Aǧrı : Ağrı (Algoloji) Derneği'nin Yayın organıdır = The journal of the Turkish Society of Algology
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The development of intracranial subdural hematoma after spinal anesthesia is a rare and serious complication that can be fatal if untreated. Needle puncture to the dura mater can cause leakage of cerebrospinal fluid, and lead to stretching and rupture of the meningeal blood vessels with resultant bleeding. A 24-year-old patient, with a completely normal history and laboratory analysis, has got a L4-5 level spinal anesthesia well done at first try, using a Quinke 25 G needle and 12,5 mg bupivacaine heavy. ⋯ Emergency cranial computerized tomography was obtained and acute fronto-temporo-parietal subdural hematoma was reported. After spinal anesthesia, continued atypical headache and presence of tinnitus must alert against an underlying subdural hematoma. Early diagnosis can be made by history of the patient combined with neurological and radiological imaging methods.
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Acute herpes zoster infection appears in the situation of depression of immune system and reactivation of varicella zoster virus which causes small pox. Pain and maculopapular lesion accompany clinical symptoms. Various pharmacological and invasive methods can be used for treatment. ⋯ Antiviral, gabapentin, and tricyclic antidepressant treatment was started after stellat ganglion blockade and patient was discharged. After 3 months complaints dissapeared and drug doses were discreased and stopped. In conclusion we think that stellate ganglion blockade can be useful in diagnosis, acute pain control, improving patient comfort and compatibility to drug therapy in atypically located herpes zoster.
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Case Reports
[The epidural blood patch technique for the management of headache due to spontaneous intracranial hypotension].
Spontaneous intracranial hypotension is a clinical entity characterized by orthostatic headache, low CSF pressure and specific cranial imaging techniques. Headache can be accompanied by the symptoms such as tinnitus, vertigo, diplopia, nausea and vomiting. ⋯ Epidural blood patch should be planned for the treatment of patients with no reduction of the complaints following conservative treatment. In this case report, we have discussed the diagnostic methods of spontaneous intracranial hypotension and the importance of an epidural blood patch for its treatment in the light of the literature.
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Case Reports
Ultrasound guided TAP block for the treatment of postoperative prolonged pain - an alternative approach.
Transversus abdominis plane (TAP) block is a relatively new regional anesthesia technique in which T7-12 intercostal nerves, ilioinguinal and iliohypogastric nerves, and cutaneous branches of L1-3 nerves are blocked between the internal oblique and transversus abdominis muscles. This technique is mostly used for the treatment of acute postoperative pain following abdominal surgery. In this case report, we evaluate the usage of TAP block in prolonged pain following upper abdominal surgery.
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There has been an increasing trends in the procedures of spine surgery in recent years. Postoperative chronic pain in spine surgery can be caused by damage or instability of spinal column; pressure on nerves or segment of spinal cord; or can be due to long lasting nociception caused by inflammation, infection or tumour. ⋯ Coping with any type of chronic pain is quite difficult. Chronic postoperative pain can be treated with: NSAIDs, paracetamol, opioids, anticonvulsants and invasive technics such as nerve blocs, central blocs.