Background: Tramadol hydrochloride is an analgesic drug used in the treatment of moderate or severe postoperative pain. The local anaesthtetic effects of tramadol were demonstrated in previous studies. The aim of this study was to compare the postoperative analgesic efficacy of intravenous tramadol with the local application of tramadol by injection into merocel in patients undergoing septoplasty.

Objectives: Local anesthetic infiltration is also a process of a painful process itself. INJEX™ technology, known as “Needle-free” drug delivery system, was designed for reducing the pain associated with cutaneous procedures. We conducted a prospective, randomized trial to evaluate the application of lidocaine with INJEX™ system and 27-gauge needle. Methods: A total of 60 consecutive patients were allocated to receive either INJEX group or 27-gauge needle group. Local anesthetic infiltration was applied two minutes before epidural needle insertion. Results: Mean VAS, at the time of local anesthetic injection was 0 for group I and 2 for group II. When the effect of epidural needle insertion was compared, the mean VAS score was one versus two for Group-I versus Group-II, respectively. Lidocaine applied with the INJEX™ system before epidural needle insertion significantly reduced the intensity of pain during that procedure and was least effective the lidocaine applied with the 27-gauge needle and patients felt less pain during at the time of local anesthetic injection in Group-I. Conclusion: Needle-free delivery of lidocaine is an effective, easy to-use and noninvasive method of providing local anesthesia for the epidural needle insertion.

To compare dexmedetomidine with remifentanil in functional endoscopic sinus surgery (FESS) in regards to intra-operative bleeding, anesthetic consumption and post-operative recovery. Randomized, double blind study. Tertiary care medical center. Fifty patients with nasal polyposis who had been scheduled for FESS were randomly divided into two groups. In group D (n = 25), dexmedetomidine 1 µg/kg infused intravenous (IV) over 10 min before anesthesia induction, followed by a continuous of 0.7 µg/kg/h infusion during operation. In group R (n = 25), 1 µg/kg remifentanil IV bolus, was administered with induction of anesthesia and continued 0.25–0.50 µg/kg/min during operation. Heart rates, mean arterial pressure, end tidal CO2, end tidal sevoflurane were recorded. The amount of bleeding, surgical field condition for bleeding and the time to reach Aldrete recovery score 9–10 were recorded. Postoperative nausea, vomiting, pain, shivering, sedation were followed up over 24 h. There was no significant difference between groups according to the amount of bleeding during surgery, assessment of surgical field condition, consumption of sevoflurane, scores of postoperative VAS, rates of nausea and vomiting, shivering, demands of additional analgesic medication (P > 0.05). The time to reach Aldrete recovery score 9–10, sedation scores at the postoperative first hour were significantly higher in group D (P = 0.001). We concluded that in comparison to remifentanil, dexmedetomidine during FESS for controlled hypotension is of limited value as it has no additional benefits in terms of control of hypotension and amount of bleeding in the surgical field and it is associated with higher recovery time and first-hour postoperative sedation scores.

Objective : In this comparative randomized cohort study, we aimed at evaluating the occurrence of sensorineural hearing loss after general and spinal anesthesia using both subjective and objective tests.Material and Methods : Fifty patients scheduled for elective cesarean section were approached, of which 21 patients received spinal anesthesia (group S), and 16 patients received general anesthesia (group G). In group S, a 27 G pencil point spinal needle was used. Pure tone audiometry and Distortion Product OtoAcoustic Emissions (DPOAE) were performed before and 48 hours after surgery.Results : No between-group significant difference in pre and postoperative audiometric hearing threshold and pure tone average value were noticed, as well as in pre and postoperative DPOAE amplitude and signal-to-noise ratio (SNR).Conclusion : In this study, we did not observe any hearing loss after cesarean section under general or spinal anesthesia. Using the non-traumatic 27 gauge pencil point needle for performing spinal anesthesia does not seem to be associated with a risk of hearing loss, similarly to general anesthesia.

PURPOSE The aim of this study was to compare pH meter and neck ultrasonograph for evaluation of nasogastric tube (NGT) position. METHODS A total of 35 adult patients who required NGT insertion were included. The NGT was inserted by an anesthetist after endotracheal intubation, and the transducer was placed transversely on the neck, just superior to the suprasternal notch. The passage of the NGT in the esophagus was evaluated by a sonographer, and the stomach was emptied by nasogastric suction. Secretion from inside the NGT was analyzed using a pH meter. The tip of the NGT was accepted as being in the stomach if the pH measured between 1 and 5. Neck ultrasonography was compared with the pH meter analysis for confirmation of NGT position. RESULTS Ultrasonography was highly sensitive (100% (95% CI 89.6-100%) and specific (97.2% (95% CI 85.4-99.5%) for evaluation of NGT position. The specificity for the pH meter was 100% (95% CI 16.6-100%), while the sensitivity was 76.5% (95% CI 58.8-89.2%). CONCLUSIONS This study showed that neck ultrasonography is more sensitive than the pH meter for confirmation of NGT position.

Purpose: The aim of this study was to investigate the incidence of transient neurological symptoms (TNS) after spinal anesthesia with levobupivacaine, bupivacaine, articaine or lidocaine. Methods: The patients (n=400) were randomly assigned to receive spinal anesthesia with levobupivacaine, bupivacaine, articaine or isobaric lidocaine. Onsets of sensory and motor block were recorded. On postoperative days 1, 2 and 3, patients were interviewed by an investigator blinded to the spinal anaesthetic agent used. The patients were classified as having TNS if there was pain in the hips, thighs and/or lower limbs following recovery from anesthesia. Results: Time to maximum sensory block was significantly longer in the articaine group than the lidocaine group. The incidence of TNS was much less after spinal anesthesia with levobupivacaine, bupivacaine and articaine than after lidocaine.

PURPOSE Articaine is used as a local anesthetic for outpatient surgery because it offers rapid onset of anesthesia and short duration motor block. Levobupivacaine is often preferred for Caesarean section. We evaluated the anesthetic characteristics of fentanyl-supplemented plain articaine and levobupivacaine for Caesarean section under combine spinal epidural anesthesia. METHODS Patients undergoing Caesarean section received in random order plain articaine 40 mg (Group A, n=50) or plain levobupivacaine 10 mg (Group L, n=50) mixed with fentanyl 20 µg intrathecally. The onset and duration of sensory and motor block, first analgesic request, and hemodynamic parameters were recorded. RESULTS Onset times of maximum motor block were longer in Group L than Group A (P=0,001). Time to two-segment regression of sensory block were 70 min for Group A and 90 min group L (P=0.001). Times to complete regression of motor blockade were significantly longer in group L than group A (P =0,001). CONCLUSION To have a faster onset and shorter duration of spinal anesthesia, we recommend the use of plain articaine for Caesarean section.

OBJECTIVES:To investigate effects of the positive end-expiratory pressure (PEEP) application of 10 cm H2O on the plasma levels of cytokines during laparoscopic cholecystectomy.METHODS:A prospective study was conducted on 40 patients who presented to the Department of General Surgery, Medical Faculty, Turgut Özal University, Ankara, Turkey scheduled for laparoscopic cholecystectomy operation during a 10 month period from September 2012 to June 2013. Forty patients scheduled for laparoscopic cholecystectomy operation were randomly divided into 2 groups; ventilation through zero end-expiratory pressure (ZEEP) (0 cm H2O PEEP) (n=20), and PEEP (10 cm H2O PEEP) (n=20). All patients were ventilated with 8 ml/kg TV. Levels of interleukin (IL)-6, tumor necrosis factor (TNF)-α, IL 10, and transforming growth factor (TGF)-β1 were measured in the pre- and post-operatively collected samples.RESULTS:Blood samples of 30 patients' were analyzed for plasma cytokine levels, and 10 were excluded from the study due to hemolysis. Post-operative plasma IL-6 levels were observed to be significantly higher than the pre-operative patients (p=0.035). Post-operative plasma TGF-β1 levels in the PEEP group was found significantly higher compared with the pre-operative group levels (p=0.033). However, there were no significant differences in the pre- and post-operative plasma cytokine levels between the 2 groups.CONCLUSION:The application of PEEP of 10 cm H2O, which has known beneficial effect on respiratory mechanics, does not have any effect on systemic inflammatory response undergoing pneumoperitoneum during laparoscopic cholecystectomy surgery.

OBJECTIVESCervical radiculopathy is widespread in society, and the methods used in the treatment cover a wide range from conservative treatment to surgical treatment. There is not yet a full consensus on the use of invasive approaches for the optimal treatment of radicular pain. However, cervical epidural steroid injection (CESI) has been used in patients with symptoms of cervical discopathy.METHODSResults of the six-month period of treatment of 58 patients, diagnosed as symptomatic cervical radiculopathy with application of CESI within a one-year period, were evaluated retrospectively. With the patients in a sitting position and with the head flexed, the epidural space was accessed from the C7-T1 aperture using the median approach and the hanging drop technique, and a pre- prepared 6 ml solution consisting of 80 mg triamcinolone with 10 mg levobupivacaine was injected following standard sterilization.RESULTSThe post-CESI treatment VAS values of the patients were significantly lower than pretreatment VAS values. The treatment success rates for CESI application were 93% in the 1st month, 86% in the 3rd month, and 72% in the 6th month, respectively.CONCLUSIONThe CESI application is an effective method in the treatment of cervical radiculopathy and reduces the rate of patients needing surgery.

Purpose: Postlaparoscopic surgery pain management can reduce the discharge and recovery time. Thus conventional nonsteroidal anti-inflammatory drugs and opioids have been used for this purpose. The aim of this trial was to compare the analgesic and opioid-sparing efficacy of diclofenac sodium intramuscular (IM) with diclofenac transdermal patch in the management of postlaparoscopy pain. Methods: Patients were randomized to receive IM diclofenac 75 mg (n=30) 15 minutes before anesthesia or transdermal diclofenac (n=30) 3 hours before laparoscopic surgery. Transdermal or IM diclofenac were reapplied 12 hours later. All patients were administered tramadol intravenously before surgery. Postoperative pain management was maintained with tramadol using a patient-controlled analgesia device. Postoperative visual analogue pain scores (VAS, 0 to 10 cm) and adverse reactions were recorded over a 24-hour period. If VAS values were >4, 25 mg tramadol was given intravenously as a rescue analgesic. Results: In both groups, VAS scores were higher in the first 4 hours. There were no significant differences in postoperative pain between the 2 groups. The postoperative tramadol consumption, and rescue analgesic needs of the patients between both groups were not statistically significant. Injection pain was observed in the IM diclofenac group, but for both groups no skin reactions were observed at the application sites of the drugs. Conclusions: Diclofenac transdermal patch provided pain relief for postoperative laparoscopic surgery as effectively as IM diclofenac and can be used.

Aim: To evaluate the effects of preoperative and intraoperative administration of intravenous meperidine as a preemptive analgesic.Materials and methods: A total of 50 patients were randomly divided into 2 groups; group P received 1 mg/kg of meperidine intravenously immediately before induction of anesthesia, and group I received the same amount of meperidine 20 min before completion of surgery. Consumption of desflurane, recovery parameters, heart rate, mean arterial pressure, sedation scores, visual analog scale (VAS) scores for pain, analgesic needs, and anesthesia-related complications were recorded for both groups.Results: Time to recovery was significantly shorter in group P than in group 1 for all parameters except spontaneous respiration. The postoperative sedation scores were mostly similar for the 2 groups, with the exception of the number of patients with postoperative 60-min sedation scores of 2; this score was seen in 1 patient in group P and 7 patients in group I. The VAS scores of group I in the postoperative period were higher than those of group P.Conclusion: Preoperative meperidine administration shows superiority to intraoperative administration with regard to recovery parameters and early postoperative pain scores, but there were no significant differences between the groups with regard to other intraoperative and postoperative parameters.

The aim of this prospective randomized, double-blinded study was to evaluate the effect of fentanyl addition to articaine on the duration of sensory as well as motor blocks, and the duration of analgesia during hemodialysis fistula creation under ultrasound-guided axillary block. Fifty patients were randomly allocated to two groups, an articaine group (A), receiving 40 mL of articaine HCI (20 mg/mL) with 2 mL of isotonic sodium chloride solution, and an articaine-fentanyl group (AF), receiving 40 mL of articaine HCI (20 mg/mL) with 2 mL (100 µg) of fentanyl. The onset as well as the duration of sensory and motor blocks, the time necessary for first analgesic administration, the hemodynamic parameters, and the side effects were recorded. Three patients in Group A and two patients in Group AF due to incomplete block were excluded from the study. The duration of sensory and motor blocks was significantly longer in the AF group than in the A group. The first time for analgesic need was also significantly longer in group AF (363 ± 134 min) than in group A (244 ± 84 min) (p = 0.001). The addition of fentanyl did not improve the onset of sensory and motor block times. Hemodynamic parameters were similar in the two groups. In conclusion, the addition of fentanyl to articaine in axillary block prolongs the duration of sensory and motor blocks, as well as the time of first analgesic requirement.

OBJECTIVES:The aim of this study was to investigate the usefulness of sonography for verifying tracheal tube placement within 3 seconds in adult surgical patients.METHODS:This was a blinded prospective randomized study. The anesthesiologist placed the tracheal tube randomly in the trachea (n = 75) or in the esophagus (n = 75) with direct laryngoscopy. A sonographer identified all tracheal and esophageal intubations. The transducer was placed transversely on the neck just superior to the suprasternal notch. The position of the tracheal tube was determined by the sonographer within 3 seconds of tracheal tube placement in the trachea or in the esophagus.RESULTS:We successfully identified 150 correct tracheal tube placements in tracheas and esophagi, resulting in sensitivity of 100% (95% confidence interval, 84%-100%) and specificity of 100% (95% confidence interval, 84%-100%).CONCLUSIONS:This investigation shows that sonography for confirming tracheal intubation is a fast and effective technique.

STUDY OBJECTIVE:The aim of this study was to evaluate whether sedo-analgesia with alfentanyl/fentanyl, using a patient-controlled analgesia (PCA) pump, may have positive outcomes in terms of safety, postprocedural workload, and expectations of the colonoscopist, nurse, and patients in elective colonoscopy.PATIENTS:One hundred American Society of Anesthesiology physical status I and II adult patients.INTERVENTIONS:Patients were randomized in a double-blind trial to receive either alfentanyl (n=50) or fentanyl (n=50) by PCA, and incremental doses of midazolam.MEASUREMENTS:Patient expectations were assessed using hemodynamic variables, willingness to have a repeat colonoscopy in the same way, adverse events, discomfort scores, and patient/operator/nurse satisfaction associated with sedo-analgesia.RESULT:All patients in both groups had adequate sedo-analgesia with high satisfaction and willingness scores. There were no serious adverse effects and except for a few events, no required medication. The total sedation times were shorter in the alfentanyl group compared with the fentanyl group.CONCLUSIONS:PCA and sedation with alfentanyl and fentanyl for colonoscopy are safe, feasible, and acceptable to most patients. However, shorter sedation times make alfentanyl more attractive for postprocedural workload.

PURPOSE:The aim of this study was to evaluate the effect of dexmedetomidine on shivering during spinal anesthesia.METHODS:Sixty patients (American Society of Anesthesiologists physical status I or II, aged 18-50 years), scheduled for elective minor surgical operations under spinal anesthesia with hyperbaric bupivacaine, were enrolled. They were administered saline (group C, n = 30) or dexmedetomidine (group D, n = 30). Motor block was assessed using a Modified Bromage Scale. The presence of shivering was assessed by a blinded observer after the completion of subarachnoid drug injection.RESULTS:Hypothermia was observed in 21 patients (70%) in group D and in 20 patients (66.7%) in group C (p = 0.781). Three patients (10%) in group D and 17 patients (56.7%) in group C experienced shivering (p = 0.001). The intensity of shivering was lower in group D than in group C (p = 0.001). Time from baseline to onset of shivering was 10 (5-15) min in group D and 15 (5-45) min in group C (p = 0.207).CONCLUSION:Dexmedetomidine infusion in the perioperative period significantly reduced shivering associated with spinal anesthesia during minor surgical procedures without any major adverse effect during the perioperative period. Therefore, we conclude that dexmedetomidine infusion is an effective drug for preventing shivering and providing sedation in patients during spinal anesthesia.

Recent studies in rats have shown that taurine can prevent oxidative changes induced in renal tissue by ischemia and reperfusion. The aim of the present study was to investigate whether taurine can prevent oxidative changes that occur in the renal tissue during a long period of cold ischemia. Materials and methods: Oxidative changes were evaluated histologically and biochemically in kidneys from a total of 40 rats, which were assigned to 1 of 4 groups of 10 rats each: control group (no taurine given, kidneys evaluated immediately after removal), taurine group (as in the control group, except that taurine was given orally at a dose of 150 mg/kg per day for 3 days preceding kidney removal), ischemia group (no taurine given, kidneys evaluated after 72 h of ischemia at 4 °C in University of Wisconsin solution), and taurine plus ischemia group (as in the taurine group, except that kidneys subsequently underwent cold ischemia as in the ischemia group). Results: Compared to the ischemia group, the taurine plus ischemia group showed significantly lower levels of malondialdehyde and significantly higher activities of copper and zinc dependent superoxide dismutase, catalase, and glutathione peroxidase. Conclusion: Orally administered taurine appears to ameliorate the oxidative stress that occurs in kidneys during cold ischemia. Compared to the ischemia group, the taurine plus ischemia group had significantly less tubular necrosis, and glomerular and epithelial injury.

Background: The aim of this study was to compare the effects of low-flow sevoflurane and low-flow sevoflurane supplemented with remifentanil anesthesia on the recovery time, consumption amount of the anesthetic drugs and hemodynamic differences. Materials and Methods: A prospective, randomized and double-blinded study with 50 patients was designed. Following intubation, group S received sevoflurane 1.8 vol%, oxygen, nitrous oxide at 4 l · min–1 and normal saline continuous infusion; group SR received sevoflurane 1.2 vol%, oxygen, nitrous oxide at 4 l · min–1 and 0.25 µg · kg–1 · min–1 remifentanil continuous infusions. Ten minutes after intubation the flow rates decreased to 1 l · min–1. Consumption of each drug, postoperative recovery characteristics and visual analog scale (VAS) scores for pain were recorded. Result: There were no significant differences in hemodynamic parameters, tramadol consumption and VAS scores for pain. The patients in group SR showed faster early recovery as compared to group S. The mean consumption of sevoflurane was 18 ml in group SR, while it was 25 ml in group S. Conclusions: Low-flow sevoflurane anesthesia combined with remifentanil regimen in patients undergoing tympanoplasty surgery resulted in a faster early recovery and decreased sevoflurane consumption.

The ganglion impar is the lowest ganglion of the paravertebral sympathetic chain, which is placed at the anterior aspect of the sacrococcygeal disc. It has been blocked in the relief of many chronic pain syndromes originating from pelvic structures such as the coccyx. Coccydynia is one of these pain syndromes, which is usually intractable to well-known treatments such as physical therapy manipulations, anti-inflammatory medications, and steroid injections.1Mitra R. Cheung L. Perry P. Efficacy of fluoroscopically guided steroid injections in the management of coccydynia.Pain Physician. 2007; 10: 775-781PubMed Google Scholar There also are many approaches, such as neurolysis with alcohol and phenol or ablative pulsed radiofrequency (PRF), for relieving coccydynia by ganglion impar block through anococcygeal ligament or sacrococcygeal disc. Although many of these approaches are neurodestructive techniques, PRF is a neuromodulative application that has been used for years for chronic pain syndromes.2Cahana A. Van Zundert J. Macrea L. Van Kleef M. Sluijter M. Pulsed radiofrequency: current clinical and biological literature available.Pain Med. 2006; 7: 411-423Crossref PubMed Scopus (147) Google Scholar We present a case of coccydynia successfully treated with PRF for neuromodulation of the ganglion impar by means of the sacrococcygeal disc. A 54-year-old man had pain over the coccyx for five years. The pain was experienced with prolonged sitting and exacerbated by pressure. He did not remember any history of trauma; the pain had begun spontaneously five years before and worsened during the following years. At the beginning, he had been diagnosed with coccydynia and treated with conservative methods, including nonsteroidal anti-inflammatory drugs and physical therapy manipulations. The patient believed that previous medications were ineffective and became frustrated and depressed because of the functional limitations and pain. He was referred to our clinic because the previous therapies had been ineffective. He described the pain as 8 on the 10-point verbal numerical rating scale (NRS). On this scale, he was asked to describe his pain as a number between zero and 10, with zero being no pain and 10 being the worst pain imaginable. The evaluation confirmed that the pain originated from the coccyx. The ganglion impar block with a neurodestructive approach, such as alcohol and phenol or ablative PRF, was planned. The test block of the ganglion impar with 1% lidocaine (3 mL) was performed by means of the transsacrococcygeal disc before the neurodestruction. The patient did not accept the neurodestructive approach and stated that he preferred PRF treatment when he learned that it is a neuromodulative technique. He was admitted to the operating theater for the application. His position was prone on the table, with a pillow under the anterior superior iliac spine to flatten the normal lumbar lordosis. First, intravenous access was inserted and monitors were attached. The midline of the sacrococcygeal area was cleaned with antiseptic and sterile drapes were placed. Lidocaine 1% (3 mL) was used for skin infiltration over the coccyx. A 22 gauge RF stimulator jet (thermocouple electrode) needle with an SMK-10 needle (NeuroTherm 22G, UK) with an active tip of 5 mm was inserted through the sacrococcygeal disc to the anterior surface of the coccygeal disc, with the guidance of anteroposterior and lateral fluoroscopy view of the sacrum and coccyx. After negative aspiration, the fluoroscopic image was observed as 2 mL of nonionic radiocontrast was injected for viewing the ganglion impar. The positions of the needle tip and ganglion impar were verified by the presence of a small blob of contrast at the anterior surface of the coccygeal disc. Before applying PRF, tissue impedance and sensory and motor tests were checked, which showed a sensory response below 0.5 V (50 Hz), a motor response below 2 Hz, and an impedance <600 Ohm. The PRF treatment consisted of passage of RF current of 2 Hz at 40 V with 20 m/second active and 480 m/second silent periods. The treatment was maintained for 120 seconds twice when the temperature at the needle tip did not exceed 42°C. The total treatment time was four minutes. No muscle contraction in the gluteal region was observed. He described the pain as zero on the NRS postprocedure. After the procedure, the patient was carefully checked for any complications such as local pain and vessel puncture. Four months later, he was asked to describe the pain once more, and it was within one to two points on the NRS. Coccydynia occurs rarely, adversely affects quality of life, and analgesic medications, such as nonsteroidal anti-inflammatory drugs, are often useless.1Mitra R. Cheung L. Perry P. Efficacy of fluoroscopically guided steroid injections in the management of coccydynia.Pain Physician. 2007; 10: 775-781PubMed Google Scholar There are trials that show that PRF application is not only effective but also safe for nerve tissue because of its application of 42°C for 240 seconds through each needle.2Cahana A. Van Zundert J. Macrea L. Van Kleef M. Sluijter M. Pulsed radiofrequency: current clinical and biological literature available.Pain Med. 2006; 7: 411-423Crossref PubMed Scopus (147) Google Scholar, 3Podhajsky R.J. Sekiguchi Y. Kikuchi S. Myers R.R. The histologic effects of pulsed and continuous radiofrequency lesions at 42°C to rat dorsal root ganglion and sciatic nerve.Spine. 2005; 30: 1008-1013Crossref PubMed Scopus (131) Google Scholar, 4Sluijter M. Racz G. Technical aspects of radiofrequency.Pain Pract. 2002; 2: 195-200Crossref PubMed Google Scholar,9 In an experimental histology study by Podhajsky et al.,3Podhajsky R.J. Sekiguchi Y. Kikuchi S. Myers R.R. The histologic effects of pulsed and continuous radiofrequency lesions at 42°C to rat dorsal root ganglion and sciatic nerve.Spine. 2005; 30: 1008-1013Crossref PubMed Scopus (131) Google Scholar it was shown that PRF application caused no significant difference in the nerve tissue. There are also other choices in the relief of coccydynia, such as ablative RF application and coccygectomy. These methods are more invasive and have higher risks of adverse effects compared with PRF application.5Hodges S.D. Eck J.C. Humphreys S.C. A treatment and outcomes analysis of patients with coccydynia.Spine J. 2004; 4: 138-140Abstract Full Text Full Text PDF PubMed Scopus (58) Google Scholar PRF was performed by means of transsacrococcygeal disc instead of anococcygeal ligament because this technique is more comfortable for patients.6Toshniwal G.R. Dureja G.P. Prashanth S.M. Transsacrococcygeal approach to ganglion impar block for management of chronic perineal pain: a prospective observational study.Pain Physician. 2007; 10: 661-666PubMed Google Scholar, 7Reig E. Abejón D. del Pozo C. Insausti J. Contreras R. Thermo-coagulation of the ganglion impar or ganglion of Walther: description of a modified approach. Preliminary results in chronic, nononcological pain.Pain Pract. 2005; 5: 103-110Crossref PubMed Scopus (67) Google Scholar, 8Munir M.A. Zhang J. Ahmad M. A modified needle-inside-needle technique for the ganglion impar block.Can J Anaesth. 2004; 51: 915-917Crossref PubMed Scopus (45) Google Scholar PRF application is a relatively new intervention derived from a well-established and proven approach in the literature and promises a safer non-neurodestructive technique.6Toshniwal G.R. Dureja G.P. Prashanth S.M. Transsacrococcygeal approach to ganglion impar block for management of chronic perineal pain: a prospective observational study.Pain Physician. 2007; 10: 661-666PubMed Google Scholar This is the first report of PRF application by means of transsacrococcygeal disc for relieving coccydynia. We believe that the transsacrococcygeal disc approach using PRF for ganglion impar block is not only simple but also effective for the treatment of coccydynia.