Ganglion impar blockis used for the treatment of chronic coccygodynia. Pulsed radiofrequency (PRF) of the ganglion impar is a promising novel technique. The aim of this study was to determine and compare the efficacy of the blockade and PRF of the ganglion impar. Thirty-nine consecutive patients diagnosed with coccygodynia and treated with a blockade or PRF of the ganglion impar were included in this retrospective study. We compared the ganglion impar block (GIB) group (n = 25) with the ganglion impar pulsed radiofrequency (GIPRF) group (n = 14) in terms of pain intensity and patient satisfaction. We applied a numeric pain rating scale (NPRS) and a Likert scale (LS). The NPRS scores in both groups had improved significantly from baseline at 3 weeks and at 3 and 6 months. However, in the sixth month, pain levels in the GIPRF group remained good, but they had returned to almost initial levels in the GIB group. Correspondingly, there were significant differences between groups in NPRS and patient satisfaction scores at 6 months (P ˂ 0.05). PRF neuromodulation provides significantly longer pain relief and reduces the risk of recurrence of pain in chronic coccygodynia as compared with blockade of the impar ganglion.

Pulsed radiofrequency (PRF) of the suprascapular nerve has been shown to be effective in the treatment of chronic shoulder pain. Ultrasound (US) guidance has gained popularity in regional blocks recently. This study aims to investigate the efficacy of suprascapular nerve pulsed radiofrequency under the guidance of ultrasonography. This retrospective study included patients treated with PRF of the suprascapular nerve with a diagnosis of partial rotator cuff tears. The patients were assessed with a numeric rating scale (NRS), the Shoulder Pain and Disability Index (SPADI), and a Likert patient satisfaction score before the treatment and 3 weeks and 6 months following the treatment. A total of 31 patients was included in the study. The patients’ mean age was 66.8 ± 13.3 years. The mean scores of the NRS, SPADI, and Likert scale before the procedure (7.32 ± 1.1, 69.0 ± 8.5, 1.6 ± 0.6) and at 3 weeks (2.9 ± 2.1, 32.1 ± 17.20, 4 ± 1.2) and 6 months (3.2 ± 2.6, 33.9 ± 20.8, 3.8 ± 1.2) after the procedure were evaluated. We observed significant improvement in NRS, SPADI, and Likert scores at 3 weeks and 6 months following the treatment (P < 0.001). The study demonstrated that US-guided suprascapular nerve PRF achieves good pain relief and functional improvement in patients with partial rotator cuff tears for at least 6 months.

Background and Aim: In oncology patients, central venous port catheter (CVPC) implantation is generally preferred for venous route. However, in this procedure, postoperative pain is often observed. This study aimed to investigate the effectiveness of ultrasound-guided Pecs II block in the management of pain after CVPC placement. Methods: One hundred and eighty-seven patients who underwent CVPC implantation between January 2017 and August 2018 were included in the study. Patients who underwent Pecs II block under ultrasound guidance were called as the Pecs group, and those who underwent local anesthesia (LA) were referred as the LA group. All procedural parameters were analyzed, including demographic characteristics of patients, visual analogue scores (VAS) at 2nd and 24th hours, and postoperative opioid, and non-steroidal anti-inflammatory drug (NSAID) consumption. Results: The postoperative 2nd hour VAS scores were similar in both groups and were lower than the 24th hour VAS scores. VAS scores at the 24th hour in the Pecs group were significantly lower than the LA group (P = 0.001). While the number of fentanyl rescue doses administered in PACU was similar, the total NSAID consumption in the first 24 hours was higher in the LA group than in the Pecs group. Conclusion: In CVPC placement, ultrasound-guided Pecs II block is a more reliable, easily applicable and longer-acting approach than LA infiltration for postoperative analgesia.

Blood loss is the most significant cause of mortality in trauma cases. In injured patients, rapid evaluation and appropriate transfusion is lifesaving. The present study aims to analyze the blood/blood products requirement based on available data and find any associations between the transfusion requirements and injury severity scores (ISS) and anatomical locations of injuries of transfused patients. Between 30 July 2014 and 30 July 2016, casualties admitted to the urban terrain hospital (UTH) and transfused at least one unit of red blood cell (RBC) were included. UTH Transfusion Record Notebook data included patients' age, mechanism and anatomical location(s) of the injury, admission hemoglobin (g/dL) level, injury severity score (ISS), transfused units of erythrocyte suspension (ES), warm fresh whole blood (WFWB), fresh frozen plasma (FFP), and massive transfusion (MT) rate. In this study, all patients were male; the mean age was 28.7±7.8 years. Overall, 59 of 579 (10%) patients were transfused 458 units of RBC (ES+WFWB). Torso (thorax ± abdomen) injury was present in 61% of the casualties who underwent transfusion, and 93% of these patients underwent massive transfusion. In 71% of patients, the ISS was >15, and there was statistically significant high blood/blood products use and MT rate in these patients, respectively (p=0.021, p=0.006). Anatomical location of injuries and ISS are valuable in the rapid determining of MT and survival rates of casualties. Especially in torso injuries, bleeding control is difficult and transfusion requirement and mortality rates are high. This study presents the trauma of urban terrain conflict-related transfusion data from a UTH.

Transnasal sphenopalatine ganglion block is a commonly used approach for treatment of a variety of headache disorders. However, no standard technique has yet been defined for this less invasive approach. In this study, our aim was to investigate morphometric and anatomical features of the sphenopalatine foramen, and to describe a more efficient approach for transnasal sphenopalatine ganglion block. The present study was designed retrospectively. Ten cadaver semi- heads and 18 adult dry skulls (28 samples totally) were included in the study. The distances between the sphenopalatine foramen and palatum durum, and also between the sphenopalatine foramen and the spina nasalis anterior, angle of elevation of the sphenopalatine foramen from palatum durum, and the length and width of the sphenopalatine foramen were measured. The mean width and length of the foramen were 3.79±0.35 and 6.44±0.94 mm, respectively. The mean distance between the palatum durum and the sphenopalatine foramen was 15.58±1.68 mm. The mean angle of elevation of the sphenopalatine foramen from the palatum durum was 26.10±3.97 degrees. The mean distance between the sphenopalatine foramen and the anterior nasal spine was 52.90±2.98 mm. In the transnasal sphenopalatine block, we suggest advancement of nasal applicator through superolateral direction for approximately 5.3 cm, and at an angle of about 26° from the nasal base..