Suleyman Deniz

A comparison of suprascapular nerve block and procedural sedation analgesia in shoulder dislocation reduction

OBJECTIVES Dislocation of the shoulder joint is one of the most common dislocations. The reduction procedure is a painful procedure. In this study, 2 different treatment groups were compared for pain control during shoulder dislocation reduction. It was aimed to evaluate the differences between the groups in reduction, success, length of hospital stay, complications, side effects, patient-physician satisfaction, and ease of application. METHODS The study was planned to be prospective and randomized. As procedural sedation analgesia (SA), titration of ketamine 1 to 2 mg/kg was administered intravenously to group 1. Suprascapular nerve block (SNB) was applied under ultrasound guidance (USG) to group 2. Conformity to normal distribution of variables was examined with the Kolmogorov-Smirnov test. The χ2 test and Fisher test were used to evaluate differences between the groups in categorical variables and the Mann-Whitney U test, and a value of P<.05 was accepted as statistically significant. RESULTS The study comprised a total of 41 patients; 20 in the group 1 and 21 in the group 2. No statistically significant difference was determined between the groups in terms of age (P=.916), sex (P=.972), reduction success (P=.540), and patient-physician satisfaction (P=.198). The time spent in the emergency department (ED) by patients in the SA group was signficantly longer compared with the SNB group. No side effects were observed in the SNB group. CONCLUSIONS Suprascapular nerve block, which can be easily applied under USG in the ED, can be evaluated as a good alternative to SA in the reduction of shoulder dislocations.

Effect of radiofrequency ablation and comparison with surgical sympathectomy in palmar hyperhidrosis

OBJECTIVES Hyperhidrosis is a the disorder of excessive sweating in certain regions of the body. It is usually treated with surgical sympathectomy. Radiofrequency therapy has been successfully used for sympatholysis. We tested the primary hypothesis that radiofrequency therapy is independently associated with decreased palmar hyperhidrosis and compared results for patients receiving this treatment with patients who underwent surgical sympathectomy. METHODS We included all the patients undergoing treatment for hyperhidrosis between March 2010 and April 2012. Patients who underwent either surgical sympathectomy or radiofrequency ablation for palmar hyperhidrosis were included and analysed. The outcomes studied included complications, success of the procedure, patient satisfaction with their procedure and compensatory hyperhidrosis. RESULTS There were 94 patients who met our criteria, of whom 46 (49%) had surgical sympathectomy and 48 (51%) had radiofrequency ablation performed. Radiofrequency had a success rate of 75% in treating hyperhidrosis, but this was found to be statistically lower than for surgical sympathectomy (95%; P < 0.01). The groups were similar regarding patient satisfaction (P = 0.26) and compensatory hyperhidrosis (P = 0.78). CONCLUSIONS This is the first clinical study to evaluate the role of radiofrequency ablation and compare it with the surgical treatment option for palmar hyperhidrosis. Radiofrequency ablation significantly decreased hyperhidrosis, but it had a lower success rate than surgical sympathectomy.

A new target of percutaneus sympathic radiofrequency thermocoagulation for treatment of palmar hyperhidrosis: T4.

OBJECTIVES Hyperhidrosis is thought to result from a functional impairment of the sympathic nervous system. In this study, percutaneous T4 sympathic radiofrequency (RF) thermocoagulation was used to treat palmar hyperhidrosis which does not respond to conservative treatment. The results were evaluated in terms of safety, efficiency and patient satisfaction. METHODS In this study, 15 patients aged 16-48 years were retrospectively evaluated from prior records. Patient satisfaction scores (very satisfied, satisfied, not satisfied), after treatment of the hand condition (dry, mild dry, no improvement), and whether the most common complication and most patients expressed by the compensatory hyperhidrosis (CH) degree (none, mild, moderate, severe) were analyzed. RESULTS No complications were observed except a coughing crisis that lasted for 2 hours in one patient, transient bradycardia in 1 patient and transient injection site pain in all cases. Two patients 1 per week and three patients 1, 2 and 6 months developed recurrence. CONCLUSION Sympathic T4 ablation with RF thermocoagulation was found to have long term (6 months) patient satisfaction (80%). It was also effective in reducing the hand sweating (80% dry or mild dry). The CH rate was 27%. According to our results, sympathic T4 ablation with RF thermocoagulation is a safe and effective treatment with a high degree of patient satisfaction.

Comparison of the postoperative analgesic efficacy of an ultrasound-guided fascia iliaca compartment block versus 3 in 1 block in hip prosthesis surgery.

OBJECTIVES In this study, we aimed to compare the postoperative analgesic efficiency of an ultrasound-guided fascia iliaca compartment block and a 3 in 1 block in patients who underwent hip prosthesis surgery as a result of hip fracture. METHODS With approval from the local ethics committee, 70 patients, aged 20 to 80, undergoing hip prosthesis surgery under elective conditions were included in this randomized, prospective, controlled study. They were informed of the patient-controlled analgesia (PCA) device and visual analog scale (VAS). All patients were separated randomly into three groups. Anaesthesia induction was standardized for all groups. An ultrasound guidance fascia iliaca compartment block (FICB) was applied to the first group before anaesthesia induction. For the second group, a 3 in 1 block was applied, while for the control group no block was applied. After incision on all patients, 20 mg tenoxicam and 1 mg/kg tramadol were injected intravenously. Following surgery, IV tramadol PCA was begun on all patients routinely. In our study, the presence of cortisol and ACTH levels, hemodinamical parameters, nausea and sedation were determined. RESULTS We observed a decrease in VAS values and opioid consumption, no adverse effects on nausea and sedation, and a suppression of stress hormones in both the ultrasound-guided FICB and 3 in 1 block groups. CONCLUSION We believe that the safe and efficient application of the ultrasound-guided 3 in 1 block and the FICB is necessary in multimodal analgesic treatment in order to enable postoperative analgesia in hip prosthesis surgery.

Ultrasound-guided pulsed radio frequency treatment in Morton's neuroma.

BACKGROUND Mortons neuroma is a perineural fibrosis of an intermetatarsal plantar nerve. Burning, numbness, paresthesia, and tingling down the interspaces of involved toes may also be experienced. Taking into account all of this information, we designed a prospective open-label study to evaluate the efficacy of pulsed radio frequency on Mortons neuroma. METHODS Twenty patients with Mortons neuroma were experiencing symptomatic neuroma pain in the foot not relieved by routine conservative treatment. All of the patients had been evaluated by a specialized orthopedist and were offered pulsed radio frequency as a last option before having surgery. Initially, pain level (numerical rating scale), successful pain control (a ≥50% pain decrease was accepted as successful pain control), comfort when walking (yes or no), and satisfaction level (satisfied or not satisfied) were evaluated. RESULTS We found a decrease in the pain level in 18 of 20 patients, successful pain control in 12, and wearing shoes and walking without pain in 16. Overall, satisfaction was rated as excellent or good by 12 patients with Mortons neuroma in this series. CONCLUSIONS This evidence indicates that ultrasound-guided pulsed radio frequency is a promising treatment modality in the management of Mortons neuroma pain.

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 cannulation of radial artery with anatomic variation.

most common epidural analgesics used and thus were selected as the comparison groups for our study. The vast majority of studies use a local anesthetic and an opioid in the epidural infusion. Thus, we stand by the results of our study, which showed safe and effective modes of postoperative analgesia. We are grateful to Drs Liang et al for the opportunity to reiterate the following main findings of our clinical study: (1) a paravertebral block represents a viable alternative to thoracic epidural analgesia in patients who may not be suitable neuraxial candidates, (2) hydromorphone deserves consideration as an effective neuraxial opioid for acute postoperative pain, and (3) combination therapy with an epidural opioid and a local anesthetic (in this case bupivacaine and hydromorphone) may be superior to local anesthetic alone. We are thankful for the opportunity to discuss our work.

Effects of dexpanthenol and N-acetylcysteine pretreatment in rats before renal ischemia/reperfusion injury

Abstract Background: We investigated the anti-inflammatory and protective effects of concomitant use of dexpanthenol (DXP) and N-acetylcysteine (NAC) induced ischemia/reperfusion (I/R) injury of kidney. Methods: Forty rats were randomly divided into 5 groups. In all groups except for Group 1(Sham), renal arteries bilaterally occluded with vascular clamp for IR injury. Group 1(Sham), received a single dose of 10 mL/kg isotonic saline daily by intraperitoneal (IP) injection for three days. Group 2(IR), received a single dose of 10 mL/kg isotonic saline daily by IP injection for three days. Group 3(IR + NAC), received 300 mg/kg NAC daily by IP injection for three days. Group 4(IR + DXP), received 500 mg/kg DXP daily by IP injection for three days. Group 5(IR + NAC + DXP), received 500 mg/kg DXP and 300 mg/kg NAC daily by IP injection for three days. Serum urea (BUN), creatinine (Cr) and neutrophil gelatinase-associated lipocalin (NGAL, lipocalin 2, siderocalin) levels were measured as kidney function tests. TNF-α levels were measured as inflammatory marker. Tissue sections were evaluated histopathologically under light microscopy. Results: IR + NAC + DXP group received both NAC and DXP before induction of renal I/R and as the biochemical and histopathological data revealed the results of the IR + NAC + DXP group and sham group were similar. Biochemically and histopathologically, combined use of NAC and DXP has better results when each of them used alone. Conclusion: We concluded that concomitant use of DXP and NAC plays a major role against I/R injury and may be useful in acute treatment of I/R induced renal failure.

0726. The effects of carnitine on renal tissue damage and metabolic alteration among the rat intraabdominal sepsis model

Sepsis is a systematic inflammatory reaction that causes renal damage frequently. Carnitine is considered as an essential mediator of metabolic pathway during sepsis and critical conditions. It has an important role in facilitating medium- and long-chain fatty acid transport from the cytosol into mitochondria for β-oxidation and energy generation [1].

Effects of the menstrual cycle on injection pain due to rocuronium

STUDY OBJECTIVE To investigate the effect of the menstrual cycle on rocuronium injection pain. DESIGN Prospective, randomized, double-blinded study. SETTING Academic medical center. PATIENTS 80 ASA physical status 1 and 2 women scheduled for elective surgery with general anesthesia. MEASUREMENTS Patients were divided into two groups according to their time in the menstrual cycle. Forty patients at days 8 to 12 of the menstrual cycle were considered to be at the follicular phase (Group F), and 40 patients at days 20 to 24 of the menstrual cycle were considered to be at the luteal phase (Group L).Withdrawal movements were recorded. MAIN RESULTS Overall frequency of withdrawal movements was significantly higher in Group L than Group F (P < 0.001). The mean withdrawal movement score was 1.77 ± 0.76 in Group L and 0.52 ± 0.67 in Group F. CONCLUSION Menstrual cycle phases affect the severity of rocuronium injection pain. Women exhibit greater pain sensitivity from rocuronium injection in the luteal phase than the follicular phase.