Objectives: This study aimed to evaluate the effectiveness of ultrasound (US)-guided and fluoroscopy (FL)-guided intra-articular steroid injections on pain and hip function. The study focused on patients with hip osteoarthritis (coxarthrosis) who were refractory to medical treatment.
Methods: In this retrospective study, 61 patients with stage ≥2 coxarthrosis and VAS ≥4 were evaluated. Patients received either US-guided (Group U) or FL-guided (Group F) corticosteroid injections. Visual analog scale (VAS), Harris Hip Score (HHS), and analgesic use were assessed at 1 week and at 1, 3, and 6 months post-treatment. Analgesic use was evaluated based on the number of days with analgesic consumption and was interpreted as increased, decreased, or unchanged compared to baseline.
Results: Both treatment methods provided significant improvements in VAS and HHS scores at all follow-up points across osteoarthritis stages (p<0.05). However, no statistically significant difference was found between the groups in terms of pain scores, functional outcomes, or analgesic use. While marked improvements were observed in stage 2 patients, the clinical effectiveness of the injections decreased as the disease stage progressed.
Conclusion: Both US-guided and FL-guided steroid injections resulted in significant pain reduction and improved functionality in patients with osteoarthritis. No clear superiority was observed between the two techniques. Treatment was most effective in patients at earlier stages of the disease, with efficacy declining as the disease advanced. Additionally, US is a safer imaging modality compared to FL, as it does not involve exposure to ionizing radiation.

Objectives: Coccydynia is a complex and often refractory pain condition involving both sympathetic and somatic components. While ganglion impar block (GIB) is a well-established interventional technique for cases unresponsive to conservative treatment, pericoccygeal injection may offer additional benefits by targeting peripheral sensitization and anococcygeal nerve-mediated pain. This study aimed to evaluate and compare the clinical effectiveness of GIB alone versus GIB combined with pericoccygeal injection in patients with refractory coccydynia.
Methods: This retrospective cohort study included 60 patients aged 18–65 years treated at a tertiary pain clinic between June 2022 and June 2024. Patients received either GIB alone or GIB combined with pericoccygeal injection in a single session under fluoroscopic guidance. Pain severity and functional outcomes were assessed using the Numeric Rating Scale (NRS-11), Oswestry Disability Index (ODI), and Paris Functional Coccydynia Impact Questionnaire (PFCIQ) before the procedure and at 1 and 3 months post-intervention.
Results: Both groups demonstrated significant improvements in NRS-11, ODI, and PFCIQ scores at 1 and 3 months compared to baseline (p<0.001). The combination therapy group showed significantly greater reductions in NRS-11 and ODI scores at 1 month (p=0.043 and p=0.036, respectively), and in ODI scores at 3 months (p=0.04). Analgesic use declined prominently in both groups, and no major complications were reported.
Conclusion: A single-session combination of GIB and pericoccygeal injection appears to offer superior short-term pain relief and func-tional improvement compared to GIB alone in refractory coccydynia. Further prospective studies are needed.

Objectives: Dexmedetomidine and clonidine have been studied separately as adjuvants with levobupivacaine, but there is no literature comparing the two drugs for caudal anesthesia in children. We compared the analgesic efficacy and adverse effects of clonidine and dexmedetomidine as adjuvants to levobupivacaine for caudal analgesia in children undergoing infraumbilical surgeries.
Methods: In this prospective randomized study, 100 pediatric patients (3 to 8 years) of either sex, scheduled for infraumbilical surgery, were randomly allocated to two equal groups in a double-blind manner. After induction of anesthesia using a standard technique, caudal anesthesia was administered using 0.2% levobupivacaine (1 ml/kg) with either 1 µg/kg dexmedetomidine (Group A) or 1 µg/kg clonidine (Group B). Hemodynamic parameters, motor block, degree of sedation, postoperative analgesia, use of rescue analgesics, and side effects were evaluated for 24 hours.
Results: The mean duration of analgesia in Group A (12.7±2.4 h) was higher than in Group B (10.6±2.2 h), which was statistically significant (p=0.000). The mean duration of sedation was higher in Group A, although it was statistically insignificant. Hemodynamic parameters were comparable in the two groups. No significant side effects were observed in the groups.
Conclusion: Dexmedetomidine (1 µg/kg) added to 0.2% levobupivacaine (1 ml/kg) for caudal block provides prolonged analgesia with better sedation scores when compared to clonidine (1 µg/kg) with 0.2% levobupivacaine (1 ml/kg) for below umbilical surgeries in pediatric patients, without increasing the incidence of adverse effects. Hence, we would recommend the use of 1 µg/kg dexmedetomi-dine as an adjuvant to 0.2% levobupivacaine.

Objectives: This study aimed to evaluate the effect of central sensitization level on treatment response in individuals older than 65 years who underwent genicular nerve radiofrequency and intra-articular injection treatments for knee osteoarthritis (OA).
Methods: In this retrospective cohort study, 37 patients were divided into two groups according to the Central Sensitization Inventory (CSI) score (CSI<40 and CSI≥40). All patients underwent genicular nerve radiofrequency ablation and intra-articular injection. Pain (NRS), functionality (WOMAC), walking capacity (6MWT), sleep quality (PSQI), and satisfaction levels were evaluated at baseline and at 1 and 3 months following the procedure. Variance and regression analyses were used for statistical evaluation.
Results: Significant clinical improvements were observed in all patient groups for the evaluated parameters (p<0.001). However, variance analysis for pain (F=22.566, p<0.001), function (F=15.283, p<0.001), sleep quality (t=–3.87, p<0.001), and walking capacity (F=13.301, p=0.001) showed lower scores in the CSI≥40 group compared with the CSI<40 group. Regression analysis confirmed lower responses in CSI≥40 patients: pain (β=–2.1; 95% CI: –3.1 to –1.1; p<0.001), function (β=–4.6; 95% CI: –7.2 to –2.0; p=0.001), walking (β=–24.6; 95% CI: –40.7 to –2.8; p=0.026), and sleep (β=–1.9; 95% CI: –2.9 to –0.9; p=0.001).
Conclusion: The presence of central sensitization significantly limits the clinical response to genicular radiofrequency ablation and intra-articular injection treatments in older patients with OA. Routine use of screening tools such as CSI in treatment planning may guide more effective and personalized approaches.

Objectives: The modified thoracoabdominal nerves block through the perichondrial approach (M-TAPA) and the oblique subcostal transversus abdominis plane block (OSTAP) provide effective analgesia management after abdominal surgeries. There are limited studies comparing these two blocks in the literature. We aimed to compare M-TAPA and OSTAP in patients who underwent laparoscopic inguinal hernia repair.
Methods: Patients with ASA status I–II, aged between 18 and 65 years, scheduled for elective TAPP under general anesthesia were included in the study. The patients were randomized into two groups: Group M-TAPA (n=30) and Group OSTAP (n=30). Blocks were performed using a total of 60 ml of 0.25% bupivacaine (30 ml per side). Postoperatively, all patients were routinely prescribed intravenous ibuprofen 400 mg three times a day. If a patient’s NRS score was ≥4 at any time, a dose of 100 mg intravenous tramadol was administered for rescue analgesia.
Results: The duration of the block procedure was significantly longer in the OSTAP group. The need for rescue analgesia and opioid consumption were similar between the groups. In the first two postoperative hours, static and dynamic NRS scores were lower in the M-TAPA group than in the OSTAP group. There were no differences between the groups in terms of the rate of adverse events. Patient satisfaction (Likert scale) was higher in the M-TAPA group.
Conclusion: The M-TAPA block is not inferior to the OSTAP block following laparoscopic inguinal hernia repair surgery. Moreover, the M-TAPA block may be an alternative option to the OSTAP block, as it is easy to apply.

Schwannomas are benign tumors originating from the peripheral nerve sheath. Although they rarely involve the sciatic nerve, their presence may result in sciatica, a condition characterized by pain radiating along the course of the sciatic nerve from the buttock or gluteal region. Despite being an uncommon cause of sciatica, sciatic nerve schwannomas present diagnostic challenges and management complexities. Their occurrence within the sciatic nerve is frequently overlooked, underscoring the need for accurate diagnosis and individualized therapeutic strategies. Surgical intervention is the primary treatment modality for sciatic nerve schwannomas and is associated with highly favorable outcomes when an appropriate surgical approach is employed. In this report, we present a case of chronic sciatica caused by a large schwannoma. Our aim is to emphasize the critical role of comprehensive imaging techniques and meticulous pathological evaluation in achieving an accurate diagnosis and guiding effective treatment planning in such cases.

Complex regional pain syndrome is a chronic pain condition characterized by regional pain without a dermatomal distribution. The primary goal of treatment is to alleviate pain and restore function in the affected limb. Multimodal therapeutic methods are adopted, including stellate ganglion block, with favorable outcomes such as pain score reduction and increased mobility in affected patients. This case presentation aims to describe the importance of early stellate ganglion block in the management of CRPS.

Notalgia paresthetica (NP) is a rare sensory neuropathy and is not a well-known condition. As a result, the diagnosis is often overlooked, and back pain may be the initial presenting symptom. Back pain is a common locomotor system complaint in children. Here, we present a 15-year-old female patient who experienced back pain, itching, and tingling for the past 4 months and was diagnosed with NP. Recognition of NP as a rare cause of back pain in children is important for initiating targeted therapy. Considering NP in the differential diagnosis of children presenting with back pain allows early diagnosis and treatment and helps prevent pain from becoming chronic.