Tolga Ergönenç

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.

Retrospective Review of Pilonidal Sinus Patients With Early Discharge After Limberg Flap Procedure

The aim of this study was to evaluate the results of cases with pilonidal sinus (PS) disease that underwent Limberg flap (LF) transposition and to compare the short and long-term results of early discharge cases with those in the literature. A total of 345 patients who underwent rhomboid excision and LF transposition for PS were evaluated retrospectively. No major anesthetic or surgical complications occurred. Partial wound dehiscence, localized flap necrosis, hematoma, wound infection, and seroma rates were determined as 4.0, 2.1, 1.5, 3.3, and 3.7% respectively. All patients other than those with a hematoma or localized necrosis were discharged with a drain in place 24 hours after the operation. The recurrence rate was 3.9% after a mean 33.1-month follow-up (range, 6-72 months). As a result, we found that short and long-term results of patients who underwent LF and were discharged 24 hours after the operation were similar to those in the literature. We suggest that patients without postoperative complications, such as hematoma or flap necrosis, can be discharged early.

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.

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.

The recovery time of sevoflurane and desflurane and the effects of anesthesia on mental and psychomotor functions and pain.

Background: Inhalation anesthetics have many advantages for outpatient general anesthesia, such as minimal postoperative side-effects and rapid and full recovery. The aim of this randomized study was to compare the postoperative recovery time of sevoflurane and desflurane and to observe the effects of anesthesia on mental, psychomotor and cognitive functions and pain in outpatients undergoing arthroscopic surgery. Patients and Methods: This study included 40 American Society of Anesthesiologists I-II patients who were divided into two groups via sealed envelopes. For maintenance of anesthesia, a mixture of 66% N2O and 33% O2 and 4–7% desflurane was used in Group D, and a mixture of 66% N2O and 33% O2 and 1–2.5% sevoflurane was used in Group S. The modified Aldrete score (MAS) was evaluated postoperatively at time points determined previously. An MAS of 8 or higher was considered to indicate alertness. Mental and psychomotor functions of the patients were evaluated using the short cognitive examination (SCE), and postoperative pain levels were evaluated using the visual analogue scale (VAS). Results: There was no difference between the groups in terms of demographic data (P > 0.05). The mean time to reach MAS 8, eye-opening, and orientation were higher in Group S as compared to Group D (P < 0.01). The mean MAS initially and at 5 and 10 min was higher in Group D as compared to Group S (P < 0.001). The mean SCE at 5 and 15 min was higher in Group D as compared to Group S (P < 0.01). There was no significant difference between the groups in terms of VAS scores (P > 0.05). Conclusion: It has been determined that desflurane provided better quality and more rapid recovery than sevoflurane, and the return of cognitive functions in the early postoperative period was faster. In conclusion, both agents can apparently be used safely in outpatient anesthetic procedures.

A Catastrophic Neurologic Complication Following Spinal Anaesthesia: Intracerebral Haematoma

Intracerebral haematoma following spinal anaesthesia is a very uncommon neurologic complication and the mechanism of intracerebral haematoma following dural puncture is not known. An 87-year-old man, who did not have any neurologic or coagulation disorder, received spinal anaesthesia for transurethral prostatectomy. Approximately 2.5 hours after spinal injection, he developed headache, slurred speech and somnolence, and brain CT revealed intracerebral haematoma. The patient was admitted to the intensive care unit and was intubated and connected to mechanical ventilator. The patient died on the 6 th postoperative day. It should be kept in mind that irreversible brain damage can develop in neurological disorders that develop soon after spinal anaesthesia and that these should be promptly evaluated radiologically.

Comparison of the intravenous and epidural administration of tumor necrosis factor-alpha antagonists in an experimental rat pain model

Introduction: Inflammatory cytokines secreted from the nucleus pulposus are thought to lead to lumbar nerve root compression-like symptoms. Tumor necrosis factor-alpha (TNF-α), an inflammatory cytokine, likely plays an important role in lumbar disc hernia-related leg pain. In this experimental study, we compared the effectiveness of TNF-α antagonists administered through the intravenous or epidural route in lumbar spine pathologies. Materials and Methods: After ethics committee approval had been obtained, 24 Sprague Dawley male rats aged 70–90 days and weighing 250–300 g each were allocated to four groups. In Group I, only the surgical procedure was performed; in Group II, 1 ml of saline solution was administered into the epidural field; in Group III, 10 mg/kg of infliximab was administered into the coccygeal vein; and in Group IV (epidural group), 25 mg of etanercept was administered into the epidural region. Results: When the left leg pull values were analyzed on day 14, whereas there was not a significant difference among the three groups, a decreasing difference was observed in Group IV (P < 0.05). When the 21st and 28th day left leg pull values were compared between groups, the values from Groups II, III, and IV were significantly lower than those of Group I (P < 0.05). Conclusion: The absence of a difference between the baseline values and left leg pull values on days 14, 21, and 28 in Group IV indicates that recovery began on day 21 with the epidural administration of etanercept. There was no difference between intravenous saline administration and intravenous infliximab administration with regard to the start of the recovery. In the present study of rats with discopathy, TNF-α antagonists administered epidurally led to earlier recovery from radiculopathy-related allodynia compared to intravenous administration.

Entübasyona bağlı hemodinamik yanıtın kontrolünde esmolol ve lidokainin etkinliğinin karşılaştırılması: Randomize kontrollü çalışma

Objectives: The purpose of this randomized study is to compare the effects of esmolol and lidocaine in the control of hemodynamic response caused by endotracheal intubation. Methods: In this study, 40 patients with ASA I-II physical status and between the ages of 19 and 76 were included and randomly divided into two groups. In the Group E (n = 20), iv bolus injection of 1.5 mg/kg esmolol, in the Group L (n = 20), iv bolus injection of 1.5 mg/kg 2% lidocaine were given with iv bolus injection in 30 seconds. All patients received the same anesthetic technique. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean blood pressure (MBP) and heart rate measurements were done at specified times and recorded. Re cords were assessed by an anesthesiologist blinded to which drug is applied. Results: There was no difference between the groups in demographic data (p>0.05). In both groups, with the implementation of the study drug, systolic blood pressure, diastolic blood pressure and mean arterial blood pressure decreased compared to controls, this reduction was lower in Group E than Group L. In Group L, SBP values of 1.5 and 7 minutes were higher than Group E (p <0.05). In Group L, DBP and MBP values of 1.5 and 3.5 minutes were higher than Group E (p <0.05). Conclusion: In conclusion, 1.5 mg/kg esmolol or 1.5 mg/ kg lidocaine administered prior to induction were not superior to each other regarding suppression of hemodynamic responses to intubation. J Clin Exp Invest 2013; 4 (1): 20-27