Effect of cervical sympathetic block on cerebral vasospasm after subarachnoid hemorrhage in rabbits

PURPOSE: Cerebral vasospasm (CVS) is a major complication after subarachnoid hemorrhage (SAH) induced by the rupture of intracranial aneurysms. The aim of the present study was to investigate the effect and mechanism of cervical sympathetic block on cerebral vasospasm of the rabbits after SAH. METHODS: After successful modeling of cervical sympathetic block, 18 healthy male white rabbits were randomly divided into three groups (n=6), ie, sham operation group (Group A), SAH group (Group B) and SAH with cervical sympathetic block group (Group C). Models of delayed CVS were established by puncturing cisterna magna twice with an injection of autologous arterial blood in Groups B and C. A sham injection of blood through cisterna magna was made in Group A. 0.5 ml saline was injected each time through a catheter for cervical sympathetic block after the first injection of blood three times a day for 3 d in Group B (bilateral alternating). 0.5 ml of 0.25% bupivacaine was injected each time through a catheter for cervical sympathetic block after the first injection of blood three times a day for 7 d in Group B. 2 ml venous blood and cerebrospinal fluid were obtained before (T1), 30 min (T2) and 7 d (T3) after the first injection of blood, respectively, and conserved in a low temperature refrigerator. Basilar artery value at T1, T2 and T3 was measured via cerebral angiography. The degree of damage to nervous system at T1 and T3 was recorded. RESULTS: There was no significant difference in diameter of basilar artery at T1 among three groups. The diameters of basilar artery at T2 and T3 of Groups B and C were all smaller than that in Group A, which was smaller than Group C, with a significant difference. There was no significant difference in NO and NOS in plasma and cerebrospinal fluid among three groups. The NO and NOS contents at T2 and T3 of Groups B and C were all lower than Group A; Group C was higher than Group B, with a significant difference. The nerve function at T3 of Groups B and C were all lower than Group A and that of Group C higher than Group B, with a significant difference. CONCLUSION: Cervical sympathetic block can relieve cerebral vasospasm after subarachnoid hemorrhage and increase NO content and NOS activity in plasma and cerebrospinal fluid to promote neural functional recovery.

Effects of dorsal root ganglion destruction by adriamycin in patients with postherpetic neuralgia / Efeitos da destruição da raiz dorsal ganglionar pela adriamicina em pacientes com neuralgia pós-herpética

PURPOSE: To investigate the effects of dorsal root ganglion destruction in patients with postherpetic neuralgia (PHN). METHODS: Seventy-two patients with PHN selected were randomly divided into two groups (n=36). Group A was the control group (treated by injection) and group B was the group of dorsal root ganglion destruction by adriamycin. Visual analog scale scores (VAS), SAS, SF-MPQ scores. Clinical effects and therapy safety were evaluated before therapy, one week, three and six months after therapy. Forty-four patients were available for intention-to-treat analysis. RESULTS: The average pain scores on the Likert scale were significantly reduced at each point in group B. Patients in group B reported clinical effectiveness at six months as excellent response, good response, improved but unsatisfactory or unchanged 16, 12 and 8.VAS scores at each time point after the operation were lower than that before operation and in group A, there was significant difference. Patients showed significant improvement in sleep scores in group B. There was significant difference at T2 in group A than T1. There was no significant difference in group A at T3, T4 after the operation than that before operation. Between group comparison: there was significant difference between group A and group B at each time point after the operation. CONCLUSIONS: Dorsal root ganglion destruction by adriamycin under guidance of C-arm perspective, the puncture operation was accurate without any adverse reaction or serious complications, which could effectively relieve pain of patients with postherpetic neuralgia, but the long-term effects needed further study.

OBJETIVO: Investigar os efeitos da destruição da raiz dorsal ganglionar em pacientes com neuralgia pós-herpética. MÉTODOS: Setenta e dois pacientes selecionados com neuralgia pós-herpética foram randomicamente distribuídos em dois grupos (n=36). Grupo A foi o grupo controle (tratado por injeção) e o grupo B foi o grupo com destruição da raiz dorsal do gânglio pela adriamicina. Os escores da Escala Analógica Visual (VAS), SAS, SF-MPQ escores, efeitos clínicos e segurança terapêutica foram avaliados as antes da terapia, uma semana, três e seis meses após a terapia. Quarenta e quatro pacientes foram avaliados pela análise de intenção-em-tratar. RESULTADOS: A média dos escores de dor na escala de Likert foi significativamente reduzida em cada ponto no grupo B. Pacientes no grupo B relataram efetividade clínica aos seis meses com excelente resposta (16), boa resposta (12), melhora mais insatisfatória ou sem modificações (8). Escores VAS a cada tempo após o procedimento foram melhores em comparação ao pré-operatório. No grupo A não foi observada diferença significativa. Pacientes mostraram melhora nos escores de dormir no grupo B. Houve diferença significante no T2 no grupo A que T1. Não houve diferença significante no grupo A nos tempos T3 e T4 após a cirurgia em relação a antes. Comparação entre os grupos: houve diferença significante entre os grupos A e B a cada tempo após a cirurgia. CONCLUSÕES: A destruição da raiz dorsal ganglionar pela adriamicina sob perspectiva guiada pelo C-arm, a cirurgia pontual foi acurada sem qualquer reação adversa ou complicação séria, que pode efetivamente aliviar a dor em pacientes com neuralgia pós-herpética, mas os efeitos de longo prazo necessitam mais estudos.