Low-dose ropivacaine for supraclavicular brachial plexus block combined with general anesthesia for successful postoperative analgesia: a case series

Ropivacaine, a long-acting local anesthetic agent, has been used for postoperative analgesia in brachial plexus block [BPB] at high doses. However, use of lower doses would reduce the occurrence of adverse effects. We applied BPB with low-dose ropivacaine [10 mL of 0.375% ropivacaine] after induction of general anesthesia for surgery of the upper extremities in 62 patients at our hospital. Ropivacaine was administered via a fluoroscopy-guided supraclavicular method. Analgesic effects during surgery, visual analog scale pain scores, skin sensation, muscle strength, and postoperative patient satisfaction indices were evaluated. Fifty-six patients [90.3%] did not require supplemental analgesics during surgery. The remaining six patients were administered fentanyl due to the insufficient analgesic effects of the nerve block. Some adverse effects, including numbness and delayed motor and sensory recovery of the upper extremities, were observed. The mean postoperative patient-evaluated visual satisfaction scale was 94.1. Our results suggest that low-dose ropivacaine is clinically acceptable for BPB under general anesthesia

Difficult passage of the endotracheal tube and massive nasal bleeding during awake nasal fiberoptic intubation in a patient with airway obstruction caused by neck hematoma-a case report

A 60 yr-old male underwent anterior cervical fusion under general anesthesia. Neck swelling was observed at the next morning. Subsequently, emergent CT scanning was performed, which revealed a retropharyngeal hematoma narrowing the upper airway and right anterior neck hematoma significantly deviating the trachea and larynx. Nasal intubation was attempted but difficult passage of the endotracheal tube counteracted this procedure. Immediately, massive nasal bleeding occurred, which worsened the situation. Subsequently, oral fiberoptic intubation with the aid of McCoy type laryngoscope was tried and intubation was barely established. The patient was submitted to emergent evacuation of the hematoma. Reevaluation of the preoperative CT images showed the nasal cavity narrowing because of widespread nasal mucosal swelling. It is necessary to anticipate that nasal mucosal swelling and bleeding tendency due to impairment of venous drainage can exist in such a case

The Effects of Shakuyaku-Kanzo-To on Spasm of the Lower Limbs Accompanying Central Nervous Disorders. Two Case Studies / 日本東洋医学雑誌

Two cases in which Shakuyakukanzo-to (extract) was effective for spasms in the lower limbs. The spasms in these two cases were associated with central nervous system disorders affecting the brain or spinal cord.<br>The first case was a 61-year-old woman suffering from myelitis sequela. The spasms in her lower left leg increased in severity in the winter, and she experienced difficulty bending her left knee and walking.<br>The second case was a 29-year-old woman with convulsive cerebral anesthesia. Walking had become difficult with exacerbation of her sciatica and with increased spasms in her feet.<br>In both cases, the various muscle relaxants were not sufficiently effective. Regular administration of Shakuyakukanzo-to, however, had a remarkable immediate effect in decreasing spasms and facilitating walking.

The Effectiveness of Toki-Shigyaku-ka-Goshuyu-Shyokyo-to for Cervical Radiculopathy / 日本東洋医学雑誌

A study was conducted of the effects of Tsumura Tokishigyaku-ka-goshuyushokyo-to extract granules on eight cases of Kankyosho (Cold and Deficient Pattern of Symptoms) that had reached a plateau in their improvement under nerve-block therapy. Three weeks after administration began, a significant improvement was seen in the symptoms and the Visual Analog Scale score went form 5.6 to 3. After three months, the symptoms disappeared entirely in two cases. No particular side effects were reported. This suggested that administration of Tokishigyaku-kagoshuyushokyo-to is effective in the longterm impovement of the peripheral circulation.

AN ORTHOPAEDICAL ANALYSIS OF THE KYUDO ATHLETE / 体力科学

The Kyudo (Japanese archery) is a most popular sport among Japanese as the Judo and Japanese fencing. Even some their athletes had complains of neck pain, joint pain and back pain, the investigations in the orthopaedic aspect were rare as compared with the Judo and Japanese fencing.<BR>The orthopaedical questionnaire were made to one hundred twenty-two athletes from eighteen to seventy-eight years old, average forty-three old, and the analysis by roentgenological and clinical findings were made to thirty athletes who were had severe troubles.<BR>The results were as follows :<BR>1) Because of most disorders were localized about the upper-extremity as main action were using of arm muscles, there were discovered the osteoarthritis and osteochondro-matosis of the elbow joint, periarthritis of the shoulder joint, atrophy of the deltoid and supra-infraspinatus muscles, injury of the hand and back pain.<BR>2) To prevent these disorders, we emphasized the necessity of warming-up and other systematic exercise as usually.<BR>3) We had obtained the conclusion that the periodical examination was most important for early diagnosis and procedures of over ten years experienced athletes.