The Effects of Lumbar Sympathetic Ganglion Block in the Patients with Spinal Stenosis and the Skin Temperature Changes according to the Contrast Spread Patterns

BACKGROUND: We hypothesized that if a fluoroscopic image of the lumbar sympathetic ganglion block (LSGB) showed the spread patterns of contrast at both the L2/3 and L4/5 disc areas, then this would demonstrate a more profound blockade effect because the spread patterns are close to sympathetic ganglia. In addition, we compared the effects of LSGB and transforaminal epidural steroid injection (TFESI) for the patients suffering with spinal stenosis. METHODS: Eighty patients were divided into two groups (Group S: the patients treated with TFESI, Group L: the patients treated with LSGB). The patients of group L were classified into three groups (groups A, B and, C) according to their contrast spread pattern. The preblock and postblock temperature difference between the ipsilateral and contralateral great toe (DT(pre), DT(post), degrees C), and the DTnet were calculated as follows. DT(net) = DT(post) - DT(pre). RESULTS: Both group showed a significant reduction of the visual analogue score (VAS) and the Oswestry disability index (ODI) score. Only the patients of group L showed a significant increase of their walking distance (WD). Group A showed the most significant changes in the DT(post) (6.1 +/- 1.2degrees C, P = 0.021), and the DTnet (6.0 +/- 1.0degrees C, p = 0.023), as compared to group C. CONCLUSIONS: LSGB showed a similar effect on the VAS, and ODI, and a significant effect, on WD, compared with TFESI. Group A showed a significant sympatholytic effect, as compared to group C.

Comparison of Blood Loss according to Different Anesthetic Technique for Total Hip Replacement / 대한마취과학회지

BACKGROUND: The mean blood loss is about 500-1,700 ml by general anesthesia technique in total hip replacement (THR) and the amount of blood loss is dependent on the degree of induced hypotension. We performed this study to evaluate the differences on the amount of blood loss and the number of transfused patients according to different anesthetic technique under the similar hypotension level. METHODS: Forty-seven patients of ASA physical status class 1, 2 and 3, scheduled for THR, were randomly assigned into epidural anesthesia group (E group), combined general epidural anesthesia group (GE group) and general anesthesia group (G group). G group was maintained with sevoflurane anesthesia and the monitoring of central and arterial blood pressure was performed. The remifentanil (0.1microgram/kg/min) was infused continuously for the target mean arterial pressure of 60 +/- 5 mmHg. GE group received general anesthesia with the same technique of G group and epidural anestheia was combined after general anesthesia. The remifentanil (0.1microgram/kg/min) was infused continuously for the target mean arterial blood pressure of 60 +/- 5 mmHg. E group received epidural anesthesia with 0.75% ropivacaine and additional bolus dose of local anesthetics was injected if the mean arterial blood pressure did not reach 60 +/- 5 mmHg. RESULTS: The mean volume of blood loss and the number of transfused patients was significantly less in E or GE group at 24 hour after surgery (P < 0.05), however we could not find any significant differences during intraoperative period. CONCLUSIONS: Epidural or combined general epidural anesthesia technique is a good method to reduce bleeding and the number of transfused patients.