Oguz Kilickaya

Rosuvastatin, a new generation 3-hydroxy-3-methylglutaryl coenzyme a reductase inhibitor, reduces ischemia/reperfusion-induced spinal cord tissue injury in rats.

BACKGROUND Severe neurological injury still represents one of the most devastating complications occurring after surgical repair of thoracoabdominal aneurysms. We aimed to investigate the role of rosuvastatin (RSV) against ischemia/reperfusion injury in an experimental model of spinal cord ischemia in rats. METHODS Experimental groups included control group (n = 8), ischemia/reperfusion group (n = 8) undergoing aortic occlusion without pharmacologic treatment, and RSV-treated group (n = 8) receiving 10 mg/kg/day of RSV orally for 3 days before spinal cord ischemia. Spinal cord ischemia was induced by occlusion of the abdominal aorta between the left renal artery and aortic bifurcation for 45 minutes, followed by reperfusion. Neurological status was assessed before spinal ischemia and at 48 hours postoperatively. Spinal cords were harvested for histopathologic examination with hematoxylin-eosin staining and biochemical analysis for tissue malondialdehyde, superoxide dismutase, and glutathione peroxidase levels. RESULTS Decreased spinal cord tissue malondialdehyde levels (p = .01) and increased tissue superoxide dismutase (p = .01) and glutathione peroxidase (p = .09) levels were observed in the RSV-treated group, as compared with the ischemia group. Histopathologic analyses demonstrated typical changes of ischemic necrosis in the ischemia group; however, RSV attenuated tissue necrosis. Total injury score in the RSV-treated group was significantly decreased, as compared with the ischemia group (p < .05). The Tarlov scores at 48 hours postoperatively were higher in the RSV group as compared with the ischemia group. CONCLUSION RSV administration before spinal cord ischemia reduces spinal cord tissue injury by increasing antioxidant enzyme levels and may reduce the incidence of associated neurological dysfunction.

Validity and reliability of Turkish version of family satisfaction in the intensive care unit

To evaluate the quality of care that is provided in intensive care units, needs and satisfaction of the patient relatives must also be considered. The aim of the study is to test the Turkish version of the Family Satisfaction in the Intensive Care Unit (FS-ICU-24) Survey, which was developed by Heyland et al. This study was planned and applied as a methodological study. Survey was conducted in the intensive care units of a military education and research hospital and a medical faculty hospital, department of anaesthesia and reanimation in the capital city Ankara of Turkey. Sample of the survey was composed of 120 participants. Cronbachs alpha value for the FS-ICU-24 general internal consistency in this study was calculated as 0.95 for total scale. In this study, the Turkish version of the FS-ICU-24 was found to be reliable and valid with Turkish population.

Assessment of the effectiveness of lumbar transforaminal epidural steroid injection for low back pain

OBJECTIVES Transforaminal epidural steroid injection (TFESI) is a minimally invasive technique used for low back pain. We aimed to assess the efficiency of TFESI in patients with low back pain who did not respond to conservative or surgical methods. METHODS This study was a retrospective analysis of the records of 37 patients (range: 24-80 years) who presented to our clinic with low back pain and were treated by TFESI. Outcomes were assessed by Visual Analog Scale (VAS) measured at the 3rd week and 6th month. RESULTS Median age of the patients was 50 years, and mean duration of symptoms was 48 months. Diagnosis was lumbar disc herniation (LDH) in 51%, failed back surgery syndrome (FBSS) in 38%, and spinal stenosis (SS) in 11% of the patients. Baseline VAS scores were similar between the three groups. The 3rd week and 6th month VAS scores of LDH and FBSS cases were significantly decreased compared to baseline scores (p<0.001, p=0.001), and no significant change was observed between the VAS scores at the 3rd week and 6th month (p>0.05). If success is defined as 50% or more decrease in VAS scores, the success rate of TFESI was 84% at the 3rd week and 78% at the 6th month. CONCLUSION TFESI significantly reduced the intensity of low back pain in most of the patients with LDH, FBSS or SS; thus, it may be considered as an effective method in the treatment of low back pain.

Ultrasound-guided facet block.

e read the article ‘‘Ultrasound-guided facet block to low ack pain: a case report’’ written by Ana Ellen Q. Saniago et al.1 with interest. The authors have reported a ase report about a patient with bilateral facet osteoarthrois and performing facet block with ultrasound-guided.1 hanks to the authors for conducting such a great study, hich is successfully designed and well documented. We elieve that these findings will enlighten further studies bout ultrasound-guided facet block and comparing ultraound and fluoroscopy in pain therapies. Lumbar facet osteoarthrosis is one of the major causes f low back pain and it also cause referred pain in the lower imb. This source of pain cannot be diagnosed by only clinical xamination or radiologic findings.2 The facet joint block is erformed for patients with low back pain and with imaging tudies determining facet osteoarthrosis.1 The facet joint lock is usually performed under fluoroscopy or computed omography (CT). The block performed under CT or fluorocopic guidance enhances the accuracy and success rate, but here are disadvantages such as the exposure to radiation nd the high cost as compared with ultrasonography.3 Recent advances in ultrasound improved significantly pinal sonoanatomy. Therefore, currently ultrasound can e used to determine or guide central neuroaxial blocks nd also peripheral regional blocks with greater success,4 ecause ultrasound is a non-invasive, safe, and simple ool and it also does not involve exposure to radiation, esides providing real-time images, and it does not have ide effects.5 Many studies comparing ultrasound and fluoroscopy at acet joint block reported that ultrasound-guided facet lock can be performed with a high success rate and clinial outcome comparable with that of a fluoroscopic-guided lock and also the advantages of not involving exposure to adiation provides the potential for use of ultrasound guidnce as an alternative to the conventional method.2,3,6 We think that ultrasound-guided identification of the orrect segment for facet nerve block has not been fully h

Bloqueio da faceta guiado por ultrassom

Lemos com interesse o artigo ‘‘Bloqueio facetário guiado por ultrassom para lombalgia: relato de caso’’ escrito por Ana Ellen Q. Santiago et al.1 Os autores relataram o caso clínico de uma paciente com osteoartrose facetária bilateral e fizeram um bloqueio facetário guiado por ultrassom.1 Agradecemos aos autores pelo estudo tão esclarecedor, que foi muito bem desenhado e documentado. Acreditamos que esses resultados serão de grande contribuição para estudos futuros sobre o bloqueio facetário guiado por ultrassom que comparem ultrassom e fluoroscopia em terapias para a dor. Osteoartrose facetária lombar é uma das principais causas de lombalgia e também causa dor refratária em membro inferior. Essa fonte de dor não pode ser diagnosticada por meio de exame apenas clínico ou achados radiológicos.2 O bloqueio facetário é feito em pacientes com dor lombar e com exames de imagem que determinam osteoartrose facetária.1 O bloqueio da articulação facetária é geralmente feito com o uso de fluoroscopia ou tomografia computadorizada (TC). O bloqueio com monitoração por TC ou fluoroscópica aumenta a taxa de precisão e sucesso, mas há desvantagens, como a exposição à radiação e o alto custo, em comparação com a ultrassonografia.3 Recentes avanços em ultrassom melhoraram de forma significativa a sonoanatomia da coluna vertebral. Portanto, atualmente, o ultrassom pode ser usado para determinar ou monitorar bloqueios neuroaxiais centrais e também bloqueios regionais periféricos com mais sucesso,4 pois se trata de uma ferramenta não invasiva, segura, simples e que não envolve exposição à radiação, além de proporcionar imagens em tempo real e não ter efeitos colaterais.5 Muitos estudos que compararam ultrassom e fluoroscopia em bloqueio facetário relataram que o bloqueio facetário guiado por ultrassom pode ser feito com uma alta taxa de sucesso e evolução clínica comparável ao blo-

Ultrasound-Guided Bilateral Infraclavicular Brachial Plexus Blockade for Bilateral Distal Radius Fracture Surgery: Case Report

DOI: 10.4328/JCAM.1134 Received: 05.06.2012 Accepted: 24.06.2012 Printed: 01.07.2015 J Clin Anal Med 2015;6(4): 516-8 Corresponding Author: Tarık Purtuloğlu, Department of Anesthesiology and Reanimation, Gulhane Military Medical Faculty, 03016, Ankara,Turkey. T.: +90 3123045911 F.: +90 3123045900 GSM: +905333909151 E-Mail: tpurtuloglu@mynet.com Özet Üst ektremite cerrahilerinde tek taraflı brakial pleksus blokları etkin analjezi ve anestezi sağlamaları nedeniyle sıklıkla kullanılmaktadır. Daha az sıklıkla da olsa bilateral ekstremite cerrahisi geçirecek hastalara; sistemik lokal anestezik toksistesi riski, pnömotoraks ve frenik sinir paralizisi gibi nedenlerle bilateral brakiyal pleksus bloğu nadiren uygulanır. Biz olgumuzda bilateral radius başı kırığı olan hastaya lokal aneztezik dozlarını azaltarak başarı bir şekilde uyguladığımız ultrason eşliğinde bilateral infraklavikuler bloğu paylaşmayı amaçladık. Biz olgumuza tek ekstremite için 15 ml lokal anestezik(10 ml 5% levobupivakain+ 5 ml 2% lidokain) toplam 30 ml ile ultrason eşliğinde bilateral lateral sagital infraklavikuler bloğu başarılı bir şekilde uyguladık ve herhangi bir komplikasyonla karşılaşmadık. Bilateral brakial pleksus blokları ultrason eşliğinde uygulansa da total olarak verilen lokal anestezik dozuna dikkat edilmeli, ultrason başarı oranını arttırmakla birlikte komplikasyonları tamamen ortadan kaldırmadığı sadece komplikasyon görülme sıklığını azalttığı hatırdan çıkartılmamalıdır.

Postoperative pain in total hip arthroplasty

Dear Editor, We read the article “Factors associated with severe postoperative pain in patients with total hip arthroplasty” written by Petrovic et al. with great interest.[1] In this study, they aimed to determine risk factors for the development of postoperative pain following total hip arthroplasty. We would like to thank the authors for their contribution, with a successfully designed and documented study. We believe that these findings will enlighten further studies regarding risk factors for the development of postoperative pain following total hip arthroplasty. Total hip arthroplasty is a common orthopedic procedure, and postoperative pain is one of the most common concerns of patients undergoing total hip arthroplasty.[2] As underlined by the authors, many risk factors may influence the severity of pain after total hip arthroplasty. However, we realized that 2 important factors are not included in the list as risk factors: 1. Anesthetic technique—The intensity of postoperative pain is found to be less severe following regional techniques like spinal or epidural blocks[3] when compared to general anesthetic technique.[4–6] 2. Intraoperative analgesic use—In particular, preemptive analgesia is found to be an effective method in terms of reducing postoperative pain.[7] To summarize, we believe that anesthetic technique and intraoperative use of analgesics should be included in the list of risk factors for the development of postoperative pain following total hip arthroplasty. DOI: 10.3944/AOTT.2015.15.0151 This abstract belongs to the un-edited version of the article and is only for informative purposes. Published version may differ from the current version.