Filiz Alkaya Solmaz

The genicular nerve: radiofrequency lesion application for chronic knee pain

BACKGROUND/AIM We investigated the short- and medium-term effectiveness of genicular nerve radiofrequency (RF) applied in patients with chronic knee pain due to osteoarthritis. MATERIALS AND METHODS Radiofrequency was performed in 49 patients with a diagnosis of knee osteoarthritis. VAS and WOMAC were measured at baseline and at 1, 4, and 12 weeks postprocedure. Under fluoroscopic guidance, the cannula was advanced percutaneously towards the area connecting the shaft to the epicondyle. The RF electrode was inserted through the cannula and the electrode tip temperature was raised to 80 °C for 90 s. One RF lesion was made for each genicular nerve. RESULTS Mean patient age was 64 ± 10.6. VAS score before the procedures was 8.9 ± 0.8, while 1, 4, and 12 weeks after the procedure it was 4.73 ± 3.23, 3.89 ± 2.9, and 3.93 ± 2.95, respectively. WOMAC score before the procedures was 64.26 ± 7.29, while 1, 4, and 12 weeks after the procedures it was 44.93 ± 13.18, 42.81 ± 13.15, and 43.04 ± 13.36, respectively. CONCLUSION RF neurotomy of genicular nerves led to significant pain reduction and functional improvement in a subset of elderly patients with chronic knee osteoarthritis pain, and thus may be an effective treatment in such cases.

Comparison of Effects of Calcium Channel Blockers and Beta Blockers on Tourniquet-Induced Hypertension During Intravenous Regional Anesthesia

ABS TRACT Objective: To investigate the efficacy of calcium channel and beta blockers for controlling tourniquet induced blood pressure increase in patients undergoing carpal tunnel operations with intravenous regional anesthesia (IVRA). Material and Methods: Files of patients who have been operated under IVRA in orthopedics clinics between January 2009 and January 2010 were retrospectively investigated. A total of 312 patients, 164 patients with carpal tunnel syndrome and 148 patients with trigger finger have been operated under IVRA. Out of 164 patients who have been operated due to carpal tunnel syndrome, 50 patients in which either calcium channel blockers or beta blockers were used for treatment of critical blood pressure increase after tourniquet inflation and in which whole data were obtained, were included to the study.The patients with systolic blood pressure above to 150 mmHg following tourniquet inflation and in which bolus dose of calcium channel blocker 10 mg (Group I) or beta blocker 0.5 mg/kg (Group II) have been administered by intravenous route constituted the study groups. The ages of the patients, onset of sensorial block, duration of sensorial block, surgery and tourniquet durations, and the tourniquet pressures were recorded from the patient files. Results: There was no difference between groups in terms of demographical variables and hemodynamic parameters (p<0.05). The efficacy of both calcium channel and beta blockers for controlling tourniquet-induced hypertension were similar (p<0.05). Conclusion: Although both calcium channel blockers and beta blockers were found to be equally effective in treatment of tourniquet-induced hypertension, there is need of large scale prospective studies in this subject.