Peripheral Nerve Blockade and Botox Treatment in Chronic Migraine: A Comparative Study

Migraine is the most commonly encountered disabling headache. Chronic migraine significantly affects the quality of life and reduces the ability to attend work and social events, and consequently becomes an increasing economic burden.In recent years, peripheral nerve block with botulinum toxin A (botox) and local analgesics has been included in alternative treatment regimens.In cases of chronic migraine, botox is injected into the facial area, maxillary and mandibular nerve, and the head and neck muscles.Recent methods such as great occipital nerve (GON), and lesser occipital nerve, supra orbital nerve (SON), sphenopalatine ganglion blockade and trigeminal ganglion blockade have been applied using local analgesics. GON and SON blockade are the most frequently used of these methods. Studies related to these methods have shown a decrease in the frequency and severity of migraine pain.The results of this study showed that both GON and SON blockade and long-term application of BTX-A treatment were highly effective in the treatment of chronic migraine and both treatment methods had a similar level of effectiveness.That the follow-up period of this study was longer than in previous research can be considered a strong aspect of the study.

Evaluation of Multimodal Anesthetic Drugs Combination in Goats undergoing laparo-ovariectomy

Objective: To evaluate the effect of multimodal analgesic drugs for alleviation of pain accompanying laparo-ovariectomy in goat. Design: Randomized controlled experimental study. Animals: Sixteen goats ageing 8-18 months and weighing 20 kg on average. Procedures: The proposed site of laparotomy in all animals was infiltrated with lidocaine hydrochloride 1% 15 minutes before surgery started. The goats were allocated into four groups of four animals each; first group (L): animals received Lidocaine infltration , second group (PL): animals received Piroxicam at a dose rate of 5 mg/kg IM, third group (PPL): animals received Piroxicam and Propofol at a dose rate of (5 mg/kg and 6 mg/kg, respectively), and finally fourth group (PPBL): animals received Butorphanol at a dose rate of 0.1 mg/kg in addition to Piroxicam- Propofol . Heart rate (HR), respiratory rate (RR), rectal temperature (RT), serum concentrations of lactate, creatinine, blood urea nitrogen (BUN), interleukin-6 (IL-6), Alanine aminotransferase (ALT) and Aspartate aminotransferase (AST) were determined at baseline (15 minutes prior to surgery), directly after administration of the anesthetic agent, during surgery, and post-surgery at 30 minutes, 60 minutes, 120 minutes for 1-3 days postoperatively. Additionally, the analgesia score was monitored. Results: Heart rate, respiratory rate, Serum levels of IL 6, BUN and ALT decreased significantly in PPBL group compared to the other groups (P≤0.05). In addition, analgesia scores were significantly higher in PPBL group than the other groups (P≤0.05). Conclusion and clinical relevance: It could be concluded that the use of Propofol and Butorphanol in the analgesic protocol during laparo-ovariectomy in goats can alleviate stress and pain response and could therefore potentiate the effects of local analgesics.

Application of intraperitoneal bupivacaine injection for pain relief after laparoscopic cholecystectomy

Introduction. Lately, intraperitoneal injection of local analgesics has been practised as an element of postoperative multimodal anaesthesia in some minimally invasive gynaecologic surgical interventions. Aim. To analyse efficacy of intraperitoneal bupivacaine injection for pain relief after laparoscopic cholecystectomy. Material and methods. Randomized double-blind clinical examination included 28 patients, aged between 32 and 60 (16 women and 12 men) who had undergone laparoscopic cholecystectomy. Patients were randomly divided into 2 groups, depending on whether bupivacaine had been applied for 24 hours in complex early postoperative anaesthesia (0.125% solution intraperitoneally, in a dose of 0.6 ml/kg (0.7 mg/kg of bupivacaine substance), every 6 hours). Patients’ condition was assessed on a visual analogue scale (VAS) 1, 4, 8, 12, and 24 hours after surgery. In addition, average number of fentanyl (mcg/kg) that had been used for a single pain relief was established. Results. Intraperitoneal bupivacaine injection after laparoscopic cholecystectomy had marked analgesic effect which revealed itself in reliable 1.47-1.77 times decrease in pain index on the VAS, and 1.55 times decrease in the analgesic dose of fentanyl. Conclusions. It seems to be appropriate to use intraperitoneal bupivacaine injection as a part of comprehensive multimodal anaesthesia in early postoperative period after laparoscopic cholecystectomy.