Quantitative assessment of steroid amount in the tissue after epidural steroid injection: a new rabbit model / 대한통증학회지

BACKGROUND: To develop a rabbit epidural steroid injection (ESI) model for analyzing steroid retention in the tissue, and to assess the difference in steroid retention in the model according to the location and time elapsed after ESI. METHODS: Fluoroscopy-guided ESI was performed using the interlaminar approach between the lowest two lumbar segments in 13 female New Zealand white rabbits. Four rabbits were allocated to each of three different groups according to the time of sacrifice: 3, 7, and 15 days post-ESI; the remaining rabbit was sacrificed immediately post-ESI to obtain baseline data. After sacrifice, two segments were harvested: the lowest two lumbar vertebrae and another two lumbar vertebrae immediately above these. The residual steroid amount (RSA) and residual steroid concentration (RSC) in the collected spinal columns were analyzed. A linear mixed model was used to compare RSAs and RSCs between the injected and adjacent segments, and among the number of days until sacrifice; P < 0.05 was considered statistically significant. RESULTS: Both RSA and RSC of the injected segment were significantly higher than those of the adjacent segment (P < 0.001, both). The RSA and RSC significantly decreased over time (P = 0.009 and P = 0.016, respectively). CONCLUSIONS: The developed rabbit ESI model verified that significantly more steroid was retained at the injected segment than at the adjacent segment and the residual steroid decreased over time. This model could be useful not only for comparing current steroid medications, but also for developing new, better steroid formulations.

Effectiveness of continuous hypertonic saline infusion with an automated infusion pump for decompressive neuroplasty: a randomized clinical trial / 대한통증학회지

BACKGROUND: Hypertonic saline (HS) injections for decompressive neuroplasty (DN) can cause pain. We assessed whether a continuous infusion of HS through an infusion pump would reduce injection-related pain compared with repeated bolus administrations. METHODS: Fifty patients scheduled for DN were randomized to either the bolus injection or the continuous infusion group. After appropriately placing the epidural catheter, 4 mL of 5% NaCl was injected as four boluses of 1 mL each at 15-minute intervals or infused over 1 hour using an infusion pump. The severity of pain induced by HS injection, as measured by the 11-point numerical rating scale (NRS), was the primary outcome. The severity of low back or lower extremity pain, as measured by the 11-point NRS and Oswestry Disability Index (ODI), 3 months following the procedure, was the secondary outcome. RESULTS: Data from 21 patients in the bolus group and 23 in the continuous infusion group were analyzed. No statistically significant difference in injection-related pain was identified between the two groups during the initial HS administration (P = 0.846). However, there was a statistically significant reduction in injection-related pain in the continuous infusion group compared to the bolus injection group from the second assessment onwards (P = 0.001, < 0.001, and < 0.001, respectively). No significant between-group differences in the NRS and ODI scores 3 months post-procedure were noted (P = 0.614 and 0.949, respectively). CONCLUSIONS: Our study suggests that administering HS through a continuous infusion is a useful modality for reducing HS injection-related pain during DN.

Results of treatment of acute lumbar disc herniation with transforaminal nerve root block / Resultados do tratamento da hérnia discal lombar aguda com bloqueio anestésico transforaminal / Resultados del tratamiento de la hernia discal lumbar con bloqueo anestésico transforaminal

ABSTRACT Objective: To determine the efficacy of anesthetic transforaminal nerve root block in patients with sciatica secondary to lumbar disc herniation through a prospective observational study. Methods: The study included 176 patients from a private clinic undergoing transforaminal injection performed by a single spinal surgeon. The patients were assessed after two weeks, three months and six months regarding to the improvement of the pain radiating to the lower limbs. In case of persistent symptoms, patients could choose to perform a new nerve root block and maintenance of physical therapy or be submitted to conventional microdiscectomy. Results: By the end of six-month follow-up of the 176 patients, 116 had a favorable outcome (95 after one block and 21 after two blocks), and only 43 required surgery. Conclusion: The results of our study suggest a positive effect of transforaminal block for the treatment of sciatica in patients with lumbar disc herniation.

RESUMO Objetivo: Determinar a eficácia do bloqueio anestésico transforaminal nos pacientes com ciática secundária à hérnia de disco lombar, por meio de um estudo prospectivo observacional. Métodos: Foram incluídos no estudo 176 pacientes de uma clínica privada submetidos à injeção transforaminal executada por um único cirurgião de coluna. Os pacientes foram reavaliados após duas semanas, três meses e seis meses quanto à melhora da dor irradiada para os membros inferiores. Na persistência dos sintomas, os pacientes poderiam optar por realizar um novo bloqueio e manutenção da fisioterapia ou serem submetidos à microdiscectomia convencional. Resultados: No final do seguimento de seis meses dos 176 pacientes, 116 apresentaram evolução satisfatória (95 após um bloqueio e 21 após dois bloqueios) e apenas 43 necessitaram da cirurgia. Conclusão: Os resultados do nosso estudo sugerem um efeito positivo do bloqueio transforaminal para o tratamento da ciatalgia nos pacientes com hérnia de disco lombar.

RESUMEN Objetivo: Determinar la eficacia del bloqueo anestésico transforaminal en pacientes con dolor radicular secundario a hernia de disco lumbar, a través de un estudio prospectivo observacional. Métodos: El estudio fue compuesto por 176 pacientes de una clínica privada sometidos al bloqueo anestésico transforaminal realizado por un único cirujano de la columna. Los pacientes fueron re-evaluados al cabo de dos semanas, tres meses y seis meses con respecto a la mejora del dolor que se irradia a las extremidades inferiores. En caso de persistencia de los síntomas los pacientes podrían optar por realizar un nuevo bloqueo anestésico y mantenimiento de fisioterapia o someterse a una microdiscectomía convencional. Resultados: Al final del seguimiento de seis meses de los 176 pacientes, 116 tuvieron resultado favorable (95 luego de sólo un bloqueo y 21 después de dos bloqueos) y en solamente 43 pacientes la cirugía fue necesaria. Conclusión: Los resultados de nuestro estudio sugieren un efecto positivo del bloqueo anestésico transforaminal para el tratamiento de la ciática en los pacientes con hernia de disco lumbar.

Efficacy of radiologic targeting epidural blood patch for spontaneous intracranial hypotension patients with multiple-level leakages of cerebrospinal fluid : an analysis of 36 cases / 中华麻醉学杂志

Thirty-six spontaneous intracranial hypotension patients with multiple-level leakages of cerebrospinal fluid were enrolled in the study.After 30 patients received targeted epidural blood intervention for 2 times and 6 patients received targeted epidural blood intervention for 3 times,the clinical symptoms were completely relieved.During injection of autologous blood,pain at the puncture site occurred in 24 cases,radiating pain in upper extremities in 5 cases,numbness in the upper extremity in 9 cases,radiating pain in lower extremities in 6 cases,numbness in lower extremities in 7 cases,headache in 4 cases,dizziness in 3 cases and transient bradycardia in 3 cases.Most of these symptoms were self-relieved after the end of injection or after slowing the injection rate,and some were self-relieved hours later.Neck stiffness was found in 2 cases and self-relived within a few hours or days after operation,and no severe nervous systemrelated complications were found.Recurrence happened in 2 cases at 3 months after the end of treatment,and the symptoms were self-relieved after receiving targeted epidural blood intervention for a second time.The patients were followed up for 15-36 months,and no serious nervous system-related complications were observed.Therefore,targeted epidural blood intervention is safe and effective when used to treat spontaneous intracranial hypotension caused by multiple-level leakages of cerebrospinal fluid in patients.

Long-term assessment of clinical outcomes of ultrasound-guided steroid injections in patients with piriformis syndrome

PURPOSE: The purpose of this study was to evaluate the long-term efficacy of ultrasound (US)-guided steroid injections in patients with piriformis syndrome. METHODS: Between January 2010 and October 2012, 63 patients (23 men and 40 women; average age, 63.2 years; range, 24 to 90 years) were diagnosed with piriformis syndrome based on clinical history, electromyography, and flexion-adduction-internal rotation test results. They were divided into two groups. The first group (37 subjects) received a US-guided steroid injection around the piriformis muscle. The second group (26 subjects) received both piriformis muscle and spinal epidural injections. The therapeutic effect was categorized as improvement, partial improvement, or failure depending on the degree of symptom alleviation one month after injection, based on a review of each patient's medical records. RESULTS: In the first group, 15 patients (40.5%) showed improvement, seven (18.9%) showed partial improvement, and 15 (40.5%) failed to respond to the initial treatment. In the second group, eight patients (30.8%) showed improvement, 11 (42.3%) showed partial improvement, and seven (26.9%) failed to respond to the initial treatment. A second piriformis injection was performed in four cases, after which two patients showed improvement within 3 years, but the other two showed no therapeutic effect. CONCLUSION: US-guided steroid injection may be an effective treatment option for patients with piriformis syndrome.

Infusión epidural cervical para tratamiento del dolor por herpes zoster. Reporte de caso con revisión temática / Cervical epidural infusion for the treatment of herpes zoster pain. Case report with review of the literature

Introducción: El herpes zoster es causado por una reactivación del virus de la varicela zoster. Clínicamente la enfermedad se manifiesta con dolor en la zona de un dermatoma asociado a un exantema vesicular. La complicación más común es la neuralgia postherpética, más frecuente en el adulto mayor. El tratamiento está enfocado al control de la infección aguda, al alivio del dolor agudo y a la prevención del dolor crónico. El tratamiento de primera línea es farmacológico, con antivirales y analgésicos; las inyecciones epidurales han sido usadas con el fin de prevenir la neuralgia posherpética. Objetivo: El objetivo del presente artículo es presentar una revisión de la literatura aprovechando el reporte de un caso de un paciente con diagnóstico de herpes zoster que fue tratado con infusiones epidurales cervicales por 16 días. Materiales y métodos: Se realizó una búsqueda en la base de datos Pubmed, que incluyó artículos de metaanálisis, revisiones sistemáticas, ensayos clínicos, revisiones narrativas y series de casos, entre 1995 y 2012, para la realización de una revisión narrativa no sistemática y reporte de un caso. Resultados:Se seleccionaron 31 artículos para la realización de la actualización en el tema propuesto y se describió el reporte del caso. Conclusiones: El uso de infusiones epidurales en pacientes con herpes zoster es una alternativa en el tratamiento del dolor agudo: favorecen una movilización pasiva de la extremidad afectada evitando la atrofia de esta, ayudan a prevenir la neuralgia posherpética, están disponibles en nuestro medio y tienen una baja incidencia de complicaciones.

Introduction: Herpes zoster is caused by a reactivation of the varicella zoster virus. Clinically, the disease manifests with pain in the area of a dermatome associated with vesicular exant-hema. The most common complication is post-herpetic neuralgia, more frequent among elderly patients. The treatment focuses on the control of the acute infection, relief of acute pain, and prevention of chronic pain. First line treatment is pharmacological using antiviral and analgesic drugs, and epidural injections have been used for the prevention of post-herpetic neuralgia. Objective: The objective of this article is to present a review of the literature on the basis of a case report of a patient diagnosed with herpes zoster who was treated with cervical epidural infusions for 16 days. Materials and methods: Search conducted in PUBMED, including meta-analyses, systematic reviews, clinical trials, narrative reviews and case series published between 1995 and 2012, in order to perform a non-systematic narrative review in reference to a case report. Results:Overall, 31 articles were selected for an update of the topic proposed, and a case report was described. Conclusions:The use of epidural infusions in patients with herpes zoster is a treatment option for acute pain; it favors passive motion of the affected limb preventing atrophy, helps prevent post-herpetic neuralgia, is available in our setting, and has a low incidence of complications.

O bloqueio combinado raqui-peridural com extensão do volume peridural causa nível mais alto de bloqueio do que a raquianestesia com dose única / Combined spinal-epidural anesthesia with epidural volume extension causes a higher level of block than single-shot spinal anesthesia / El bloqueo combinado raquiepidural con extensión del volumen epidural causa nivel más alto de bloqueo que la raquianestesia con dosis única

JUSTIFICATIVA E OBJETIVOS: Avaliamos os efeitos da administração peridural de levobupivacaína ou solução salina, extensão do volume peridural (EVE), em bloqueio combinado raqui-peridural (BCRP) para cesariana. MÉTODOS: Foram incluídas no estudo 138 pacientes com gravidez a termo de 37-42 semanas programadas para cesariana. O Grupo 1 (n = 48) recebeu raquianestesia com dose única (RADU), o Grupo 2 (n = 45) recebeu BCRP-EVE com solução salina e o Grupo 3 recebeu BCRP-EVE com levobupivacaína. As características do bloqueio motor e sensorial os efeitos nas alterações hemodinâmicas maternas e nos recém-nascidos foram comparados. RESULTADOS: O tempo para atingir o bloqueio sensorial máximo foi significativamente menor no Grupo 3 do que nos grupos 1 e 2 (p < 0,05). O tempo de regressão do bloqueio sensório em dois segmentos foi significativamente menor no Grupo 1, enquanto foi significativamente maior no Grupo 3 em relação ao Grupo 2 (p < 0,05). O tempo de início do bloqueio motor foi significativamente maior no Grupo 1 do que nos grupos 2 e 3 (p < 0,05). O tempo para atingir o bloqueio motor máximo foi significativamente menor no Grupo 3 do que nos grupos 1 e 2 (p < 0,05). O tempo de recuperação do bloqueio motor foi significativamente maior no Grupo 3 do que nos grupos 1 e 2 (p < 0,05). O tempo para o primeiro analgésico foi significativamente maior no Grupo 3 (p < 0,05). CONCLUSÃO: Bloqueio sensório-motor rápido e adequado foi obtido em todas as pacientes do presente estudo; no entanto, o bloqueio sensório-motor teve início mais rapidamente, foi mais prolongado e atingiu um novel mais alto nos grupos 2 e 3; esses efeitos foram mais acentuados no Grupo 3.

BACKGROUND AND OBJECTIVES: We evaluated the effects of epidural injection with levobupivacaine or serum physiologic, epidural volume extension (EVE), when using combined spinal-epidural anesthesia (CSEA) for cesarean delivery. METHODS: One-hundred and thirty-eight patients with a full-term pregnancy of 37-42 weeks that were scheduled for cesarean delivery were included. Group 1 (n = 48) received single-shot spinal anesthesia (SSS), group 2 (n = 45) received CSEA-EVE with saline, group 3 received CSEA-EVE with levobupivacaine. The characteristics of motor and sensory block, the effects on maternal hemodynamic changes and the effects on the newborn were compared. RESULTS: Time to reach maximum sensory block was significantly shorter in groups 3 than in group 1 and 2 (p < 0.05). Two-segment regression time of sensory block was significantly shorter in group 1, whereas it was significantly longer in group 3 than in group 2 (p < 0.05). Time to onset of motor block was significantly longer in group 1 than in groups 2 and 3 (p < 0.05). Time to reach maximum motor block was significantly shorter in group 3 than in groups 1 and 2 (p < 0.05). Time to recovery of motor block was significantly longer in group 3 than in groups 1 and 2 (p < 0.05). The time to first analgesic was significantly longer in group 3 (p < 0.05). CONCLUSIONS: Sufficient and rapid motor and sensory block was achieved in all the patients in the present study; however, motor and sensory block had faster onset, lasted longer, and was of a higher level in groups 2 and 3; these effects were more pronounced in the group 3.

JUSTIFICATIVA Y OBJETIVOS: Evaluamos los efectos de la administración epidural de levobupivacaína o solución salina en BCRE para cesárea. MÉTODOS: Se incluyeron en este estudio 138 pacientes con embarazo a término de 37-42 semanas programadas para cesárea. El Grupo 1 (n = 48) recibió raquianestesia con una dosis única (RADU), el Grupo 2 (n = 45) recibió BCRE-EVE con una solución salina y el Grupo 3 recibió BCRE-EVE con levobupivacaína. Las características del bloqueo motor y sensorial y los efectos en las alteraciones hemodinámicas maternas y en los recién nacidos fueron comparados. RESULTADOS: El tiempo para alcanzar el bloqueo sensorial máximo fue significativamente menor en el Grupo 3 que en los grupos 1 y 2 (p < 0,05). El tiempo de regresión del bloqueo sensorial en dos segmentos fue significativamente menor en el Grupo 1, siendo significativamente mayor en el Grupo 3 con relación al Grupo 2 (p < 0,05). El tiempo de inicio del bloqueo motor fue significativamente mayor en el Grupo 1 que en los grupos 2 y 3 (p < 0,05). El tiempo para alcanzar el bloqueo motor máximo fue significativamente menor en el Grupo 3 que en los grupos 1 y 2 (p < 0,05). El tiempo de recuperación del bloqueo motor fue significativamente mayor en el Grupo 3 que en los grupos 1 y 2 (p < 0,05). El tiempo para el primer analgésico fue significativamente mayor en el Grupo 3 (p < 0,05). CONCLUSIONES: El bloqueo sensorial-motor rápido y adecuado se obtuvo en todas las pacientes del presente estudio. Sin embargo, el bloqueo sensorial-motor se inició más rápidamente y se extendió más, alcanzando un nivel más alto en los grupos 2 y 3. Esos efectos fueron más acentuados en el Grupo 3.

Efeitos da inclinação de agulha peridural e diferentes velocidades de injeção na distribuição de anestesia peridural / Effects of epidural needle rotation and different speeds of injection on the distribution of epidural block / Efectos de la inclinación de la aguja epidural y diferentes velocidades en la distribución de la anestesia epidural

JUSTIFICATIVA E OBJETIVOS: Este estudo prospectivo e randomizado avaliou o efeito das velocidades da injeção na anestesia peridural unilateral sobre as características do bloqueio, parâmetros hemodinâmicos e critérios de alta hospitalar em 60 pacientes. Levobupivacaína a 5% foi administrada nos pacientes (n = 30) do Grupo F durante 1 minuto (rápido) e durante 3 minutos nos pacientes (n = 30) do Grupo S (lento), com agulha em ângulo de 5º-10º a partir da linha média. O sucesso da anestesia peridural unilateral foi mais significante no Grupo S do que no Grupo F (70,3% vs 16%, p < 0,001). Nos pacientes do Grupo S, o tempo necessário para o nível máximo de bloqueio sensitivo nos lados não operados foi mais curto e o tempo de regressão para dois segmentos, mais longo (p < 0,05). O tempo para walk-out foi mais longo no Grupo F (p < 0,05). Consideramos que a administração lenta de anestésico local em anestesia peridural unilateral é mais eficaz do que a administração rápida.

BACKGROUND AND OBJECTIVES: This prospective, randomised study examined the effect of injection speeds for unilateral epidural anesthesia on block characteristics, hemodynamic parameters, and discharge criteria in 60 patients. Levobupivacaine 5% was administered to Group F over 1 min (fast) and to Group S over 3 min (slow) (n = 30 each) with the needle angulated at 5º-10º from the midline. Unilateral epidural block was significantly more successful in Group S than in Group F (70.3% vs. 16%; p < 0.001). On the non-operated sides in group S, the maximal sensorial block time was shorter and the regression time for 2 segments was longer (p < 0.05). And the walk-out time was longer in group F (p < 0.05). We consider that the slow administration of local anesthetic in unilateral epidural anesthesia is more effective than rapid administration.

JUSTIFICATIVA Y OBJETIVOS: Este estudio prospectivo y aleatorio ha evaluado el efecto de las velocidades de la inyección para la anestesia epidural unilateral sobre las características del bloqueo, parámetros hemodinámicos y criterios del alta hospitalaria en 60 pacientes. La levobupivacaína al 5% se administró en los pacientes (n = 30) del Grupo F durante 1 minuto (rápido) y durante 3 minutos en los pacientes (n = 30) del grupo S (lento), con una aguja en ángulo de 5º-10º a partir de la línea media. El éxito de la anestesia epidural unilateral fue más significativo en el Grupo S que en el Grupo F (70,3% vs 16%, p < 0,001). En los pacientes del Grupo S, el tiempo necesario para el nivel máximo de bloqueo sensitivo en los lados no operados fue más corto y el tiempo de regresión para los dos segmentos, más largo (p < 0,05). El tiempo para walk-out fue más largo en el Grupo F (p < 0,05). Consideramos que la administración lenta de anestésico local en la anestesia epidural unilateral es más eficaz que la administración rápida.

Appropriate dose of dexmedetomidine for epidural analgesia / 中华麻醉学杂志

Objective To compare the effects of different doses of dexmedetomidine on the median effective concentration (EC50) of ropivacaine for epidural block and investigate the appropriate dose.Methods One hundred and twenty ASA Ⅰ patients of both sexes,aged 20-55 yr,weighing 50-75 kg,scheduled for knee arthroscopic operation,were randomly divided into 4 groups (n =30 each):no dexmedetomidine group (group D0),0.25 μg/kg dexmedetomidine group (group D0.25),0.50μg/kg dexmedetomidine group (group D0.50),and 1.00μg/kg dexmedetomidine group (group D1.00).In group D0,ropivacaine 20 ml was injected into epidural space.The ropivacaine-dexmedetomidine mixtures containing 0.25,0.50 and 1.00 μg/kg dexmedetomidine were injected into epidural space in groups D0.25,D1.00 and D0.50 respectively.The volume of mixtures was 20 nl in groups D0.25,D1.00 and D0.50.The initial concentration of ropivacaine was set at 0.40 ％,0.40 ％,0.28 ％ and 0.20 ％ in groups D0,D0.25,D0.50 and D1.00 respectively and then the EC50 was determined by up-and-down technique.The concentration of ropivacaine was increased/decreased by 0.02％ in the next patient.The analgesic effect was assessed using VAS score.VAS score =0 was considered as effective analgesia.The EC50 and 95％ confidence interval (CI) of ropivacaine were calculated using probit method.Adverse effects were recorded.Results The EC50 and 95 ％ CI of ropivacaine was 0.38％ (0.35-0.41)％,0.34％ (0.31-0.36)％,0.22％ (0.20-0.24)％ and 0.14％ (0.12-0.15) ％ in groups D0,D0.25,D0.50 and D1.00 respectively.The EC50 of ropivacaine was decreased gradually in groups D0,D0.25,D0.50 and D1.00 ( P ＜ 0.05).Compared with group D0,the incidonce of hypotension and bradycardia was significantly increased in group D1.00 ( P ＜ 0.05),while no significant change was found in the incidence of adverse effects in groups D0.25 and D0.50 (P ＞ 0.05).Conclusion The appropriate dose of dexmedetomidine for epidural analgesia is 0.50 μg/kg.

Optimum dose of normal saline for preloading epidural space required to prevent injury to blood vessel by epidural catheter placement for caesarean section / 中华麻醉学杂志

Objective To determine the optimum dose of normal saline (NS) for preloading epidural space required to prevent the injury to blood vessel by epidural catheter placement for caesarean section.Methods Two hundred ASA Ⅰ or Ⅱ parturients with a single baby at full term in vertex presentation,aged 24-35 yr,weighing 63-78 kg,scheduled for caesarean section under continuous epidural anesthesia,were randomly divided into4 groups (n-50 each):control group (group Ⅰ),NS2 ml group (group Ⅱ),NS5 ml group (group Ⅲ)and NS 10 ml group (group Ⅳ).The epidural puncture was performed at L2-3 interspace with a Tuohy needle attached to a 5 ml syringe.Loss of resistance was used to identify the epidural space.In group C no fluid was injected into the epidural space before insertion of the catheter,while in groups Ⅱ,Ⅲ and Ⅳ NS 2,5 and 10 ml were injected into the epidural space before the catheter insertion respectively.After a test dose of 3 ml 1.5％ lidocaine,0.75％ ropivacaine 10-20 ml was administered through the epidural catheter.MAP and HR were recorded before epidural puncture (T0),at 10 and 20 min after the end of epidural administration (T1.2),and at the end of surgery (T3).The number of patients in whom blood or blood tinted fluid was withdrawn from the epidural catheter was recorded.The amount of ropivacaine consumed was recorded.The upper level of anesthesia was measured by pin-prick and the degree of motor block was assessed using modified Bromagc scale at T2.Results The hemodynamic parameters were in the normal range in the four groups.MAP was significantly lower at T2,the upper level of anesthesia was significantly higher,and the degree of motor block was significantly smaller in group Ⅳ than in groups Ⅰ,Ⅱ and Ⅲ (P ＜ 0.05).There was no significant difference in MAP among groups Ⅰ,Ⅱ and Ⅲ (P ＞ 0.05).There was no significant difference in HR and the amount of ropivacaine consumed among the four groups (P ＞ 0.05).The number of patients in whom blood or blood tinted fluid was withdrawn fiom epidural catheter was significantly smaller in groups Ⅲ and Ⅳ compared with groups Ⅰ and Ⅱ (P ＜ 0.05).Conclusion Preloading the epidural space with NS 5 ml can prevent the occurrence of injury to blood vessel induced by insertion of epidural catheter with no influence on the efficacy of anesthesia and NS 5 ml is the optimum dose.

Effects of epidural administration of a mixture of betamethasone and lidocaine on nerve root inflammation and epidural space adhesion in rabbits / 中华麻醉学杂志

Objective To investigate the effects of epidural administration of a mixture of betamethasone and lidocaine on nerve root inflammation and epidural space adhesion in rabbits. Methods Twenty-four adult male New Zealand white rabbits weighing 2.0-2.1 kg, were randomly divided into 2 groups ( n = 12 each): control group and treatment group. A catheter was inserted into epidural space at L2,3 interspace. Twenty-four hour after epidural catheter placement, talcum powder 0.5 mg/kg was injected into epidural space to make the model of nerve root inflammation and epidural space adhesion. Three days later a mixture of lidocaine 2.5 mg/kg and betamethasone 0.25 mg/kg was injected via the epidural catheter in treatment group, while the equal volume of normal saline was given in control group. At 21 days after administration of lidocaine and betamethasone, the spinal cord was removed, and dura mater and nerve root were checked with naked eye, light microscope and electron microscope.The neutrophil count in the dura mater was determined. Results There was nerve root inflammation and epidural space adhesion in control group. The nerve root inflammation and epidural space adhesion was not observed in treatment group. The neutrophil count was reduced in treatment group (21 ± 12) compared with control group (250 ±43) ( P < 0.01) . Conclusion Epidural administration of a mixture of betamethasone and lidocaine can alleviate nerve root inflammation and epidural space adhesion.

Effect of injection of air into the epidural space on subarachnoid puncture during combined spinal-epidural block / 中华麻醉学杂志

Objective To investigate the effect of injection of air into the epidural space on the subarachnoid puncture during the combined spinal-epidural anesthesia (CSEA) .Methods Two hundred and ten ASA Ⅰ or Ⅱ parturients who were at full term with a singleton fetus, aged 20-42 yr, weighing 57-82 kg (height 152-170cm) , undergoing cesarean section under CSEA, were randomly divided into 3 groups ( n = 70 each) : hanging drop technique group (group Ⅰ ) and injection of small volume of air group (group Ⅱ ) and injection of large volume of air group ( group Ⅲ ) . The epidural space was indentified using hanging drop technique in group Ⅰ and using loss of resistance to air technique in Ⅱ and Ⅲ groups. Injection of air was stopped as soon as the clear loss of resistance identified the epidural space in group Ⅱ , whereas all 4 ml of air was injected in group Ⅲ . After the epidural space was confirmed at L3,4 interspace, a 25-gauge spinal needle protruding 14 mm beyond the 18-gauge epidural needle was introduced through the epidural needle. Subarachnoid placement was confirmed by backflow of cerebrospinal fluid (CSF) . If no backflow of CSF was observed, the spinal needle was withdrawn and an epidural catheter was inserted through the epidural needle to perform epidural anesthesia. Successful subarachnoid puncture, failures to observe backflow of CSF and adverse reactions were recorded. Results The three groups were comparable with respect to age, height, body weight and gestation weeks. The success rate of subarachnoid puncture was 91% ,93% and 79% in Ⅰ ,Ⅱ and Ⅲ groups respectively, and it was significantly higher in Ⅰ and Ⅱ groups than in group Ⅲ ( P < 0.05) . There was no significant difference in the success rate of subarachnoid puncture between Ⅰand Ⅱ groups ( P > 0.05) . Bilateral segmental analgesia presented in all cases who received only epidural anesthesia after no backflow of CSF was observed, and the expected analgesia also presented in all cases in whom back flow of CSF was observed. No adverse reactions occurred. Conclusion Injection of air into the epidural space is related to the success of subarachnoid puncture during CSEA and injection of a large volume of air lowers the success rate.

Effect of preloading epidural space with normal saline on the incidence of injury to blood vessel by epidural catheter placement for cesarean section / 中华麻醉学杂志

Objective To evaluate the effect of preloading the epidural space with normal saline (NS) on the incidence of injury to blood vessel by epidural catheter placement for cesarean section. Methods One hundred and fifty parturients with a single baby at full term in vertex presentation scheduled for cesarean section under continuous epidural anesthesia were randomly divided into 3 groups ( n = 50 each): Ⅰ group control; Ⅱ group NS needle attached to a 5 ml syringe. Loss of resistance was used to identify the epidural space. In group Ⅰ no fluid was injected into the epidural space before insertion of catheter; while in group Ⅱ and Ⅲ NS 5 ml with or without whom blood or blood tinted fluid was withdrawn from epidural catheter was recorded. Results The number of patients in whom blood or blood tinted fluid was withdrawn from epidural catheter was significantly lower in group Ⅱand Ⅲ than in group Ⅰ but was not significantly different between group Ⅱ and Ⅲ. Conclusion Preloading the epidural space with 5 ml NS can reduce the incidence of injury to blood vessel induced by insertion of epidural

Effect of treatment with epidural blood patch on intracranial hypotension / 中国病理生理杂志

AIM: To examine the effect of treatment with epidural blood patch on intracranial hypotension in rabbits and the possible mechanism.METHODS: The stable intracranial hypotension was made by lumbar puncture,then some blood was injected into the epidural space,and the changes of the intracranial pressure was determined continuously. Furthermore, the components of cerebrospinal fluid and the changes of choroid plexus epithelial cells, the spine and the dura were examined with electron microscope and light microscope 5 days later.RESULTS: The intracranial pressure was increased at once after the treatment with epidural blood patch and maintained at the normal level. The pathologic examinations showed that thrombus could be seen in the epidural space,and there was inflammatory reaction in the spinal dura mater. The results of electron microscope show that the choroid plexus epithelial cells appear actively for secretion.CONCLUSION: Intracranial hypotension could be effectively reversed by treatment with epidural blood patch. The possible mechanism might include physical squeeze,the leaking hole blocked and the cerebrospinal fluid increased by thrombus.

The analgesic effect of continuous infusion of ropivacaine with epidural catheter placed at different interspaces after gynecologic surgery / 中华麻醉学杂志

Objective To assess the analgesic effect of continuous infusion of 0.2% ropivacaine with epidural catheter placed at T11-12 or L2-3 after abdominal hysterectomy. Methods Eighty ASA Ⅰ -Ⅱ patients undergoing elective abdominal hysterectomy were randomly divided into 4 groups with 20 patients in each group : in group Al and A2 the epidural catheter was placed at T11-12 and in group Bl and B2 at L2-3 . After surgery two infusion pumps were used. The first pump was used for continuous epidural infusion of 0.2% ropivacaine in the 4 groups. The second pump was used for patient controlled intravenous analgesia (PCIA) with 0.08% lornoxicam in group Al and Bl or with 0.1% morphine in group A2 and B2. The PCIA bolus dose was 1 ml with a lockout time of 5 min. The analgesic effect (assessed using VAS) and the consumption of lomoxicam / morphine were compared among the four groups. Results The ropivacaine consumption was 192 mg during the 24 h after operation in the 4 groups. The lornoxicam and morphine consumption were (3.9?2.8) mg and (4.6?3.5) mg in group Al and A2 with the epidural catheter placed at T11-12 and (7.7?2.5) mg and (7.8?2.4) mg in group B2 and B2 with catheter placed at L2-3.The consumption of lomoxicam or morphine was significantly less with epidural catheter placed at T11-12 than that with epidural catheter at L2-3 (P

Patient-controlled epidural analgesia with ropivacaine combined with fentanyl for labor / 中华麻醉学杂志

Objective To compare two methods of patient controlled epidural analgesia (PCEA) with 0 2% ropivacaine plus fentanyl 2?g?ml -1 with or without background infusion for labor Methods Ninety ASA Ⅰ Ⅱ full term primigravidae in active labor who had a single fetus with vertex presentation and were expected to have vaginal delivery were randomly divided into three groups of 30 each: group A received PCEA without background infusion; group B received PCEA with background infusion and group C received no analgesia of any kind and served as control PCEA included a bolus of 4 ml with a 15 minute lock out When the primigravida was in first stage of labor, an intravenous line was established and 5% glucose normal saline 500 1000 ml was being infused When the external cervical os was dilated to 3 cm, epidural catheter was placed at L 2 3 and a test dose of 4 ml was given 5 min later when no signs of subarachnoid injection was evident, block height was tested by pinprick and another 6 ml was given 30 min later in group B background infusion of 0 2% ropivacaine + fentanyl 2?g?ml -1 was started at a rate of 4 ml?h -1 until the second stage of labor began Maternal vital signs (BP, ECG, SpO 2, P ET CO 2), VAS scores, degree of motor block, drug consumption, side effects of PCEA, gas analysis of umbilical venous blood, progress of labor, and Apgar scores were noted Venous blood samples were taken before PCEA and at the end of first stage of labor for determination of serum epinephrine and norepinephrine levels Results There were no significant differences in Apgar scores, blood gas of umbilical venous blood and the durations of first and second stage of labor among the three groups There were no differences in VAS scores, degree of sensory and motor block, serum concentrations of epinephrine and norepinephrine and percentage of cesarean section between group A and B The percentage of cesarean section was significantly higher in control group than that in group A and B Plasma NE and E concentrations at the end of the first stage of labor were significantly higher in control group than those in group A and B The ropivacaine and fentanyl consumption was less and the incidence of itching and percentage of instrumental delivery were lower in group A than those in group B Conclusions PCEA with 0 2% ropivacaine and fentanyl 2?g?ml -1 was safe and effective It reduces the percentage of cesarean section PCEA without background infusion provides the same level of analgesia as PCEA with background infusion with less drugs and side effects

Pharmacokinetics and clinical evaluation of epidural triamcinolone for treatment of radicular neuralgia / 中华麻醉学杂志

0.05). Conclusion: With slow absorption rate and long half life of elimination, the epidural administration at one week interval can avoid the accumulation of triamcinolone A.

The effect of postoperative patient-controlled-epidural-analgesia on respiratory function in elderly patients / 中华麻醉学杂志

Objective To evaluate the effect of postoperative patient controlled epidural analgesia (PCEA) on respiratory function in patients aged over 65 years Methods 41 ASA Ⅰ Ⅱ patients (male 22,female 19)aged between 65 80 years, weighing 58 78kg, scheduled for upper abdominal surgery were divided randomly into two groups: control group(n=20)and PCEA group(n=21) Epidural block was performed at T 8 9 with an epidural catheter inserted cranially for 4 cm A test dose of 1 5% lidocaine 4 5ml was given via epidural catheter When epidural blockade was confirmed, general anesthesia was induced with diazepam 0 2mg?kg -1 ,etomidate 0 3 mg?kg -1 ,fentanyl 4?g?kg -1 and vecuronium 0 1mg?kg -1 ,and maintained with epidural 0 5% bupivacaine infusion (6 7ml/2h) combined with inhalation of low concentration of isoflurane and intermittent iv boluses of fentanyl and vecuronium For postoperative analgesia in control group intramuscular pethidine was given on demand; In PCEA group PCEA was used A loading dose of 3ml of 0 15% bupivacaine mixture (morphine 10mg and haloperidol 5mg/0 15% bupivacaine 100ml) followed by continuous infusion of 0 5 1ml/h Superimposed by boluses of 2ml with a lock out time of 25min The maximal amount of bupivacaine mixture was 8ml/h VAS, Bruggman′s comfort scale and Rawsay′s sedation score were evaluated BP, HR, respiratory rate (RR) and SpO 2 were measured and recorded every 30min 4 h after operation Vital volume, Forced vital capacity, forced expiratory volume (first second:FEV 1 0 ),PEEP, MMEF were measured before operation and on 1st,3rd,5th and 7th postoperative days Blood gas analysis was checked before operation, during operation (30min and 90min after induction of anesthesia) and the 1st,3rd, 5th and 7th postoperative days Results The total amount of narcotic in 72h was 11 36mg (morphine equivalent dose) in control group and 5 4mg in PCEA group VAS was higher in control group than PCEA group The postoperative respiratory function was significantly better in PECA group Conclusions In elderly patient after upper abdominal operation PECA can greatly improve the respiratory function with better analgesia

Effect of epidural administration of different combinations of lidocaine, corticosteroids and vitamins on epidural space adhesion and nerve root inflammation in rabbits / 中华麻醉学杂志

Objective To compare the effects of epidural administration of different combinations of lidocaine, corticosteroids (dexamethasone, prednisolone) and vitamins(B 1,B 6,B 12 ) on epidural space adhesion and nerve root inflammation in rabbits Methods Forty eight adult Japannese white rabbits of either sex weighing (2 38?0 31)kg were anesthetized with intramuscular ketamine 15 mg?kg -1 and midazolam 0 2 0 3 mg?kg -1 A catheter was inserted into epidural space at L 2 when the ligamentum flavum was exposed by surgery and advanced caudally for 2 3cm Correct placement of the catheter in epidural space was confirmed by injecting 0 5% lidocaine 0 2 ml through the cathter when the animal was awake 24h after epidural cathter placement 0 2ml?kg -1 of normal saline containing talcum power 1mg?ml -1 was injected into epidural space 3 days later the animal were randomly divided into 8 groups: group Ⅰ received no treatment, group Ⅱ epidural normal saline 0 2ml?kg -1 , group Ⅲ epidural 0 5% lidocaine 0 2ml?kg -1 , group Ⅳ epidural compound lidocaine solution 1 (lidocaine 100mg +dexamethasone 10 mg in 20 ml normal saline) 0 2ml?kg -1 , group V epidural compound lidocaine solution 2 (lidocaine 100mg+prednisolone 50 mg in 20 ml normal saline)0 2 ml?kg -1 , group Ⅳ epidural compound lidocaine solution 3 (lidocaine 100mg+dexamethasone 10 mg+vitamin B 1 200mg in 20 ml normal saline) 0 2 ml/kg, group Ⅵ epidural compound lidocaine solution 4 ( lidocaine 100mg+dexamethasone 10 mg+vitamin B 6 200mg in 20 ml normal saline) 0 2 ml/kg, and group Ⅷ epidural compound lidocaine solution 5 (lidocaine 100mg+dexamethasone 10 mg+vitamin B 12 200mg in 20 ml normal saline) 0 2 ml/kg One week later animals were killed by intravenous injection of air Spinal column below L 1 was removed Epidural space and nerve root adhesion was checked first with naked eye then examined under microscope Epidural space adhesion was divided into 4 grades according to Rydell Results 1 Macroscopic examination of epidural space for adhesion: there was no significant different between group Ⅰ and group Ⅱ,Ⅲ, also between group Ⅱ,Ⅲ and group Ⅳ,Ⅴ,Ⅵ,Ⅶ,Ⅷ; there was significant different between group Ⅰ and groupⅣ,Ⅴ,Ⅵ,Ⅵ,Ⅷ (P

Effects of different analgesic methods on neuroendocrine and cytokines / 中华麻醉学杂志

Objective To observe the influences of different analgesic methods on blood sugar, stress hormones and cytokinesMethods According to different postoperative analgesic methods, 30 patients immediately after elective cholecystectomy, were randomly divided into four groups: normal saline was infused epidurally in group C as control; analgesia via epidural infusion of morphine 2 mg in group EM; patient-controlled analgesia via epidural or intravenous fentanyl in group PCEFA or group PCIFABlood sugar, cortisol, insulin, interlukin-2 (IL-2), interlukin-6 (IL-6) and tumor necrosis factor-?(TNF-?) levels were determined during the perioperative periodResults Postoperative visual analog score was higher in group C than that in group EM, group PCEFA or group PCIFA (P005)Conclusions Postoperative application of PCEFA can much more help to maintain the stability of neuroimmunoendocrinal system