A AB BS S T TR RA AC CT T O Ob bj je ec ct ti iv ve e: : Diabetic peripheral neuropathic pain affects the functionality, mood, and sleep patterns of approximately 10 to 20 percent of patients with diabetes mellitus. Treatment goals include restoring function and improving pain control. In this study we aimed to compare the efficacy of transcutaneous electrical nerve stimulation (TENS) and placebo TENS in the treatment of peripheral neuropathic pain in patients with type II diabetes mellitus (DM). M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : Forty patients who were diagnosed as type II DM with peripheral neuropathy were enrolled to this study. Patients were randomly divided into two groups as Group A (n= 20) TENS group and Group B (n= 20) placebo TENS group. Forty-eight hours before the beginning of TENS therapy, the drugs used for the treatment of neuropathic pain were discontinued. The electrodes of the TENS were bilaterally placed on the lumbosacral region, 3 cm lateral of the vertebral column. The frequency of the electrostimulation which was used in Group A patients was 80 hertz and the amplitude was high enough to create paresthesia. No electrostimulation was given to Group B patients. TENS was applied 30 minutes daily and the procedure was continued for 20 days in both groups. Visual analog scale (VAS) scores and pain grades of the patients at certain times were taken into account for evaluating the effectiveness of the procedure. R Re es su ul lt ts s: : The demographic data of the groups were not significantly different. Although VAS scores before procedure and on the 5 th day of the procedure were not significantly different between groups (p> 0.05), VAS scores on 10 th and 20 th days of the procedure in Group A were significantly lower than Group B (p< 0.001). There was no significant difference between pain grades of Group A and B at the beginning of the study, but pain grades in Group A were significantly lower than Group B when evaluated at the end of the study (p< 0.001). C Co on nc cl lu us si io on n: : Treatment of the patients with DN is a challenging for the physicians. TENS can be used as an efficient and safe treatment option especially in DN patients in whom pharmachologic treatment is contraindicated or inefficient. Placebo TENS has a limited placebo effect in diabetic neuropathy patients. Bu ul lg gu ul la ar r: : Gruplar arasında demografik veriler yönünden anlamlı farklılık yoktu. İşlem öncesi ve işlemin 5. gününde VAS skorları yönünden gruplar arasında farklılık olmamakla birlikte, Grup A'nın 10. ve 20. günlerdeki VAS skorları grup B'ninkilerden anlamlı olarak daha düşüktü. Çalışma başlangıcında gruplar arasında ağrı dereceleri yönünden fark olmamasına rağmen, çalışma sonunda Grup A'nın ağrı dereceleri Grup B'ninkilerden anlamlı derecede daha düşüktü. S So on nu uç ç: : Diabetik nöropatik ağrısı olan hastaların tedavisi ciddi bir problemdir. TENS özellikle farmakolojik tedavinin kontrendike veya yetersiz olduğu diabetik nöropati hastalarında etkin ve güvenilir bir tedavi...

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Background: This study investigated the efficacy and safety of transnasal sphenopalatine ganglion block (SPGB) for treatment of postural puncture headache (PDPH) in non-obstetric patients.Methods: This retrospective study was conducted at the Ankara Research and Educational Hospital, in Turkey, and included 26 non-obstetric patients (age, "18 years) who were diagnosed with PDPH and unresponsive to conservative therapy or unable to continue it because of side effects. Transnasal SPGB was performed in each nostril. Pain severity was assessed with the Visual Analogue Scale (VAS) at 15 min, 30 min, 24 h, and 48 h after the procedure, while patients were seated. The patients were monitored for 48 h for adverse effects (AEs). Patient treatment satisfaction was assessed at 48 h after the procedure by using the Patient Global Impression of Change (PGIC) scale.Results: Headache at 15 min post-procedure was relieved rapidly. At 24 h post-procedure, nearly half of patients (42.3%) had no pain, and all patients (100%) had a VAS score of <3. Nasal discomfort, throat numbness, and nausea were AEs reported after SPGB; however, these AEs were completely relieved at 24 h after the procedure. According to the PGIC scale scores at 48 h post-procedure, 73.1% of patients evaluated themselves as "much improved" and 26.9% evaluated themselves as "very much improved". Conclusion:When PDPH does not respond to conservative treatment, it may be treated effectively with transnasal SPGB, which is a noninvasive, safe, well-tolerated, and straightforward method with a low complication rate.

Introduction Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive procedure for both diagnosis and treatment of pancreatic and biliary pathologies. The process requires a certain depth of sedation. The purpose of conscious sedation is to keep verbal communication while ensuring the patient unresponsive to painful stimuli [1]. Patients should be kept at least at the level of conscious sedation or slightly deeper. Sedation scoring can be used to achieve this; in our study, the Ramsay sedation scale (RSS) scoring was employed. General anaesthesia may be preferred, especially for patients with severe cardiac and respiratory problems. Under general anaesthesia, the patient's airway is safer and hemodynamic instability can be controlled better. Nitrous oxide and nasal masks, as well as adequate sedation levels, are frequently applied in patients with paediatric dental problems [2]. Obstructive Sleep Apnoea Syndrome (OSAS) Background/aim: Endoscopic retrograde cholangiopancreatography (ERCP) often requires deep sedation. Propofol provides adequate sedation and amnesia at subhypnotic doses, but safe guarding the patient's airway is important for preventing respiratory depression or hypoxic events. This study compared sedation levels, operator satisfaction, intraoperative and recovery characteristics using sevoflurane with nasal mask and propofol in ERCP. Material and methods: Sixty-one patients underwent ERCP (Group I: propofol, n = 31; Group II, sevoflurane, n = 30), with sedation controlled by the Ramsay sedation scale (RSS). The patients' demographic data, procedure length, overall drug dose, hemodynamic changes, duration of recovery and Aldrete scores during recovery were evaluated. In addition, satisfaction of the gastroenterologist was evaluated. Results: The mean sphincterotomy satisfaction scores were statistically significant (P= 0.043). The Aldrete scores and RSS of the groups were similar; there was a significant difference between groups at the beginning of the procedure regarding peripheric oxygen saturations and Group II's saturation levels increased during sedation. Conclusion: In ERCP, propofol infusion provides shorter recovery duration and adequate sedation levels. Sevoflurane and oxygen with a nasal mask can be chosen to generate specific anaesthesia in patients, especially for strong airway support and safety treating hypoxemic patients.

A AB BS ST TR RA AC CT T OOb bj je ec ct ti iv ve e: : Addition of opioids to local anesthetics for epidural obstetric analgesia provides effective analgesia with decreased side effects. We compared the analgesic quality of 0,0625% bupivacaine and 0,1% bupivacaine with 0.5 μg/mL sufentanil. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : Study participants were 18-45-year-old, primiparous 30 parturients. An epidural catheter was placed, 8-10 mL of 0.0625% bupivacaine with 0.5 μg/mL sufentanil and 0.1% bupivacaine with 0.5 μg/mL sufentanil were given to Group I and Group II, respectively. Hemodynamic parameters, obstetric examination findings, pain grades, time to reach visual analog scale (VAS)<4 and the first dose interval were recorded. Satisfaction levels, motor and sensorial blocks, oxytocin and valetamate bromide consumption, side effects were assessed. Total and additional drug use, duration of second stage of the delivery, mean delivery times, instrumental delivery, Apgar scores, fetal heart rates and uterine contraction pressures were recorded. The percentage of participation of the parturients to the delivery was assessed. R Re es su ul lt ts s: : Median VAS values were significantly lower in Group II. Median VAS values were lower than 4 in both groups after 15 th minute. The time to the second analgesic dose was longer in Group II. Systolic, diastolic and mean arterial blood pressures were measured lower in Group II. Satisfaction scores were significantly higher in Group II. C Co on nc cl lu us si io on n: : In the present study, satisfactory analgesia was produced in both groups. Although median VAS scores were lower in Group II, VAS<4 could be reached in Group I. We concluded that 0.0625% bupivacaine+0.5 μg/mL sufentanil combination, as providing VAS<4, could be a preferable alternative to 0.1% bupivacaine+0.5 μg/mL sufentanil. K Ke ey y W Wo or rd ds s: : Analgesia, obstetrical; analgesia, epidural Ö ÖZ ZE ET T A Am ma aç ç: : Epidural obstetrik analjezi için lokal anesteziklere opioidlerin eklenmesi daha efektif bir analjezi sağlar ve yan etkileri azaltır. Biz bu çalışmada %0,0625 bupivakain ve %0,1 bupivakaine 0,5 mikrog/mL sufentanil ekleyerek analjezi kalitesini karşılaştırdık. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Çalışmaya, 18-45 yaşları arasında, 30 primipar gebe dahil edildi. Epidural kateter yerleştirildikten sonra %0,0625 bupivakain ile 0,5 mikrog/mL sufentanil veya %0,1 bupivakain ile 0,5 mikrog/mL sufentanil sırasıyla Grup I ve Grup II olarak belirlendi ve 8-10 mL uygulandı. Hemodinamik parametreler, obstetrik muayene bulguları, ağrı düzeyleri, vizuel analo skala (VAS)<4 olma zamanı ve ilk analjezik gereksinim zamanı kayıt edildi. Memnuniyet dereceleri, motor ve duyusal blok, oksitosin ve valetamat bromür kullanımı ve yan etkiler değerlendirildi. Toplam ve ek ilaç kullanımı, doğumun 2. evresinin süresi, doğumun toplam süresi, doğumda yardımcı alet kullanımı, Apgar skorları, fetal kalp hızı ve uterin kontraksiyon basınçları kayıt edildi. Gebelerin doğuma katılı...