAOGULATION OF A PATIENT WITH MANDIBULAR NEURALGIA

thermo detection and pain thresholds and pressure algometry). Structured interviews by a psychologist highly experienced in evaluation of sexual dysfunction were performed to evaluate the psycho-sexual profile of the patients. Result: 9 patients were examined. Sensory dysfunctions in the operated groin compared with the non operated groin were present in all (hypoesthesia and hyperalgesia, decreased pressure pain detection threshold, tactile allodynia and wind-up pain phenomenon). Maximum pain was always located over the annulus inguinalis externus. Psychological evaluation did not reveal any psychological disturbances, and the sexual dysfunction disturbance was attributed to the chronic pain state. Conclusion: Sensory disturbances of are present in patients with ejaculatory pain related sexual dysfunction following groin hernia repair. Psychosexual evaluation indicates a somatic origin (nerve damage) rather than a psychological pathogenesis.

613 ALLERGIC REACTIONS WITH ORAL TRAMADOL — 4 CASES

pain relief was 62%±27% at 12m. EQ-5D health status improved from 0.19±0.32 to 0.46±0.36 (p< 0.001). Oswestry scores also improved from 53±12, categorized as severe disability, to 38±19 (p< 0.001), categorized as moderate disability. 93% of patients would elect SCS again for the same result, and 98% would recommend SCS to a friend with similar pain. Conclusions: All patients independently recharged the neurostimulator battery. Significant improvements in pain reduction, quality of life, and functional status were observed throughout 12 months post-implant, with a high rate of patient satisfaction with the therapy.

217 INVESTIGATING THE THERAPEUTIC EFFICACY OF PULSED RADIOFREQUENCY (PRF) THERMOCOAGULATION APPLICATION IN NEUROPATHIC PAIN

Results: A significant up-regulation of both Prkce and Prkcc mRNA was detected in traumatic pain models but not in the metabolic one. In the CCI and axotomy models the change in gene expression for the two isozymes was detected both at dorsal horn and dorsal root ganglia (DRG) levels, whereas only Prkcc expression was changed in brainstem samples. Interestingly, Prkcc has been regarded up to now as a spinal cord specific isoform being mainly expressed in the CNS. We here report expression and modulation of this enzyme in DRG for the first time. Conclusions: Our results unravel a fundamental difference in gene expression regulation of Protein Kinase C in injury-associated versus metabolic pain models. Our findings support the hypothesis that specific neurochemical changes occur in the spinal cord and primary afferents in different models of neuropathic pain.