Mehmet Beyazova

Effects of perineural opioids on nerve conduction of N. suralis in man

In this study the effects of agonist acting drugs (morphine sulphate, fentanyl citrate and meperidine hydrochloride) on nerve conduction were studied in 43 healthy young volunteers divided into four groups randomly. According to analgesic equivalent doses, the first group received 2 mg morphine sulphate, the second group 0.02 mg fentanyl citrate, the third group 20 mg meperidine hydrochloride, and as control the fourth group received 2 ml of saline. The latencies, amplitudes of the responses and nerve conduction velocities were obtained immediately before and every 5 min after injections up to 30 min. No significant change was observed within or among the morphine sulphate, fentanyl citrate and saline groups whereas in the meperidine hydrochloride group the amplitudes diminished significantly and this finding was still apparent at 30 min. Four of the cases displayed complete blocks. Nerve conduction velocity did not change in the other 6 cases. The significant decrement of the amplitude of the compound nerve action potential in the meperidine hydrochloride group is probably due to local anesthetic‐like action of this drug. Morphine sulphate, fentanyl citrate or saline did not show this effect.

Muscular and condylar response to rapid maxillary expansion. Part 1: Electromyographic study of anterior temporal and superficial masseter muscles

INTRODUCTION In this prospective clinical study, we investigated the effects of rapid maxillary expansion (RME) on the electromyographic (EMG) activities of the anterior temporal and superficial masseter muscles. METHODS The sample included 18 subjects (11 girls, 7 boys; mean age, 12.54 years) with unilateral or bilateral posterior crossbites involving 3 or more posterior teeth. There was no control group in this study because of the short observation period. The EMG activity was recorded simultaneously from both muscles during swallowing a sip of water and unilateral gum chewing. RESULTS The mean EMG (mEMG) activities of the right and left anterior temporal muscles showed no statistically significant difference during swallowing and unilateral chewing. The mEMG activities of the right and left masseter muscles showed a statistically significant difference at unilateral chewing (P <0.01). There were a decrease of the mEMG activities for both muscles after RME and an increase during the observation period for unilateral chewing (P <0.05). Swallow-related mEMG activities of both muscles showed increases after RME and during the observation period (P <0.05). CONCLUSIONS RME affected the EMG activities of the anterior temporal and superficial masseter muscles during swallowing and unilateral chewing. These findings suggest that the alterations in the EMG activities of these muscles should be considered in both the treatment and the the stability of maxillary transverse deficiencies.

Intraoperative neurophysiological monitoring during surgery for tethered cord syndrome.

AIM The tethered cord syndrome refers to a variety of lesions that can cause the conus medullaris to be low-lying or incapable of movement within the spinal canal. Permanent or temporary neurological complications were reported following surgical release. In this report, peri- and postoperative results in cases with tethered cord syndrome that were followed by multimodal intraoperative neurophysiological monitoring (MIONM) methods are presented. MATERIAL AND METHODS An IONM system (Nicolet CR Endeavor) was used for monitoring during tethered cord surgery. Somatosensory evoked potentials (SEPs), motor evoked potentials (MEPs), direct nerve root/rootlet stimulation, free-run electromyography (EMG) and F-waves were used during tethered cord surgery of 10 cases to prevent possible nerve injuries. RESULTS MEP and SEP recordings did not change in any of the cases during surgery. The nervous tissue was identified and differentiated from connective tissue in three cases when motor responses were elicited with direct stimulation of nerve roots. None of the cases had neurological deficits following the operation. CONCLUSION Direct nerve root/rootlet stimulation should be one of the components of MIONM during surgery for tethered cord syndrome to prevent postoperative neurological deficits.

Femoral Nerve Injury Following a Lumbar Plexus Blockade

BACKGROUND Lumbar plexus blockade (LPB) combined with sciatic nerve block (SNB) is frequently used for lower extremity surgery. Perioperative nerve injury is a rarely encountered complication of peripheral nerve blocks (PNB). CASE REPORT Here we report a 44-year-old male patient who developed a partial femoral nerve injury (FNI) following a LPB which was performed before the surgery of a patellar fracture. The clinical and electroneuromyographic findings of the patient were recovered almost completely within the following six months. CONCLUSION The presented case demonstrated a FNI despite the absence of any pain or paresthesia sensation, with the disappearance of motor response under 0.3 mA of neurostimulation in the experienced hands.

Impairment of upper trapezius branch of the spinal accessory nerve during bypass grafting: a stretch injury?

Internal jugular vein catheterization has been implicated in spinal accessory nerve (SAN) injuries after coronary artery bypass grafting (CABG). Stretch injury due to prolonged positioning during CABG has also been proposed as another mechanism of injury. Herein we describe a male patient with left shoulder pain and abduction difficulty following CABG, who displayed electromyographic abnormalities confined to the left upper trapezius muscle. Internal jugular vein catheterization had not been performed during surgery. Although unusual, the possibility of upper trapezius muscular branch paralysis should be considered in patients with shoulder pain or weakness after CABG. Muscle Nerve, 2010

Carpal Lock and the Volar-Supporting Orthosis in Mild and Moderate Carpal Tunnel Syndrome

Zinnuroglu M, Baspinar M, Beyazova M: Carpal lock and the volar-supporting orthosis in mild and moderate carpal tunnel syndrome. Objective:The carpal lock, which is a hand/wrist orthosis that supports the dorsal aspect of the hand, was used in patients with mild-moderate carpal tunnel syndrome, and its clinical and electrophysiological effectiveness was compared with that of a volar-supporting orthosis. Design:Nerve conduction study and clinical evaluation of 24 patients (41 hands) with mild or moderate carpal tunnel syndrome were performed before and 3 mos after the use of the carpal lock or the volar-supporting orthosis. Results:Significant improvement was observed in electrophysiological parameters and clinical outcomes after use of both orthoses. There was no statistically significant difference between the two groups. Patients in the carpal lock group used the orthosis 89.6% of the prescribed time, whereas those in the volar-supporting orthosis group used the orthosis 79.2% of the prescribed time (P < 0.05). Conclusions:The carpal lock may be used as an alternative to the volar-supporting orthosis.

Perineural meperidine blocks nerve conduction in a dose-related manner: a randomized double-blind study.

Background: Meperidine has been shown to exhibit a sensory block in peripheral nerves. However, its motor blockade ability is controversial. The aim of this study was to investigate, electroneurographically, the ability of meperidine to inhibit conduction in both sensory and motor fibres in the ulnar nerve.

Reliability of a Novel Visual Feedback System Developed for Increasing the Efficiency of Posterior Pelvic Tilt Exercise

Abstract Objectives: This study aimed to develop and assess the reliability of a visual feedback system intended to improve the patient’s perception and the performance of posterior pelvic tilt [PPT] exercises. The feedback setup designed and constructed by the authors included a bed covered with a mat with three embedded force sensors corresponding to the lumbosacral region of the subject lying supine; a data acquisition card to collect and convert data; and two monitors, one above the subject and one on the physician’s table. Software was developed to monitor the force exerted vertically upon the force sensors during PPT to be followed both by the physician and the subject. Methods: Fifteen healthy volunteers were enrolled for a relability trial. The subjects were asked to perform five consecutive PPT with maximum effort. Each subject was evualated three times by two physicians. Intraclass correlation coefficients (ICC) were computed to determine the intrarater and interrater reliability of the maximum force values measured by the visual feedback PPT exercise system. Results: The ICC were 0.89 and 0.98 for intrarater and 0.89, 0.89, and 0.96 for interrater reliability. Conclusions: The novel visual feedback system for PPT proved to be highly reliable for both intrarater and interrater measurements of maximum force.

P22.2 Effect of perineurally administered tramadol on nerve conduction

Background: It has been shown that the admixture of tramadol with mepivacaine for axillary plexus block provides a prolongation of blockade. Moreover, it was postulated that tramadol has local anesthetic-like effect in an invitro study. Objective: By using an electroneurographical method, we investigated if tramadol had a nerve conduction blocking effect when administered perineurally in vivo. Methods: After approval by the Ethics Committee of our institution and obtaining informed consent from healthy volunteers, 24 cases were randomized into four equal groups [saline (placebo), 0.5% tramadol, 1% tramadol and 1.5% tramadol]. The study was designed to be double-blinded. Two milliliters of working solution was administered to sural nerve perineurally at the level of ankle using a nerve stimulator. Sensory response amplitudes were recorded electroneurographically. A minimum of 20% decrement with respect to control amplitude was sought to accept that the block had occurred. Results: According to electroneurographical recordings, none of the volunteers in saline group had block. However, the block rates with 0.5%, 1% and 1.5% tramadol were 1/6, 4/6 and 6/6, respectively (p < 0.05). The maximum decrement in the sensory response amplitudes with respect to control amplitudes given as median values were as follows: 7.8% with saline; 12.5% with 0.5% tramadol; 38.5% with 1% tramadol; 77.5% with 1.5% tramadol (p < 0.05). While the median duration of sensory block with 1% tramadol was 15 min, it was 35 min with 1.5% tramadol. Conclusion: Perineural tramadol blocks sensory conduction in peripheral nerves.