A Comparison of the Spread Level of the Cervical Epidural Block in Terms of Volume / 대한통증학회지

BACKGROUND: Cervical epidural injection, performed via the interlaminar approach, represents a useful interventional pain management procedure indicated in patients with a cervical herniated disk. Due to thedecreased epidural space in the cervical region, cervical epidural injections may result in potentially serious complications, especially during a large volume injection. METHODS: Thirty-four patients with neck pain due to a cervical herniated disk that were referred to the pain clinic for cervical epidural steroid injection were randomized into two groups. One group received a cervical epidural injection of 4 ml drug and the other group received 2 ml drug. The injected mixture included triamcinolon, ropivacaine and omnipaque. Spread levels of the drug after injection were estimated with the use of C-arm fluoroscopy. RESULTS: Spread levels to the cephalad for patients in the two groups were 4.88 +/- 0.78 segments and 4.53 +/- 0.49 segments, respectively. Spread levels to the caudad for patients in the two groups were 4.59 +/- 0.93 segments and 4.47 +/- 0.51 segments, respectively. The results showed no significant difference in the spread level between the two groups. CONCLUSIONS: Use of a small volume of drug (2 ml) can provide a sufficient spread level of the injected drug that is desirable for patients with a cervical herniated disk.

The Effect of Ketamine on Norepinephrine Release in the Rat Hippocampus / 대한마취과학회지

BACKGREOUND: Since it has been reported that ketamine, an intravenous anesthetic, is a non-competitive antagonist of N-methyl-D-aspartic acid (NMDA) receptors, a large number of experimental data on the several mechanism of this process have been accumulated. But the mechanism about the effect of ketamine on neurotransmitter release in central nervous system has not been clearly elucidated yet. Therefore the present study was undertaken to investigate the effects of ketamine and thiopental sodium on hippocampal norepinephrine (NE) release, and also to examine the relationship between ketamine and NMDA receptor mechanisms in the rat hippocampus. METHODS: Slices from rat hippocampus were equilibrated with [3H]norepinephrine ([3H]NE) and the release of labelled products was evoked by electrical stimulation (3 Hz, 5 V/cm, 2 ms, rectangular pulses, 2 min), and the influence of various agents on the evoked tritium-outflow and the basal rate of release were investigated. RESULTS: In rat hippocampal slices, ketamine (1~30 micrometer) and thiopental sodium (1~30 micrometer) did not affect the evoked NE release and the basal release in the normal and Mg2 free medium. NMDA (3~100 micrometer) did not alter the NE release in the normal medium, but NMDA (1~30 micrometer) increased the basal rate of NE release in the Mg2 free medium. The increasing effects of NMDA on basal release were completely abolished by ketamine treatment in a concentration dependent manner. But, thiopental sodium did not affect the NMDA effect. CONCLUSIONS: These results suggest that increment of the basal rate of NE release is mediated by NMDA receptor in the rat hippocampus and ketamine completely block this effect, but thiopental sodium is not involved in these process.