The effects of adjuvant intrathecal fentanyl on postoperative pain and rebound pain for anorectal surgery under saddle anesthesia / 대한마취과학회지

BACKGROUND: Intrathecal opioid has been known to enhance the quality and prolong the duration of spinal anesthesia, as well as to reduce postoperative pain. The purpose of this study was to evaluate postoperative analgesic characteristics of intrathecal fentanyl for the first 48 hours after anorectal surgery under saddle anesthesia. METHODS: Eighty patients were recruited in our study. Forty patients were randomly allocated to group B that received 0.5% bupivacaine 5 mg with 0.3 ml normal saline. The other 40 patients were assigned to group BF which was given 0.5% bupivacaine 5 mg with fentanyl 15 μg. The primary outcome variable was a numeric rating scale (NRS) at six hours postoperatively. Secondary outcomes included changes in the NRS score between one and 48 hours postoperatively, consumption of rescue analgesics, and the frequency of rebound pain. RESULTS: Group BF exhibited a lower mean NRS score at postoperative six hours compared to group B (P < 0.001). However, the mean NRS score was not different after postoperative six hours between the two groups. The median consumption of rescue analgesics in group BF was less than that of group B (P = 0.028) and the frequency of rebound pain decreased in group BF when compared to group B (P = 0.021). The levels of sensory block were S1 dermatome and motor block scores were 0 for both groups. There was no significant difference in adverse effects between the groups. CONCLUSIONS: Intrathecal fentanyl 15 μg for anorectal surgery under saddle anesthesia led to an improved pain score for the first six hours after surgery and decreased postoperative analgesic use. Rebound pain diminished with intrathecal fentanyl and adverse effects did not increase.

Prediction of the Development of Neurogenic Bladder in Patients with Lumbar Disc Herniation / 대한정형외과학회잡지

PURPOSE: To predict the development of a neurogenic bladder based on an analysis of the clinical and radiological findings in patients with lumbar disc herniations. MATERIALS AND METHODS: Twenty-six patients, who were suspected of having neurogenic bladders, underwent urodynamic testing. The anteroposterior diameters and the cross-sectional areas of the dural sacs at the herniated disc levels were measured by magnetic resonance imaging. Clinically, we evaluated lower back pain, radiating pain, saddle anesthesia, bladder function, motor weakness of the lower limbs, and the Japanese Orthopaedic Association (JOA) score. RESULTS: Thirteen (50%) of the 26 patients were diagnosed with positive neurogenic bladders. The average anteroposterior diameters of the dural sacs in group I (13 cases) with positive neurogenic bladders and in group II (13 cases) with negative neurogenic bladders, were 6.8 (range, 4-9) mm and 9.0 (range, 8-10) mm, respectively (p<0.001). When an anteroposterior diameter of 7 mm was used as the threshold value for differentiation between the anteroposterior diameter of the dural sac and a neurogenic bladder, the sensitivity and specificity were 61.5% and 100%, respectively. The average cross-sectional areas of the dural sacs in group I and group II were 74.9 (range 50-96) mm(2) and 86.2 (range 60-103) mm(2), respectively (p=0.069). When a cross-sectional area of 77 mm2 was used as the threshold value for differentiation between the cross-sectional area of the dural sac and a neurogenic bladder, the sensitivity and specificity were 61.5% and 84.6%, respectively. All 9 patients who had saddle anesthesia were diagnosed with positive neurogenic bladders. However, there was no statistical significance between the preoperative JOA score and the development of a neurogenic bladder. CONCLUSION: The anteroposterior diameter of the dural sac and saddle anesthesia might be important factors in predicting the presence of a neurogenic bladder in patients with lumbar disc herniation.

2 Cases of Cauda Equina Syndrome with Disc Herniation

We experienced 2 cases of cauda equina syndrome with lumbar and lumbosacral disc herniations. They have symptoms of motor paralysis, decreased deep tendon reflex, sensory change on the corresponding dermatome or saddle area, and bladder dysfunction. We had performed neurologic examination, simple spine radiography, lumbosacral myelography, computed tomography, and cystometry for diagnosis. Patients were received operations of laminectomy and discectomy, and revealed significant degree of recovery on motor or sensory change but, not for the bladder dysfunction.