Is an Epidural Steroid Injection with an Addition of an Intravenous and Intradermal Injection of Lidocaine Advantageous in the Pain Management of Herpes Zoster? / 대한마취과학회지

BACKGROUND: An epidural blockade has been considered a standard therapy for the management of pain in acute herpes zoster. However, it has many complications. Recently, we experienced good analgesia with a combination therapy including intravenous lidocaine infusion and intradermal injection of a local anesthetic and steroid in acute herpes zoster. Therefore, this study was performed to evaluate the necessity of an epidural steroid injection, added in a combination therapy, on the pain control of acute herpes zoster. METHODS: This retrospective study was based on the analysis of data of medical records. Forty-three patients suffering severe acute herpes zoster pain, were randomly divided into two groups. Intravenous lidocaine infusion (5 mg/kg) and an intradermal injection of lidocaine and a steroid into the wound were used twice a week in the Lidocaine group (n = 23), and in the Epidural group (n = 20), an epidural block with 0.5% lidocaine 6-8 ml with triamcinolone 30 mg was added once a week in addition to the above. We compared the efficacy of pain control using a pain relief scale (PRS) at 4 weeks after the initial visit to the pain clinic. RESULTS: Both groups were similarly managed in pain control. There were no statistical differences comparing the PRS between the two groups. CONCLUSIONS: Our results suggest that an epidural steroid injection, added in a combination therapy such as an intravenous lidocaine infusion and an intradermal injection of a local anesthetic and steroid, has no more advantages for the management of pain in acute herpes zoster. A further prospective study is recommended to compare the efficacy of pain control and the incidence of postherpetic neuralgia in a large number of acute herpes zoster patients.

Anesthetic Consideration Concerning a Congenital Diaphragmatic Hernia in a Patient with a Single Ventricle: A case report / 대한마취과학회지

A congenital diaphragmatic hernia is a life threatening condition. It causes pulmonary hypertension with right to left shunting that contributes to severe hypoxemia in neonates. A particulary poor prognosis is predicted if a congenital diaphragmatic hernia is associated with cardiac deformities and pulmonary hypoplasia. We experienced a case of a 3,500 gm female infant with a congenital diaphragmatic hernia and a single ventricle with left pulmonary atresia. Of prime concern was the maintenance of pulmonary vascular resistance, and this was achieved by altering ventilation, inspired oxygen concentration and blood pH. Also postoperative management of pulmonary hypertension is as important as surgical correction of the congenital diaphragmatic hernia. We performed general anesthesia with O2-fentanyl-isoflurane for correction of diaphragmatic hernia. The fentanyl infusion continued after the operation for blunting of stress responses in the pulmonary circulation. The patient was given a Blalock-Taussig shunt at postoperative day 12.

Gender Differences in Delayed Focal Cerebral Infarctions of Rats and Their Inflammatory Response

Only male rats were used in the experimental studies of cerebrovascular disease to exclude any potential effects of hormones which may cause more inflammatory reaction in female rats. Inflammatory responses in cerebral infarctions may modulate acute tissue damage and repair to affect infarction size. The authors investigated the differences in the degree of cerebral infarction between both gender groups and the hypothesis that increased inflammatory responses in female rats may have adverse effect on cerebral infarction. 12-week-old Sprague-Dawley rats(10 males and 8 females) were subjected in this study. The right middle cerebral artery was ligated by a 10-0 nylon and both common carotid arteries were occluded by microclips for 30 minutes, and then the three vessels were opened to reperfuse. Their brains were obtained at 72 hours after the operations, and a focal cerebral infarction was established uniformly at right frontal lobe. The volume of the infarction was measured. Inflammatory cells were counted at the peri-infarct area. The mean volume of the cerebral infarction was 11.8+/-.9mm3 in the male group and 6.9+/-.1mm3 in the female group. The infarction volume was significantly larger in the male group(p0.05). These data indicate that the infarction volume may be affected by gender but the cellular immunity was not influenced by gender and even have no direct effect on the cerebral infarction.