Lütfiye Pirbudak

Epidural corticosteroid injection and amitriptyline for the treatment of chronic low back pain associated with radiculopathy

AbstractThe therapeutic role of epidural steroids has not been established for patients whose chances for improvement are poor, e.g. patients with chronic symptoms. In such cases, supplementary treatment with some medications are proposed, but no randomised prospective study is available regarding the results of these combinations. In this study, we evaluated the outcome of a protocol consisting of amitriptyline and epidural corticosteroid. Ninety-two patients suffering from chronic low back pain together with unilateral radicular involvement were introduced into the study. The patients were randomly assigned to two groups. All patients received benzylprednisolone (14 mg) + bupivacaine (0.25%) combination via epidural route. In addition, amitriptyline (10–50 mg p.o.) was administered to group 2 for 9 months. The results were assessed by a visual analogue scale and Oswestry Low back Pain Disability Questionnaire. At 2 weeks, both groups showed statistically significant improvement. At 6 weeks, recovery was...

Effect of ascorbic acid on surgical stress response in gynecologic surgery.

Surgical stress may cause neural, endocrine, metabolic and humoral responses depending on the severity of the procedure. In this study, we aimed to study the effect of the preoperatively given ascorbic acid (AA), which is an anti‐oxidant, and its role in the biosynthesis of neuropituitary hormones on the surgical stress response. Twenty‐two American Society of Anaesthesiologists I and II patients ageing between 18 and 40, who have no endocrine and metabolic disease, and undergoing abdominal operation for non‐malignant diseases were allocated to the study. These non‐premedicated patients were divided into two groups in random: Group I, etomidate group; and Group II, AA plus etomidate group. AA was given to patients in Group II 20 min before etomidate injection. After monitoring the patient, anaesthetic induction was applied by giving 0.3 mg/kg of etomidate, 2 µg/kg of fentanyl and 0.1 mg/kg of vecuronium. Anaesthesia was continued with 1–0.7% isoflurane and N2O/O2 (67 and 37%, respectively). Tramadol was given for the management of post‐operative analgesia. Blood samples were obtained from all patients before the operation and at second, sixth, twelfth and twenty‐forth hours after the beginning of operation for cortisol, adrenocorticotropic hormone (ACTH), osteocalcin, insulin and blood glucose level analyses. There was no statistically significant difference in cortisol, osteocalcin, insulin and glucose levels in both groups, when compared to the control levels. Whereas, patients in Group II had higher levels of cortisol than the control group at sixth hour, which were in normal limits, and there was no decrease in osteocalcin concentration. ACTH level was increased at the second and sixth hours, which was statistically significant, but at twelfth and twenty‐forth hours, they were close to control group levels. As a result, we conclude that AA given before anaesthesia achieved by etomidate is not sufficient for the prevention of surgical stress response and that AA induction before anaesthesia should be preferred, particularly for the prevention of decrease in osteocalcin levels.

Antibacterial effect of bupivacaine and ropivacaine; effect of adjuvant drugs

Background: In this study, we assessed the effect of bupivacaine and ropivacaine on the bacterial growth as well as the impact of adjuvant drugs (morphine, meperidine, fentanyl, ketamine, clonidine, tramadol and midazolam) on the antibacterial activity of the local anesthetics. Methods: Using microdilution technique, the antimicrobial effects of the local anesthetics were tested against 135 bacteria (Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, Staphylococcus epidermidis, Klebsiella pneumoniae, Proteus spp., Enterococcus spp.). The bacteria were standardized according to 0.5 McFarland units, and added to serial diluted solutions of the local anaesthetics. Adjuvant anaesthetic materials were also added to these solutions and their interactions with bupivacaine and ropivacaine were assessed. Results: E. coli, Kl. pneumoniae, P. aeruginosa, methisillin-sensitive Staphylococcus aureus (MSSA), methisillin-sensitive Staphylococcus epidermis (MSSE) and Proteus species were sensitive to bupivacaine at a concentration of 5 mg ml−1. MSSA, MSSE and Proteus species were sensitive to ropivacaine at a concentration of 7.5 mg ml−1. None of the adjuvant materials demonstrated antibacterial activity in the absence of local anesthetics. But, the combination of bupivacaine (5 mg ml−1) with ketamine 15 mg ml−1 was effective against MSSA and Kl. pneumoniae species. Bupivacaine 5 mg ml−1 and fentanyl 3 mg ml−1 combination, ropivacaine and meperidine 12.5 mg ml−1 combination, and ropivacaine and ketamine 15 mg ml−1 combination were effective against one of the E. coli species. Conclusion: 0.75% ropivacaine and 0.5% bupivacaine have anti-bacterial effects. The antimicrobial effect of ropivacaine is less than that of bupivacaine by approximately 50%. The adjuvant drugs have no antimicrobial activity and they do not potentiate the antimicrobial effects of the local anesthetics. summary

Single perioperative wound infiltration with combination of bupivacaine, tramadol, and tenoxicam for pain relief after cesarean delivery with spinal anesthesia

Abstract Background : The aim of our study was to assess the efficacy of single perioperative wound infiltration with a combination of a local anesthetic, tramadol, and tenoxicam in patients who had undergone cesarean delivery with spinal anesthesia. Methods : In this randomized double blind study, patients undergoing cesarean delivery with spinal anesthesia were treated with a perioperative wound infiltration using a combination of analgesic drugs. The infiltration was applied to the abdominal wall layers including visceral and parietal peritoneum, fascia, and subcutaneous tissue during the closure of the abdominal wall. Patients were randomized to receive a 40 ml infiltration into the wound perioperatively of either 0.25% bupivacaine, 100 mg tramadol, and 20 mg tenoxicam (n= 30; group I) or normal saline (n= 30; group II). Postoperative pain was assessed using a visual analogue scale (VAS). The dosage of postoperative tramadol was assessed at 3, 6, 12, and 24 hours. The time until the first requirements...

Intraperitoneal and abdominal wall infiltration with bupivacaine plus tramadol and tenoxicam after total abdominal hysterectomy provides analgesia

Abstract Background: The aim of our study was to assess the effect of intraperitoneal and abdominal wall infiltration with bupivacaine plus tramadol and tenoxicam after total abdominal hysterectomy. Methods: Sixty patients who have undergone abdominal hysterectomy were allocated randomly to three different groups: group I (bupivacaine + tramadol): 20 patients infiltrated with 40 ml 0.25% bupivacaine plus 100 mg tramadol; group II (bupivacaine + tenoxicam): 20 patients infiltrated with 40 ml 0.25% bupivacaine plus 20 mg tenoxicam; and group III (bupivacaine + tramadol + tenoxicam): 20 patients infiltrated with 40 ml 0.25% bupivacaine + 100 mg tramadol + 20 mg tenoxicam. The intraperitoneal and abdominal wall infiltration was done to each patient after hysterectomy. The study was performed in a double-blind controlled manner. Results: In group III, pain scores (VAS) and analgesic requirement (tramadol) during the 24 h after surgery were significantly lower than in groups I and II. Tramadol requirements afte...

Arterial blood gases in extraperitoneal laparoscopic urethrocystopexy

Background: The aim of this study was to investigate the effects of extraperitoneal laparoscopy and carbon dioxide insufflation on hemodynamic parameters, arterial blood gases and complications in urethrocystopexy operations.

The Effect of Acupressure on Pain in Cancer Patients With Bone Metastasis: A Nonrandomized Controlled Trial

Background: Pain is a serious and common problem in bone metastases. For this purpose, complementary and supportive practices are also applied along with medical treatment. This study was conducted for the purpose of evaluating the effect of acupressure on pain in cancer patients with bone metastasis. Methods: The study was conducted in a nonrandomized controlled trial with patients who applied to the radiotherapy unit of an oncology hospital. The data of the study were collected by using a questionnaire and the Visual Analog Scale. A total of 8 acupressure sessions, which lasted for approximately 10 minutes each (with warming and acupressure periods), was applied to the intervention group. The data were analyzed by using χ2 test, paired t test, and Pearson’s correlation coefficient. Results: It was determined that the pain mean score of the intervention group was 7.6 ± 1.9 before the acupressure and decreased to 6.8 ± 1.9 after the acupressure and this result was statistically significant. On the other hand, no significant difference was determined in the pain mean score of the control group. Conclusions: Acupressure is applicable for cancer patients with bone metastasis by nursing staff after receiving brief training and may make a difference in relieving pain of the patients. Further well-designed trials should be conducted.

Effects of intravenous ketamine and fentanyl combined with midazolam on analgesia and side effects during paediatric outpatient lithotripsy

AbstractExtracorporeal shock wave lithotripsy (ESWL) is considered a safe and effective treatment for urolithiasis in children. To decrease the pain experienced by the child is very important. In this study, fentanyl-midazolam combination has been compared to ketamine-midazolam bolus combination in paediatric outpatient lithotripsy.Forty patients were randomly divided into two groups; a ketamine group received 2 mg kg−1 ketamine i.v. 10 min before ESWL, and a fentanyl group received 2 μg kg−1 fentanyl i.v. 3 min before ESWL. All patients received 0.1 mg kg −1 midazolam i.v. 3 min before ESWL for intraoperative sedation. The pain intensity was evaluated by a numeric rating scale (NRS). The degree of sedation was assessed with Observers Assessment of Alertness/Sedation Scale.A supplemental analgesia with i.v. fentanyl (5 μg) was given if analgesia was inadequate (NRS > 3). Oxygen supplement though a face mask was given when the SpO2 fell below 94%. Side effects, and the time of discharge from the post-anae...

The effect of adding bupivacaine to intrathecal fentanyl on second stage labor analgesia

Abstract Objective: The highly lipophilic opioids, sufentanil and fentanyl, have both been widely used as intrathecal analgesics for labor. Our aim was to determine whether adding bupivacaine (1.25 mg) to intrathecal fentanyl (25 μg) provides better second stage labor analgesia. Study design: Our study was designed in a prospective, randomised, double-blind manner. Forty-four pregnant women, who had a cervical dilatation of ≥7 cm, cervical effacement of ≥80%, no contraindication for labor analgesia ASA I-II, 20–31 years old were included in our study.Patients received intrathecal injections in sitting position as routine, and were allocated randomly to two groups. In group I 25 μg of fentanyl plus 1.25 mg of bupivacaine, and in group II only 25 μg of fentanyl were given by intrathecal injection. Complications during the application process, side effects of drugs (nausea, itching, fetal bradycardia, etc.), postpartum analgesia time, and patient satisfaction were recorded. Results: There were no significant...