Suleyman Ozyalcin

The effects of three different analgesia techniques on long-term postthoracotomy pain.

In this clinical, randomized, prospective study, we compared the effects of three different analgesia techniques (thoracic epidural analgesia [TEA] with and without preoperative initiation and IV patient-controlled analgesia [IV-PCA]) on postthoracotomy pain in 69 patients. In two groups, a thoracic epidural catheter was inserted preoperatively. Group Pre-TEA had bupivacaine and morphine solution preoperatively and intraoperatively. Postoperative analgesia was maintained with epidural PCA with a similar solution. Group Post-TEA, with no intraoperative medication, had the same postoperative analgesia as Group Pre-TEA plus the bolus dose. Group IV-PCA received only IV-PCA with morphine for postoperative analgesia. Pain was evaluated every 4 h during the first 48 h at rest, cough, and movement. Pre-TEA was associated with decreased pain compared with the other groups. Six months later, the patients were asked about their pain. The incidence and the intensity of pain were most frequent in Group IV-PCA (78%) and were the least in Group Pre-TEA (45%) (Group Pre-TEA versus Group IV-PCA, P = 0.0233; Group Pre-TEA versus Group IV-PCA, P = 0.014). Patients having pain on the second postoperative day had 83% chronic pain. TEA with preoperative initiation is a preferable method in preventing acute and long-term thoracotomy pain.

The Efficacy and Safety of Venlafaxine in the Prophylaxis of Migraine

Objective.—To evaluate the efficacy and safety of venlafaxine in the prophylaxis of migraine.

The effect of venlafaxine on ongoing and experimentally induced pain in neuropathic pain patients: a double blind, placebo controlled study

Background and aim The aim of this randomized double blind placebo controlled study was to investigate the effectiveness and the safety of venlafaxine XR 75 and 150 mg on ongoing pain and on quantitative sensory tests in 60 patients with neuropathic pain for 8 weeks.

Neurotoxicity of midazolam in the rabbit

Safe and efficient use of spinal drugs requires neurotoxicologic animal studies before ethical application. We have evaluated the neurotoxicologic interruptions of intrathecal administration of midazolam in rabbits. Eighteen white New Zealand rabbits were randomly assigned into three groups consisting of six rabbits each. In conscious animals, 0.3 ml 0.9% normal saline solution, 0.3 ml 0.1% midazolam (Roche, Dormicum) or 0.3 ml preservative free midazolam were intrathecally administered. Light and fluorescence microscopy evaluations were performed on transverse spinal cord sections by a neurohistopathologist in a blind fashion. Midazolam and preservative free midazolam treated rabbits showed significant histologic changes in light and fluorescence microscopy. The histologic and vascular lesions with the use of midazolam and preservative free midazolam suggested neurotoxic effects; thus chronic intrathecal administration of midazolam should be avoided in humans.

Effect of agmatine on acute and mononeuropathic pain.

Abstract: Agmatine is a polycationic amine synthesized from L‐arginine by arginine decarboxylase in brain and several tissues. It binds to N‐methyl‐D‐aspartate (NMDA) subtype of glutamatergic, a2‐adrenergic and imidazoline (I) receptors. The present study was designed to investigate effect of agmatine on acute and mononeuropathic pain after chronic constriction injury (CCI). CCI was created by four loose ligations around the right sciatic nerve. The analgesic threshold in rats was evaluated by using thermal hyperalgesia/allodynia (THA) at 4°C. The evaluations were made preoperatively, on postoperative day 15, and after drug administration. Agmatine (10, 20, 40, 80, and 100 mg/kg) was administered intraperitoneally for 5 days beginning on postoperative day 15. Agmatine significantly reduced the hyperalgesia in all doses applied. When agmatine was injected intraperitoneally (10, 20, 40, 80, and 100 mg/kg), it increased the nociceptive threshold in the tail‐immersion test in a dose‐dependent manner, but it had no effect in the hot‐plate test. This effect of agmatine in the tail‐immersion test was blocked by both yohimbine (1 mg/kg) and idazoxan (0.5 mg/kg). When agmatine was administered intracerebroventricularly (25‐200 mg/10 mL), it increased the nociceptive threshold in the hot‐plate but not in the tail‐immersion test. We conclude that agmatine, an endogenous substance derived from arginine, can modulate both acute and chronic pain.

Superior cluneal nerve entrapment

Background and Objectives Pain due to superior cluneal nerve entrapment is an infrequent cause of unilateral low back pain. Here we present a case of acute unilateral low back pain treated by superior cluneal nerve (SCN) block. Case Report A 55-year-old woman presented to the outpatient clinic suffering from unilateral low back pain localized to right iliac crest and radiating to the right buttock. Her history was taken, physical examination was performed, and a thorough radiologic evaluation was performed to minimize radiculopathy and facet syndromes as causative. After transient pain relief with a diagnostic trigger point injection, entrapment of SCN was diagnosed and therapeutic nerve block with local anesthetic and steroid combination was performed. Conclusion SCN is prone to entrapment where it passes through the fascia near the posterior iliac crest. Unilateral low back pain and deep tenderness radiating to the ipsilateral buttock are the clinical findings accompanying SCN entrapment. The case presented emphasizes the relief of possible SCN after limiting other etiologic causes of low back pain.

Childhood traumatic events and dissociative experiences in patients with chronic headache and low back pain

ObjectiveThe aim of this study was to examine childhood traumatic experiences and dissociative characteristics in women with chronic headache and low back pain. SettingThe patients were evaluated in the multidisciplinary pain clinic of a university hospital. SubjectsThis study included 73 patients: 41 with chronic headache and 32 with chronic low back pain. Outcome MeasuresAll the patients were assessed with use of a semistructured questionnaire, the Dissociative Experiences Scale (DES), the Somatoform Dissociation Questionnaire (SDQ), and the Childhood Abuse and Neglect Questionnaire. Results and ConclusionsThere were no significant differences between the headache and low back pain groups in terms of prevalence of history of neglect; abuse; or sexual, physical, and emotional abuse separately. In addition, no significant differences were found between the groups with respect to the Dissociative Experiences Scale scores. However, analysis of the SDQ scores showed that the neglect rate in the two groups differed significantly. According to our findings, the neglect rate was higher in the headache group, thus warranting further research to investigate the sensitivity of the SDQ for neglect.

Effect of Harmane on Mononeuropathic Pain in Rats

Abstract: This study was designed to investigate the effect of the endogenous b‐carboline, harmane, on neuropathic pain produced by chronic constriction injury (CCI) of the sciatic nerve. Thermal allodynia evaluations were made preoperatively, postoperatively on the fifteenth day, and after harmane administration. Harmane (1, 2.5, 5, 10, or 20 mg/kg) was administered intraperitoneally for 5 days beginning from postoperative day 15. Treatment with harmane had a profound anti‐allodynic effect in a dose‐dependent manner. In conclusion, harmane might provide a new approach to treatment of neuropathic pain.

Cranial Magnetic Resonance Imaging in Spontaneous Intracranial Hypotension after Epidural Blood Patch

▪ Abstract:  Spontaneous intracranial hypotension (SIH) is a syndrome characterized by orthostatic headache, nausea, vomiting, photophobia, and diplopia. Subdural effusion, diffuse dural enhancement, dilatation of epidural veins, and increased height of hypophysis are cranial magnetic resonance (MR) imaging findings in SIH. Epidural blood patch is reportedly one of the effective treatment options. We present the follow‐up MR imaging findings in a case of SIH after a successful epidural blood patch treatment. We propose that cranial MR imaging as an objective test to evaluate the success of epidural blood patch treatment. ▪

Perioperative dexketoprofen or lornoxicam administration for pain management after major orthopedic surgery: a randomized, controlled study.

OBJECTIVE Non-steroidal anti-inflammatory drugs (NSAIDs) are recommended for multimodal postoperative pain management. The purpose of this study was to evaluate the postoperative pain relief and opioid-sparing effects of dexketoprofen and lornoxicam after major orthopedic surgery. METHODS After obtaining ethical committee approval and informed consent, 120 patients undergoing elective hip or knee replacement under general anesthesia were randomized to receive two intravenous injections of 50 mg dexketoprofen (GD), 8 mg lornoxicam (GL) or saline as placebo (GP) intravenously. Postoperatively, patient-controlled analgesia (PCA) morphine was started as a 0.01 mg.kg-1 bolus dose, with lockout time of 10 minutes without continuous infusion. Pain assessment was made using the Visual Analogue Scale (VAS) at rest or during movement at postoperative 1, 2, 4, 6, 8, 12, and 24 hours. RESULTS The three groups were similar in terms of age, gender, American Society of Anesthesiologists (ASA) class, number of patients who underwent hip or knee surgery, weight, height, and operation duration. Patients in GD and GL demonstrated significantly reduced pain scores at rest and active motion compared to GP, with lower scores in the dexketoprofen group. Patients in GD and GL used significantly less morphine in the postoperative period compared to GP. The total morphine consumption of patients in GD was lower than in GL. CONCLUSION Intravenous application of 50 mg dexketoprofen twice a day and 8 mg lornoxicam twice a day improved analgesia and decreased morphine consumption following major orthopedic surgery. When the two active drugs were compared, it was found that dexketoprofen was superior to lornoxicam in terms of analgesic efficacy and opioid consumption.