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Application for ESRA Abstract Prizes: I apply as an Anesthesiologist (Aged 35 years old or less)Background and Aims We aimed to evaluate pain scores after ganglion impar block and caudal epidural steroid injection in patients with chronic anococcygeal pain syndrome, who did not respond to conservative treatment.MethodsThe information of 31 patients with anococcygeal pain, who underwent Ganglion impar block and caudal epidural steroid injection was retrospectively reviewed. G.impar block (6mL of bupivacaine%0.125+methylprednisolone 40mg mixture) and caudal steroid injection (7mL of bupivacaine%0.125 +methylprednisolone 40mg mixture) were applied to all patients. After one month, G. impar pulsed radiofrequency(pRF) (6minutes at 42degrees) and caudal injection (7mL of bupivacaine%0.125+methylprednisolone 40mg mixture) were applied to patients who temporarily benefited from the procedure. All procedures were performed under fluoroscopy. Demographic data, etiology of pain, and visual analog scale(VAS) scores before and after the procedure were obtained from patient records.ResultsA total of 31 patients of which 5 males(16%) and 26 females(84%) were included in the study. Average age was 41.5 years. Etiology was trauma in 20 patients, surgery in 2 patients, gastrointestinal disease in 2 patients, vaginal delivery in 1 patient, and idiopathic in 5 patients.The mean score of the VAS before the procedure was 7.74. After Impar and caudal block with pRF, average VAS score was decreased to 1.48. 21 patients became pain- free after the procedure, which remained for an average of 52.4 days (2-1840 days). 2 patients reported transient paresthesia and 1 patient reported transient distal edema after the procedure.ConclusionsG.İmpar block,pRF and caudal epidural steroid injection are effective procedures for patients with anococcygeal pain without significant complications.

Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)Application for ESRA Abstract Prizes: I apply as an Anesthesiologist (Aged 35 years old or less)Background and Aims Congenital hip dislocation (CHD) is caused by abnormal formation of the hip joint during early stages of fetal development. Patients with this disorder may have recurrent hip surgeries and may need physical therapy in the following years. The aim of this case report is to raise awareness among doctors, that hip denervation can be used in pain management for the rehabilitation of patients with congenital hip dislocation.MethodsAfter repeated hip surgeries, limitation of hip joint mobility developed in a 27-year-old female patient with congenital hip dislocation (figure 1 ). Due to her pain, she could not receive restricted treatment and could not continue physical therapy. Repetitive Pericapsular nerve group (PENG) blocks (bupivacaine%0.125 + methylprednisolone 40mg mixture) were applied to the patient under USG guidance, and the pain was relieved for a limited time. A perminent pain relief theraphy was sought. Sensory branches of the obturator and femoral nerve pulsed radiofrequency (PRF) (for 6 minutes at 42 degrees) which is called hip denervation, were applied to the patient for long-term pain management under fluoroscopy guidance.ResultsAfter the intervention, the patient‘s pain decreased and she was able to continue physical therapy and exercise. At the 6th month follow-up, the patient‘s pain was under control. No procedural adverse event was noted.Abstract #36470 Figure 1Patient with congenital hip dislocation[Figure omitted. See PDF]ConclusionsThe use of this hip denervation technique for hip pain control is evolving. In our experience, percutaneous radiofrequency lesioning of the sensory branches of the nerves innervating the hip joint can be an option for patients with intractable hip joint pain.

Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)Application for ESRA Abstract Prizes: I apply as an Anesthesiologist (Aged 35 years old or less)Background and Aims Cancer pain is most of the times relieved by pharmacological treatment. When pharmacological treatment is not sufficient, interventional pain procedures are considered. Here we present a case complicated by epidural hematoma.Methods58 years old female patient with stage 4 metastatic colon and urethelial carcinoma was referred to our clinic for hip and leg pain. She had multiple bone metastasis. Medical treatment was not enough, so transforaminal epidural steroid injection (TFESI) and lumbar sympathectomy was offered. The needle was fluoroscopically aimed for left L2 TFESI through the ‘safe’ triangle. Needle insertion happened to be intravascular with spontaneous return of blood. It was decided not to proceed further with the injection. Other interventions were performed uneventfully.Results12 hours later, the patient experienced left-sided sensorimotor loss. Left lower extremity examination revealed 0/5 motor functions of left hip and knee extension and flexion with hypoesthesia from T10 to L2 dermatome were noted. Sensorimotor function of the right lower extremities were normal. Urgent thoracolumbar MRI revealed left sided epidural hematoma extending from T8 to L2 (figure 1 ). Emergent epidural hematoma decompression surgery was offered, which she declined due to her comorbidities.Abstract #36426 Figure 1Epidural hematoma extending from T8 to L2 level, compressing spinal cord. Sacral metastases can also be seen[Figure omitted. See PDF]ConclusionsAlthough lumbar TFESI was found to be safe, we experienced an epidural hematoma, which we believe was because the ‘safe’ triangle approach was chosen, where blood vessels lie. To our knowledge, our case is the first one to report unilateral paresis following a massive epidural hematoma. We believe, Kambin’s triangle approach may prevent from, a rare but debilitating complication, epidural hematoma.