Study Of Effect Of Intermittent Epidural Injection Of Normal Saline On Duration Of Motor And Sensory Blockade After Combined Spinal Epidural (cse) Anaesthesia. A Prospective, Rct

BACKGROUND: Prolonged motor and sensory block following Central Neuraxial Blockade (CNB) is associated with extended postoperative immobilization and its complications. Speedy recovery from motor blockade would improve the patients' acceptance of neuraxial anesthesia. Previous studies in patients undergoing epidural anaesthesia, demonstrated rapid motor recovery after administration of epidural crystalloids. We studied the effect of intermittent bolus injection of Normal saline (NS) on the duration of sensory and motor recovery after Combined spinal epidural anaesthesia (CSEA). METHODS:60 patients (ASA I-III) scheduled for surgeries under CSEA lasting for 1½ to 2 hrs were divided equally by systematic random sampling at the end of surgery. Control group - No bolus of NS flush was given through the epidural catheter. Intervention group -15 ml of NS flush through epidural catheter was given thrice. Sensory level, Motor blockade and vitals were noted at 5 min interval for 2 hours from end of surgery. RESULTS: 1. Sensory levels in two groups were significantly different (p-value < 0.001) at the end of two hours. In intervention group, T8 level was predominant, while in control group L1 level was predominant. 2. Difference in motor block in two groups was significant as (p-value < 0.001). In intervention group, 86.67% had Bromage score 0, while in control group 80% had score 1 at the end of 2 hrs. Conclusion: Postoperative epidural flush with 45 ml Normal saline hastened the motor recovery following CSEA without shortening of the duration of sensory blockade.

Sensory Recovery After Skin Graft Using Allogenic Dermis

It is well known that the thicker dermis is grafted, the lesser adhesion and contracture can be resulted. In spite of all advantages, thicker layer of dermis can also cause pain, infection, hypertrophic scar and delayed healing at the donor site. In addition, full thickness skin graft can result in best quality in recipient site, but it is limited in donor site and harvested size. Processed allogenic dermis(Alloderm(R)) has been developed and applied to solve the above-mentioned problems as permanent dermal augmentation for full thickness skin defect. From March 2002 to December 2003, we have applied allogenic dermis (Alloderm(R)) and ultra-thin split thickness skin graft on 30 patients (Group A) who had hypertrophic scar, 3rd degree burn, full thickness skin defect and various cosmetic problems. The control patients (Group B) are treated by conventional autologous thick split thickness skin graft only. We evaluated wound contracture, degree of sensory recovery, color change, functional and histological aspect between Group A and B. In Group A, by providing a dermal augmentation, the grafted dermal matrix permitted a thin autograft from the donor site. The harvested ultra-thin split-thickness skin remained fewer complications on the donor site and had faster healing process. And allogenic dermis exhibited excellent elastisity and good pigmentation with minimal scarring and wound contracture. But in sensory reinnervation study, Group A was not fully recovered compared to the conventional skin graft in Group B. In histological study, small nerve fiber bundles are scattered in the mid-dermis of processed allogenic dermis in Group A, but in Group B nerve fiber bundles extended into the upper dermis. Most nerve fibers were not sufficiently innervated into upper dermis in allogenic dermis because it was assumed that allogenic dermis play an important role as a barrier. In conclusion, if we perform ultra-thin split thickness skin graft using an allogenic dermis, wounds can be covered in a single stage with an adequate layer of dermal augmentation with minimal donor site morbidity, and we can also get good functional recovery, and avoid undesirable complications. However, application of allogenic dermis in the important area of sensation, such as hands and feet, should be conservative at present. Further scientific refinement is necessary for the improvement of sensory recovery in using allogenic dermis and a large scale experimental study should be performed.

Sensory Recovery after Reconstruction of Oral Cavity and Oropharynx using Non-sensate Flap

The ablation surgery of the oral cavity and oropharyngeal carcinoma induced some disturbance in multiple aspects of normal anatomy and physiologic function. Sensation is one of the most important factor for restoration of many disturbed oral function like articulation, swallowing and mastication. Thirteen oral cavity and oropharyngeal carcinoma patients with reconstruction using non- sensate flap including free flap or musculocutaneous pedicled flap were subjects of this study. The sensory recovery was evaluated among the following 5 subjective senses: light touch, deep touch(pressure), pain, warm and cold sense and the two point discriminations were also recorded after postoperative 6 months. For histologic examination, after the flap tissues including the normal mucosa were obtained, H&E and immunohistochemical stains with anti-S-100 protein were performed at the same time. The subjective sensation, especially deep touch(pressure) and pain were almost restored(92%) in the flap and histologic changes, such as loss of keratin, granular layer and hyperkeratosis were observed. But, only 15% of the flap revealed positive reaction in staining with S-100 protein. Our results demonstrates some recovery of sensation in the non-sensate flap and the changes in epidermis of the flap such as mucosalization. However, histologic evidence were lack on the sensory nerve regeneration. Therefore, detailed study should be included electromicroscopic examination and comparison between the sensate and non-sensate flap.