Transforaminal epidural steroid enjeksiyonu radiküler ağrı tedavisi için kullanılan yaygın bir girişimdir. Komplikasyonları nadir fakat katastrofiktir. En nadir katastrofik komplikasyonlarından biri Adamkiewicz arter (AKA) oklüzyonu ile ilgilidir. Bu sunumda transforaminal epidural steroid enjeksiyonu ile ilişkili AKA injurisinden kaçınmak için uyguladığımız yaklaşımı sunduk. 71 yaşında erkek hasta kliniğimize lomber disk hernisine bağlı radikülopati ile başvurdu. Hastaya transforaminal steroid enjeksiyonu planlandı. Radyokontrast enjeksiyonu sonrasında vasküler dolum görüldü. Bunun üzerine iğneye yeniden pozisyon verilerek epidural alana ulaşmak için inferior giriş uygulandı. Vasküler yayılım görülmedi ve dexametazon enjekte edildi. Transforaminal epidural enjeksiyon radiküler ağrı için efektif bir girişimsel ağrı tedavisidir. Fakat muhtemel katastrofik komplikasyonlar nedeniyle dikkatli olmayı gerektirir. AKA büyük oranda foramenin üst yarısında lokalizedir. Spinal kord iskemisini önlemek için AKA'nın çok geniş bir anatomik varyasyona sahip olduğunu akılda bulundurmak çok önemlidir.Anahtar sözcükler: Adamkiewicz arteri; infranöral yaklaşım, spinal kord iskemisi; transforaminal epidural enjeksiyon.
Objectives: A new type of coronavirus outbreak has emerged in China and caused a pandemic. World Health Organization (WHO) announced the official name of this disease 'COVID-19' . The main purpose of this study is to evaluate pain in COVID-19 patients. Methods: Patients who were followed in the ward of an infectious diseases department because of possible or confirmed COVID-19 between May and September of 2020 were included in the study. The Turkish version of the Brief Pain Inventory (BPI) was applied. Demographic features, frequency, location, the intensity of pain, and response to analgesics were analyzed. Results: A total of 178 participants were included in the study. Ninety-one (51.1%) of patients had pain complaints and the mean pain score (MPS) was 2.28±2.81 over 10. Fifty-nine (56.0%) of participants with pain required analgesic therapy and 41 (80.3%) of them showed ≥50% pain relief with simple analgesics. Twelve of the remaining 18 who did not get enough pain relief with simple analgesic were taking their analgesics pro re nata (PRN) rather than around the clock (ATC). Pain frequency and intensity and mean hospitalization duration (MHD) were similar between confirmed and possible cases. Conclusion:Regarding the results, we conclude that pain is not one of the challenging symptoms and easily manageable in patients with a mild-moderate intensity of COVID-19. Our results were not enough to make a correlation between pain and the clinical course of the disease. Further studies are required for the evaluation of pain including patients in intensive care units.
The main object of this study is to evaluate the psychological status of chronic pain patients (CPP) and describe the characteristics and frequency of psychological disorders of CPP. Two hundred sixty-three patients with complaints of chronic pain longer than 1 year and fifty healthy volunteers were included in the study. Patients with cancer were not included. Turkish version of Symptom Checklist-90 Revised (SCL- 90-R) was used for the assessment of the psychological status of participants. CPP were divided into 5 subgroups regarding their painful regions: Headache, cervical or upper extremity pain, axial or radicular back pain, lower extremity pain, and diffuse pain. Global severity index (GSI) and subscales of SCL-90-R were analyzed. In CPP, GSI and almost all subscale scores of SCL-90-R were significantly higher than the control group. Headache patients had worse psychological symptoms than other subgroups of CPP. SCL-90-R scores of female patients were significantly higher than males. 24.7% of patients had moderate and 14.8% had severe psychological symptoms. While the intensity of the pain had a moderate correlation with increased psychological symptoms, the level of education and age had a weak negative correlation with SCL- 90-R scores. Patients with chronic pain are convenient to have phycological symptoms. While almost half of the patients have increased psychological symptoms, the degree of the symptoms can be serious in some of them. Thus, treatment of chronic pain necessitates a multidisciplinary approach.
ÖzetSpinal kord stimülasyonunun (SCS) birçok kronik ağrı sendromunun tedavisinde etkili bir yöntem olduğu gösterilmiştir. Ayrıca SCS ile ağrı palyasyonunun sağlanması immobilizasyon ve immobilizasyon ile ilişkili komplikasyonları azaltabilir. Biz bu olguda postlaminektomi sendromu nedeniyle spinal kord stimülatörü uygulanan hastada deneme dönemi sırasında görülen pulmoner emboliye yaklaşımımızı sunduk. SCS hastalarında pulmoner emboli şüphesi akılda bulundurulması gereken bir durumdur. Ayrıca SCS ile ağrı palyasyonunun sağlanması immobilizasyon ve immobilizasyon ile ilişkili komplikasyonları azaltabilir.Anahtar sözcükler: İmmobilizasyon; pulmoner emboli; spinal kord stimülasyonu. SummarySpinal cord stimulation (SCS) has been shown to be an effective method for treating many chronic pain syndromes. In addition, providing pain relief with SCS can reduce immobilization and complications related to immobilization. The present case describes pulmonary embolism (PE) that occurred in patient being treated with SCS for post-laminectomy syndrome. The possibility of PE must be kept in mind while treating patients with SCS.
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