The Effect of the Addition of Fentanyl and Midazolam to Lidocaine in a Supraclavicular Brachial Plexus Block / 대한마취과학회지

BACKGROUND: This study was conducted to evaluate the effects of fentanyl and midazolam when used as adjuvant in a supraclavicular brachial plexus block. METHODS: 100 adult patients with an ASA status of I-II that were scheduled to undergo upper extremity surgery performed under a supraclavicular brachial plexus block were prospectively evaluated in this study.The patients were randomly divided into 4 study groups:Group 1, which received 40 ml of 1.5% lidocaine, Group 2, which received 3 mg of midazolam with 40 ml of 1.5% lidocaine, Group 3, which received 100microgram of fentanyl with 40 ml of 1.5% lidocaine, and Group 4, which received 3 mg of midazolam and 100microgram of fentanyl with 40 ml of 1.5% lidocaine.The onset time, as well as the duration of analgesia and motor blocks, proportion of successful blocks, hemodynamic parameters, and adverse events were then noted. RESULTS: The incidence of successful block was higher in group 4 (92%) than in any other groups (68-72%) (P = 0.185). In addition, the mean duration of analgesia was longer in groups 2 and 4 (165 min and 175 min) than in groups 1 and 3 (114 min and 131 min) (P < 0.05).Furthermore, the mean duration of motor block was longer in groups 2 and 4 (169 min and 180 min) than in groups 1 and 3 (123 min and 126 min) (P < 0.05).No significant difference was observed in the onset time of the sensory block and motor block when the groups were compared. CONCLUSIONS: Although the addition of 3 mg of midazolam and 100microgram of fentanyl to lidocaine in a supraclavicular brachial plexus block does not affect the onset of sensory or motor block, it does prolong the duration of analgesia and motor block.

Severe Hypotension Caused by Coronary Spasm during Recovery from Combined Spinal Epidural Anesthesia: A case report / 대한마취과학회지

In order that anesthesiologists may reduce the anesthetic and surgical stress on the heart, they frequently use regional anesthesia in patients with coronary artery disease, even though there is no evidence that it reduce the incidence of myocardial ischemia. We report a case of life-threatening cardiovascular collapse that occurred in a 47 years old male patient at the emergence from regional anesthesia. He underwent open reduction and internal fixation for femur fracture under combined spinal epidural anesthesia.The cause of serious hypotension is suspected of myocardial ischemia on the basis of ST segment elevation on EKG. We considered that these cardiovascular events were due to coronary spasm.The possible inducing factors of coronary spasm were altered autonomic balance and arteriosclerotic change related endothelial dysfunction.

Tongue Numbness following Endotracheal General Anesthesia: A case report / 대한마취과학회지

Lingual nerve palsy is a rare multi-etiological disease.Almost all devices used for airway manipulation can cause this complication, including laryngoscopes, laryngeal masks, cuffed oropharyngeal airways, tongue retractors, and suspension laryngoscopes.We report a case of transient lingual nerve palsy after general anesthesia, using orotracheal intubation, for surgery of a humerus fracture in the prone position.

A Comparison of the Efficacy of Epidural Steroid Injections in Terms of the Dosages and Frequency of Triancinolone Injections for the Pain Related to Lumbar Spinal Stenosis or Herniated Disks / 대한통증학회지

BACKGROUND: The objective of this study was to describe the extent of pain relief after an epidural steroid injection in the patients suffering from chronic low back pain from herniated disks or lumbar spinal stenosis. METHODS: The study was prospectively designed for patients suffering with lumbar spinal stenosis (LSS) and herniated disks (HD) who were referred to a hospital-based pain clinic for epidural steroid injections (ESI). The pain was assessed with using a visual analog scale at baseline, two weeks after the first ESI and two weeks after the third ESI. RESULTS: Eighty patients were enrolled, and all of them provided pain ratings before and after the injections. The LSS patients seemed to improve less than did the HD patients. The results showed no significant differences in the triamcinolone dosage and the frequency of injections for determining the efficacy of ESI. CONCLUSIONS: The LSS patients tended to have a less effective respond to ESIs than did the HD patients. The unsatisfactory response to ESI by the LSS patients underscores the need for randomized controlled trials of performing ESI in this population.