This study aimed to evaluate the effectiveness of adding caudal epidural steroid injection (CESI) to ganglion impar pulsed radiofrequency (GI-PRF) therapy in patients with refractory chronic coccygodynia, and to determine the effect of pain duration and trauma on treatment success. Forty patients who underwent GI-PRF (n = 20) or GI-PRF + CESI (n = 20) were retrospectively assessed for age, gender, pain duration, history of trauma to the coccyx, Numerical Rating Scale (NRS) pain scores pre-procedure and 1, 3, and 6 months post-procedure and satisfaction rates at 6 months post-procedure. Satisfaction was categorized as excellent, high, moderate, and low. In both groups, NRS scores were significantly decreased at 6 months (pre-vs. 6 mo. post-procedure: GI-PRF [8 vs. 5], GI-PRF + CESI [8.5 vs. 3.5]; p < 0.001). The proportion of patients reporting excellent satisfaction was significantly higher in the GI PRF + CESI group (50 % vs. 15 %; p < 0.05). Patients with trauma history in the GI-PRF + CESI group had significantly lower median NRS values at 6 months compared to patients in both groups with negative trauma history (p < 0.02). Within the GI-PRF only group, patients with trauma history had significantly lower NRS scores at 6 months than those without a history of trauma (p = 0.012). Pain duration did not significantly impact satisfaction levels (p = 0.055). GI-PRF therapy was effective in coccygodynia, especially in patients with positive trauma history, and adjuvant CESI increased patient satisfaction by providing better pain control.

Arthroplasties,elderly,hip replacement,nerve block,opioids

Background. The COVID-19 pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has prompted the widespread use of corticosteroids as a treatment strategy, particularly in cases of severe pneumonia and cytokine storm. While this therapy has saved countless lives, its side effects have also been well-documented, including the development of avascular necrosis. Case presentation. This case report presents a rare instance of simultaneous bilateral avascular necrosis (AVN) affecting both the humeral and femoral heads in a 49-year-old male patient recovering from severe COVID-19. The patient was treated with high-dose corticosteroids, receiving 1250 mg of prednisolone over five days during hospitalization for COVID-19 pneumonia. Six months after discharge, he developed persistent hip pain, which was later diagnosed as AVN in both femoral heads. During hyperbaric oxygen therapy, the patient reported new shoulder pain, and MRI confirmed stage III AVN in both humeral heads. The patient’s pain was managed with bilateral suprascapular nerve radiofrequency ablation and bilateral Pericapsular Nerve Group (PENG) blocks, which provided significant relief. Conclusions. This case emphasizes the potential for corticosteroid-induced AVN, even months after treatment, and underscores the need for long-term monitoring of patients receiving corticosteroids for COVID-19. The involvement of four major joints highlights the severe musculoskeletal complications that can arise, supporting the importance of early diagnosis and timely intervention for pain relief.

Amaç: Mezuniyet sonrası pratisyen hekimler; ağrılı hastanın değerlendirmesinde ve birinci basamak ağrı tedavisinin düzenlenmesinden sorumludurlar. Bu çalışma ile Mersin Üniversitesi Tıp Fakültesi 5. Sınıf öğrencilerinin Anesteziyoloji ve Reanimasyon AD stajı öncesi ağrı ve tedavisi hakkındaki bilgilerinin “Hazır Bulunuşluk Testi” ile değerlendirilmesi amaçlandı. Yöntem: Anesteziyoloji ve Reanimasyon stajına 01/09/2012-01/01/2020 tarihleri arasında gelen Mersin Üniversitesi Tıp Fakültesi 5. Sınıf öğrencilerine staj öncesinde uygulanan Hazır Bulunuşluk Testlerinden, eksiksiz olarak doldurulduğu saptanan 848 testin sonuçları retrospektif olarak değerlendirildi. Test içeriğinde ağrının değerlendirilmesi, ağrıya ait tedavi yöntemleri, kullanılan ilaçlar ve ağrı tipleri konuları bulunmakta idi. Veriler tanımlayıcı istatistik analizleri ile değerlendirildi. Bulgular: Öğrencilerin sadece 85’i (%10.0) ağrı duyusunu taşıyan lifleri doğru olarak tanımlamıştı. Öğrencilerden sadece 57’sinin (%6.7) Dünya Sağlık Örgütü tarafından önerilmiş ‘Ağrıda Basamak Tedavisi’ hakkında bilgisinin olduğu saptandı. Opioidlerin hastaya uygulama yollarını doğru olarak işaretleyen 13 (%1.5) öğrenci mevcuttu. Hastanın ağrısını değerlendirmede kullanılan Vizuel Analog Skala’yı doğru olarak tanımlayan 200 (%23.6) öğrenci vardı. Ağrı tedavisinde kullanılan ilaçlardan, yeşil reçeteye yazılanlara öğrencilerin 61’nin (%7.2), kırmızı reçeteye yazılanlara ise 209’unun (%24.6) doğru analjezik örneği verdiği bulundu. Anketlerin 59’unda (%6.9) parasetamol ve NSAI ilaçların yeşil ve/veya kırmızı reçeteye örnek olarak yazıldığı saptandı. Sonuç: Anketi yanıtlayanların ¼ kadarının doğru bilgi sahibi olduğu saptandı. Tıp fakültelerinde klinik öncesi ağrı ile ilgili bilgi aktarımının, klinik korelasyonla gerçekleştirilmesinin daha kalıcı bilgi oluşturacağı düşüncesindeyiz. Ayrıca eğitim öncesinde ve tamamlandıktan sonra yapılacak değerlendirmeler ile bilgi içeriğinin yapılandırılması gerektiği kanısındayız.

Although spontaneous intracranial hypotension cases related to connective tissue diseases have been reported in the literature, to the best of our knowledge, no cases of iatrogenic intracranial hypotension have been described. In this paper, we plan to discuss a case of acute subdural haematoma and postdural puncture headache that developed after spinal anaesthesia in a patient with Sjogren's syndrome.

Lumbar puncture (LP) is performed by specialists in different branches of medicine, complications may be encountered in various settings. In our study, we evaluated the awareness and knowledge of the diagnosis and treatment of post-dural puncture headache (PDPH) among specialists who performed LP and/or encountered complications. This was a prospective questionnaire/scale study of 253 physicians: LP performers (anaesthesiologists, Group A; others, Group B) and those who worked in departments that did not perform LP but frequently encountered complications following LP (Group C). The questionnaire assessed specialization, frequency of LPs utilization, needle types used, positions employed, awareness of LP complications, diagnosis, management, and risk factors for PDPH. Group A had the highest percentage of physicians who stated they had knowledge about PDPH (Group A: 96.4%, Group B: 77.3%, Group C: 39.4%; P=0.000). Group C was found to be statistically less informed than the other two groups (P=0.000). It was determined that only one (1%) physician from Group C correctly answered the question about the diagnostic criteria for PDPH. To our knowledge this is the first study in which the awareness of PDPH has been compared according to physicians’ fields of specialisation. We believe that post-specialty training programs should be organized for physicians who will either perform LP or monitor patients who have undergone LP, and the curriculum content in relevant specialties should be reviewed.