ABSTRACT
Objective:To analyze the factors influencing the poor effect of short-term electrical spinal cord stimulation in the treatment of postherpetic neuralgia (PHN).Methods:The medical records of PHN patients of either sex, aged 40-85 yr, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, who received short-term electrical spinal cord stimulation from July 2017 to July 2022, were retrospectively collected. The therapeutic effect was evaluated using the modified MacNab criteria at 3 months after operation, and the patients were divided into good efficacy group (excellent and good efficacy) and poor efficacy group (fair and poor efficacy). General information, disease course, lesion site, complicated diseases, ossification of the yellow ligament in the diseased spinal segment, severity of pain in the herpetic stage, standard antiviral therapy in the herpetic stage (for more than 7 days) and use of neurotrophic drugs in the herpetic stage (for more than 7 days) were collected. Multivariate logistic regression analysis was used to screen the influencing factors for the poor effect of electrical spinal cord stimulation in the treatment of PHN.Results:A total of 168 patients were eventually enrolled, among which 69 had poor curative effect, and the rate of poor curative effect was 41.1%. The results of multivariate logistic regression analysis showed that the patient′s age ( OR=2.230, P=0.015), course of disease ( OR=2.191, P=0.027), complication with diabetes mellitus( OR=8.859, P=0.010), ossification of ligamentum flavum at the same segment ( OR=6.602, P=0.019), severity of pain in the herpetic stage ( OR=5.788, P=0.038) and non-standard antiviral therapy in the herpetic stage ( OR=6.765, P=0.021) were the influencing factors for the poor effect of electrical spinal cord stimulation in the treatment of PHN. Conclusions:Age, course of disease, complication with diabetes mellitus, ossification of ligamentum flandum at the same segment, severity of pain in the herpetic stage and non-standard antiviral therapy in the herpetic stage are the factors influencing the poor effect of short-term electrical spinal cord stimulation in the treatment of PHN.
ABSTRACT
Objective To evaluate the role of mammalian target of rapamycin (mTOR) in the synaptic plasticity of entorhinal area-hippocampal formation in rats with inflammatory pain.Methods Twenty-four healthy adult male Sprague-Dawley rats,weighing 180-240 g,were divided into 4 groups (n =6 each) by using a random number table method:control group (group C),inflammatory pain group (group IP),dimethyl sulfoxide (DMSO) group and mTOR inhibitor rapamycin group (group R).Inflammatory pain model was established by subcutaneous injection of 50 μl bee venom into the plantar surface of the left hindpaw.The equal volume of normal saline was subcutaneously injected into the plantar surface of the left hindpaw in group C.In group DMSO,2％ DMSO was administered by intragastric gavage for 3 days,1 ml per day,and the inflammatory pain model was established at 1 h after administration on 3rd day.In group R,rapamycin was administered by intragastric gavage for 3 days,1 ml per day,and the inflammatory pain model was established at 1 h after administration on 3rd day.Mechanical paw withdrawal threshold (MWT) and thermal paw withdrawal latency (TWL) were measured at 2 h after establishing the model.The rats were sacrificed after measurement of the pain threshold,and hippocampi were removed to prepare hippocampal slices.Hippocampal CA1 region and dentate gyrus (DG region) were located with an inverted microscope.Planar microelectrode array technique was used to record the number of channels and the standardized amplitude of evoked effective field excitatory postsynaptic potentials (fEPSPs) (fEPSPs amplitude＞20％ of the baseline value) at different stimulus intensities.Results Compared with group C,MWT was significantly decreased,TWL was shortened,the number of effective fEPSP channels at different stimulus intensities was increased,and the amplitude of standardized fEPSPs in hippocampal DG and CA1 regions was increased in group IP (P＜0.05 or 0.01),and no significant change was found in the parameters mentioned above in group R (P＞0.05).Compared with group IP,MWT was significantly increased,TWL was prolonged,the number of effective fEPSP channels at different stimulus intensities was decreased,and the amplitude of standardized fEPSPs in hippocampal DG and CA1 regions was decreased in group R (P＜0.05 or 0.01),and no significant change was found in the parameters mentioned above in group DMSO (P＞0.05).Conclusion mTOR is involved in the changes in the synaptic plasticity of entorhinal areahippocampal formation in rats with inflammatory pain.
ABSTRACT
Objective To compare the single-and double-injection techniques for sciatic nerve block.Methods Sixty ASA physical status Ⅰ or Ⅱ patients of both sexes,aged 18-64 yr,weighing 48-72 kg,undergoing elective unilateral foot and ankle surgery,were randomly divided into 2 groups (n =30 each) using a random number table:single-injection group (group S) and double-injection group (group D).Labat-winnie approach to sciatic nerve block was performed under the guidance of a nerve stimulator.When ankle dorsal or plantar flexion developed,group S received a single injection of 0.5％ ropivacaine 30 ml.When ankle dorsal and plantar flexion developed,0.5％ ropivacaine 15 ml was injected each time in group D.The failure of location was recorded.The time spent performing the procedure,onset time and duration of sensory and motor blockade,and the total time for the block were recorded.The effectiveness of block (success,failure) was assessed.Results The failure rate of location was 10％ in group D.The success rate of block was 93％ in group S,and was 96％ in group D,and there was no significant difference in the success rate of block between the two groups.Compared with group S,the onset time of sensory and motor blockade was significantly shortened,the time spent performing the procedure was prolonged,and no significant change was found in the total time for the block,duration of sensory and motor blockade in group D.Conclusion Single-injection technique is recommended for the sciatic nerve block in the patients undergoing lower extremity surgery.
ABSTRACT
Objective To evaluate the effects of the sciatic nerve block on emergence agitation following sevoflurane-based anesthesia in pediatric patients undergoing foot orthomorphia.Methods Sixty pediatric patients,aged 3-7 yr,weighing 12-20 kg,of ASA physical status Ⅰ or Ⅱ,scheduled for elective foot orthomorphia,were randomly assigned to one of two groups (n =30 each):control group (group Ⅰ) and sciatic nerve block group (group Ⅱ).After induction of anesthesia,laryngeal mask airway was inserted,and artificial or mechanical ventilation was performed.Anesthesia was maintained with inhalation of sevoflurane (end-tidal concentration 0.5％-2.0％) and iv fentanyl 0.5-2.0 μg/kg.The sciatic nerve block on the affected side was performed under the guidance of a nerve stimulator,and 0.25％ bupivacaine 0.5 ml/kg was injected.Laryngeal mask airway removal time and emergence time were recorded.At 30 min of recovery from anesthesia,agitation was scored and the development of emergence agitation was recorded.Pain was evaluated with Faces Pain Scale-Revised (FPS-R) at 10 and 30 min of recovery from anesthesia.Adverse reactions including hypoxemia and nausea and vomiting were also recorded during recovery from anesthesia.Results Compared with group Ⅰ,the intraoperative consumption of fen tanyl and mean end-tidal concentration of sevoflurane were significantly decreased,laryngeal mask airway removal time and emergence time were shortened,and the incidence of emergence agitation,PPS-P scores and incidence of hypoxemia were decreased in group Ⅱ.Conclusion The sciatic nerve block is helpful in decreasing the development of emergence agitation following sevoflurane-based anesthesia in pediatric patients undergoing foot orthomorphia.