This study aimed to perform genicular nerve RF neurotomy using two different imaging methods, fluoroscopy and ultrasound, and to compare the clinical effects and reliability of the two methods. Fifty patients with osteoarthritis were included in this study. Patients were randomly allocated into group 1 (fluoroscopy imaging) and group 2 (ultrasound imaging). Outcomes were measured using a pain scale (visual analog scale; VAS) and the Western Ontario and McMaster Universities (WOMAC) Index of Osteoarthritis. The application time in the ultrasound group (20.2 ± 6.4 min) was shorter than in the fluoroscopy group (25 ± 4.8 min) (p < 0.05). There was no difference in pain relief and functional status between the ultrasound and fluoroscopy groups. Decrease in VAS score and WOMAC total score in the first and third months was significant in both groups (p < 0.001). GNRFT under ultrasound guidance was easily applicable, safe and dynamic, and required no radiation to achieve the same benefit as the fluoroscopy-guided interventions.
Kronik refrakter angina pektoris tedavisine medikal yaklaşım, lazer revaskülarizasyon, transmyokardial lazer revaskülarizasyon, angiogenesis, growth faktör gen terapisi, torakal epidural anestezi ve spinal kord simülatörü kullanılmakla birlikte, unilateral sol stellat ganglion blokajı bir alternatif olarak önerilmektedir. Özellikle yaşam süresi kısa olan hastalarda tercih edilebilecek bir palyatif bir girişim olarak düşünülmelidir. Bizde 66 yaşında erkek hasta son dönem kalp yetersizliği ile takip edilen ve kronik refrakter angina pektorisin tedavisinde unilateral sol stellat ganglion blokajı yapılan olguyu sunduk. Anahtar sözcükler: Kronik refrakter angina pektoris; son dönem kalp yetmezliği; palyatif tedavi; unilateral sol stellat ganglion blokajı.
INTRODUCTION: Spinal Anesthesia (SA) can lead to hypotension due to sympathic denervation, which causes a reduction in venous return to the heart as a result of peripheral vasodilation and redistribution of intravascular blood. Transthoracic Echocardiography (TTE) is a noninvasive and easy-to-use method to visualize cardiac reserve and functions. We aimed to evaluate whether parameters attained via transthoracic echocardiography are predictive of development of post-SA hypotension. METHODS: Forty-two patients between the ages of 18 and 80, who would undergo inguinal hernia operation under SA, with ASA physical status I-II and had no clinically recognized cardiovascular disease, were included in the study. TTE was performed for each patient 30 minutes before the operation, and measurements were recorded along with the intraoperative hemodynamic parameters. RESULTS: There was a statistically significant difference between the medians of left ventricle end-diastolic diameter (LVEDD) (cm) according to the status of post-SA hypotension (p=0.003).Accordingly, median LVEDD of patients who did not develop hypotension was significantly larger compared with that of those who had hypotension. Similarly, a statistically significant difference emerged between the medians of right ventricular (RV) tricuspid annular plane systolic excursion (TAPSE) (cm) showing RV global function according to the status of post-SA hypotension (p=0.001). Accordingly, patients who did not have hypotension had a larger RV-TAPSE median compared with that of those who had hypotension. The difference between the medians of RV isovolumetric relaxation time (RV-IVRT), which is one of the indicators of RV diastolic functions was again statistically significant according to the status of post-SA hypotension (p=0.025). DISCUSSION AND CONCLUSION: TAPSE, RV-IVRT and LVEDD measured via preoperative TTE, can be significant parameters to predict the development of post-SA hypotension.
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