Do Severity Score and Skin Temperature Asymmetry Correlate with the Subjective Pain Score in the Patients with Complex Regional Pain Syndrome?

BACKGROUND: The diagnostic criteria of complex regional pain syndrome (CRPS) have mainly focused on dichotomous (yes/no) categorization, which makes it difficult to compare the inter-patient's condition and to evaluate the intra-patient's subtle severity over the course of time. To overcome this limitation, many efforts have been made to create laboratory methods or scoring systems to reflect the severity of CRPS; measurement of the skin temperature asymmetry is one of the former, and the CRPS severity score (CSS) is one of the latter. However, there has been no study on the correlations among the CSS, temperature asymmetry and subjective pain score. The purpose of this study was to evaluate whether there is any correlation between the CSS, skin temperature asymmetry and subjective pain score. METHODS: Patients affected with CRPS in a unilateral limb were included in this study. After making a diagnosis of CRPS according to the Budapest criteria, the CSS and skin temperature difference between the affected and unaffected limb (DeltaT) was measured in each patient. Finally, we conducted a correlation analysis among the CSS, DeltaT and visual analogue scale (VAS) score of the patients. RESULTS: A total of 42 patients were included in this study. There was no significant correlation between the DeltaT and VAS score (Spearman's rho = 0.066, P = 0.677). Also, the CSS and VAS score showed no significant correlation (Spearman's rho = 0.163, P = 0.303). CONCLUSIONS: The DeltaT and CSS do not seem to reflect the degree of subjective pain in CRPS patients.

Do Severity Score and Skin Temperature Asymmetry Correlate with the Subjective Pain Score in the Patients with Complex Regional Pain Syndrome?

BACKGROUND: The diagnostic criteria of complex regional pain syndrome (CRPS) have mainly focused on dichotomous (yes/no) categorization, which makes it difficult to compare the inter-patient's condition and to evaluate the intra-patient's subtle severity over the course of time. To overcome this limitation, many efforts have been made to create laboratory methods or scoring systems to reflect the severity of CRPS; measurement of the skin temperature asymmetry is one of the former, and the CRPS severity score (CSS) is one of the latter. However, there has been no study on the correlations among the CSS, temperature asymmetry and subjective pain score. The purpose of this study was to evaluate whether there is any correlation between the CSS, skin temperature asymmetry and subjective pain score. METHODS: Patients affected with CRPS in a unilateral limb were included in this study. After making a diagnosis of CRPS according to the Budapest criteria, the CSS and skin temperature difference between the affected and unaffected limb (DeltaT) was measured in each patient. Finally, we conducted a correlation analysis among the CSS, DeltaT and visual analogue scale (VAS) score of the patients. RESULTS: A total of 42 patients were included in this study. There was no significant correlation between the DeltaT and VAS score (Spearman's rho = 0.066, P = 0.677). Also, the CSS and VAS score showed no significant correlation (Spearman's rho = 0.163, P = 0.303). CONCLUSIONS: The DeltaT and CSS do not seem to reflect the degree of subjective pain in CRPS patients.

Successful thrombolytic therapy with recombinant tissue-type plasminogen activator for massive pulmonary embolism: A case report / 대한마취과학회지

Massive pulmonary embolism is associated with significant perioperative morbidity and mortality. We report here on a case of a 69-year-old man who suffered a massive pulmonary embolism with pulseless electrical activity during knee arthroscopic surgery. After a diagnosis was made by performing transthoracic echocardiography, the patient was treated with recombinant tissue-type plasminogen activator. The patient was transferred to the intensive care unit after his hemodynamic status improved. The patient went on to make a full cardiopulmonary recovery without any complications.

A study on the usefulness of motor evoked potentials monitoring during spinal surgery

BACKGROUND: Intraoperative monitoring of transcranial electrical motor evoked potentials (TCE-MEPs) can be a useful tool to detect iatrogenic spinal cord injury. But the efficacy of TCE-MEPs monitoring in the spine surgery has not been reported in South Korea. The purpose of this study is to investigate the reliability of intraoperative TCE-MEPs in spinal surgery. METHODS: Thirty five patients scheduled for elective surgery for spine correction were enrolled in the study. After induction of general anesthesia with target controlled infusion (TCI) system of propofol and remifentanil, intraoperative TCE-MEPs from upper or lower limb muscles were monitored. No additional muscle relaxants were given except for tracheal intubation. We recorded intraoperative abnormal signs of TCE-MEPs and postoperative neurologic deficits. From these results, sensitivity, specificity, positive predictive value, and negative predictive value of TCE-MEPs monitoring for the detection of neurologic damage during spinal surgery were calculated. RESULTS: Six patients showed decreases in amplitudes. Postoperative neurologic deficits occurred in 5 patients out of them. Only one patient developed postoperative neurologic deficit even though there were no intraoperative TCE-MEPs change. Sensitivity, specificity, positive predictive value, and negative predictive value of TCE-MEPs monitoring for the detection of neurologic deficits were 83.3%, 96.7%, 83.3%, 96.7%, odds ratio was 140 and relative risk was 24.2. CONCLUSIONS: Intraoperative TCE-MEPs monitoring is a reliable and sensitive method to detect the neurologic deficits during spinal surgery.

The effect of tranexamic acid used for spine surgery on blood loss and transfused volume

BACKGROUND: In this randomized controlled study, we evaluate the effect of tranexamic acid on perioperative blood loss and transfused volume in patients undergoing spine surgery. METHODS: We enrolled and randomly allocated 40 patients scheduled for spine surgery under general anesthesia to either tranexamic group or control group. Tranexamic acid was given to tranexamic group with loading dose 10 mg/kg for 15 minutes followed by continuous infusion at the rate of 1 mg/kg/h. In control group, equivalent volume of normal saline was given with the same manner and rate, until the end of procedure. We examined the total blood loss and transfused volume perioperatively. Also we evaluated hemoglobin, platelet, prothrombin time, partial thromboplastin time and thromboelastography before and after surgery. RESULTS: The groups did not differ significantly. Intraoperative blood loss was 1,130.0 +/-563.9 (mean +/-SD) ml in control group and 1,061.5 +/-509.7 ml in tranexamic group. Blood loss at postoperative 12 h and 24 h were 392.0 +/-222.0 ml, 466.0 +/-323.2 ml in control group and 158.5 +/-100.6 ml, 470.2 +/-232.7 ml in tranexamic group respectively. Transfused volumes at intraoperative and postoperative period were differing significantly (1,300.0 +/-709.3 ml, 800.0 +/-343.3 ml in control group compared to 1,020.0 +/-476.3 ml, 340.0 +/-325.0 ml in tranexamic group). CONCLUSIONS: Loading dose of 10 mg/kg tranexamic acid and followed infusion at 1 mg/kg/h reduce perioperative blood transfused volume during spinal surgery.

The effect of two types of humidifying devices on humidity of inspired gas and tidal volume by ventilator monitoring

BACKGROUND: In general anesthesia, a heat and moisture exchanger (HME) is used to prevent hypothermia and to maintain humidity of inspired gas. We hypothesized that after using a HME expiratory tidal volume decreases because a HME traps the expired vapor.The aim of this study was to evaluate the humidity of expired gas and to investigate the accuracy of tidal volume monitoring. METHODS: Forty patients undergoing elective surgery under general anesthesia were randomly allocated into two groups.Group P (n = 20) used Pall Breathing filter (pall BB25, ACE medical, Korea) and Group H (n = 20) used Hygrobac S (Mallinckrodt Dar, Mirandola, Italy) between endotracheal tube and Y-piece.And with same kind of ventilator, we measured expiratory tidal volume, temperature and relative humidity at before and after HEM.And we recorded expiratory tidal volume monitored by ventilator with and without HME. RESULTS: The relative humidity was significantly higher at before using HEM than after using HEM in both group.The temperature in Group H was higher when measured at before HME but not in Group P.The measured expiratory tidal volume at before and after HEM was not significantly different. The tidal volume monitored by ventilator with HEM was significantly smaller than without HEM, by 3.1% in Group P and 5.3% in Group H. CONCLUSIONS: The HMEs improve inspiratory humidity and temperature of anesthetic gas.But monitored expiratory tidal volume was underestimated when using HMEs.

Subdural hemorrhage after scoliosis correction surgery: A case report / 대한마취과학회지

An 11-year-old boy underwent thoracolumbar surgery to correct a deformity caused by congenital kyphoscoliosis from the 6th thoracic vertebra to the 2nd lumbar vertebra. During a screw insertion, some tore and cerebro-spinal fluid (CSF) leaked. After CSF leakage, the amplitude of the motor evoked potential in the left lower extremity was reduced by 90% compared to baseline value, but there was no nerve damage at the surgical site. His post-surgical mental status did not recover completely. Brain computed tomography revealed a subdural hemorrhage in the inter-hemispheric fissure, with both tentorium and right frontotemporooccipital and diffuse brain edema. On the 4th postoperative day, mental status recovered to near alertness, but upper motor strength was grade II, right lower motor strength was grade II and left lower motor strength was grade I. Right hemifacial palsy was also noted. At 2.5 months after surgery, right facial palsy remained, but motor function recovered to near normal levels with conservative care.

Right Shoulder Pain due to Metastatic Lung Cancer: A case report / 대한통증학회지

Frozen shoulder is known to be a self-limited disease, and it is associated with chronic pain and limitation of joint movement. Although its etiology is still unknown, frozen shoulder is associated with several diseases. The diagnosis is made based on the medical history, the clinical and radiological examinations and exclusion of other shoulder pathologies. The skeleton is one of the most common sites of metastasis in patients with lung cancer. It has been reported that the incidence of bone metastases in lung cancer patients is approximately 30-40%, and the median survival time of patients with such metastases is 6-7 months. We experienced a case of a 77-year-old female patient who complained of right shoulder pain and limited joint mobility, and these symptoms were due to metastatic lung cancer in the shoulder.