Percutaneous and Endoscopic Adhesiolysis.

Low back and leg pain may be due to many causes including scarring in the epidural space. Scar tissue often causes irritated swollen and inflamed nerves, which can cause pain. Adhesiolysis eliminate the pain-causing effects of scar tissue by releasing or decompression of a nerve from scar tissue. Percutaneous adhesiolysis is a safe and effective procedure, while epiduroscopy is a minimally invasive technique that offers diagnostic and therapeutic advantages in cases of chronic low back pain and radiculopathy. The aim of this review is to describe the comparison of percutaneous and endoscopic procedures in the lysis of adhesions in epidural fibrosis in terms of indications, contraindications, complications, technique and efficacy..

Patient-controlled analgesia and morphine consumption in sickle cell anemia painful crises: A new protocol.

OBJECTIVES: The sudden and rapidly increasing severity of pain in sickle cell anemia painful crises frequently requires the use of strong opioids. Patients require continuous administrations of various doses (increased/decreased) within the following hours. This study aims to retrospectively evaluate the effects of a structured protocol based on standardized Visual Analogue Scale (VAS) and Patient-controlled analgesia (PCA) patient demand count on morphine consumption in painful crises. METHODS: A total of 177 painful crises of 93 patients who were administered morphine using the PCA method according to appropriate analgesia protocol between 2004-2018 were evaluated in this study. The demographic data, hemoglobin chromatography and genotypes, painful episode follow-up time, VAS scores before and after treatment, and daily morphine consumption of the patients were recorded. Morphine consumption during the crisis according to age groups and sex were compared. RESULTS: Of the patients, 57% were homozygous hemoglobin type SS (HbSS). Mean morphine consumption with PCA method was 56.9±35.4 mg (min-max: 10-232 mg) and mean follow-up time was 3.4±2.1 days (min.-max.: 1-11). VAS scores were significantly lower after treatment (6.8±2.3 pre-treatment; 0.8±0.6 post-treatment) (p<0.05). CONCLUSION: To our knowledge, our study is the first structured protocol based on VAS and PCA demand data. We believe lower morphine dosage using PCA protocol according to the rapidly changing pain levels of the patients will provide effective analgesia. Prospective studies with fewer limitations will more effectively demonstrate the effectiveness of this protocol.

Postdural Puncture Headache and Acute Subdural Haematoma in Sjögren's Syndrome.

Although spontaneous intracranial hypotension cases related to connective tissue diseases have been reported in the literature, to the best of our knowledge, no cases of iatrogenic intracranial hypotension have been described. In this paper, we plan to discuss a case of acute subdural haematoma and postdural puncture headache that developed after spinal anaesthesia in a patient with Sjögren's syndrome.