Safinaz Karabayirli

Comparison of the analgesic effects of oral tramadol and naproxen sodium on pain relief during IUD insertion.

OBJECTIVE To compare the analgesic efficacy of oral tramadol and naproxen sodium on pain during insertion of an intrauterine device (IUD). DESIGN Randomized, double-blinded, clinical trial (Canadian Task Force classification I). SETTING University-affiliated hospital. Single-center. PATIENTS One hundred three patients scheduled for insertion of an IUD. INTERVENTIONS Patients were randomly assigned to receive oral tramadol 50 mg capsules (n = 35) or naproxen sodium 550 mg tablets (n = 34) or placebo (n = 34) 1 hour before insertion of the IUD. After insertion of the IUD, pain intensity was evaluated using a visual analog scale (VAS, 0-10). Adverse effects, patient satisfaction with the medication, and preference for using it during future insertions were also recorded. MEASUREMENTS AND MAIN RESULTS The VAS scores were significantly different during IUD insertion among the 3 groups (p = .001). Pain scores in the tramadol group were significantly lower than in the naproxen group (p = .003), and the scores in the naproxen group was significantly lower than in the control group (p = .001). Patient satisfaction with the medication and preference for its future use were significantly lower in the control group than in the other 2 groups (p = .001). CONCLUSION Prophylactic analgesia using 50 mg tramadol and 550 mg naproxen, delivered orally, can be used to relieve pain during IUD insertion. However, tramadol capsules were found to be more effective than naproxen tablets.

Patient-controlled analgesia and sedation with alfentanyl versus fentanyl for colonoscopy: a randomized double blind study.

Study Objective The aim of this study was to evaluate whether sedo-analgesia with alfentanyl/fentanyl, using a patient-controlled analgesia (PCA) pump, may have positive outcomes in terms of safety, postprocedural workload, and expectations of the colonoscopist, nurse, and patients in elective colonoscopy. Patients One hundred American Society of Anesthesiology physical status I and II adult patients. Interventions Patients were randomized in a double-blind trial to receive either alfentanyl (n=50) or fentanyl (n=50) by PCA, and incremental doses of midazolam. Measurements Patient expectations were assessed using hemodynamic variables, willingness to have a repeat colonoscopy in the same way, adverse events, discomfort scores, and patient/operator/nurse satisfaction associated with sedo-analgesia. Result All patients in both groups had adequate sedo-analgesia with high satisfaction and willingness scores. There were no serious adverse effects and except for a few events, no required medication. The total sedation times were shorter in the alfentanyl group compared with the fentanyl group. Conclusions PCA and sedation with alfentanyl and fentanyl for colonoscopy are safe, feasible, and acceptable to most patients. However, shorter sedation times make alfentanyl more attractive for postprocedural workload.

The comparative effects of transdermal and intramuscular diclofenac on postlaparoscopic surgery pain.

Purpose: Postlaparoscopic surgery pain management can reduce the discharge and recovery time. Thus conventional nonsteroidal anti-inflammatory drugs and opioids have been used for this purpose. The aim of this trial was to compare the analgesic and opioid-sparing efficacy of diclofenac sodium intramuscular (IM) with diclofenac transdermal patch in the management of postlaparoscopy pain. Methods: Patients were randomized to receive IM diclofenac 75 mg (n=30) 15 minutes before anesthesia or transdermal diclofenac (n=30) 3 hours before laparoscopic surgery. Transdermal or IM diclofenac were reapplied 12 hours later. All patients were administered tramadol intravenously before surgery. Postoperative pain management was maintained with tramadol using a patient-controlled analgesia device. Postoperative visual analogue pain scores (VAS, 0 to 10 cm) and adverse reactions were recorded over a 24-hour period. If VAS values were >4, 25 mg tramadol was given intravenously as a rescue analgesic. Results: In both groups, VAS scores were higher in the first 4 hours. There were no significant differences in postoperative pain between the 2 groups. The postoperative tramadol consumption, and rescue analgesic needs of the patients between both groups were not statistically significant. Injection pain was observed in the IM diclofenac group, but for both groups no skin reactions were observed at the application sites of the drugs. Conclusions: Diclofenac transdermal patch provided pain relief for postoperative laparoscopic surgery as effectively as IM diclofenac and can be used.

Effect of positive end-expiratory pressure administration on intraocular pressure in laparoscopic cholecystectomy: Randomised controlled trial.

first-pass success rate was significantly higher than pooled first-pass rates with the palpation technique when combining either all individual studies (P1⁄4 0.001) or studies in adults (P1⁄4 0.039). It would be more interesting to compare our results with other ultrasound-guided approaches. Unfortunately, as we are aware of the meaning of the bevel line and automatically track it during the procedures, we could not compare our technique with the standard in-plane technique (i.e. without tracking of the bevel line) in a blinded manner. Of note, visualisation of the bevel line significantly increased the rate of successful attempts in our study, and this finding indirectly supports the usefulness of our modification to the standard in-plane approach.

Cervical epidural steroid injections for symptomatic disc herniations

OBJECTIVES Cervical radiculopathy is widespread in society, and the methods used in the treatment cover a wide range from conservative treatment to surgical treatment. There is not yet a full consensus on the use of invasive approaches for the optimal treatment of radicular pain. However, cervical epidural steroid injection (CESI) has been used in patients with symptoms of cervical discopathy. METHODS Results of the six-month period of treatment of 58 patients, diagnosed as symptomatic cervical radiculopathy with application of CESI within a one-year period, were evaluated retrospectively. With the patients in a sitting position and with the head flexed, the epidural space was accessed from the C7-T1 aperture using the median approach and the hanging drop technique, and a pre- prepared 6 ml solution consisting of 80 mg triamcinolone with 10 mg levobupivacaine was injected following standard sterilization. RESULTS The post-CESI treatment VAS values of the patients were significantly lower than pretreatment VAS values. The treatment success rates for CESI application were 93% in the 1st month, 86% in the 3rd month, and 72% in the 6th month, respectively. CONCLUSION The CESI application is an effective method in the treatment of cervical radiculopathy and reduces the rate of patients needing surgery.

A Needle-Free Injection System (INJEX™) with lidocaine for epidural needle insertion: A randomized controlled trial.

Objectives: Local anesthetic infiltration is also a process of a painful process itself. INJEX™ technology, known as “Needle-free” drug delivery system, was designed for reducing the pain associated with cutaneous procedures. We conducted a prospective, randomized trial to evaluate the application of lidocaine with INJEX™ system and 27-gauge needle. Methods: A total of 60 consecutive patients were allocated to receive either INJEX group or 27-gauge needle group. Local anesthetic infiltration was applied two minutes before epidural needle insertion. Results: Mean VAS, at the time of local anesthetic injection was 0 for group I and 2 for group II. When the effect of epidural needle insertion was compared, the mean VAS score was one versus two for Group-I versus Group-II, respectively. Lidocaine applied with the INJEX™ system before epidural needle insertion significantly reduced the intensity of pain during that procedure and was least effective the lidocaine applied with the 27-gauge needle and patients felt less pain during at the time of local anesthetic injection in Group-I. Conclusion: Needle-free delivery of lidocaine is an effective, easy to-use and noninvasive method of providing local anesthesia for the epidural needle insertion.

The Effect of Dexmedetomidine and Propofol on Oxidative Stress Parameters during Lower Extremity Surgery: A Prospective Randomized Trial

Background: This study aims to compare the impact of sedation, continuous dexmedetomidine and propofol infusion, to oxidative stress that occurred as a result of tourniquet-induced ischemia reperfusion (IR) during lower extremity surgery. Material & Methods: All patients were administered combined spinoepidural anesthesia; Group D received infusion of 1µg kgdexmedetomidine for 10 minutes and 0.5µg kg h infusion, Group P was administered 0.2 mg kg-propofol following bolus 2 mg kg-min-. At baseline, 20 minutes and two hours after the tourniquet was released, plasma total antioxidant status (TAS), total oxidant status (TOS), paraoxonase (PON), stimulated paraoxonase (SPON), arylesterase, ceruloplasmin, myeloperoxidase (MPO), ischemia modified albumin (IMA) and advanced oxidation protein products (AOPP) levels were analyzed. Results: In Group D, ceruloplasmin values taken post tourniquet release were lower compared to the baseline values (p = 0.02 and 0.008, respectively). As for Group P, a decrease in the TAS and TOS values was recorded two hours after the tourniquets were released (in both p = 0.008). No differences were found in other markers of oxidative stress during intra-group comparisons (p >