The Prognostic Factors of Selective Transforaminal Epidural Block in Patients with Low Back Pain / 대한통증학회지

BACKGROUND: Selective transforaminal epidural block (STEB) has showen effectiveness as a diagnostic and therapeutic option for the management of patients with low back pain or sciatica. This study was carried out in order to determine the short-term effects and prognostic factors associated with STEB in patients with low back pain or sciatica. METHODS: Ninety-seven patients were selectedfor participation in this study. Their diagnosis were based werewason the clinical symptoms and MRI findings. We performed STEB under fluoroscopic guidance and injected 3 ml of radio opaque dye in order to confirm the technical success of the procedure. We then injected 20 mg of triamcinolone mixed into 3 ml of 0.5% mepivacaine. One month later, we classified the patient outcomes as excellent, good, moderate or poor, according to the degree of reduction in VAS score from baseline. The independent variables assessed included symptom duration, block level, number of blocks, primary diagnosis, prior caudal block, anterior epidural space filling of dye, medication history, demographic data, radiating pain, back surgery and spondylolisthesis. RESULTS: At a mean follow-up period of 1 month after STEB, excellent results were noted in the patients diagnosed with herniated lumbar disc (70%), non-specific spondylosis (54%), spinal stenosis (44%), and failed back syndrome (28%). The patients with epidural adhesion and combined spondylolisthesis were associated with poorer outcomes. Combined caudal block, symptom duration and the extent of epidural spread of the drug were not related to the effectiveness of the treatment. CONCLUSIONS: Selective transforaminal epidural block is effective in treating patients with radiculopathy, such as herniated lumbar disc, but it isrelatively ineffective in treating patients with structural deformities, such as failed back syndrome and spondylolisthesis.

The Incidence of Nausea and Vomiting in Immediate Postanesthetic Period / 대한마취과학회지

BACKGROUND: Postoperative nausea and vomiting (PONV) continues to be a common complication of surgery and patients report that avoidance of PONV is of greater concern than avoidance of postoperative pain. The overall incidence of postoperative nausea and vomiting has been reported to be in the 20-30%. The incidence of PONV in the recovery room was 9-10% but it was increased 30% during the first 24 hours after surgery. This retrospective study was designed to find the incidence of PONV in immediate postanesthetic period as well as the difference in incidence of PONV due to gender, age, duration of surgery, different inhalation agents and method of patient controlled analgesia. METHODS: The anesthesia and postanesthesia records for 12,895 patients receiving surgery under general and regional anesthesia between September 2001 and August 2002 one year were retrospectively reviewed. RESULTS: The overall incidence of nausea, vomiting and nausea/vomiting (either nausea, vomiting or both) in immediate postanesthetic period was 1.5%, 2.0% and 2.9% of patients, respectively. The incidence of nausea, vomiting and nausea/vomiting in immediate postanesthetic period was significantly higher in female than in male, general anesthesia with enflurane than with sevoflurane or isoflurane, and patients receiving patient controlled analgesia (PCA) via intravenous route than via epidural route. The incidence of nausea, vomiting and nausea/vomiting in immediate postanesthetic period was significantly lower in surgery duration less than 60 minutes. CONCLUSIONS: Patients with female gender, intravenous PCA and under enflurane anesthesia had significantly higher incidence of nausea, vomiting and nausea/vomiting in immediate postanesthetic period.

Effects of Dexamethasone on Neuromuscular Transmission in a Phrenic Nerve-Hemidiaphragm Preparation in the Rat / 대한마취과학회지

BACKGROUND: MacFarlane and Rosenthal reported a case of acute quadriplegia after nondepolarizing muscular blocking agents in status asthmaticus patient treated with high doses of corticosteroid. Reports regarding the reactions of glucocorticoid treated muscles to neuromuscular blocking agents are sparse and inconsistent. The aims of this study were to examine the degree of muscle atrophy and its effects on sensitivity to neuromuscular blocking agents in relation to the dose and duration of dexamethasone. METHODS: Sixty Sprague-Dawley rats were divided into six groups. They were treated daily with dexamethasone 0.4 mg/kg and 4 mg/kg daily for 1 week or 3 weeks. The two control groups were treated with normal saline. The day after treatment, the dose-response curves of vecuronium were measured using a phrenic nerve-hemidiaphragm preparation. To classify muscle fiber, the diaphragm was stained for myofibrillar adenosine triphosphatase after alkaline and acid preincubation, and a morphometric examination was carried out. RESULTS: The diaphragmatic muscle in rats treated with long term, high dose dexamethasone showed significant atrophy. For the short term, low dose dexamethasone group, the ED50 and ED95 of vecuronium decreased 41.5% and 26.8% compared to those of the control group, respectively (P<0.05). However, the ED50 of vecuronium in the long term, high dose dexamethasone group increased 22.2% compared to that of the control group (P<0.05). CONCLUSION: This study suggests that sensitiviy to vecuronium was not modulated by dexamethasone-induced muscle atrophy. Quantitative changes of receptors at the neuromuscular junction or some anoother process might be responsible for this change.

Availability of waist circumference as a anthropometric index of abdominal obesity

BACKGROUND: Obesity is a risk factor of hyperlipidemia, DM, hypertension and cardiovascular diseases. In clinical practice the evaluation of obesity has been done indirectly by anthropomet ric indices such as BMI, waist to hip ratio, waist and hip circumference. This study was attempted to show whether waist circumference is better simple anthropometric index of abdominal obesity and has better correlation of metabolic profile than waist to hip ratio which has been commonly used. METHODS: We gathered 286 cases who have undergone medical examination from May 1997 to July 1997 at Dankook University Hospital and measured BMI, relative ideal body weight by Modified Broca method, waist circumference, waist to hip ratio, metabolic profiles, fasting blood sugar, systolic and diastolic blood pressure. RESULTS: Waist to hip ratio and waist circumference showed high correlation with BMI and Modified Broca index. In men, correlation coefficient of waist circumference and waist to hip ratio with BMI was r=0.761, r=0.467, and correlation coefficient of waist circumference and waist to hip ratio with Modified Broca index was r=0.726, r=0.458. In women, correlation coefficient of waist circumference and waist to hip ratio with BMI was r=0.791, r=0.628, and correlation coeffience of waist circumference and waist to hip ratio with Modified Broca index was r=0.769 r=0.660. This finding showed waist to hip ratio and waist circumference is more closely related to BMI and Modified Broca index in women than men and showed higher correlation with waist circumference than waist to hip ratio. There were significant differences of correlation coefficient of obesity indices between waist circumference and waist to hip ratio (p25 and modified Broca index>120%. CONCLUSION: Waist circumference, index of abdominal obesity has better correlation with obesity indices than waist to hip ratio and is a simpler method.