Neurogenic thoracic outlet syndrome (nTOS) is a condition caused by compression of the brachial plexus in the thoracic outlet, often leading to pain and paresthesia. In this article, we report a 34-year-old female patient with chronic nTOS symptoms refractory to prior management. Ultrasound-guided diagnostic blocks of the anterior scalene and pectoralis minor muscles provided significant temporary relief. Subsequent ultrasoundguided onabotulinum toxin A (BTX-A) injections into the scalene muscles resulted in near-complete symptom resolution lasting approximately six months. Over an 18-month follow-up, repeated injections at six-month intervals produced consistent clinical improvement without adverse effects. In conclusion, repeated ultrasound-guided BTX-A injections may be a safe and effective option within a multimodal treatment approach for nTOS.
BACKGROUND:This study aims to investigate the association between tobacco use and central sensitization (CS), as measured by the Central Sensitization Inventory (CSI), and to identify demographic and clinical factors associated with CS. PATIENTS AND METHODS:In this cross-sectional study, a total of 380 adults were included using a convenience sampling method between December 2024 and January 2025. Data collection was performed through an online survey platform to ensure accessibility and broad participation. The survey was distributed via digital platforms, social media networks, and email lists to reach a diverse adult population across Türkiye. Demographic characteristics, clinical variables, and tobacco product use status were recorded. Central sensitization was assessed using the CSI. Multiple linear and logistic regression analyses were performed to identify predictors of CSI scores. RESULTS:Of a total of 380 participants, 131 were male and 249 were female with a mean age of 41.21 ± 11.40 (range, 18 to 65) years. Tobacco users had significantly higher CSI total scores compared to non-users (p = 0.029). A higher proportion of individuals with a CSI score ≥ 40 was observed among tobacco users (p = 0.003). In the multiple linear regression model, age (β = -0.295), female sex (β = 6.255), chronic disease status (β = 4.524), chronic pain (β = 12.093), and tobacco use (β = 6.538) were independent predictors (p < 0.001). Logistic regression analysis indicated a significant association between tobacco use and the likelihood of having a CSI score ≥ 40 (odds ratio [OR] = 0.488, 95% confidence interval [CI]: 0.302-0.789). CONCLUSION:Tobacco use is positively associated with higher CS symptom severity. Given the cross-sectional design, these findings reflect a correlation rather than direct causality. Nevertheless, screening for smoking habits may provide valuable context during the clinical evaluation of chronic pain.
BACKGROUND:This study aims to assess the efficacy of erector spinae plane block (ESPB) for postoperative analgesia in patients undergoing total hip arthroplasty (THA) under spinal anesthesia. PATIENTS AND METHODS:In this randomized-controlled trial, a total of 30 patients (American Society of Anesthesiologists Class I-III, 20 to 65 years) who underwent elective unilateral THA under spinal anesthesia were included between January 2023 and December 2023. The patients were randomized either to Group E (n = 15) to receive ultrasound-guided lumbar ESPB with 40 mL of 0.25% bupivacaine in addition to spinal anesthesia (2.5 mL of 0.5% hyperbaric bupivacaine with 10 µg of fentanyl), or Group C (n = 15) who received spinal anesthesia alone. Primary outcomes were duration of analgesia and Visual Analog Scale (VAS) scores at 6 h. Secondary outcomes included VAS scores at 0, 0.5, 2, 4, 12, 24 h and total additional analgesic requirement in the first 24 h. RESULTS:Of a total of 30 patients included in the study, 22 were male and 8 were female with a mean age of 36.86 ± 13.24 (range, 18 to 65) years. The duration of analgesia was significantly longer in group E (10.76 ± 1.96 h vs. 4.18 ± 1.36 h; p < 0.01). The VAS scores were lower in group E at 0.5 h (p = 0.009), 2 h (p < 0.001), 4 h (p < 0.001), 6 h (p < 0.001), and 12 h (p = 0.02). Additional analgesic requirement during the first 24 h was higher in Group C. Surgeon and patient satisfaction scores significantly improved in Group E. No hemodynamic instability or motor weakness was observed. CONCLUSION:Lumbar ESPB with 40 mL of 0.25% bupivacaine significantly prolongs postoperative analgesia and reduces pain scores and analgesic consumption in patients undergoing THA under spinal anesthesia. Based on these findings, lumbar ESPB may provide effective and safe adjunctive analgesia in this patient population.
