Serbülent Gökhan Beyaz

Fluoroscopy guided cervical interlaminar steroid injections in patients with cervical pain syndromes: a retrospective study.

OBJECTIVE The objective of this retrospective study was to examine the efficacy of fluoroscopically guided cervical interlaminar epidural steroid injections (CILESI). MATERIALS AND METHODS Sixty-five patients who received their first fluoroscopically guided CILESI over a 12 month interval were retrospectively identified. Patients who had failed conservative non-surgical management and patients who were otherwise candidates of surgery were included in this trial of CILESI. The verbal numerical rating scales (VNRS) before the treatment, within one hour after the treatment, and upon follow-up, were analyzed. RESULTS The most preferred intervention level of CILESI was C5-C6. There was a statistically significant improvement in the VNRS scores from before the injection to immediately after the injection, and upon follow-up. Fifty-one patients (80%) had perfect/good scores. No major complications were encountered after CILESI, but one patient (1.54%) had a vasovagal reaction and another patient (1.54%) had a transient increase of pain after injection. CONCLUSION Fluoroscopy guided CILESI is a safe and an effective treatment for patients with cervical pain syndromes. The success rates show that a large percentage of the patients may obtain relief from radicular symptoms and avoid surgery for the follow-up period up to 12 months.

Comparison of efficacy of intra-articular morphine and steroid in patients with knee osteoarthritis

Introduction: Primary therapeutic aim in treatment of osteoarthritis of the knee is to relieve the pain of osteoarthritis. The aim of this study was to compare the efficacy of intra-articular triamcinolone with intra-articular morphine in pain relief due to osteoarthritis of the knee in the elderly population. Materials and Methods: Patients between 50 and 80 years of age were randomized into three groups. Group M received morphine plus bupivacaine intra-articularly, Group T received triamcinolone plus bupivacaine intra-articularly, and Group C received saline plus bupivacaine intra-articularly. Patients were evaluated before injection and in 2nd, 4th, 6th, and 12th weeks after injection. First-line supplementary analgesic was oral paracetamol 1500 mg/day. If analgesia was insufficient with paracetamol, oral dexketoprofen trometamol 50 mg/day was recommended to patients. Results: After the intra-articular injection, there was statistically significant decrease in visual analog scale (VAS) scores in Groups M and T, when compared to Group C. The decrease of VAS scores seen at the first 2 weeks continued steadily up to the end of 12th week. There was a significant decrease in Groups M and T in the WOMAC scores, when compared to Group C. There was no significant difference in the WOMAC scores between morphine and steroid groups. Significantly less supplementary analgesics was used in the morphine and steroid groups. Conclusion: Intra-articular morphine was as effective as intra-articular triamcinolone for analgesia in patients with osteoarthritis knee. Intra-articular morphine is possibly a better option than intra-articular steroid as it has lesser side effects.

Postmastectomy Pain: A Cross-sectional Study of Prevalence, Pain Characteristics, and Effects on Quality of Life

Background:Postmastectomy pain syndrome (PMPS) is defined as a chronic (continuing for 3 or more months) neuropathic pain affecting the axilla, medial arm, breast, and chest wall after breast cancer surgery. The prevalence of PMPS has been reported to range from 20% to 68%. In this study, we aimed to determine the prevalence of PMPS among mastectomy patients, the severity of neuropathic pain in these patients, risk factors that contribute to pain becoming chronic, and the effect of PMPS on life quality. Methods:This cross-sectional study was approved by the Sakarya University, Medical Faculty Ethical Council and included 146 patients ranging in age from 18 to 85 years who visited the pain clinic, general surgery clinic, and oncology clinic and had breast surgery between 2012 and 2014. Patients were divided into two groups according to whether they met PMPS criteria: pain at axilla, arm, shoulder, chest wall, scar tissue, or breast at least 3 months after breast surgery. All patients gave informed consent prior to entry into the study. Patient medical records were collected, and pain and quality of life were evaluated by the visual analog scale (VAS) for pain, a short form of the McGill Pain Questionnaire (SF-MPQ), douleur neuropathique-4 (DN-4), and SF-36. Results:Patient mean age was 55.2 ± 11.8 years (33.0–83.0 years). PMPS prevalence was 36%. Mean scores on the VAS, SF-MPQ, and DN-4 in PMPS patients were 1.76 ± 2.38 (0–10), 1.73 ± 1.54 (0–5), and 1.64 ± 2.31 (0–8), respectively. Of these patients, 31 (23.7%) had neuropathic pain characteristics, and 12 (9.2%) had phantom pain according to the DN-4 survey. Patients who had modified radical mastectomy were significantly more likely to develop PMPS than patients who had breast-protective surgery (P = 0.028). Only 2 (2.4%) of PMPS patients had received proper treatment (anticonvulsants or opioids). Conclusions:PMPS seriously impacts patients’ emotional situation, daily activities, and social relationships and is a major economic burden for health systems. We conclude that the rate of PMPS among patients receiving breast cancer surgery in Turkey is 64.1% and that challenges to the proper treatment of these patients deserve further investigation.

Chronic postsurgical pain and neuropathic symptoms after abdominal hysterectomy: A silent epidemic.

Abstract Chronic postsurgical pain (CPSP) is an important clinic problem. It is assessed that prevalence of chronic pain extends to 30% but it is contended that there are various risk factors. We aimed to evaluate the prevalence of chronic pain after hysterectomy, risk factors of chronicity, neuropathic features of pain, and sensorial alterations at surgery area. Between years 2012 and 2015, 16 to 65 ages old patients that electively undergone total abdominal hysterectomy bilateral salpingo-oophorectomy and passed minimum 3 months after surgery were included to study. Visual analog scale (VAS) and Douleur Neuropathique 4-questionnaire (DN-4) surveys were used to evaluate pain symptoms, algometry device was used for evaluating abdominal pressure threshold and Von Frey Filament was used for sensorial alterations. Ninety-three of 165 eligible patients were included to study. As the groups were compared by demographic data, no difference was obtained (P > 0.05). There was no difference between groups regarding patient and surgery attributes (P > 0.05). Most frequently performed incision type was Pfannenstiel. Neuropathic symptoms were observed in 90 patients (96.8%). Sensorial alterations as hypoesthesia and hyperesthesia were detected around abdominal scar in 18 patients (19.4%) with pinprick test. Neuropathic symptoms should not be ignored in studies evaluating CPSP and a standard methodology should be designed for studies in this topic.

The effects of N-acetylcysteine on hepatic function during isoflurane anaesthesia for laparoscopic surgery patients

Introduction: Although most general anaesthesia procedures are performed without any complications, volatile agents may have adverse effects on various living systems. This study aims to compare the antioxidant effects of isoflurane and N-acetylcysteine (NAC) on liver function. Methods: Forty-one patients in the ASA I-II risk groups, who were scheduled to undergo gynaecologic laparoscopy, were randomly divided into two groups: The placebo (group P, n=21) and the NAC group (group N, n=20). In both groups, anaesthesia was maintained with 1–2% isoflurane in 50% Oxygen–50% N2O at 6 l/min, also administered by inhalation. Venous blood samples were obtained before anaesthesia induction, and then in the postoperative 1st hour and at the 24th hour. The samples were centrifuged and serum levels of glutathione S-transferase (GST), malondialdehyde (MDA), aspartate amino transferase (AST), alanine amino transferase (ALT), lactate dehydrogenase (LDH), gamma glutamyltranspeptidase (GGT), prothrombin time (PT), activated partial thromboplastin time (aPTT) and international normalised ratio were determined. Results: GST levels were significantly higher in group N than in group P in the postoperative 1st hour. Postoperative values of GST in the two groups were higher when compared to preoperative values (P<0.05). When postoperative levels were compared with preoperative levels, the postoperative MDA levels of group N were significantly higher (P<0.05). Levels of AST, ALT, GGT and LDH in both groups revealed significant decreases at the postoperative 1st hour and postoperative 24th hour compared to preoperative values (P<0.05, P<0.001). PT values were significantly higher in both groups in the postoperative 1st hour and 24th hour (P<0.05, P<0.001), although there were no differences in aPTT levels. Conclusion: Our results showed that liver functions were well preserved with administration of NAC during anaesthesia with isoflurane. Isoflurane with NAC has lesser effect on liver function tests compared to isoflurane alone.

Total Spinal Block after Thoracic Paravertebral Block.

Thoracic paravertebral block (TPVB) can be performed with or without general anaesthesia for various surgical procedures. TPVB is a popular anaesthetic technique due to its low side effect profile and high analgesic potency. We used 20 mL of 0.5% levobupivacaine for a single injection of unilateral TPVB at the T7 level with neurostimulator in a 63 year old patient with co-morbid disease who underwent cholecystectomy. Following the application patient lost consciousness, and was intubated. Haemodynamic instability was normalised with rapid volume replacement and vasopressors. Anaesthetic drugs were stopped at the end of the surgery and muscle relaxant was antagonised. Return of mucle strenght was shown with neuromuscular block monitoring. Approximately three hours after TPVB, spontaneous breathing started and consciousness returned. A total spinal block is a rare and life-threatening complication. A total spinal block is a complication of spinal anaesthesia, and it can also occur after peripheral blocks. Clinical presentation is characterised by hypotension, bradicardia, apnea, and cardiac arrest. An early diagnosis and appropriate treatment is life saving. In this case report, we want to present total spinal block after TPVB.

The thoracic paravertebral block performed for open cholecystectomy operation in order to anesthesia: Two cases.

It is known that, unilateral thoracic paravertebral block (TPVB) applications performed with general anesthesia provide satisfactory conditions for open cholecystectomy increase the quality of post-operative analgesia and patient comfort and decrease the frequency of post-operative nausea and vomiting. In this case report, the TPVB was presented which was performed for two patients with high risk of anesthesia who have been planned to undergo open cholecystectomy.

Comparação das técnicas transforaminal e interlaminar de injeções epidurais de esteroides para o tratamento de dor lombar crônica

STUDY DESIGN A cross-sectional study. OBJECTIVE We compared the 12 month outcomes of fluoroscopically guided transforaminal epidural steroid injections with interlaminar epidural steroid injections for the treatment of chronic lumbar spinal pain. Chronic lower back pain is a multifactorial disorder with many possible etiologies. The lifetime prevalence of spinal pain is reportedly 65-80% in the neck and lower back. Epidural injection of corticosteroids is a commonly used intervention for managing chronic spinal pain. METHODS Patients who did not benefit from previous treatments were included in this study. Injections were performed according to magnetic resonance imaging findings at the nearest level of lumbar pathology; 173 patients received interlaminar epidural steroid injections and 126 patients received transforaminal epidural steroid injections. All of the patients were regularly followed up for 12 months using a verbal numeric rating scale. Magnetic resonance imaging findings, complications, verbal numeric rating scale, and satisfaction scores were recorded. RESULTS Lumbar disk pathology was the most frequently encountered problem. The interlaminar epidural steroid injections were preferred at the L4-L5 intervertebral level. Verbal numeric rating scale scores significantly decreased during the 12-month period compared to basal scores (p<0.001). Significant differences between the two groups according to verbal numeric rating scale and satisfaction scores were not observed (p>0.05). There were no major complications; however, the interlaminar epidural steroid injections group had 22 (12.7%) minor complications, and the transforaminal epidural steroid injections group had 12 (9.5%) minor complications. CONCLUSIONS This study showed that interlaminar epidural steroid injections can be as effective as transforaminal epidural steroid injections when performed at the nearest level of lumbar pathology using fluoroscopy in 12-month intervals.

Combined Use of High Radiofrequency Disk Ablation, Annulus Modulation, and Manual Nucleotomy in a Patient with Extruded Disk Herniation

Different minimally invasive procedures are used to treat lumbar disk herniation. It is important to differentiate these techniques due to their specific effects and the disparate technical issues associated with each. This report describes a successful case involving the use of mechanical decompression in conjunction with radiofrequency ablation to treat a patient with pain and neurological deficits due to an extruded disk hernia.

Epiduroscopy (Epidural Endoscopy)

Epiduroscopy is a relatively new technique used in the evaluation and treatment of low back pain via advancements in optical fiber technology. As a minimally invasive endoscopic technique, it allows for direct endoscopic imaging of the epidural space and helps the patients for the pain management who having post–lumbar surgery syn‐ drome (PLSS) and other cases of low back pain and radiculopathy. An advanced understanding of the anatomy of epidural space and adjacent structures are also essential for positive and successful clinical outcomes. The use of epiduroscopy in the pain clinic is performed as a day procedure, and the patient is awake and can communicate with the doctor. During an epiduroscopy, thin tubes with a bright light and tiny fiberoptic camera at the end are inserted through the sacral hiatus into the epidural space around the dura and guided up toward the affected site. Anterior epiduroscopy and epiduroscopic laser neural decompression (ELND) have been recently introduced in treating herniated disc decompressions, and chronic low back pain and radicular pain, respectively. The most common complications of epiduroscopic approach are the pain in the intervention point, dural puncture, and headache.