ISSN: 1300-0012 | E-ISSN: 2458-9446
Volume : 36 Issue : 4 Year : 2025
Quick Search



CLOCKSS system has permission to ingest, preserve, and serve this Archival Unit

Agri - Ağrı: 36 (4)
Volume: 36  Issue: 4 - 2024
FRONT MATTER
1. Front Matter

Pages I - X

REVIEW
2. Cranial nerve palsies following neuraxial blocks
Mete Manici, Rafet Onur Görgülü, Kamil Darçın, Yavuz Gürkan
PMID: 39431676  doi: 10.14744/agri.2024.69345  Pages 209 - 217
Spinal anesthesia is one of the most frequently performed regional anesthesia techniques for a variety of surgeries world-wide. Cranial nerve palsy is a rarely reported complication of central neuraxial block. The etiology varies; however, it is most often associated with nerve compression or traction due to intracranial hypotension. In October 2023, we searched PubMed and Google Scholar databases for English-language articles published between 1952 and 2023. The following search terms were used in the search strategy: olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, vestibulocochlear, glossopharyngeal, vagus, accessory, hypoglossal nerve palsies, and epidural, spinal anesthesia, or dural puncture. The search was limited to humans and case reports written in English. We analyzed 89 articles and case reports in this review. In this article, a review of 105 cases published so far in the literature is presented. Cranial nerve palsies were more common in obstetric and gynecological cases. The 6th cranial nerve palsy was reported most frequently. Paralysis of more than one cranial nerve may develop simultaneously and may be bilateral or unilateral. In general, unilateral paralysis has been observed. The most common finding in 3rd, 4th, and 6th cranial nerve palsies was diplopia. In 8th cranial nerve palsy, hearing loss was the most observed symptom. PDPH is mostly associated with cranial palsies in most cases. It was observed that early recognition of patients with symptoms and utilization of diagnostic methods were effective in treatment. The most common cranial nerve injuries following spinal and epidural anesthesia and dural puncture are 6th and 3rd cranial nerve palsies. Symptoms are believed to occur mainly due to variations in cerebrospinal fluid (CSF) pressure. It is recommended to design treatment plans based on the mechanism.

EXPERIMENTAL AND CLINICAL STUDIES
3. The impact of trans-sacral epiduroscopic laser decompression on quality of life in lumbar disc herniation
Sibel Özcan, Arzu Muz, Aysun Yıldız Altun, Rustem Payam, Mehmet Fatih Polat, Selami Ateş Önal
PMID: 39431678  doi: 10.14744/agri.2023.75983  Pages 218 - 226
Objectives: Trans-sacral epiduroscopic laser decompression (SELD), employing a video-guided catheter and laser, is one of the preferred options for minimally invasive treatment in lumbar disc disease. The aim of this study was to evaluate the effect of SELD treatment on pain, disability, and quality of life in patients with lumbar disc herniation.
Methods: Between January 2015 and June 2017, a total of 76 patients who underwent SELD were examined retrospectively. The Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) scores were recorded preoperatively, as well as 1, 3, 6, and 12 months after SELD. Quality of life was recorded preoperatively and 12 months after SELD. Patient satisfaction was evaluated based on Odom’s Criteria at the final follow-up.
Results: Improvement was observed in low back pain and radicular pain, with the VAS score decreasing from 6.5±0.9 and 7.2±0.3 to 2.31±1.6 and 2.9±1.3 at the final follow-up (p<0.001). The rate of disability, assessed by ODI, decreased from 65.21±1.7 to 21.38±1.0 at the final follow-up. SF-36 scores were statistically higher for all sub-variables of the questionnaire after the procedure. At the final follow-up, 65.8% of patients reported a degree of satisfaction as excellent-good based on Odom’s Criteria.
Conclusion: Trans-sacral epiduroscopic laser decompression enhances quality of life by improving pain and disability scores in patients with chronic low back and/or radicular pain who do not respond to conservative treatments and epidural steroid administration.

4. The effect of colored masks used in pediatric emergency clinics on children's pain perception: Randomized controlled study
Eda Gülbetekin, Fatma Gül Can, Selahattin Karagöz
PMID: 39431669  doi: 10.14744/agri.2023.00086  Pages 227 - 235
Objectives: This study was conducted in a randomized controlled manner to examine the effect of colored surgical masks used by nurses in pediatric emergency clinics on children’s pain perception.
Methods: The study included 81 children aged 1–3 years who applied to the pediatric emergency clinic of a State Hospital located in a province in eastern Turkey. Data were collected using the “Personal Information Form” and the “Facial Expression, Leg Movement, Activity, Cry, Consolability (FLACC) Pain Assessment Tool” to measure the level of pain perception. During the vascular access procedure, colored surgical masks were used in the experimental group, while white surgical masks were used in the control group. Children’s pain was assessed based on nurse observations. Independent samples t-test and ANOVA were employed to assess the data. The results were evaluated with a 95% confidence interval and a significance level of p<0.05.
Results: It was observed that in the white mask group, 35% of the children were 1 year old and 35% were 3 years old. In the colored mask group, 46.3% of the children were 2 years old. Furthermore, 52.5% of the children in the white mask group and 31.7% in the colored mask group were girls. The total mean score of the “FLACC” scale was 8.92±1.526 in the white mask group and 4.73±2.721 in the colored mask group.
Conclusion: The use of colored surgical masks by nurses during vascular access in children aged 1–3 years was found to be effective in reducing children’s pain perception.

5. Retrospective evaluation of patients treated with intradiscal discectomy + RFTC using the Disc-Fx method in lumbar discopathy
Hatice Kaykusuz, Süheyla Karadağ Erkoç, İbrahim Aşık
PMID: 39431672  doi: 10.14744/agri.2023.20633  Pages 236 - 247
Objectives: Low back pain is an important public health problem that impairs quality of life and causes limitations in both social and working life. It is attempted to be treated with conservative or surgical procedures. However, how wise is it to plan surgery with a high complication rate when conservative treatment fails to respond?
Methods: In this study, it was planned to investigate the effectiveness of the Disc-Fx procedure, which is one of the minimally invasive techniques for low back pain. Patients who underwent the Disc-Fx procedure were included. After consent was obtained, questions were asked before and after the procedure. The data of the patients were obtained by telephone and hospital database. Data of 40 patients older than 18 years of age were collected and analyzed retrospectively according to the established protocol. Then, the data were subjected to statistical calculation and the results were obtained.
Results: Similar to the literature, there was a significant difference between preoperative and postoperative 1st, 6th, and 12th months of VAS, ODI, and MacNab values. In fact, a significant difference was found between the VAS, ODI, and MacNab values in each postoperative period compared to the preoperative period. In addition, factors that may be important in the etiology of low back pain were also evaluated.
Conclusion: The Disc-Fx procedure is thought to be a promising procedure for carefully selected patients due to its low complication rates. It has been concluded that more precise results can be obtained as a result of randomized controlled studies with a larger number of patients and longer follow-up of patients.

6. Investigation of trunk muscle endurance and standing balance according to severity of disability in women with moderate to severe disability due to neck pain
Müge Kırmızı, Gamze Yalçınkaya Çolak, Yeşim Salık Şengül, Orhan Kalemci
PMID: 39431680  doi: 10.14744/agri.2023.90907  Pages 248 - 256
Objectives: To investigate the association between trunk muscle endurance, standing balance, and neck disability in women with chronic neck pain (CNP) and to compare trunk muscle endurance and standing balance according to disability severity.
Methods: Thirty-one women with CNP and Neck Disability Index scores of 30%–70% were included. Isometric endurance times of neck flexors, trunk flexors, extensors, and lateral flexors were measured. Overall stability index (OSI), anterior/posterior stability index (APSI), and medial/lateral stability index (MLSI) were obtained to assess standing balance under the following conditions: eyes-open on a firm surface (EO-Firm), eyes-closed on a firm surface, eyes-open on foam, and eyes-closed on foam (EC-Foam). Higher index scores indicate larger postural sway. Linear regression analysis was used for association. Participants were divided into two groups based on their disability scores, either having moderate or severe disability, and the groups were compared.
Results: Trunk flexor endurance time had an effect on disability (R-squared=0.18, F(1.29)=6.453) and APSI under the EC-Foam condition (R-squared=0.17, F(1.29)=6.105) (p<0.05). Trunk extensor endurance time had an effect on OSI under the EO-Firm condition (R-squared=0.14, F(1.29)=4.775, p<0.05). Women with moderate disability had longer endurance times than those with severe disability for trunk flexors (Cohen’s d=0.89, p<0.05).
Conclusion: Isometric endurance times of trunk flexors and extensors were associated with standing balance in women with CNP. Trunk flexor endurance was also associated with neck disability. Furthermore, women with moderate disability had better trunk flexor endurance than those with severe disability, with a large effect size.

7. Pain phenotypes in caregivers of children with cerebral palsy
Tuğba Cirit, İsmail Saraçoğlu
PMID: 39431674  doi: 10.14744/agri.2024.28999  Pages 257 - 265
Objectives: To determine the phenotypes of chronic pain seen in individuals caring for children with cerebral palsy (CP). Methods: A current classification system was used to determine the prevalence of predominant pain phenotypes in caregivers of children with CP. To this end, the Visual Analog Scale, Margolis pain diagram, Central Sensitization Inventory, and Short Form-36 questionnaire were administered to the participants. In addition, the participants underwent a quantitative sensory examination.
Results: This study was concluded with 60 individuals. The predominant pain phenotype was nociceptive pain in 30% of the participants, nociplastic pain in 25%, and neuropathic pain in 5%. The pain duration (p=0.365) and quality of life of the individuals did not significantly differ according to the predominant pain phenotypes (p>0.05). However, there was a statistically significant difference between the pain phenotypes in terms of pain severity (p=0.016) and the Central Sensitization Inventory scores (p<0.001).
Conclusion: Nociceptive pain was the most common pain phenotype in caregivers of children with CP. We also concluded that among the pain phenotypes, pain intensity was highest in neuropathic pain. There is a need for further studies in this area to demonstrate the validity and reliability of the evaluated mechanism-based classification system in order for it to be included in clinical guidelines.

CASE REPORTS
8. Persistent hiccups as a rare complication after transforaminal epidural steroid injection: A Case Report
Ferhat Ege
PMID: 39431673  doi: 10.14744/agri.2022.90688  Pages 266 - 268
A male patient presented to the clinic with persistent hiccups and the complaint of subacute low back pain. Subsequently, he was administered a transforaminal epidural betamethasone injection (TFESI) plus lidocaine and developed persistent hiccups thereafter, which lasted for 6 days and subsided spontaneously. He presented with similar complaints again 5 months later and was administered TFESI, this time along with betamethasone and saline. Yet, he once again developed persistent hiccups, which this time lasted for 7 days and subsided spontaneously. This case report, featuring a patient who was administered TFESI due to subacute low back pain and subsequently developed persistent hiccups as a rare complication, aims to contribute to the literature in the relevant area of specialization.

9. An unusual imaging finding mimicking double contour sign following ultrasound-guided intra-articular knee injection of steroid: A case report
Serdar Kokar, Özlem Mercan, Kenan Akgün
PMID: 39431671  doi: 10.14744/agri.2022.10179  Pages 269 - 271
Examination of monosodium urate crystals in the synovial fluid remains the gold standard for the diagnosis of gout. On ultra-sound (US) examination, the double contour sign (DCS) is one of the most common imaging findings of gout. In this article, we present, for the first time, a unique imaging finding mimicking DCS after US-guided intra-articular knee injection of steroid and discuss it in light of the literature data.

10. Percutaneous fluoroscopic lumbar facet joint synovial cyst aspiration for manifesting with radiculopathy and low back pain
Kamer Dere
PMID: 39431670  doi: 10.14744/agri.2022.07742  Pages 272 - 275
Lumbar facet joint synovial cysts are benign degenerative abnormalities of the lumbar spine and can cause lower extremity ra-diculopathy, spinal stenosis, and low back pain. Herein, we report a case with a synovial cyst treated by percutaneous fluoros-copic aspiration via the facet joint. A 46-year-old woman presented to the neurosurgery clinic complaining of a 2-month history of low back pain with left-sided radicular symptoms. Her physical examination was consistent with a left L5 radiculopathy, and MRI confirmed a left L5–S1 facet joint synovial cyst compressing the nerve root. Percutaneous fluoroscopic cyst aspiration via the facet joint was planned. The cyst was aspirated, and a total of 0.2–0.3 cc of fluid was removed. During the aspiration, the patient reported pain relief. Thus, the procedure was completed. An MRI taken after 3 weeks showed that the cyst had become smaller than before, with no evidence of nerve root compression. For 1 year, the patient has had no pain or neurological symptoms. Patients who undergo a fluoroscopic percutaneous rupture by filling of the facet joint cyst typically have successful outcomes. We conclude that aspiration of the facet joint cyst without rupture can also result in the same successful outcome.

11. Early diagnosis and treatment management with USG in a patient who developed unilateral diaphragmatic paralysis after interscalene block
Zülfü Çevik, Deniz Kara, Ayda Türköz
PMID: 39431675  doi: 10.14744/agri.2022.47750  Pages 276 - 280
Interscalene brachial plexus block is frequently used for anesthesia and analgesia in shoulder, clavicle, and humerus surgeries. However, complications such as infection, hematoma, vascular injury, local anesthetic toxicity, nerve damage, total spinal anesthesia, diaphragmatic paralysis, and Horner syndrome may occur after an interscalene block. In this case report, a case of unilateral diaphragmatic paralysis that developed after an ultrasound-guided interscalene brachial plexus block for intraoperative and postoperative analgesia, which was rapidly diagnosed and treated bedside with ultrasound, is presented and discussed. We believe that ultrasound has become an indispensable means of monitoring anesthesia practice, both in peripheral nerve block and in the diagnosis and treatment of complications, in recent years.

12. Bilateral occipital infarcts due to persistent migraine with aura in an elderly
Melek Kandemir Yılmaz, Pınar Kırıklı
PMID: 39431679  doi: 10.14744/agri.2022.79989  Pages 281 - 284
Migrainous infarction is a rare complication of migraine that mostly occurs in the posterior circulation and in younger women, with an incidence of less than 1%. It is known that migraine, especially migraine with aura, is a risk factor for ischemic stroke in younger adults but not in the elderly. We report a 71-year-old male patient who experienced abnormal visions due to migraine headache and persistent aura, causing bilateral occipital infarcts. He has been suffering from migraine with aura since his adolescence. The frequency and severity of his attacks decreased with age. He has recently been diagnosed with hypertension as a vascular risk factor, in addition to migraine and advanced age. His symptoms have been brought under control with verapamil. Migrainous infarction can present itself at older ages without prominent vascular risk factors, and it can be managed with verapamil.

LETTER TO THE EDITOR
13. Ultrasound-guided ınjections of 2 internal rotators with one needle: Trigger point treatment for shoulder pain
Yakup Erden, Fatih Bağcıer
PMID: 39431677  doi: 10.14744/agri.2023.73444  Pages 285 - 286
Abstract |Full Text PDF

OTHER
14. Reviewer List

Page 287
Abstract |Full Text PDF