Sinem Sari

Complication belong to stellate ganglion blockade after cervical trauma

Stellate ganglion block (SGB) is one of the most often used sympathetic blockade procedure. Despite performed by experienced physicians some complications may occur. The right brachial plexus injury was diagnosed in the patient who admitted to orthopedia clinic, with weakness in the right arm, and pain after motor vehicle accident. There was no response to medical treatment of fortyfour-years-old female patient and there was loosing of sensation from dis the right elbow joint to fingers on the radial and median nerve tracing. In the electromyelography; C5-T1 root avulsion, and MRI; Patient was evaluated as CPRS I (Complex regional pain syndrome) phase 1. In spite of medical treatment, SGB was performed. Respiratory arrest occurred 4-5 minutes after injection. Patient was breated with mechanical ventilator during 2 hours, and discharged 24 hours later with normal vital functions. One year later, the patient admitted the algology polyclinic with strong pain in the same area. Stellate ganglion Radyofreguency (RF) was planned. The first RF cannula was placed under fluoroscopy. Cerebrospinal fluid was seen in the second canula, and canula was withdrawn. Third cannula was placed in another region, and conventional RF was performed through two canuls. For anatomical structure defect, we planned cervical MR myelography. In the cervical MR myelography, traumatic pseudomeningocele was observed at the level of C6-T1 on the brachial plexus. Intraspinal block was thought to develop during blockade of stellate ganglion due to this.

Pediatrik hastalarda sugammadeks kullanımının yan etkileri

Objective: It is accepted that sugammadex show its effects more rapidly than the other neuromuscular block antagonists in many studies, however especially in pediatric cases, it is seen that about its reliability and side effects are limited in some studies. In our retrospective study, we aimed to present our experiences on sugammadex in terms of its side effects in the pediatric cases in our hospital for a 1-year period. Methods: The patient files and intraoperative anesthesia records, postoperative 24th hour and after postoperative 24th hour of the cases that underwent the application of sugammadex under general anesthesia in pediatric surgery operating room in a 1-year period were analyzed. Results: Totally 46 patients received sugammadex; infants (28 days-23 months) (n=24), children (2 years-11 years) (n=16) and adolescent (11-17 years) (n=6). None of the patients showed hypersensitivity and statistically significant side effects correlated to sugammadex. Conclusion: We think that sugammadex may open new doors in pediatric patient group with its features. However, more documentation is needed about the safety in pediatric patient group, particularly in infants. J Clin Exp Invest 2013; 4 (3): 265-268

Effect of statin use on pain relief by transforaminal epidural steroid injection

Aim To investigate the impact of statin use on response to fluoroscopy-assisted transforaminal anterior epidural steroid injection (TAESI). Methods Patients undergoing TAESI for low back pain were recruited and stratified according to statin use. Pain was evaluated with a visual analogue scale (VAS) before and at 1, 3, and 6 months after TAESI. Health-related quality-of-life was evaluated using the Short Form 36 (SF-36) questionnaire 6 months after TAESI. Results There were no significant differences in VAS scores after TAESI between statin users (n = 40) and statin nonusers (n = 253). The SF-36 subgroup: role limitations due to emotional problems score was significantly lower in statin users than statin nonusers. There were no significant between-group differences in any other SF-36 parameter. Conclusion Statin use had no effect on pain scores after TAESI.

Which one is more effective for the clinical treatment of chronic pain in knee osteoarthritis: radiofrequency neurotomy of the genicular nerves or intra-articular injection?

To compare the efficacy of intra‐articular injection and radiofrequency (RF) neurotomy of genicular nerves in patients with chronic knee osteoarthritis (OA) pain.

A influência do ciclo menstrual na dor aguda e persistente após colecistectomia laparoscópica

BACKGROUND AND OBJECTIVES Fluctuations of female sex hormones during menstrual cycle influence pain perception. Endogenous pain inhibition is impaired in follicular phase of menstrual cycle. We tested the primary hypothesis that the women having surgery during their follicular phase have more acute pain and require higher opioids than those in the luteal phase, and secondarily we tested that women who have surgery during their follicular phase have more incisional pain at 3 month postoperatively. METHODS 127 adult females having laparoscopic cholecystectomy were randomized to have surgery during the luteal or follicular phase of their menstrual cycle. Standardized anesthesia and pain management regimen was given to all patients. Pain and analgesic consumption were evaluated in post-anesthesia care unit and every 4h in the first 24h. Adverse effects were questioned every 4h. Time to oral intake and ambulation were recorded. Post-surgical pain, hospital anxiety, depression scale, SF-12 questionnaire were evaluated at 1 and 3 month visits. RESULTS There was no difference in acute pain scores and analgesic consumption through the 24h period, Visual Analog Scale at 24h was 1.5±1.5cm for follicular group 1.4±1.7cm for luteal group (p=0.57). Persistent postoperative pain was significantly more common one and at three month, with an incidence was 33% and 32% in the patients at follicular phase versus 16% and 12% at luteal phase, respectively. The Visual Analog Scale at one and at three month was 1.6±0.7cm and 1.8±0.8cm for follicular group and 2.7±1.3cm and 2.9±1.7cm in the luteal group (p=0.02), respectively. There were no significant differences between the groups with respect to anxiety and depression, SF-12 scores at either time. Nausea was more common in follicular-phase group (p=0.01) and oral feeding time was shorter in follicular phase (5.9±0.9h) than in luteal phase (6.8±1.9h, p=0.02). CONCLUSIONS Although persistent postoperative pain was significantly more common one and three months after surgery the magnitude of the pain was low. Our results do not support scheduling operations to target particular phases of the menstrual cycle.

The use of train of four monitoring for clinical evaluation of the axillary brachial plexus block.

Abstract The axillary approach of brachial plexus anesthesia is the most commonly used technique for forearm and hand surgery. Dynamometer is known as objective test for the clinical assessment of motor block of the nerves in brachial plexus block. However, the use of this device may not always be practical in operating room. The train-of-four (TOF) test is a non-invasive peripheral nerve stimulator that shows the level of motor block of muscle relaxants. The aim of the study is to investigate the use of TOF testing as a peripheral nerve stimulator for objective clinical evaluation of motor block at axillary brachial plexus block. 44 patients were randomized according to the development of partial or complete motor in the axillary brachial plexus block. The nerves were selectively localized by nerve stimulation and ultrasound guidance. After obtaining an appropriate peripheral motor response, predetermined volumes of bupivacaine were selectively injected to the 4 nerves. Sensory, motor block levels and TOF values were measured at 10th, 20th, 30th minutes immediately after the axillary brachial plexus block. TOF values were gradually decreased and significant difference was observed between the development of a complete and partial motor block at 30th minute. TOF values were also significantly less in patients of complete sensory block than the patients of partial sensory block at 30th minute. The use of TOF monitoring may be beneficial to assess the objective clinical effect of motor block in the patients with axillary brachial plexus nerve block.