Effects of Epidural Naloxone on Pruritus Induced by Hydromorphone Epidural Patient-Controlled Analgesia / 대한통증학회지

BACKGROUND: Opioid delivered by epidural patient-controlled analgesia (PCA) is effective in relieving pain after surgery, but it is associated with side effects, such as nausea, vomiting, pruritus, respiratory depression, and urinary retention. The purpose of this study was to compare hydromorphone related side effects and the quality of analgesia when naloxone was added to epidural PCA regimen. METHODS: Fifty-two thoracotomy patients with PCA were allocated blindly into two groups. Patients in group H (n = 26) received continuous epidural hydromorphone (16microgram/ml) in 0.1% bupivacaine; patients in group N (n = 26) received an epidural infusion containing naloxone (2 microgram/ml) and hydromorphone (16microgram/ml) in 0.1% bupivacaine. The basal rate of PCA was 4 ml/hr and the demand dose was 1.5 ml with a lockout time of 15 min. Pain intensity, sedation, pruritus, nausea and vomiting, respiratory depression were checked at 6, 12, 24 hours postoperatively. RESULTS: The Visual Analog Scale (VAS) scores were significantly lower in group H than in group N. There were no significant differences in the overall incidence of pruritus, nausea and sedation between the two groups. CONCLUSIONS: Continuous epidural infusion of naloxone combined with hydromorpho-ne is not effective in reducing the incidence and severity of pruritus induced by epidural hydromorphone.

Post-Spinal Meningitis and Autoimmune Encephalopathy: A case report / 대한마취과학회지

Meningitis and subsequent autoimmune encephalopathy after spinal anesthesia has never been reported. A 39-year-old patient developed dizziness, headache, fever (38 degrees C), drowsiness, and neck stiffness 3 days after uneventful and uncomplicated spinal anesthesia and surgery for total hip replacement. Under the impression of bacterial meningitis, antibiotic therapy was immediately started after CSF sampling. However, the CSF was clear and showed an inappropriate profile for bacterial meningitis. CSF stain and culture, an antibody study, and polymerase chain reaction for pathogens were negative. Therefore, aseptic meningitis was suspected. Eleven days later, clinical symptoms and laboratory findings had improved to near normal, but unexpected visual and phonation difficulties, lower leg paralysis, and myotonia developed. Brain MRI revealed autoimmune encephalopathy of unknown etiology, and antithyroglobulin and antimicrosomal antibody were high. Steroid therapy was started and symptoms improved, but mild sequela remain.