Popliteal block is effective for postoperative analgesia, decreasing the paracetamol consumption and sevoflurane requirement in children with CP undergoing lower limb surgery. Trial registration ClinicalTrial.gov identifier: NCT02507700.

Introduction Sjögren's syndrome (SS) is a connective tissue disease, in which organ-specific or systemic symptoms may occur in addition to the exocrine gland dysfunction. The peripheral or central nervous system involvement is reported in 0%-68% of cases (1). There are case reports of cerebral infarction due to vasculopathy (2) and intracranial bleeding (3) in the literature. One of the most common complications of spinal anaesthesia is the developing headache with cerebrospinal fluid (CSF) leakage from the extradural space following dural puncture. The needle size, needle tip, gender, pregnancy and young age are factors shown to be associated with a high risk of headache. Although there are many studies in the literature on spontaneous intracranial hypotension in connective tissue disorders, to the best of our knowledge, no study has yet been conducted on the risk of postdural puncture headache (PDPH). This study aimed to discuss causes of PDPH and acute subdural haematoma in a case of primary SS in a scope of literature data. Case Presentation A 61-year-old female patient diagnosed with primary SS and bladder cancer underwent cystoscopy under spinal anaesthesia. Three hours after the operation, the patient was consulted due to throbbing headache in the back of the neck, radiating to the forehead accompanied by tinnitus, photophobia and phonophobia, with decreased severity when lying down and increased severity when standing up. The visual analogue scale (VAS) score was 7 at the initial examination. A physical examination revealed no neurological pathology aside from orthostatic headache. Biochemical results and the bleeding profile were within the normal range. According to the patient's anaesthesia record, spinal anaesthesia was performed with a 22 G atraumatic spinal needle at the L3-L4 interspace as a single application. The patient was diagnosed with PDPH. The VAS score >4 led to the administration of theophylline 200 mg (Polteofilin 200, Polifarma Pharmaceuticals) as a 45-minute slow intravenous infusion accompanied by monitorisation.

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.

No abstract

No abstract