Prolonged Effect of Repetitive Erector Spinae Plane Block in Reducing Thoracic Pain Caused by Lung Cancer.

INTRODUCTION: Pain significantly affects the quality of life of lung cancer patients. We aimed to evaluate the effect of the erector spinae plane block (ESPB) on pain in these patients. METHODS: We reviewed the medical records of patients with primary lung and bronchial cancer who experienced refractory pain in the thoracic region and underwent repeated ESPBs (three blocks at 24-hour intervals) between 2019 and 2020 in this single-center retrospective study. Visual analog scale (VAS) scores recorded before the procedure and on the first day (first day after the third block) and the first and third months of follow-up in 43 patients were analyzed.  Results: The study population consisted of 31 male and 12 female patients, with a mean age of 56.7 years. The mean pre-procedure VAS score was 8.9±0.8, which showed a significant decrease on the first day (2.9), first month (3.6), and third month (4.6) of the follow-up. Four patients experienced minor complications (pain at the procedure site and hypotension); however, no major complications were observed. CONCLUSION: We observed a prolonged effect of repeated ESPBs for ≥3 months. The block efficacy decreased with time; however, an approximately 50% reduction in the VAS score persisted even in the third month. Repetitive ESPBs may be regarded as a straightforward, safe, and replicable intervention to complement medical treatment and diminish the need for opioids in managing lung cancer-related pain.

Pain beliefs of chronic headache patients.

OBJECTIVES: This study was designed to explore the origin of the pain beliefs of chronic headache patients. METHODS: This qualitative research has been designed using a case study method. Selected using the criterion sampling method, patients consisted of a total of six chronic headache patients in algology outpatient clinic at a University Hospital in Turkey. The data were collected using focus group methods. Data were obtained using a semi-structured interview form composed of eight open-ended questions. Data were evaluated by analyzing both descriptive and content data. RESULTS: Chronic headache patients' views on why they have pain and which beliefs they have about origin of the pain have three subthemes: (1) Organic beliefs, (2) psychological beliefs, and (3) environmental beliefs. Patients' most frequently cited organic beliefs were genetics (familial) and physiological (tissue damage, surgery, and lifting of heavy objects). Patients' most frequently cited psychological beliefs were stress, sadness, and having a sensitive personality. CONCLUSION: It is suggested to take pain beliefs differences and qualitative research into consideration in the management of pain in nursing care.

Fluoroscopically guided transforaminal epidural catheterization of the ankylosing spondylitis.

Ankylosing spondylitis (AS) is a chronic, progressive, autoimmune collagen tissue disease characterized by inflammation and lower back pain. General anesthesia may pose a high risk in the AS due to intubation difficulty, as well as affected respiratory and cardiovascular organs. In cases of involvement of the vertebrae, neuraxial anesthesia may be difficult or even impossible. In this article, we discuss a case of AS that received a successful an epidural catheter was placed using a transforaminal route under C-arm fluoroscopy guidance for total hip replacement surgery, which was difficult due to intubation and an interlaminar neuraxial anesthesia.

Anxiety, depression and coping behaviors with pain in cancer patients who are aware or unaware of their cancer.

OBJECTIVES: This study aimed to investigate whether there are differences in depression, anxiety, pain and styles of coping with pain between cancer patients with and without awareness of their cancer diagnosis. METHODS: In this study, 30 cancer patients aware of their diagnosis and 30 cancer patients unaware of their diagnosis, all of whom visited a clinic for pain treatment, were enrolled in this study. A sociodemographic information form, a questionnaire comprising questions about pain severity and related variables, Hospital Anxiety Depression Scale, and the Pain Coping Questionnaire were administered to the patients. RESULTS: No significant association was observed between the patients with awareness or unawareness of cancer with respect to anxiety, depression, pain severity, or coping with pain. Pain intensity was significantly associated with depression in both the patient groups. CONCLUSION: The study enrolled patients who were admitted for pain treatment, and the sampling group was small. However, this is the first study to investigate the effects of the awareness of cancer diagnosis on pain and its management.

Coping with the pain of elderly pain patients: Nursing approach.

OBJECTIVES: This study was designed to examine methods used by elderly patients to cope with pain and serve as a guide for nurses. METHODS: This descriptive survey was carried out with geriatric patients (n=100) aged 60 years or more in inpatient Algology Unit of a university hospital between November 28, 2014 and January 28, 2015. Data were collected using descriptive characteristics questionnaire prepared based on review of the literature and via one-on-one interviews using Pain Coping Questionnaire (PCQ). Data were evaluated using descriptive statistical methods, Independent sample t-test, one-way analysis of variance test, and Pearson correlation coefficient. RESULTS: Duration of pain experienced by the patients ranged from 1 month to 40 years, with mean duration of 63.57±82.65 months. Mean subscale scores of PCQ were: self-management, 19.22±6.54; helplessness, 13.45±3.86; conscious coping efforts, 11.90±3.97; and medical remedies, 12.62±3.98. Score of the patients who reported that they could manage their pain on their own (p<0.05), and of those who relied on medical remedies, believing that pain control is in the hands of nurses (p<0.05), were significantly higher. CONCLUSION: Means of coping with pain vary in geriatric patients and it is recommended that these differences be taken into account in nursing interventions.

Preventive effect of dexketoprofen on postoperative pain.

OBJECTIVES: Preventive analgesia has been defined as reduction in noxious stimuli during preoperative, intraoperative, and postoperative periods. The aim of the present study was to prevent central sensitization by administering ketamine infusion throughout the surgical procedure. In addition, possible preventive effects of dexketoprofen when administered before and after incision were evaluated. METHODS: Fifty patients were included. Group I was administered 50 mg intravenous dexketoprofen prior to surgical incision, and Group II received the same amount 10 minutes after the incision had been made. Following induction of general anesthesia, all patients received a bolus of 0.50 mg/kg ketamine in 0.07 mg/kg/h intravenous infusion. RESULTS: When postoperative visual analog scale values were compared, values for Group I after 1 and 4 hours were significantly lower than those of Group II. In addition, morphine consumption at 4, 8, 12, and 24 hours was significantly lower in Group I. CONCLUSION: Combined with the prevention of central sensitization with ketamine, administration of dexketoprofen prior to incision led to a lower rate of morphine consumption and more effective analgesia than post-incision administration.

The Relationship Between Pain Beliefs and Coping with Pain of Algology Patients'.

A patient's beliefs, expectations, and attitudes about coping with pain are effective on the patient's pain control. The aim of this investigation was to evaluate the correlation between pain beliefs and coping with pain in algology patients. This descriptive study was carried out with 201 patients at a University Hospital Algology Clinic between May and July 2014. The research instruments used included a Descriptive Characteristics Data Form, Pain Beliefs Questionnaire, and Pain Coping Questionnaire. Data were evaluated by descriptive statistical methods, Spearman's correlation, and the Mann-Whitney U and Kruskal-Wallis tests. According to the findings, the duration of pain in the patients ranged from 1 month to 40 years, with a mean duration of 68.37 ± 89.42 months. Patients' organic beliefs mean score was 3.97 ± 0.78 and the psychological beliefs mean score was 5.01 ± 1.01. There was a significant negative correlation between patients' organic beliefs score and the self-management (p < .001, r = -.388) and conscious cognitive interventions scores (p < .001, r = -.331); with the helplessness score (p < .001, r = .365) there was a positive correlation. There was also a positive correlation between patients' psychological beliefs score and self-management score (p < .05, r = .162). Moreover, there is significant difference between organic beliefs score and patients who use opioid analgesic. Patients who believe that their pain's origin is a organic cause, such as damage and harm in the body, cannot cope with pain and feel more helplessness. Appropriate nursing interventions for individuals' pain beliefs should be implemented to nursing care plans on pain management.

[The effect of flunarizine pretreatment on postoperative morphine consumption]. / Flunarizin ön tedavisinin postoperatif morfin tüketimine etkisi.

OBJECTIVES: This study was designed to document the effects 10 mg flunarizine, administrated in the preoperative period, on postoperative morphine requirement and analgesic quality, in abdominal surgery. METHODS: Thirty patients, aged 18 to 55 years, were studied. Patients were randomly allocated to one of two equally sized groups, and received either 2 capsules of 5 mg flunarizine (Group I) or 2 placebo capsules (Group II) 2 hours before the operation, immediately after the extubation and at the 15th minute, Aldrete postanesthesia recovery scores were assessed. In the postoperative period, patients were connected to a patient-controlled analgesia device for intravenous morphine, and the first analgesic requirement time was recorded. Ramsay sedation scale, visual analogue pain scale and morphine consumption were assessed after the extubation. RESULTS: Systolic arterial pressures at the 5th minute of the preoperative period were significantly lower in the flunarizine group than placebo group. Heart rates in the 45th minute were also lower in the flunarizine group. Flunarizine patients reported statistically lower visual analogue pain scale values in the postoperative 12th hour. There was no significant difference in postoperative sedation scores between the groups. Flunarizine did not lengthen the first analgesic requirement time and similarly did not lessen the morphine requirement. CONCLUSION: We conclude that 10 mg flunarizine administered in the preoperative period had no significant effects on clinical parameters, had no analgesic effect and did not augment the analgesic effects of morphine at this dose.

Possible heart failure associated with pregabalin use: case report.

Pregabalin and gabapentin are widely used analgesic, anticonvulsant and anxiolytic agents as they are relatively reliable and easily tolerated. However, they may cause some side effects such as dizziness, somnolence, dose-dependent peripheral edema, and weight gain, which may cause patients to abandon their use. Furthermore, there are a few reports in the literature addressing elderly patients with serious chronic disease and cardiac history, who develop heart failure during pregabalin application. In this report, we present a patient with no cardiac history treated with 300 mg/kg pregabalin due to neuropathic pain, who developed peripheral and then central edema, which were determined after advanced investigations. After stopping pregabalin, the situation regressed. Then, peripheral edema developed associated with the recommended dose of gabapentin, which was used in place of pregabalin. Despite the lack of any published evidence, the New York Heart Association issued a warning about using caution when prescribing pregabalin to type III-IV heart failure patients. Though the effect mechanisms of pregabalin and gabapentin are not well known, the calcium channel relationship may lead to these side effects. In summary, we believe that pregabalin and gabapentin, which is mostly used nowadays, should be administered with care not only in patients with advanced cardiac pathology but also in all patients, due to the potential side effects.

Lornoxicam in extracorporeal shock-wave lithotripsy; comparison with tenoxicam and placebo in terms of analgesic consumption.

OBJECTIVE: To assess the analgesic efficacy of lornoxicam and compare it with that of tenoxicam in patients undergoing extracorporeal shock-wave lithotripsy (ESWL) for renal stones. MATERIAL AND METHODS: The study was carried out in a randomized, double-blind fashion and involved 60 patients (American Society of Anesthesiologists physical status I-II) undergoing ESWL who were divided into three groups. Patients in the placebo group (n = 20) received saline and those in the lornoxicam group (n = 20) received lornoxicam 8 mg intravenously 60 min before the procedure. In the tenoxicam group, patients (n = 20) received tenoxicam 20 mg intravenously at the same time point. All patients were started on patient-controlled i.v. meperidine analgesia during the procedure. The effectiveness was assessed by using a visual analog scale (VAS) and by calculating the total analgesic consumption of meperidine during the procedure. Arterial blood pressure, oxygen saturation, and respiratory rate were recorded throughout the procedure; nausea and vomiting, agitation, and respiratory depression were assessed. RESULTS: Compared with patients in the placebo group, patients in the lornoxicam and tenoxicam groups received smaller doses of meperidine at all time points (p < 0.05). After 30, 45, and 60 min of ESWL, patients in the lornoxicam group required significantly smaller doses of meperidine than those in the tenoxicam group (p < 0.05). Patients in the placebo group showed higher VAS scores than those in the lornoxicam and tenoxicam groups at 15, 30 and 60 min. The VAS score in the lornoxicam group was lower than that in the tenoxicam group at 15, 30, and 45 min, but the difference between the groups was statistically significant only at 45 min (1 and 3, respectively; p < 0.05). CONCLUSION: In patients undergoing ESWL the i.v. administration of a single dose of 8 mg lornoxicam provides significantly better pain control compared with tenoxicam 20 mg and placebo, without increasing adverse side-effects.

Effects of tramadol on myocardial ischemia-reperfusion injury.

OBJECTIVES: The aim of the present study was to evaluate the effect of tramadol on isolated rat hearts subjected to global ischemia-reperfusion injury. DESIGN: Langerdorff perfused isolated rat hearts were subjected to 60 min of global ischemia following 60 min of reperfusion. In group I and III hearts were received tramadol before the onset of ischemia. Following the ischemic period, group II and III hearts were received tramadol infusion. Group I and IV hearts were subjected to saline at the same time point. The myocardial postischemic recovery was compared using hemodynamic, coronary flow, biochemical parameters from coronary effluent, and oxidative stress markers from heart tissue homogenates. RESULTS: There were significant differences between tramadol and saline used groups in hemodynamic parameters. GPx values of groups I and III were significantly lower than group IV (p<0.05). SOD values of groups I, II and III were higher than group IV (p<0.05). LDH values of groups I and II were significantly lower than groups III and IV (p<0.05). CONCLUSION: Tramadol provides a cardioprotective effect against myocardial ischemia-reperfusion in isolated rat heart.

Cauda equina syndrome after epidural steroid injection: a case report.

OBJECTIVE: Conventional treatment methods of lumbusacral radiculopathy are physical therapy, epidural steroid injections, oral medications, and spinal manipulative therapy. Cauda equina syndrome is a rare complication of epidural anesthesia. The following case is a report of cauda equina syndrome possibly caused by epidural injection of triamcinolone and bupivacaine. CLINICAL FEATURES: A 50-year-old woman with low back and right leg pain was scheduled for epidural steroid injection. INTERVENTION AND OUTCOME: An 18-gauge Touhy needle was inserted until loss of resistance occurred at the L4-5 level. Spread of the contrast medium within the epidural space was determined by radiographic imaging. After verifying the epidural space, bupivacaine and triamcinolone diacetate were injected. After the injection, there was a reduction in radicular symptoms. Three hours later, she complained of perineal numbness and lower extremity weakness. The neurologic evaluation revealed loss of sensation in the saddle area and medial aspect of her right leg. There was a decrease in the perception of pinprick test. Deep-tendon reflexes were decreased especially in the right leg. She was unable to urinate. The patient's symptoms improved slightly over the next few hours. She had a gradual return of motor function and ability of feeling Foley catheter. All of the symptoms were completely resolved over the next 8 hours. CONCLUSION: Complications associated with epidural steroid injections are rare. Clinical examination and continued vigilance for neurologic deterioration after epidural steroid injections is important.

[Pain in trauma and burns]. / Travma ve yanik agrisi.

Trauma is tissue damage caused by an extrinsic force. The stress response comprises an activation of neurohumoral and physiologic process that would lead to improved survivability of an untreated organism following a traumatic injury. The sequelae of inadequate pain control following an injury are more than physiological. Chronic neuropathic pain is a frequent sequelae of trauma. Trauma and burn victims usually have poor pain management, because of the fear of hemodynamic alterations and respiratory depression. Early or even preemptive treatment of pain have been shown to reduce analgesic requirements over time. Individual patients will have widely variant requirements for pain medications, so induction of analgesia must be carefully adjusted, ideally in a closely monitored environment. Pharmacotherapy and interventional methods can be used in a wide variety for the management of pain in trauma and burns.

Magnesium added to prilocaine prolongs the duration of axillary plexus block.

BACKGROUND AND OBJECTIVE: The aim of this study was to evaluate the effect of the addition of magnesium to prilocaine on the duration of sensory and motor-nerve block. METHODS: After institutional approval, 60 ASA physical status I and II patients, between 18 and 60 years of age and scheduled for forearm and hand surgery under axillary brachial plexus block, were included in the study. Patients were randomly assigned to 1 of 4 groups. All of the patients received 5 mg/kg of 2% prilocaine and isotonic sodium chloride solution in 35 mL total volume for axillary brachial plexus block. Group I received intravenous saline, and group II received 150 mg intravenous magnesium at the same time as local anesthetic administration. In group III, 100 mg of magnesium, and in group IV, 150 mg of magnesium, were added to local anesthetic solution. Sensory block and motor block of musculocutaneous, radial, median, and ulnar nerves were recorded at 5-minute intervals. RESULTS: The duration of motor block was significantly longer in group IV than in other groups (167 +/- 30, 177 +/- 17, 180 +/- 20, and 250 +/- 19 minutes in groups I to IV, respectively) (P < .01). Mean duration of sensory block in both of the perineural magnesium groups was statistically different than in groups I and II (P < .001). Duration of sensory block in group IV (304 +/- 30 minutes) was significantly longer than in group III (253 +/- 23 minutes) (P < .001). CONCLUSION: The admixture of magnesium to prilocaine for axillary brachial plexus block provided a pronounced prolongation of sensory and motor block without side effects.

[Pain and pain behavior]. / Agri ve agri davranisi.

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Behavioral manifestation of pain, distress, and suffering have been characterized as pain behaviors. Pain behavior is the way individuals think, feel, and act in relation to their pain status. Pain behaviors are either adaptive or pathological, as when the pain behavior is disproportionate to the objective pathology. It's reported that when pain behavior exists in patients with pain, a psychiatric disorder might to increase pain. The relation between psychological factors and pain behavior is investigated in several studies.

Evaluation of forearm microvascular blood flow regulation by laser Doppler flowmetry, iontophoresis, and curve analysis: contribution of axon reflex.

The relative contribution of vasodilating factors to the control of blood flow in the forearm cutaneous microcirculation is not well defined. Therefore, a mathematical transformation is introduced to decompose the superimposed signal and to investigate the involved mechanisms separately. Transdermal iontophoresis was used for the delivery of acetylcholine (ACh) or sodium nitroprusside (SNP) into the forearm, and cutaneous perfusion was measured using a laser Doppler flowmeter (LDF). The curve fitting procedure used in this study indicates that the LDF signal in response to ACh iontophoresis can be described by the superposition of two independent hyperbolic response curves. Obviously, each component of LDF signal indicates the existence of a separate mechanism, with corresponding rate constant k, latency T, and the saturation level Fmax. Blockade of C-fiber function (axon reflex) with topical anesthesia removes one of the two components of this response and allows the precise quantification of its contribution. SNP-evoked response also has two components, but their parameters were different from those of ACh. Therefore, ACh and SNP cause vasodilation in the skin microcirculation through different pathways. These findings have implications for clinical studies that use the iontophoresis technique for assessing vascular function and comparing responses to ACh and SNP to evaluate endothelial dysfunction.