Background Although neuropathic pain is a severe and common pain, its pathophysiology has not been elucidated yet. Studies in recent years have focused on the immune system’s role in the pathogenesis of neuropathic pain. The aim of this study was to investigate the role of immunological mechanisms in neuropathic pain and the effect of pregabalin by measuring immunological marker levels in peripheral blood before and after pregabalin treatment in postherpetic neuralgia (PHN) patients with neuropathic pain. Methods Forty patients diagnosed with PHN were included in the study. CD4, T follicular cells (Tfh CD4 + CXCR5 + PD1 + ), Th17 (CD4 + CCR6 + and CD4 + IL17A + ), regulatory T cells (Treg CD4 + CD25 + foxp3 + ), Th1 (CD4 + CXCR3 + and CD4 + IFN-γ + ) and Th2 (CD4 + IL-4 + ) cell ratios were measured in peripheral blood samples before treatment and after 3 months of treatment. Results When immunological marker and inflammation parameter levels were compared before and after treatment, the helper T cell ratio (CD3 + , CD4 + ) was 30.28 ± 12.27% before treatment and 34.93 ± 11.70% after treatment, so there was a statistically significant increase ( P = 0.028). Th17 was 4.75 ± 5.02% before treatment and 5.80 ± 3.13% after treatment, and there was a statistically significant increase ( P = 0.036). Conclusions Immunological mechanisms play an essential role in the pathogenesis of neuropathic pain, immunologically based treatment approach will be the critical point of treatment.
The aim of this study was to compare the efficacy of an intercostal nerve block, which has been used for many years in the treatment of postherpetic neuralgia, and the more recent alternative of an erector spinae plane (ESP) block. Methods: The records of 39 patients who were treated in the algology department for postherpetic neuralgia between May 1, 2015 and May 1, 2018 were evaluated retrospectively. Patients who received an intercostal nerve block constituted Group 1 and those who received an ESP block were categorized as Group 2. The change in numeric rating scale (NRS) and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scores in the short term and in the long term were the primary results of the study. Results: The NRS, LANSS, and sleep interference scale (SIS) scores of the patients in Group 1 and Group 2 were found to be significantly lower at the 24 th hour, week 4, and week 12 compared with the values obtained before block application. In Group 1, the scores recorded at week 4 and week 12 were significantly higher than the 24 th hour values, whereas no difference was observed between these results in Group 2. There was no significant difference between the groups in the week 4 and week 12 scores. Similarly, no significant difference was observed in the NRS, LANSS, or SIS scores before the block application or at the 24 th hour. However, the scores at week 4 and week 12 were significantly lower in Group 2 compared with Group 1. Conclusion: The results indicated that an ESP block significantly decreased neuropathic pain symptoms and the need for additional treatment in postherpetic neuralgia treatment in the long term.
Pregabalin ve gabapentin, analjezik, antikonvülsan ve anksiyolitik özelliklere sahip benzer bileşiklerdendir. Bu tür farmakolojik özellikler nedeniyle, nöropatik ağrı tedavisinde ve anksiyete bozukluklarında genel olarak dünyada yaygın olarak kullanılmaktadırlar. Santral sinir sisteminde baş dönmesi ve uyuşukluk gibi hafif ila orta şiddette yan etkiler pregabalinin kullanımını sonlandırmada önemli faktörlerdir. Aynı zamanda, bazı çalışmalarda, doza bağlı pregabalin kullanımı, hastalarda periferik ödem ve kilo vermeye neden olmuştur. Bu olguda, önceden pregabalin kullanan hastanın ilaç dozunda bir artış yapıldıktan sonra oluşan işitme kaybını sunmak istedik.
BACKGROUND: Cerebral autoregulation is a steady-state of cerebral blood flow despite major changes in arterial blood pressure. Inhalation anesthetics are cerebral vasodilators. In <1 MAC values, the net effect is a moderate decrease in cerebral blood flow and maintenance of responsiveness to carbon dioxide. This study aims to investigate the effects of steady-state sevoflurane anesthesia on hemodynamic and cerebral artery diameter measurements in patients undergoing flow diverter device placement under general anesthesia. METHODS: Forty-six patients aged 18-70 years who underwent flow diverter devices under general anesthesia were included in this study. Routine monitoring was performed on the patients. Mean arterial pressure (MAP) values were recorded. Internal carotid artery, middle cerebral artery and anterior cerebral artery diameter measurements were made from digital subtraction angiography (DSA) images of patients with anterior aneurysms. Baseline artery, right posterior cerebral artery and left posterior cerebral artery diameter measurements were made from DSA images of patients with posterior aneurysms. These measurements were recorded as preoperative measurements. The same measurements were made from the DSA images performed before the Flow diverter device placement procedure performed under steady-state sevoflurane anesthesia for the same patients. These measurements were recorded as peroperative measurements. RESULTS: The average age of the patients was 56.6±15.1. The MAP of the patients before induction was 76.28±5.13 mmHg, MAP after induction was 64.36±3.23 mmHg, and MAP during sevoflurane anesthesia was 68.26±4.30 mmHg, there was a statistically significant difference. There was a statistically significant difference between the preoperative and perioperative values of anterior cerebral artery diameters. There was a strong relationship between the MAP change percentage and the ICA diameter change percentage (p<0.001, p=-0.785) and a moderate relationship between the MCA diameter change percentage (p=0.033, p=-0.338). CONCLUSION: In patients undergoing flow diverter devices, <1 MAC sevoflurane has a hemodynamic effect and creates significant vasodilation in the cerebral artery diameters.
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