Amaç: Ailede migren öyküsü bulunan hastalarda bazý bireysel ve klinik özelliklerin, aile öyküsü olmayanlara göre farklý olabileceðini bildiren kýsýtlý sayýda çalýþma mevcuttur. Amacýmýz aile öyküsü olan ve olmayan migren hastalarýný tanýsal ve klinik özellikler bakýmýndan karþýlaþtýrmak, migren yükü ve migrene baðlý dizabiliteye olan etkilerini ortaya koymaktýr.
Gereç ve Yöntem: Çalýþmaya Uluslararasý Baþ aðrýsý Derneði kriterlerine uygun olarak taný almýþ 530 ardýþýk migren hastasý dahil edildi. Hastalarýn detaylý sistemik ve nörolojik muayeneleri yapýldý, kan basýncý, aðýrlýk ve boy ölçümleri ve vücut kitle endeksleri hesaplandý, klinik ve demografik bilgileri, Vizüel analog skala (VAS), Allodini Semptom Anketi (ASC) ve Migrene baðlý dizabilite ölçeði (MIDAS) skorlarý kaydedildi. Aile öyküsü olan ve olmayan gruplar kendi aralarýnda istatistiksel olarak karþýlaþtýrýldý.
Bulgular: Pozitif aile öyküsü olanlarýn eðitim düzeylerinin lise ve üzerinde olma oranlarý (p<0.05) ve aðrýnýn fiziksel aktivite ile tetiklenmesi diðer gruba göre daha yüksek orandaydý (p=0.013). Hastalýk baþlangýç yaþý aile öyküsü olan grupta belirgin olarak daha erken (p=0.049), hastalýk süresi daha uzun (p=0.030) ve MIDAS skorlarý daha yüksekti (p=0.028).
Sonuç: Ailede migren öyküsü bulunmasý, erken baþlangýç yaþý ve daha uzun hastalýk süresi ile iliþkili olup migrene baðlý dizabilite bu hastalarda belirgin olarak artmýþtýr. Aile öyküsü migrenli hastalarda genetik yüklülüðün bir iþareti olarak düþünülerek bu hastalarda erken taný ile doðru klinik yaklaþým, migrene baðlý kýsýtlýlýðýn engellenmesi açýsýndan önem taþýmaktadýr.

Objectives: There are only a handful of studies examining the clinical differences between patients with and without a family history of migraine. Our aim is to compare the descriptive and clinical properties of patients with and without a family history, and to investigate the association between the migraine burden and disease characteristics and disability of migraine.
Methods: A total of 530 consecutive patients diagnosed with migraine according to the International Headache Society criteria were enrolled into the study. Detailed systemic and neurological examinations, and blood pressure, weight, height, and body mass index measurements, clinical and demographical data, the visual analog scale, allodynia symptom checklist, and the Migraine Disability Assessment Scale (MIDAS) scores were recorded. The groups with and without a family history of migraine were compared statistically.
Results: Patients with a positive family history had a higher educational status (high school and higher) (p<0.05) and an increased triggering of pain with physical activity (p=0.013). The age at onset was earlier (p=0.049); disease duration was longer (p=0.030), and MIDAS scores were significantly higher (p=0.028) in patients with a family history of migraine.
Conclusion: Having a family history of migraine is associated with an earlier age at onset and a longer disease duration, in addition to an increased disability in these patients. The family history may be assumed as a marker of the genetic load in migraineurs; therefore, an early diagnosis and an appropriate management are essential in these patients to avoid migraine-related disability.

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Amaç: Algoloji kliniðinde yatan hastalarýn aðrýyla ilgili etik konulardaki görüþlerini belirlemektir.
Gereç ve Yöntem: Tanýmlayýcý çalýþmanýn örneklemini algoloji kliniðindeki 135 hasta oluþturmuþtur. Veriler Visüel Analog Skala (VAS) ve aðrýyla ilgili etik konularý kapsayan soru formuyla toplandý. Verilerin deðerlendirilmesinde yüzdelik daðýlým, Tukey testi ve Varyans analizi kullanýldý.
Bulgular: Hastalarýn %92.6’sý aðrýlarýnýn giderilmesi hakký olduðuna, %94.8’i kendileriyle ilgili karar alýnýrken görüþlerinin alýnmasý gerektiðine inanmaktadýrlar. “Ýleri dönem kanseri olan bir hastanýn dindirilmesi mümkün olmayan þiddetli aðrýsý için ölümüne neden olabilecek miktarda aðrý kesici ilaç istediðinde doktor aþýrý doz ilacý vermelidir” önermesine hastalarýn %43.0’ünün katýlmadýðý belirlendi. Ayný durumda iken ölümüne neden olabilecek miktarda aðrý kesici ilacý, aile-hasta istediðinde doktorun aþýrý doz ilacý vermesi gerektiðine katýlýmcýlarýn %51.9’unun, aile istemeyip, hasta istediðinde doktorun aþýrý doz ilacý vermesi gerekliliðine ise %44.4’ünün katýlmadýðý saptandý. VAS puan ortalamalarý ile ileri dönem kanseri olan bir hastanýn dindirilmesi mümkün olmayan þiddetli aðrýsý için ölümüne neden olabilecek miktarda aðrý kesici ilacý hastanýn kendisi istediðinde veya ilacý aile istemeyip hasta istediðinde doktor aþýrý doz ilacý vermesi gerektiði ile ilgili önermeler arasýnda istatistiksel olarak anlamlý fark olduðu bulundu (p<0.05).
Sonuç: Hastalar konuyla ilgili bilgilendirme yapýlmasýný, görüþlerinin sorulmasýný isterken ölümüne neden olacak aþýrý doz ilacýn verilmesini istememektedirler.

Objectives: To determine the views of patients hospitalized in the algology clinic about ethical issues related to pain.
Methods: A total of 135 patients admitted to the algology clinic comprised the population of this descriptive study. Data were collected using the visual analogue scale (VAS) and the questionnaire on ethical issues related to pain. To evaluate the data, percentage distribution and the Tukey test of variance were used.
Results: Of the patients, 92.6% believed that they had the right to pain relief, and 94.8% believed that they should be consulted when decisions about them were made. It was determined that 43.0% of the patients disagreed with Proposition 1, “When a terminal-stage cancer patient with unrelievable pain requests an overdose of pain medication, possibly to cause death, the physician must prescribe it,” while 51.9% of the participants disagreed with Proposition 2, “When a terminal-stage cancer patient with unrelievable pain and his or her family request an overdose of pain medication, possibly to cause death, the physician must prescribe it,” and 44.4% of them disagreed with Proposition 3, “When a terminal-stage cancer patient with unrelievable pain requests an overdose of pain medication, possibly to cause death even though his or her family refuses, the physician must prescribe it.” A statistically significant relationship (p<0.05) was found between the mean VAS scores and Propositions 1 and 3.
Conclusion: The patients were willing to be informed and to be asked about their views regarding the issue, but they did not want to be prescribed a high dose of pain medication, possibly to cause overdose and death.

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Amaç: Memenin kompleks innervasyonuna baðlý olarak meme cerrahisinden sonra postoperatif analjezi saðlamak anestezistler için zorlu bir durumdur. Erektör spina plan bloðu (ESPB), yeni tanýmlanmýþ ve bu amaç için umut verici bir tekniktir. Bu çalýþmanýn amacý, ultrason eþliðinde uygulanan ESPB’nun meme cerrahisindeki analjezik etkinliðini, postoperatif opioid tüketimi üzerine etkisine bakarak deðerlendirmektir.
Gereç ve Yöntem: Çalýþmaya elektif meme cerrahisi planlanan, Amerikan Anesteziyoloji Derneði (ASA) fiziksel skoru I-II ve yaþlarý 25 ile 70 arasýnda olan 50 kadýn hasta dahil edildi. Hastalar ESPB ve Kontrol grubu olarak iki gruba ayrýldý. ESPB grubundaki tüm hastalara, preoperatif, 20 ml% 0.25 bupivakain (her seviye için 10 ml) ile iki seviye (T2-T4) ultrason eþliðinde ESPB yapýldý. Tüm hastalara postoperatif analjezi için intravenöz hasta kontrollü analjezi cihazý verildi. Numerik aðrý skalasý (NRS) skorlarý ve postoperatif morfin tüketimleri 1, 6, 12 ve 24’üncü saatlerde kaydedildi.
Bulgular: Postoperatif morfin tüketimi ESPB grubunda kontrol grubuna göre postoperatif 6., 12. ve 24. saatlerde anlamlý olarak düþüktü (tüm zaman aralýklarý için p<0.001). Yirmi dördüncü saatteki morfin tüketimi %75 azaldý. NRS skorlarýnda anlamlý fark yoktu (sýrasýyla median NRS deðerleri 2, 1, 0, 0 ve 2, 2, 1, 1 idi).
Sonuç: Çalýþmamýz göstermiþtir ki; meme cerrahisi geçiren hastalarda ultrason eþliðinde iki seviye ESPB ile opioidden baðýmsýz analjezik etki saðlanabilir.

Objectives: Due to the complex breast innervation, postoperative analgesia after breast surgery is a challenge for the anesthesiologists. The erector spinae plane block (ESPB) is a newly defined promising technique for this purpose. The main purpose of this study was to evaluate the analgesic efficacy of the ultrasound-guided ESPB in breast surgery, monitoring its effect on the postoperative opioid consumption.
Methods: Fifty female patients, who were scheduled to undergo elective breast surgery, with the American Society of Anesthesiology physical score I–II, and aged between 25 and 70 years, were included into the study. Patients were randomized into two groups, as the ESPB and the control group. All patients in the ESPB group received a bi-level (T2–T4) ultrasound-guided ESPB with 20 ml 0.25 % bupivacaine (10 ml for each level) preoperatively. An intravenous patient-controlled analgesia device for the postoperative analgesia was given to all patients. The numeric rating scale (NRS) scores for pain and postoperative morphine consumptions were recorded at the 1st, 6th, 12th, and 24th hour postoperatively.
Results: Postoperative morphine consumption was significantly lower in the ESPB group compared to the control group at the postoperative 6th, 12th, and 24th hour (p<0.001 for each time interval). The morphine consumption at the 24-hour was reduced by 75%. There was no significant difference in the NRS scores (median NRS values were 2, 1, 0, 0, and 2, 2, 1, 1, respectively).
Conclusion: Our study has shown that a significant opioid-sparing analgesic effect in patients undergoing breast surgery could be achieved with a US-guided bi-level ESP block.

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Amaç: Çalýþmamýzda, laparoskopik jinekolojik cerrahide intraperitoneal, insizyonel ve intraperitoneal+insizyonel levobupivakainin analjezik etkinliðini araþtýrmayý amaçladýk.
Gereç ve Yöntem: Grup 1’de 20 ml levobupivakain intraperitonal olarak, Grup 2’de 20 ml levobupivakain trokarlarýn insizyon bölgesine, Grup 3’de ise 20 ml levobupivakain intraperitoneal uygulanýrken, trokar insizyon bölgelerine de 20 ml levobupivakain infiltre edildi. Postoperatif 2., 4., 12. ve 24. saatlerde hastalarýn omuz aðrýsý, istirahat ve hareketle ortaya çýkan karýn aðrýsý VAS ile deðerlendirildi. VAS >3 olarak deðerlendirilen hastalarýn analjezisi yetersiz olarak kabul edildi ve diklofenak sodyum uygulandý. Olgularýn postoperatif ilk analjezik gereksinim zamaný, toplam analjezik tüketimi, analjezik etkinlik ve analjezik yöntemden memnuniyetleri deðerlendirildi.
Bulgular: Gruplar arasýnda VAS skorlarýnda anlamlý farklýlýk yoktu (p>0.05). Grup 2’deki hastalarda, Grup I ve Grup III’deki hastalara göre postoperatif analjezik tüketimi daha fazla ve ilk analjezik gereksinim zamaný daha kýsa idi, fakat fark anlamlý deðildi. Hastalarýn uygulanan anestezik yöntemden memnuniyetleri gruplar arasýnda benzerdi.
Sonuç: Jinekolojik laparoskopik cerrahilerde intraperitoneal levobupivakain uygulamalarýnýn sadece cilt insizyonuna levobupivakain uygulanan gruba göre istatistiksel olarak anlamlý olmasa da daha az omuz ve karýn aðrýsý, daha düþük total analjezik tüketimi ve daha etkin bir analjezi ile alternatif bir yöntem olabileceðini düþünmekteyiz. Ancak, konu ile ilgili farklý lokal anestezikleri de karþýlaþtýran daha ileri çalýþmalara ihtiyaç vardýr.

Objectives: We aimed to investigate the analgesic efficacy of intraperitoneal, incisional, and intraperitoneal + incisional levobupivacaine in laparoscopic gynecological surgery.
Methods: Group 1 received levobupivacaine 20 mL intraperitoneally, Group 2 received levobupivacaine 20 mL to the trocar wounds, Group 3 received levobupivacaine 20 mL intraperitoneally and levobupivacaine 20 mL to the trocar wounds. Postoperative abdominal pain at rest and during mobilization and shoulder pain were assessed at the 2nd, 4th,12th, and 24th postoperatively by VAS. If VAS was >3, the analgesia was assessed as inadequate, and diclofenac sodium was injected. In addition, time the first analgesic requirement, total analgesic consumption, analgesic effectiveness, and the satisfaction of patients about the analgesic method were recorded during the postoperative period.
Results: No significant difference was found between groups with respect to VAS (p>0.05). Patients in Group 2 had a higher postoperative analgesic consumption and lower timing of the first analgesic requirement than Groups 1 and 3, but these differences were not significant (p>0.05). The satisfaction of the patients about the analgesic technique was similar between the groups.
Conclusion: The use of levobupivacaine intraperitoneally is an alternative method to reducing of postoperative shoulder and abdominal pain in gynecological laparoscopic surgery. Also, we observed a lower total analgesic consumption and more analgesic effectiveness in intraperitoneal groups than the other. Further studies are needed with different intraperitoneal local anesthetics.

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Amaç: Bu çalýþmada algoloji kliniðine baþvuran pankreas kanserli hastalarýn özellikleri ve analjezik tedavisi deðerlendirildi.
Gereç ve Yöntem: Algoloji kliniðine baþvuran 60 pankreas kanserli hastanýn demografik özellikleri, patolojik tanýsý ve metastazý, kanser tedavisi ve analjezik müdahaleleri incelendi.
Bulgular: Algoloji kliniðine baþvuru süresi taný aldýktan sonra ortalama 3.9±0.92 ay, baþvurudaki visual analog skala (VAS) skoru ortalama 6.96±0.11’idi. Analjezik basamak tedavisine göre hastalarýn %58.33‘de nonopioid+zayýf opioid+kuvvetli opioid (transdermal form), %5’de nonopioid+zayýf opioid+kuvvetli opioid (oral form), %36.66’da nonopioid+zayýf opioid tedavi uygulandý. Hastalarýn %31.66’a adjuvan eklenmezken %68.33’e adjuvan eklendi (%80.48 benzodiazepin, %19.51 antidepresan). Metastatik pankreas kanserli hastalarda ortalama sað kalým süresi 3-6 ay arasýnda deðiþirken aðrý kliniðine baþvuran hastalarda 8.48±7.46 ay olarak tespit edildi.
Sonuç: Pankreas kanserinde karýn aðrýsý hastalarýn yaþam kalitesini olumsuz etkileyen en yaygýn semptomdur. Aðrý sað kalýmý azaltýrken iyi bir analjezi ise sað kalýmý iyileþtirir. Bu çalýþmanýn sonuçlarý, algoloji kliniðinde etkili aðrý tedavisi alan metastatik pankreas kanserli hastalarýn sað kalýmýnýn daha uzun olabileceðini göstermektedir.

Objectives: In this study, characteristics and analgesic treatment of patients with pancreatic cancer who applied to the algology clinic were evaluated.
Methods: Demographic characteristics, pathologic diagnosis, metastasis, cancer treatment, and analgesic interventions in 60 patients with pancreatic cancer, referred to the algology clinic, were examined.
Results: The application time of the patients to the clinic was 3.9±0.92 months after the diagnosis, and the visual analog scale (VAS) was 6.96±0.11 at the initial assessment. According to the analgesic step ladder protocol, a nonopiod + weak opioid + strong opioid (transdermal) were applied in 58.33%, a nonopioid + weak opioid + strong opiod (oral) in 5%, and nonopiod + weak opioid in 36.66% of the patients. Adjuvant pain medications were used in 68.33% of the patients (benzodiazepine, 80.48%; antidepressant, 19.51%), while no adjuvant was used in 31.66% of the patients. While the mean survival time for patients with pancreatic cancer changed from 3 to 6 months, it was 8.48±7.46 months for patients who applied to the pain clinic.
Conclusion: Abdominal pain in pancreatic cancer is the most common symptom that negatively affects the quality of life. A good analgesia improves the survival, while pain decreases the survival. The results of the present study demonstrated that the survival of the patients with metastatic pancreatic cancer who received effective pain therapy in the algology clinic may be longer.

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Epidural steroid enjeksiyonu kronik bel aðrýsýnda yaygýn kullanýlan bir tedavidir. Epidural steroid enjeksiyonun en sýk görülen komplikasyonu, dural yýrtýðýn eþlik ettiði yada etmediði çoðunlukla geçici olan baþ aðrýsýdýr. Gözlenen diðer komplikasyonlar arasýnda; intravasküler enjeksiyon, lokal hematom, kanama, bel aðrýsýnda artýþ, yüzde flushing, vazovagal reaksiyonlar, bulantý ve ateþ bildirilmiþtir. Bu olgu sunumunda lumber radikülopatiye baðlý kronik bel aðrýsý olan hastaya uygulanan epidural steroid enjeksiyonunu takiben geliþen akut rabdomiyolizi sunduk.

Epidural steroid injection is a very common intervention in the treatment of low back pain and sciatic symptoms. The most common complication for epidural steroid injection is transient headache with or without identifiable dural puncture. Other complications have also been reported, including intravascular entry, local hematoma, bleeding, increased back pain, facial flushing, vasovagal reactions, nausea, and fever. We report a case of rhabdomyolysis following epidural steroid injection for lumbar radiculopathy.

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Quadratus lumborum bloðu, tek taraflý T4 seviyesinden L1 seviyesine kadar paravertebral alanda ilaç daðýlýmý gösterilmiþ bir fasyal plan bloðudur. Quadratus lumborum kasý ile komþuluðundaki psoas major kasý arasýndaki fasya planýndan uygulanan lokal anestezik madde, paravertebral alana yayýlarak ilgili dermatomlarda analjezi saðlar. Ancak, bu bloðun çeþitli cerrahi iþlemler için yayýnlanmýþ çalýþma sayýsý sýnýrlýdýr. Burada, kolesistektomi ve sað nefrektomi operasyonu olan hastada postoperatif aðrý yönetimi açýsýndan ultrason eþliðinde QLB 3 uyguladýðýmýz 46 yaþýndaki ASA I hasta sunulmaktadýr. Genel anestezi indüksiyonundan sonra, hasta sol yan pozisyondayken iliak krestin biraz üstünde, mid-aksiller hatta konveks prob yerleþtirilerek quadratus lumborum ve psoas major kaslarý ile komþuluðundaki transvers process görüntülendi. In-plane teknik ile, quadratus lumborum kasý ile psoas major kasý arasýndaki fasyal alana 20cc %0.25 bupivakain enjekte edildi. Stabil ve komplikasyonsuz seyreden operasyon sonrasýnda hastaya IV morfin PCA düzenlendi.. Yirmidört saatin sonunda VAS skoru 0 olan hastanýn toplam morfin tüketimi 13 mg idi. Bu olgu sunumu, quadratus lumborum bloðunun nefrektomi ve kolesistektomi operasyonunlarýnda postoperatif analjezi açýsýndan etkili bir yöntem olabileceðini göstermektedir.

The quadratus lumborum block (QLB) is a unilateral facial plane block, which extends from T4 to L1 at the paravertebral space. Injecting local anesthetic between the facial plane of the quadratus lumborum muscle and the psoas major muscle provides the block of the referred dermatomes. However, the number of published studies for QLB used in various surgical procedures is limited. In this case report, we share the results of a 46-years-old ASA I female patient, who underwent open surgery for cholecystectomy and right-sided nephrectomy in the same session. After general anesthesia was induced, QLB was performed in the left lateral decubitus position. A convex probe was placed in transversely between the iliac crest and the costal margin at the midclavicular line. 20cc of 0.25% bupivacaine was injected to the facial plane between the quadratus lumborum and psoas major muscles. The surgery lasted 4 hours and completed uneventfully. In the postoperative period, the patient was provided with morphine PCA. After 24 hours, the VAS score was 0, and the total demanded morphine dose was 13 mg. This case report recommends that QLB may be an adequate choice in the postoperative pain management for patients undergoing cholecystectomy and nephrectomy.

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Quadratus lumborum yeni tanýmlanan baþarýlý, güvenli, ve uzun analjezi saðlayan ultrason rehberliðinde yapýlan bir bloktur. Quadratus lumborum bloðu lokal anestezik maddenin quadratus lumborum kasýnýn posteriorundan torakalumbar fasyanýn orta katýna ve paravertebral alana yayýlmasýna izin verir. Biz quadratus lumborum bloðu ile baþarýlý bir postoperatif analjezi saðladýðýmýz tek taraflý inguinal herni operasyonu geçiren 3 yaþýnda 14 kilo çocuk hastayý sunacaðýz. Hastanýn ailesi hastanýn genel durumundan ve aðrýsýzlýðýndan memnun kaldýlar.

The quadratus lumborum block (QLB) is a newly described block providing successful, safe, and long-lasting analgesia with the guidance of ultrasound. The QLB allows local anesthetic to spread posterior to the quadratus lumborum muscle and expand beyond the middle layer of the thoracolumbar fascia and paravertebral space. We present our experience with the use of an unilateral QLB to provide postoperative analgesia in a 3-year-old pediatric patient weighing 14 kg who underwent a unilateral inguinal hernia repair. His family was satisfied with the general status and pain cessation in the patient.

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