Results of genicular nerve ablation by radiofrequency in osteoarthritis-related chronic refractory knee pain

Background/aim: The aim of this study was to investigate the medium- to long-term effects of radiofrequency (RF) ablation of genicular nerves for chronic refractory knee pain due to osteoarthritis (OA). Materials and methods: Forty-eight patients who underwent RF ablation of the genicular nerves were evaluated retrospectively. The visual analogue scale (VAS) score, Western Ontario and McMaster universities osteoarthritis index (WOMAC index), opioid and nonsteroidal antiinflammatory drug (NSAID) use score, quality of life score, and treatment satisfaction score were examined at 1, 3, and 6 months after the procedure. Results: The mean VAS scores were significantly lower at the 1-, 3-, and 6-month evaluations compared with the preoperative values (P < 0.001). A significant decrease was observed in the WOMAC index compared with preoperative values (P < 0.001). It was found that 66.7% of opioid users and 56.3% of NSAID users stopped using medication. No serious complications were encountered during or after the procedure. Conclusion: In chronic refractory knee pain due to OA, the application of RF ablation to the genicular nerve is an effective and safe treatment option in the medium to long term.

MR Tractography in Short Lasting Unilateral Neuralgiform Headache Attacks with Conjunctival Injection and Tearing (SUNCT) Patients: Case Reports.

BACKGROUND: Short-lasting unilateral neuralgiform headache attack with conjunctival injection and tearing (SUNCT) is one of the trigeminal autonomic cephalalgias where neurovascular compression was detected in neuroimaging in recent years. CASE: We report two cases, a 52-year-old adult and a 69-year-old elderly patient with short-lasting and recurrent headache combined with cranial autonomic features. Diffusion tensor imaging (DTI) and magnetic resonance (MR) tractography of both patients outlined structural changes of the trigeminal nerve revealing neurovascular compression. Pain and autonomic symptoms were completely relieved in the 52-year-old patient who underwent microvascular decompression surgery. CONCLUSION: To our knowledge, this is the first time in the literature where MR tractography revealed structural changes in the trigeminal nerve secondary to neurovascular compression in SUNCT patients. We suggest that in SUNCT patients high-resolution magnetic resonance imaging (MRI) and/or DTI-MR tractography should be performed to exclude neurovascular compression. We propose that the compression of the trigeminal nerve could generate SUNCT symptoms and the posterior hypothalamus could be activated secondarily. With this point of view, trigeminal neuralgia and SUNCT could represent the different features of the neurovascular compression spectrum.

Treatment of post-dural puncture headache with bilateral greater occipital nerve block.

(Headache 2010;50:869-881) Epidural blood patch is an effective treatment with a low complication rate. It is also an invasive method that can cause permanent neurological sequelae such as early and late back pain, radiculopathy, spinal-subdural hematoma, spinal-epiarachnoid hematoma, intrathecal hematoma, arachnoiditis, and infection. We report a case in which a postdural puncture headache resolved within 2 minutes of a greater occipital nerve block, a minimally invasive and easy procedure with a low complication rate. This case report suggests that a greater occipital nerve block may be a successful alternative treatment for patients with post-dural puncture headache.

[The effects of two different multimodal analgesic regimens in total hip replacement surgery]. / Total kalça protezi operasyonlarinda iki multimodal analjezi yönteminin etkinligi.

OBJECTIVES: This study evaluated the effectiveness of two different multimodal analgesia protocols in terms of postoperative pain relief, tramadol consumption during patient-controlled analgesia (PCA) and side effects after total hip replacement surgery. METHODS: Group F (n=18) received general anesthesia after a 3-in-1 femoral nerve block (FNB) was applied using 40 ml of bupivacaine 0.25%. Group FD (n=18) received general anesthesia after the same block and dexketoprofen p.o. was given. All patients received intravenous tramadol at the end of surgery via a PCA device. Group FD was given dexketoprofen 75 mg/day for 48 hours postoperatively. Pain scores were evaluated at 0, 1/2, 1, 4, 8, 12, 24 and 48h at rest and on movement of the hip. Side effects and global satisfaction scores in both groups were also evaluated in this setting. RESULTS: Total tramadol consumption was lower in Group FD (377.7+/-137.4) than in Group F (593.9+/-132.3) (p<0.05). Visual analogue scale (VAS) scores were

Ketamine combined with morphine for the management of cancer pain in a patient with meperidine tolerance and addiction.

Pain treatment of patients with opioid addiction and tolerance may be challenging due to their unexpectedly higher pain sensitivities and opioid requirements. It has been reported that the N-methyl-D-aspartate receptor is involved in mechanisms of tolerance to opioid analgesics. Recently enhancement of morphine induced analgesia by low dose ketamine addition to the treatment regimen has been reported. We report a cancer patient with meperidine tolerance and psychological dependency to the agent who was afterwards successfully treated with morphine-ketamine combination.