Comparison of Antinociceptive Effect and c-Fos Expression of Pre- versus Posttreatment with Intrathecal Neostigmine on the Formalin Test / 대한마취과학회지

BACKGROUND: Intrathecal neostigmine produces antinociceptive effects in many pain tests. Comparisons of pre- versus postinjury drug interventions have been made using the formalin test as a model for central sensitization. The purpose of this study was to compare behavioral antinociceptive responses with spinal fos-like immunoreactivity (FLI) in an intrathecal neostigmine injection between pre- versus post-formalin administration in a rat pain model. METHODS: Sprague-Dawley rats (250 300 g) were prepared with a PE 10 indwelling intrathecal catheter to receive either saline or neostigmine. The formalin test was performed on the second day after surgery with 5% 100microl. All rats were randomly divided into one of five groups; Sham, basal, control, pretreatment or posttreatment group. The Sham group (n = 4) received a dry needle at the hindpaw and the basal group (n = 6) received saline 100microl at the hindpaw. Saline 20microl was injected intrathecally after the formalin test in the control group (n = 8). Neostigmine (7.5microgram/10microl in volume) was administered intrathecally 7 minutes before the formalin test in the pretreatment group (n = 8) and 7 minutes after the formalin injection in the posttreatment group (n = 8). Pain related behavior was quantified by counting the incidence of flinches of the injected hindpaw for 60 minutes. Two hours after injection of formalin, animals were perfused with PBS and the spinal cords were removed immediately. The effect of pre- versus posttreatment with the neostigmine on c-Fos protein in the cord was examined by immunohistochemistry using specific antibodies. Immuno-positive cells in laminae I-II and III-V in the lumbar enlargement were calculated. RESULTS: Intraplantar formalin injection produced a biphasic appearance of the flinch behavior (phase 1 = 0 5 minutes, phase 2 = 20 60 minutes) in the control, pretreatment and postreatment groups. In the pretreatment group, rats showed less remarkable phase 1 and 2 responses than other groups. Flinches of phase 1 were 2.3 2.1, 33.2 7.6 (P< 0.05 vs. basal), 10.0 6.6 and 33.0 13.4(P< 0.05 vs. basal) in basal, control, pre- and posttreatment groups respectively. Flinches of phase 2 were 0.3 0.5, 224.5 66.4 (P< 0.05 vs. basal), 120.6 151.3 and 187.5 76.8 (P< 0.05 vs. basal) in basal, control, pre- and posttreatment groups respectively. Similarly, the pretreatment group virtually inhibited formalin-induced expression of FLI (P< 0.05 vs. control, posttreatment) in the laminae I-II ipsilateral to injection. The posttreatment group inhibited formalin-indeced expression of FLI (P< 0.05 vs. control) in the laminae III-V ipsilateral to injection. CONCLUSIONS: Pretreatment of intrathecal neostigmine inhibits nociceptive behaviors and FLI in the laminae I-II following formalin injection in rats, suggesting that pretreatment plays an important role in the development of plasticity in this model.

Lumbar Root Compression Secondary to Epidural Air Retension: A case report / 대한마취과학회지

Air can be introduced into the epidural space during the loss of resistance technique used to identify needle entry into the epidural space. Complications resulting from the injection of air into the epidural space include pneumocephalus, spinal cord and nerve root compression, retroperitoneal air collection, subcutaneous emphysema, venous air embolism, and possibly, incomplete analgesia and anesthesia. We experienced a case of a large epidural collection of air following epidural anesthesia attempted one month before. The CT scan revealed epidural air extending from L1-S1 with moderate compression of nerve root at L4-5.

Comparison of Spinal and Epidural Anesthesia for Transurethral Resection of Prostate (TURP) / 대한마취과학회지

BACKGROUND: The purpose of this study was to determine whether spinal or epidural anesthesia is more suitable in terms of sensory and motor blockade, cardiovascular stability, intraoperative blood loss, postoperative recovery and patient satisfaction in elderly patients undergoing TURP. METHODS: Fourty patients undergoing TURP were randomly allocated to either a spinal or an epidural anesthesia group. The spinal group (n = 20) received 10 12 mg of 0.5% tetracaine in 10% dextrose, while the epidural group (n = 20) received 20 25 ml of 2% lidocaine at L4-5 intervertebral space. After injection of the agent, changes in sensory and motor blockade, blood pressure and heart rate were measured in the two groups. We compared serum Hb, serum Na, foley removal, hospital stay, side effects, analgesic use, and patient satisfaction between the two groups. RESULTS: The two techniques were similar with regard to the level of blood pressure, heart rate, Hb and Na changes, foley removal and hospital stay. At 15 and 30 minutes after spinal and epidural anesthesia, the results for sensory blockade were T8 +/- 2.2 S5, T9 +/- 1.2 S5 (spinal) and T10 +/- 1.5 S3, T8 +/- 2.1 - S4 +/- 1.0 (epidural), and motor blockade was complete in the spinal group but incomplete in the epidural group. Patient satisfaction was better in the epidural group than in the spinal group, but analgesic use was more frequent in the spinal group than in the epidural group. CONCLUSIONS: Both spinal and epidural anesthesia are suitable for TURP. Spinal anesthesia was technically easier and produces a complete and more reliable block of the sacral segment, but was also an unnecessarily profound motor block of the lower extremity. Epidural anesthesia is less pronounced and gives a shorter duration of motor blockade with good patient satisfaction.

Closed Lock of the Jaw on Induction of Anesthesia / 대한마취과학회지

The temporomandibular joint (TMJ) is unique among joints in the human body, since it can be dislocated without external force. Manipulation of the upper airway other than laryngoscopy is a risk factor in patients who have a history of habitual dislocation of the TMJ. The case report illustrates that severe limitation of the jaw opening ("closed lock") requiring manipulation for restoration may occur during induction of general anesthesia.

The Effect of Perioperative Intravenous Lidocaine Infusion on Bowel Function and Pain / 대한마취과학회지

BACKGROUND: Postoperative ileus and pain are concerns among surgical patients. Epidural anesthesia and analgesia with local anesthetics can decrease the duration of postoperative ileus and pain. Significant systemic absorption of local anesthetics occurs during epidural use. The object of the study was to define the effect of intravenous (iv) lidocaine on postoperative ileus and pain. METHODS: In a double-blind prospective study, 24 patients undergoing foot surgery were studied with one half of the patients receiving a lidocaine bolus (1.5 mg/kg) and infusion (2 mg/min) (n=12 Lidocaine group); the other half received a saline infusion (n=12 Control group). IV lidocaine initiated before general anesthesia and continued 1h postoperatively. We compared faces pain rating scale (at recovery room, op. day 7 PM, postop. 1 day 7 PM, postop. 2 day 7 PM), the total amount of analgesic use, the return of bowel function (first passage of flatus), hospital stay, side effects, patient satisfaction. RESULT: Perioperative IV lidocaine infusion reduced the pain scale at recovery room, op.day 7 PM, postop. 1 day 7 PM but not postop. 2 day 7 PM. No significant difference was found in return of bowel function, additional analgesics use, hospital stay, subjective satisfaction between 2 groups. No specific side effect due to lidocaine was found. CONCLUSION: IV lidocaine-treated patients has less pain postoperatively, but no faster return of bowel function in patients undergoing foot surgery.

The Effect of Perioperative Intravenous Lidocaine Infusion on Bowel Function and Pain / 대한마취과학회지

BACKGROUND: Postoperative ileus and pain are concerns among surgical patients. Epidural anesthesia and analgesia with local anesthetics can decrease the duration of postoperative ileus and pain. Significant systemic absorption of local anesthetics occurs during epidural use. The object of the study was to define the effect of intravenous (iv) lidocaine on postoperative ileus and pain. METHODS: In a double-blind prospective study, 24 patients undergoing foot surgery were studied with one half of the patients receiving a lidocaine bolus (1.5 mg/kg) and infusion (2 mg/min) (n=12 Lidocaine group); the other half received a saline infusion (n=12 Control group). IV lidocaine initiated before general anesthesia and continued 1h postoperatively. We compared faces pain rating scale (at recovery room, op. day 7 PM, postop. 1 day 7 PM, postop. 2 day 7 PM), the total amount of analgesic use, the return of bowel function (first passage of flatus), hospital stay, side effects, patient satisfaction. RESULT: Perioperative IV lidocaine infusion reduced the pain scale at recovery room, op.day 7 PM, postop. 1 day 7 PM but not postop. 2 day 7 PM. No significant difference was found in return of bowel function, additional analgesics use, hospital stay, subjective satisfaction between 2 groups. No specific side effect due to lidocaine was found. CONCLUSION: IV lidocaine-treated patients has less pain postoperatively, but no faster return of bowel function in patients undergoing foot surgery.

The Effects of Propofol as s Sole Intravenous Anesthetics on Endourologic Transurethral Lithotripsy / 대한마취과학회지

BACKGROUND: Propofol is an intravenous anesthetic characterized by rapid induction and prompt recovery. Recently, its is used widely in clinical practice, especially when early discharge is advisable. We conducted this study for the evaluation of the effects of propofol as a sole intravenous anesthetic on the operation with minimal pain such as TUL(transurethral lithotripsy). METHODS: Patients were recruited for ASA class 1 and 2 from those who received TUL operation. Propofol was administered 2 mg/kg for induction and continuously infused at the rate of 1.2~1.4 mg/kg/hr after the loss of consciousness. With the stabilization of the vital signs, we reduced the dose of propofol to 1.0~1.2 mg/kg/hr. We checked the patients' movement, vital signs, recovery time and monitored the appearance of the symtoms such as nausea, vomiting postoperatively. RESULTS: 1) The average time of operation was 15+/-12 minutes. 2) The average recovery time was 15+/-9 minutes(range 2~30 min). 3) Blood pressure and peripheral oxygen saturation(SpO2) were declined during anesthesia, but SpO2 was normalized in the recovery room. 4) No significant complications were observed. 5) Mild movement of the patient was noticed in the begining of operation, but it did not affect the surgical procedure. CONCLUSIONS: Propofol was effective as a sole intravenous anesthetic to minimize postoperative complications such as nauea, vomiting for TUL with minimal pain.