Efficacy of Interscalene Block Anesthesia on the Early Postoperative Pain after Arthroscopic Shoulder Surgery: Comparison with General Anesthesia / 대한정형외과학회잡지

PURPOSE: After shoulder arthroscopy via general anesthesia, most patients complain of severe pain during the early post operative period. In this study, the efficacy of pain control during the early post operative period with interscalene block anesthesia for shoulder arthroscopy was investigated and compared with general anesthesia. MATERIALS AND METHODS: A prospective randomized controlled study was conducted on 40 patients who underwent shoulder arthroscopy between September 2008 and March 2009. The patients were grouped according to the method of anesthesia. The visual analogue scale (VAS) at the preoperative and early postoperative periods was checked and compared. In addition, the duration of patient controlled analgesia (PCA) usage and additional pain killer injections were examined. RESULTS: There was no significant difference between the two groups for the VAS score before surgery, but the interscalene block group showed a significantly lower VAS score. The duration of PCA usage was also significantly longer for the interscalene block group, which implies less pain. The number of additional pain killer injections was significantly less in the interscalene block group. CONCLUSION: The patients who underwent shoulder arthroscopy with interscalene block had significantly less pain during the immediately post operative period for up to 48 hours. So patients could conduct initial rehabilitation and experience minimized side effects caused by analgesics due to the decreased use of pain killer. Therefore, interscalene block is considered a good method of anesthesia for the immediate postoperative pain control after shoulder arthroscopy.

One Anchor Double Fixation (OADF) Technique for Arthroscopic Bony Bankart Repair

PURPOSE: The aim of this study was to evaluate the usefulness of arthroscopic Bony Bankart repair using a One Anchor Double Fixation Technique. MATERIALS AND METHODS: Seventeen patients with a Bony Bankart lesion were treated using the One Anchor Double Fixation Technique (OADF Technique). There were 13 males and 4 females. The average age was 24 years (range 17-42). The average follow-up period was 22.3 months. One 3.0 mm suture anchor with doubly loaded sutures was inserted into the glenoid rim. One suture strand was passed the around the small bony fragment and tied first. Another suture strand was passed through the capsule and tied over the bony fragment. The result was measured using Rowe's evaluation index & KSS score. The glenoid defect & bony fragment were measured by 3D-CT scan. RESULTS: Rowe's evaluation index on the final follow-up showed an overall improvement from an average of 54 (range, 23-71) to 83.4 (range 71-90). Of the 17 cases, 13 were excellent, 3 were good, and 1 was fair. KSS scores showed improvement from an average of 71 (range 49-82) to 92.5 (range 82-94). There were no cases where pain continued to the final follow-up, and no cases being re-dislocated during the follow-up period. For six cases, we confirmed the bony healing of the bony Bankart lesion by CT. CONCLUSION: Bony Bankart lesion repair using this new method achieves excellent clinical results with low recurrence rates and is considered another choice for bony Bankart lesions.

Management of Lumbar Pyogenic Spondylitis with Posterior Decompression and Interbody Fusion Using Transpedicular Screws / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to assess the efficacy of posterior decompression and interbody fusion with posterior instrumentation in treating lumbar pyogenic spondylitis. MATERIALS AND METHODS: Twenty-one patients with lumbar pyogenic spondylitis who underwent posterior decompression and lumbar interbody fusion with posterior fixation were reviewed. Clinically infection control (CRP normalization time) and rehabilitation were investigated. And radiologically, timing of achievement of fusion and changes of sagittal alignment were investigated. RESULTS: Infection was controlled successfully without any recurrence and breakage of instrument. Stable interbody fusion was achieved in all cases within 6 months. Postoperative interval to achieve normal CRP was 28.7 (10-64) days. Ambulation was started on 5.8th (2-19) day. Sagittal angle was 12.3 degrees before operation, became more lordotic to 16.4 degrees, but decreased to 11 degrees at final follow-up. Final sagittal alignment was almost same with the preoperative status. CONCLUSION: By achieving favorable results clinically and radiologically, posterior decompression and interbody fusion seemed to be an effective method in management of lumbar pyogenic spondylitis.

A Study on the Epidermis Undergoing Apoptosis After Bone Marrow Transplantation / 대한해부학회지

GVHD (Graft-versus-Host Disease) results from the cytotoxic T lymphocytes from the bone marrow recognizing the recipient's minor histocompatibility antigens. In experimental murine models, either CD4+ or CD8+ T-cell subsets can cause GVHD, depending upon the particular strain combination utilized. Recent studies suggest that the keratinocyte undergo apoptosis in GVHD. However, morphological data supporting this concept are still lacking. The present study was undertaken in order to document apoptosis in experimental acute GVHD via sequential analysis of ultrastructure .Acute GVHD was produced across minor histocompatibility loci using appropriately matched murine strains. Acute GVHD was mediated with the use of highly purified preparations of donor CD4+ and CD8+ T-cell subsets. Whole T cells were used as a positive control and T cell depleted bone marrow as a negative control. Conventional transmission electron microscopy was used to define apoptosis structurally Sequential ultrastructure revealed that the keratinocyte underwent apoptosis in CD4+, CD8+ and whole T cell groups. This study demonstrates the sequential ultrastructure of the keratinocyte undergoing apoptosis from the beginning to the end. Both of the basal and the suprabasal keratinocytes show the morphology of early apoptosis, and the detachment of the tonofibril from the basement membrane and the adjacent cell was the general findings in the apoptotic cell Sequences of the cytoplasmic condensation was demonstrated . Through ultrastructural quantitation the apoptotic indices were depicted in all the experimental groups. Characteristically, numerous lymphocytes underwent apoptosis in CD8+ groups at day 28 and 35.

Spinal Anesthesia for Pediatric Surgery / 대한마취과학회지

Spinal anesthesia has been safely and reliably performed in minor pediatric surgery. Preterm infants are more likely to develop respiratory or cardiovascular complications after general anesthesia than full tern infants. This regional anesthesia may offer special advantages for surgical procedures such as inguinal hernia repair in former premature infants with a history of apnea and bradycardia of prematurity. Spinal anesthesia was done in sixty seven infants and children under 15 years of age, who were to undergo minor abdominal and lower extremity orthopedic procedure. In all cases 0.25 mg/kg of 0.5% hyberbaric tetracaine was injected into subarachnoid space. Age-related 4 groups (0~1, 1~6, 6~12, 12~15 years-old) were divided. The depth of lumbar puncture, sensory block, hemodynamic changes, status of sedation, duration of anesthesia, complication following spinal anesthesia were observed. The results were as follows; 1) Lumbar puncture was successed in 66 cases(98.5%), but failed in 1 case(1.5%). 2) The highest correlation in depth of lumbar puncture was with body-surface area(y=1.19+2.06x, r=0.956, p<0.001). 3) The mean height of sensory block in all age-related groups was similar between T(5) to T(6) skin dermatome. 4) Chidren less than 6 years of age showed a little changes in blood pressure and heart rate following spinal anesthesia. But children more than 6 years of age had widely varible decreases in blood pressure and heart rate, and recieved ephedrine(4 cases) or atropine(2 cases). 6) 55 cases(82.1%) required sedation with midazolam or propofol, 8 cases(10.6%) required general anesthesia to complete operative procedure. 7) The time needed to regain motor funtion increased with age (y=1.04+/-O.llx, r=0.952, p<0.001). 8) Preoperative complications were bloody tap (5 cases), hypotension (14 cases), bradycardia (6 cases), nausea or vomiting (4 cases), insufficient analgesia (2 cases), and failed tap (1 case). Postoperative complication was nonspecific postdural puncture headache (1 case). From the above results, it was suggested that spinal anesthesia without use of potent inhalational anesthetics in minor pediatric surgery is one of useful method under meticulous monitoring and observation.

Vasodilator Properties of Nitroglycerin, Isosorbide Dinitrate and Chlorpromazine during Cardiopulmazine during Cardiopulmonaty Bypass / 대한마취과학회지

In a placebo-controlled trial, we have studied the vasodilator properties of bolus dose of nitroglycerin, isosorbide dinitrate and chlorpromazine in 38 patients during cardiopulmonary bypass with a constant pump flow. Mean arterial pressure and blood volume of the venous reservoir were recorded for 10 min after drug administration to detect changes in arteriolar resistance and venous capacitance, respectively. Nitroglycerin, 2.5 ug/kg, decreased arterial pressure, but the effect lasted for 3 minutes. Chlorpromazine, 0.1 mg/kg, decreased arterial pressure for 9 minutes. Isosorbide dinitrate, 20 ug/kg, had no significant change on arterial pressure. The venous capacitance-increasing effects of nitroglycerin and chlorpromazine were significant for 4 minutes after the bolus. Thereafter the effect of nitroglycerin began to decline, while that of chlorpromazine significantly continued. Isosorbide dinitrate had no significant change on venous reservoir level. The SVR reduction effects of nitroglycerin was significant for 3 minutes, chlorpromazine decreased SVR for over 10 minutes. In conclusion chlorpromazine effect on arterial pressure and venous capacitance was more potent and longer than nitroglycerin and isosorbide dinitrate. Nitroglycerin and chlorpromazine effect on preload and afterload were significant after bolus dose.

Effect of Needle-through-Needle Method on Regional Anesthesia for Elective Caesarian Section / 대한마취과학회지

Spinal and epidural anesthesia were performed with a 26 gauge, long spinal needle through a 17 gauge Tuohy needle in thirty patients undergoing elective Caesarian section. To study the effects of subarachnoid local anesthetic solution, the thirty patients were classified into 3 groups on the anesthetics used respectively; a group treated with 0,5% hyperbaric tetracaine 10 mg alone (group I), a group treated 0.5% hyperbaric tetracaine 10 mg and fentanyl 10 mg (group II), a group treated 0.5% hyperbaric tetracaine 10 mg, fentanyl 10 ug and epinephrine 0.3 mg (group III). Each group contained 10 patients. The results were as follows. 1) Onset time of analgesia to T10 sensory level was significantly longer in group IlI than in remained groups and that to T4 sensory level was significantly shorter in group II than in other groups (p<0.05). 2) The time recovered from motor and sensory block was significantly longer in group III than in other groups (p<0.05). 3) The time requiring fentanyl from postoperative pain was significantly longer in group III than in other groups (p<0.05). 4) Complications after postoperative pain block were as follows; delayed awakening (3 cases), itching (3 cases), and one was nausea and vomiting. However serious complications such as respiratory depression did not occurred. In summary, We can concluded that use of needle-through-needle method of anesthesia for elective Caesarian section has benifits not only of spinal anesthesia but also of facilitating postoperative pain block.

A Comparision of Propofol and Enflurane for Tonsillectomy in Children / 대한마취과학회지

For anesthesia of sixty children undergoing elective tonsillectomy, we randomly assigned the patients as 2 groups, intravenous propofol for induction and 6-12 mg/kg/hr propofol infusion with 66% nitrous oxide for maintenance(propofol group) or intravenous 4 mg/kg thiopental for induction and inhalation of enflurane with 66% nitrous oxide for maintenance(enflurane group). We compared the effects of two groups for induction time, hemodynamic change, recovery time, and side effects. The results were as follows. 1) Time for loss of eyelid reflex was significantly shorter in enflurane group than in propofol group(P <0.05). 2) Heart rate was increased significantly in both groups at 1 min after intubation, 1 min after operation, 5min after end of operation(P< 0.05). But there were no significant differences between groups. 3) Systolic and diastolic arterial pressure were increased significantly in both groups at 1 min after intubation(P<0.05). But there were no siginificant differences between groups. 4) The recovery time was shorter siginificantly in propofol group than in enflurane group(P< 0.05), and recovery scores according to modified Steward coma scale were higher in propofol group than in enflurane group until 25 min after end of anesthesia(P< 0.05). 5) Pain on injection at induction was siginificantly more frequent in propofol group than in enflurane group(P< 0.05), and excitatory effect during emergence was significantly more frequent in enflurane group than in propofol group(P< 0.05).